Outcomes Evaluation Proposal: Maryland HSP Homelessness Program

Background and Rationale for the Evaluation

The proposed evaluation focuses on homelessness. The 2009 Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act defines homelessness as a situation where a family or individual lacks an adequate, regular, and fixed nighttime residence (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). This definition includes persons living in transitional housing, emergency shelters, abandoned buildings, the streets, and other places not meant for habitation. Individuals who stand to lose their nighttime residence within 14 days, or who are fleeing domestic violence and lack the resources to obtain alternative housing, are also considered homeless under the HEARTH Act of 2009 (SAMHSA, 2023).

Data from the National Alliance to End Homelessness shows that the number of homeless people in the United States has risen by approximately 6 percent since 2017 (SAMHSA, 2023). Contrary to expectations, the COVID-19 pandemic that peaked in 2020 had no significant effect on the U.S. homelessness rate (National Alliance to End Homelessness, 2023). According to a report by the Maryland Interagency Council on Homelessness (2022), this is due to increases in economic assistance programs and efforts to de-congregate shelters in line with social distancing requirements at the time. Nonetheless, a point-in-time count conducted in 2022 showed that over 582,000 people — nine in every 5,000 — were homeless across the United States (National Alliance to End Homelessness, 2023). Individual adults made up 72 percent of this population, while 28 percent lived on the streets and in other unfit environments with their children (National Alliance to End Homelessness, 2023).

In Maryland, point-in-time count data from 2020 showed that slightly over 6,300 people were homeless statewide, with Baltimore City accounting for the highest rates of homelessness at 35 percent (Maryland Interagency Council on Homelessness, 2022). The statewide annual count showed that Maryland had approximately 28,288 homeless people in 2020 (Maryland Interagency Council on Homelessness, 2022). Homelessness disproportionately affects special populations, including persons with disabilities, mentally ill individuals, veterans, unaccompanied youth, and victims of domestic violence (Maryland Interagency Council on Homelessness, 2022). Twenty-one percent of homeless people in the state, per the 2020 point-in-time count, were chronically homeless individuals who had been homeless for over a year and struggled with a physical disability, substance use disorder, or severe mental illness (Maryland Interagency Council on Homelessness, 2022). Homeless veterans made up 7.5 percent of the homeless population, while individuals experiencing domestic violence and unaccompanied homeless youth made up 5 percent and 4 percent, respectively (Maryland Interagency Council on Homelessness, 2022).

Policymakers across the U.S. need to institute ways of addressing homelessness because it increases the risk of mortality and reduces average life expectancy among affected populations (Maryland Interagency Council on Homelessness, 2022). Studies have shown that homeless people report higher rates of injury-related death and violence than the general population. Data from the Office of the Chief Medical Examiner (as cited in Maryland Interagency Council on Homelessness, 2022) shows that approximately 243 homeless people died in Maryland in 2020 — a death rate of 3,835 per 100,000 people, which is three times the death rate of the general Maryland population.

On average, homelessness reduces an individual's life expectancy by 30 years relative to the general population (Maryland Interagency Council on Homelessness, 2022). Homelessness is also associated with a higher risk of drug overdose and other complications related to substance use. For instance, 65 percent of deaths reported among homeless individuals in 2020 were due to drug overdose and related complications, with opioid overdoses accounting for 88 percent of those deaths (Maryland Interagency Council on Homelessness, 2022).

A significant body of literature exists on homelessness interventions. To identify studies for review, the evaluator searched three databases — Cochrane, PubMed, and Science Direct — for studies on homelessness prevention, case management, income assistance, and permanent supportive housing programs. Inclusion criteria required randomized controlled trials (RCTs) or systematic reviews conducted in high-income countries, published in peer-reviewed journals before 2020, and using housing stability as the primary outcome of interest.

Generally, the studies found homelessness prevention programs and interventions effective in preventing and reducing homelessness. Dwyer et al. (2023) found that unconditional cash transfers, coupled with coaching supports and workshops on plan-making, goal-setting, and self-affirmation, improved housing stability within three months better than cash transfers alone. Similarly, Phillips and Sullivan (2022) found that financial assistance coupled with case management increased housing stability and reduced evictions more than monetary assistance alone. The primary weakness of these evaluations is their narrow focus on income interventions, disregarding supportive housing programs. Aubry et al. (2020) address this gap in their systematic review by studying the combined effect of housing support and income assistance interventions. They found that, compared to usual care, housing support programs increase long-term housing stability at a rate of 1.13, while income assistance coupled with case management improved the number of days a homeless individual is housed by eight days relative to usual care.

While these evaluations provide valuable insights into the effectiveness of homeless assistance interventions, they have a limited scope, focusing on one or two interventions at a time. The proposed evaluation seeks to assess the HSP, which incorporates a diverse range of interventions. Moreover, the reviewed studies do not focus specifically on Maryland, and it would be valuable to determine whether findings from other settings can be replicated in the state.

References

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Appendices

Appendix 1: Budget Table for the HSP Evaluation Project

Staffing Expenses

Project Director: $139,109.00 — The project director manages and coordinates all project activities. The annual salary reflects the average for an MD program director per Indeed.

Project Assistant (1): $51,776.00 — Full-time employee assists the project director and case managers in coordinating and scheduling training, distributing vouchers, managing records and accounting, and handling data entry.

Case Managers (10): $296,870.40 — Part-time employees providing case management services to the homeless population in Maryland, conducting assessments, assisting with housing applications, and arranging transportation to potential housing sites. Calculated at $25.77/hr × 24 hr/week × 4 weeks/month × 12 months × 10 staff = $296,870.40.

Program Analyst: $35,763.84 — Collects, runs, and validates data; completes program assessments; and monitors the program. Engaged two weeks per month at $62.09/hr.

Staffing Subtotal: $523,519.24

Benefits

Project Director: $41,732.70 (30% of salary for full-time employees).

Project Assistant: $15,532.80 (30% of salary).

Case Managers (10): $35,624.40 (12% of salary for part-time employees).

Program Analyst: $4,291.66 (12% of salary).

Benefits Subtotal: $97,181.56

Training

Consultant Fees: $4,000.00 (flat fee of $500 per class × 8 classes).

Training Lunch: $1,600.00 ($20 × 10 participants × 8 sessions).

Training Subtotal: $5,600.00

Equipment and Supplies

Emergency Food or Clothing Vouchers: $22,500.00 (one voucher per participant at $150 × 150 participants).

Rental Assistance Vouchers: $10,000.00 (one-time payment per eligible participant; funds allocated until exhausted).

Furniture and Housing Supplies Vouchers: $10,000.00 (to assist participants transitioning from homelessness to residency).

Participant Incentives: $500.00 ($50 × 10 interview participants).

Equipment and Supplies Subtotal: $43,000.00

Total Projected Budget: $669,300.80

Appendix 2: Gantt Chart (Activity Timeline for HSP Evaluation Project)

[Gantt chart included in original project materials.]

Appendix C: Client Satisfaction Questionnaire (CSQ-8)

Client Satisfaction Questionnaire (CSQ-8, v. TMS-180S) — Larsen et al., 1979

Instructions for participants: Please help us improve our service by answering some questions about the help you have received. We are interested in your honest opinions, whether positive or negative. Please answer all questions. We also welcome your comments and suggestions.

1. How would you rate the quality of service you received? Excellent (4) / Good (3) / Fair (2) / Poor (1)

2. Did you get the kind of service you wanted? No, definitely not (1) / No, not really (2) / Yes, generally (3) / Yes, definitely (4)

3. To what extent has our service met your needs? Almost all of my needs have been met (4) / Most of my needs have been met (3) / Only a few of my needs have been met (2) / None of my needs have been met (1)

4. If a friend were in need of similar help, would you recommend our service to him or her? No, definitely not (1) / No, I don't think so (2) / Yes, I think so (3) / Yes, definitely (4)

5. How satisfied are you with the amount of help you received? Quite dissatisfied (1) / Indifferent or mildly dissatisfied (2) / Mostly satisfied (3) / Very satisfied (4)

6. Have the services you received helped you deal more effectively with your problems? Yes, they helped a great deal (4) / Yes, they helped somewhat (3) / No, they really didn't help (2) / No, they seemed to make things worse (1)

7. In an overall, general sense, how satisfied are you with the service you received? Very satisfied (4) / Mostly satisfied (3) / Indifferent or mildly dissatisfied (2) / Quite dissatisfied (1)

8. If you were to seek help again, would you come back to our service? No, definitely not (1) / No, I don't think so (2) / Yes, I think so (3) / Yes, definitely (4)

Scoring: Scores are summed across all items. Items 2, 4, 5, and 8 are reverse scored. Total scores range from 8 to 32, with higher scores indicating greater satisfaction.

Appendix D: Financial Well-Being Scale (CFPB)

Part 1: How well does this statement describe you or your situation? (Response options: Completely / Very well / Somewhat / Very little / Not at all)

1. I could handle a major unexpected expense.

2. I am securing my financial future.

3. Because of my money situation, I feel like I will never have the things I want in life.

4. I can enjoy life because of the way I'm managing my money.

5. I am just getting by financially.

6. I am concerned that the money I have or will save won't last.

Part 2: How often does this statement apply to you? (Response options: Always / Often / Sometimes / Rarely / Never)

7. Giving a gift for a wedding, birthday, or other occasion would put a strain on my finances for the month.

8. I have money left over at the end of the month.

9. I am behind with my finances.

10. My finances control my life.

Part 3: Tell us about yourself.

11. How old are you? 18–61 / 62+

12. How did you take the questionnaire? I read the questions / Someone read the questions to me.

Scoring Worksheet: Response values for Part 1 items are as follows — Items 1, 2, 4: Completely=4, Very well=3, Somewhat=2, Very little=1, Not at all=0. Items 3, 5, 6 are reverse scored: Completely=0, Very well=1, Somewhat=2, Very little=3, Not at all=4. Response values for Part 2 — Item 8: Always=4, Often=3, Sometimes=2, Rarely=1, Never=0. Items 7, 9, 10 are reverse scored: Always=0, Often=1, Sometimes=2, Rarely=3, Never=4. Scores are summed to produce a total response value.

Appendix E: VI-SPDAT Tool V2.0 for Single Adults

[The Vulnerability Index–Service Prioritization Decision Assistance Tool (VI-SPDAT) v2.0 for single adults is included in the original project materials.]