HomePath is a combined Housing First and shared-medical-appointments intervention. It aims to increase housing stability, improve treatment outcomes, and reduce returns to shelters, emergency rooms, and justice systems for people who have experienced homelessness and are struggling with opioid addiction.

Housing First is a person-centered approach to reducing chronic homelessness that works by first providing permanent supportive housing, regardless of substance dependency or other issues. There are no treatment or sobriety conditions for being placed in or staying in housing. Once housed, people can decide whether and when to make use of the supportive services and treatment plans that are available to them.

Shared medical appointments combine medical treatment, behavioral health treatment, and social work help. Usually, a group of about 10 to 15 patients and three to five health care and social service providers meet weekly. Each patient has time to discuss his or her treatment and progress toward personal goals. Everyone in the group can ask questions and share concerns and experiences with each other. A shared medical appointment can address many needs at once. Patients can get prescription refills, information about transportation or other services, support for recovery, and connections to housing and supportive services that use a Housing First approach.

With funding from Arnold Ventures, MDRC is conducting an 18-month feasibility study to determine whether to conduct a full-scale rigorous evaluation of HomePath. If the feasibility study shows promise, the full-scale evaluation would begin in 2020.

Agenda, Scope, and Goals

The recent opioid epidemic has led to a sharp increase in the unsheltered homeless population across the country, and the housing field has not found a consistently effective approach to treating substance use disorder among its most vulnerable residents.

The goal of the HomePath study is to build evidence on a treatment model that incorporates Housing First and shared medical appointments. Ultimately, the study aims to evaluate whether HomePath can increase housing stability and treatment retention for substance use disorder and reduce the use of shelter, hospital, and criminal justice systems for individuals who have experienced homelessness and have opioid use disorder.

Design, Sites, and Data Sources

MDRC is conducting the HomePath feasibility study in Chicago, Illinois; Philadelphia, Pennsylvania; and Richmond, Virginia. The study will gauge whether it would be possible to conduct a rigorous, full-scale evaluation of Housing First with shared medical appointments. To do so, MDRC will assess:

  1. Whether it would be viable to recruit enough sample members to have the statistical power necessary for a rigorous full-scale evaluation
  2. Whether the treatment contrast (that is, differences in services received) between the program and control groups is large enough to warrant further testing for program effects
  3. Whether reliable outcome data can be collected using administrative data sources

In Philadelphia and Richmond, the study will examine only the implementation of the program. In Chicago, MDRC will adopt a mixed-methods approach to assess feasibility by pilot testing a natural experiment using the city’s coordinated entry system for permanent supportive housing. MDRC will also collect implementation data on patients who are referred directly to the clinic for opioid addiction treatment. MDRC is using data from a baseline survey, administrative data, participation data, and qualitative data across the three cities for the feasibility study.

In spring 2020, MDRC will make a recommendation to Arnold Ventures about whether to conduct a full-scale evaluation of the HomePath intervention.