Crisis Response, Durable Lessons: A Mixed Methods Examination of a Large-Scale Hoteling Intervention for People Experiencing Homelessness

New York University School Of Medicine, New York NY

Investigators

Abstract

Over 1.4 million people experience homelessness in the U.S. each year. A large body of evidence has demonstrated the bidirectional relationship between homelessness and substance use (SU), and overdose is the leading cause of death among people experiencing homelessness. The existing and overlapping crises of homelessness and SU have continued to grow. Within the past five years, localities across the U.S. have taken new steps to mitigate risk among their homeless populations, but there has not yet been research on how these efforts have affected SU. We propose to conduct community-partnered, mixed methods research to examine SU and related health impacts of a large-scale initiative to place people experiencing homelessness into commercial hotels. The proposal leverages a natural experiment in New York City, where 9,500 homeless individuals were moved to hotels from congregate shelters in 2020–2021. Aim 1 is to explore how SU behaviors and treatment access changed for people experiencing homelessness who were placed into hotels, using in-depth interviews with homeless services clients and staff. Aim 2 is to examine effects of hotel placement on SU-related and other health care outcomes using a difference-in-differences approach with linked homeless services and Medicaid data. Aim 3 is to understand effects of hotel placement on SU-related outcomes and to identify strengths, gaps, and best practices to inform future efforts, using merged findings from Aims 1 and 2. We will additionally conduct a national environmental scan of promising recent innovations at the intersection of SU and homelessness. The research will be conducted by a transdisciplinary investigator team in partnership with the NYC Department of Social Services and Project Renewal, Inc., a nonprofit homeless and health services provider. The research team will work together with a Stakeholder Advisory Board that includes individuals with lived experience of homelessness to maximize the practical impact of the research, which has been designed to inform local and national programmatic and policy interventions. The study will identify challenges, assets, and innovations with durable lessons for the future that will be critical to inform future programs and policies to better respond to the overlapping crises of homelessness and substance use disorder. This research is especially important given large increases in homelessness, as well as ongoing crises of SU and overdose, nationally. Additionally, questions remain regarding how communities can best address homelessness, including the potential uses of hotels or similar non-congregate settings for shelter and housing. It is therefore critically important to understand the benefits and potential unintended consequences—and how to best mitigate them—of such initiatives.