title: A prospective study of the associations among housing status and costs of services in a homeless population.
abstract: OBJECTIVE
  The complex needs of homeless populations result in use of a wide range of services and high costs for housing programs and psychiatric and general medical care. Allocation of resources often is not congruent with assessed needs. A series of cost-congruence hypotheses was developed to test assumptions that needs are associated with resources provided for appropriate services in homeless populations.
  
  
  METHODS
  Individuals (N=255) who were homeless were followed for two years and were categorized by housing status over time (consistently housed, housed late, lost housing, or consistently homeless). Detailed information about the individuals was obtained at baseline, and follow-up data were collected one and two years later. Extensive data about the costs of services provided by type (medical, psychiatric, substance abuse, and homeless maintenance and amelioration) were derived from 23 agencies, and service use information was collected from the agencies and by self-report. Multiple regression models were used to test the hypotheses.
  
  
  RESULTS
  Medical, psychiatric, and homeless maintenance costs varied by housing status. Serious mental illness predicted costs for psychiatric services, as expected, but also costs for substance abuse services and acute behavioral health care and total costs. Alcohol use disorders predicted substance abuse service costs.
  
  
  CONCLUSIONS
  This study followed a homeless cohort prospectively and provided estimates of costs of service use derived from a large number of agencies. This research increases the understanding of patterns of service use in a homeless population and informs the provision of services appropriate to the complex needs of this difficult-to-serve population.
authors.affiliation: Dr. Fuehrlein, Dr. Balfour, and Dr. North are with the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (e-mail: fuehrlein@gmail.com ). Dr. North is also with the U.S. Department of Veterans Affairs North Texas Health Care System, also in Dallas. Dr. Cowell is with the Department of Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina. Dr. Pollio is with the Department of Social Work, University of Alabama, Tuscaloosa. At the time of this research, Ms. Cupps, now deceased, was with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Fuehrlein
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Cowell
authors.forename: David
authors.initials: D
authors.lastname: Pollio
authors.forename: Lori
authors.initials: L
authors.lastname: Cupps
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Balfour
authors.forename: Carol S
authors.initials: CS
authors.lastname: North
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data; D011632:Public Assistance / Q000191:economics / Q000706:statistics & numerical data