Research Proposal Option: Proposal to Conduct an Evaluation

(Evaluation Template)

Proposed Outcomes Evaluation of the Maryland Department of Housing and Community

Developments Homelessness Solutions Program

HM893

January 26, 2024

Note: You are provided recommended page lengths per section to guide your writing efforts. Your entire paper should be a maximum of 30 pages (including Title Page, Abstract, References, and Appendices)

Abstract (150 to 250 words maximum): The abstract should contain the following information:

What is the public health problem addressed?

What is the program/policy you plan to evaluate?

Who is the target population?

What is/are the main evaluation question(s)?

What is the evaluation design?

What are the expected implications of the evaluation?

What data will be collected and used to conduct the evaluation?

Where and when will the evaluation be conducted?

Note: The abstract should be on a separate page after the title page and before Section 1.

The proposed evaluation seeks to address the homelessness issue in Maryland. Point-in-time data showed that over 6,300 people in the state were homeless in 2020. While homelessness rates in the state have declined over the past decade, special populations such as veterans, chronically ill patients, and unaccompanied youth continue to be overrepresented among the homeless population. This evaluation seeks to evaluate the effectiveness of the Maryland Homelessness Solution Program (HSP) in reducing homelessness among Marylanders. The target population is individuals experiencing or at risk of homelessness in Maryland. The evaluation will be conducted between January 2024 and December 2025 at 10 homeless shelters across Baltimore City, Baltimore, and Anne Arundel Counties. The evaluation questions are: Compared to non-participants, are HSP participants more able to secure and maintain stable housing? How does their financial well-being compare with non-participants? Is the program accessible and relevant to the needs of homeless people? Are program participants satisfied with the services offered? The evaluation will follow a case-control design. It will use survey and interview data collected from 300 randomly selected participants (150 HSP participants and 150 non-participants) at baseline, program end, and at six months follow-up. The cases will come from 5 homeless shelters that receive HSP grants, and the controls from 5 that do not receive HSP grants. Descriptive statistics will be used to assess the program's effectiveness in reducing homelessness and participants' satisfaction with available services. The findings will inform public health policy by providing insights on designing effective homelessness prevention interventions.

Keywords: health, homelessness, Maryland, community, program, case, control group

Section 1: Background/Rationale for Proposed Evaluation: This section should address the following elements (2-3 double spaced pages):

1. What public health problem and/or issue does the program/policy address?

2. Why is this problem or issue important?

3. What does existing data demonstrate about the magnitude and potential health impacts of this problem or issue?

4. What population(s) is affected by this public health problem/ issue?

5. What has previous evaluation literature found regarding this problem? Use peer-reviewed references to summarize the findings from evaluations of similar programs or policies. Address the following elements:

a. Describe your search methods, inclusion criteria, and studies that you reviewed

b. Describe the overall evaluation findings, including the strengths and weaknesses of this work

6. What are the gaps or limitations in the evaluation literature? How does your proposed evaluation address these issues?

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 of homelessness 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 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 (US) 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 US homelessness rate (National Alliance to End Homelessness, 2023). According to a report by the Maryland Interagency Council on Homelessness (2022), this is due to the increase in economic assistance programs and attempts to de-congregate shelters in line with social distancing requirements that took place at the time. Nonetheless, a point-in-time count conducted in 2022 showed that over 582,000 (9 in every 5,000) people 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 in the streets and 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). Generally, the statewide annual count showed that Maryland had approximately 28,288 homeless peole in 2020 (Maryland Interagency Council on Homelessness, 2022). Unfortunately, homelessness disproportionately affects special populations, including persons with disability, mentally ill individuals, veterans, unaccompanied in-parenting youth, and victims of domestic violence (Maryland Interagency Council on Homelessness, 2022). Twenty-one percent of homeless people in the state, as 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 of the homeless population, respectively (Maryland Interagency Council on Homelessness, 2022).

Policymakers across the US need to institute ways of addressing homelessness because it increases the risk of mortality and reduces the average life expectancy of 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 (Maryland Interagency Council on Homelessness, 2022). 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. This translates to a death rate of 3,835 per 100,000 people for homeless populations, which is three times the death rate of the general Maryland population (Maryland Interagency Council on Homelessness, 2022).

On average, homelessness reduces an individual's life expectancy by 30 years relative to the average person (Maryland Interagency Council on Homelessness, 2022).

Besides mortality, homelessness is associated with a myriad of other adverse health outcomes. The most commonly-studied health outcomes among homeless populations include cardiovascular diseases (CVD), HIV and other infectious diseases, communicable diseases, opioid-related overdose, mental health problems, and mortality. A systematic review by Al-Shakarchi et al. (2020) sought to compare the risk of CVD in homeless and non-homeless populations using data from studies drawn from…

Research Proposal Option: Proposal to Conduct an Evaluation

(Evaluation Template)

Proposed Outcomes Evaluation of the Maryland Department of Housing and Community

Developments Homelessness Solutions Program

HM893

January 26, 2024

Note: You are provided recommended page lengths per section to guide your writing efforts. Your entire paper should be a maximum of 30 pages (including Title Page, Abstract, References, and Appendices)

Abstract (150 to 250 words maximum): The abstract should contain the following information:

What is the public health problem addressed?

What is the program/policy you plan to evaluate?

Who is the target population?

What is/are the main evaluation question(s)?

What is the evaluation design?

What are the expected implications of the evaluation?

What data will be collected and used to conduct the evaluation?

Where and when will the evaluation be conducted?

Note: The abstract should be on a separate page after the title page and before Section 1.

The proposed evaluation seeks to address the homelessness issue in Maryland. Point-in-time data showed that over 6,300 people in the state were homeless in 2020. While homelessness rates in the state have declined over the past decade, special populations such as veterans, chronically ill patients, and unaccompanied youth continue to be overrepresented among the homeless population. This evaluation seeks to evaluate the effectiveness of the Maryland Homelessness Solution Program (HSP) in reducing homelessness among Marylanders. The target population is individuals experiencing or at risk of homelessness in Maryland. The evaluation will be conducted between January 2024 and December 2025 at 10 homeless shelters across Baltimore City, Baltimore, and Anne Arundel Counties. The evaluation questions are: Compared to non-participants, are HSP participants more able to secure and maintain stable housing? How does their financial well-being compare with non-participants? Is the program accessible and relevant to the needs of homeless people? Are program participants satisfied with the services offered? The evaluation will follow a case-control design. It will use survey and interview data collected from 300 randomly selected participants (150 HSP participants and 150 non-participants) at baseline, program end, and at six months follow-up. The cases will come from 5 homeless shelters that receive HSP grants, and the controls from 5 that do not receive HSP grants. Descriptive statistics will be used to assess the program's effectiveness in reducing homelessness and participants' satisfaction with available services. The findings will inform public health policy by providing insights on designing effective homelessness prevention interventions.

Keywords: health, homelessness, Maryland, community, program, case, control group

Section 1: Background/Rationale for Proposed Evaluation: This section should address the following elements (2-3 double spaced pages):

1. What public health problem and/or issue does the program/policy address?

2. Why is this problem or issue important?

3. What does existing data demonstrate about the magnitude and potential health impacts of this problem or issue?

4. What population(s) is affected by this public health problem/ issue?

5. What has previous evaluation literature found regarding this problem? Use peer-reviewed references to summarize the findings from evaluations of similar programs or policies. Address the following elements:

a. Describe your search methods, inclusion criteria, and studies that you reviewed

b. Describe the overall evaluation findings, including the strengths and weaknesses of this work

6. What are the gaps or limitations in the evaluation literature? How does your proposed evaluation address these issues?

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 of homelessness includes persons living…

Research Proposal Option: Proposal to Conduct an Evaluation

(Evaluation Template)

Proposed Outcomes Evaluation of the Maryland Department of Housing and Community

Developments Homelessness Solutions Program

HM893

January 26, 2024

Note: You are provided recommended page engths per section to guide your writing efforts. Your entire paper should be a maximum of 30 pages (including Title Page, Abstract, References, and Appendices)

Abstract (150 to 250 words maximum): The abstract should contain the following information:

What is the public health problem addressed?

What is the program/policy you plan to evaluate?

Who is the target population?

What is/are the main evaluation question(s)?

What is the evaluation design?

What are the expected implications of the evaluation?

What data will be collected and used to conduct the evaluation?

Where and when will the evaluation be conducted?

Note: The abstract should be on a separate page after the title page and before Section 1.

The proposed evaluation seeks to address the homelessness issue in Maryland. Point-in-time data showed that over 6,300 people in the state were homeless in 2020. While homelessness rates in the state have declined over the past decade, special populations such as veterans, chronically ill patients, and unaccompanied youth continue to be overrepresented among the homeless population. This evaluation seeks to evaluate the effectiveness of the Maryland Homelessness Solution Program (HSP) in reducing homelessness among Marylanders. The target population is individuals experiencing or at risk of homelessness in Maryland. The evaluation will be conducted between January 2024 and December 2025 at 10 homeless shelters across Baltimore City, Baltimore, and Anne Arundel Counties. The evaluation questions are: Compared to non-participants, are HSP participants more able to secure and maintain stable housing? How does their financial well-being compare with non-participants? Is the program accessible and relevant to the needs of homeless people? Are program participants satisfied with the services offered? The evaluation will follow a case-control design. It will use survey and interview data collected from 300 randomly selected participants (150 HSP participants and 150 non-participants) at baseline, program end, and at six months follow-up. The cases will come from 5 homeless shelters that receive HSP grants, and the controls from 5 that do not receive HSP grants. Descriptive statistics will be used to assess the program's effectiveness in reducing homelessness and participants' satisfaction with available services. The findings will inform public health policy by providing insights on designing effective homelessness prevention interventions.

Keywords: health, homelessness, Maryland, community, program, case, control group

Section 1: Background/Rationale for Proposed Evaluation: This section should address the following elements (2-3 double spaced pages):

1. What public health problem and/or issue does the program/policy address?

2. Why is this problem or issue important?

3. What does existing data demonstrate about the magnitude and potential health impacts of this problem or issue?

4. What population(s) is affected by this public health problem/ issue?

5. What has previous evaluation literature found regarding this problem? Use peer-reviewed references to summarize the findings from evaluations of similar programs or policies. Address the following elements:

a. Describe your search methods, inclusion criteria, and studies that you reviewed

b. Describe the overall evaluation findings, including the strengths and weaknesses of this work

6. What are the gaps or limitations in the evaluation literature? How does your proposed evaluation address these issues?

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 of homelessness 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 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 (US) 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 US homelessness rate (National Alliance to End Homelessness, 2023). According to a report by the Maryland Interagency Council on Homelessness (2022), this is due to the increase in economic assistance programs and attempts to de-congregate shelters in line with social distancing requirements that took place at the time. Nonetheless, a point-in-time count conducted in 2022 showed that over 582,000 (9 in every 5,000) people 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 in the streets and other unfit environments with ....... 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). Generally, the statewide annual count showed that Maryland had approximately 28,288 homeless people in 2020 (Maryland Interagency Council on Homelessness, 2022). Unfortunately, homelessness disproportionately affects special populations, including persons with disability, mentally ill individuals, veterans, unaccompanied in-parenting youth, and victims of domestic violence (Maryland Interagency Council on Homelessness, 2022). Twenty-one percent of homeless people in the state, as 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 of the homeless population, respectively (Maryland Interagency Council on Homelessness, 2022).

Policymakers across the US need to institute ways of addressing homelessness because it increases the risk of mortality and reduces the average life expectancy of 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 (Maryland Interagency Council on Homelessness, 2022). 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. This translates to a death rate of 3,835 per 100,000 people for homeless populations, which is three times the death rate of the general Maryland population (Maryland Interagency Council on Homelessness, 2022).

On average, homelessness reduces an individual's life expectancy by 30 years relative to the average person (Maryland Interagency Council on Homelessness, 2022).

Besides mortality, homelessness is associated with a myriad of other adverse health outcomes. The most commonly-studied health outcomes among homeless populations include cardiovascular diseases (CVD), HIV and other infectious diseases, communicable diseases, opioid-related overdose, mental health problems, and mortality. A systematic review by Al-Shakarchi et al. (2020) sought to compare the risk of CVD in homeless and non-homeless populations using data from studies drawn from North America and Europe. The findings showed that the risk of CVD and CVD-related mortality among homeless populations was three times greater than that of non-homeless populations (Al-Shakarchi et al., 2020). Sources attribute this to the high prevalence of CVD-related risk factors among homeless populations, including smoking, use of illicit substances, and high cholesterol levels (Al-Shakarchi et al., 2020).

Studies have also found a positive association between homelessness and the risk of HIV, sexually-transmitted diseases, and Hepatitis C (Arum et al., 2021). This is because homeless individuals are more likely to engage in risky behaviors such as sharing of drug-injection needles and irresponsible sexual behavior (Arum et al., 2021). At the same time, homelessness increases the risk of communicable diseases such as influenza, tuberculosis, mosquito-borne illnesses, skin infections, and Hepatitis A because of limited access to vaccination, low health literacy levels, living in congregate settings, and low levels of personal hygiene (Liu et al., 2020). Homeless populations are also associated with higher use of illicit substances and opioid overdose, as well as opioid-related deaths (Fine et al., 2022). For instance, 65 percent of deaths reported among homeless individuals in 2020 were due to drug overdose and other related complications, with opioid overdoses accounting for 88 percent of these deaths (Maryland Interagency Council on Homelessness, 2022). In a study by Fine et al. (2022) on mortality rates among 60,092 homeless adults between 2003 and 2018, 12 percent of participants died during the study period, with drug overdoses accounting for 25 percent of the reported deaths.

Studies have also found homeless individuals to have higher prevalence of mental health disorders than their non-homeless counterparts (Gutwinski et al., 2021). A systematic review by Gutwinski et al. (2021) found that approximately 12 percent of homeless individuals had either schizophrenia spectrum disorders or major depression, compared to 0.7 percent of the non-homeless population. The study also found a higher risk of mortality among homeless individuals with mental health disorders as compared to the general population (Gutwinski et al., 2021). These adverse health outcomes necessitate programs or policies aimed at reducing homelessness. These programs are often implemented by government agencies or non-governmental organizations.

Many studies have sought to evaluate the effectiveness of interventions that focus on preventing or reducing homelessness. To inform this evaluation, a systematic review of peer-reviewed articles on homelessness prevention interventions was conducted. The search strategy targeted databases such as Cochrane, PubMed, and Science Direct, with inclusion criteria limited to studies published in the last ten years, conducted in the US, and evaluating homelessness prevention or intervention programs. The review identified several studies that evaluated programs similar to the HSP (Dwyer et al., 2023; Philips & Sullivan, 2022; Aubry et al., 2020).

Generally, the studies found that homelessness prevention programs and interventions were effective in preventing and reducing homelessness (Dwyer et al., 2023; Philips & Sullivan, 2022; Aubry et al., 2020). However, the studies also found some interventions or combinations of interventions to be more effective than others. For instance, Dwyer et al. (2023) evaluated the impact of unconditional cash transfers and coaching support programs in increasing housing stability among homeless individuals. The study found that unconditional cash transfers, coupled with coaching supports and workshops on plan-making, goal-setting, and self-affirmation, improved housing stability for homeless people within three months better than cash transfer programs alone. Similarly, Philips and Sullivan (2022) evaluated the effectiveness of financial assistance and case management programs in reducing and preventing homelessness among vulnerable populations. The study found that financial assistance coupled with case management for homeless people increased housing stability and reduced evictions more than monetary assistance programs alone. The primary weakness of these evaluations is that they focus on income intervention programs alone, and disregard supportive housing programs, which are also quite common.

In their systematic review, Aubry et al. (2020) address this weakness by studying the impact of both housing support and income assistance interventions targeting homeless individuals. The study found that compared to usual care, housing support programs increase long-term housing stability at a rate of 1.13. At the same time, income assistance coupled with case management improved the number of days a homeless individual is housed by eight days relative to usual care (Aubry et al., 2020).

The primary strength of this body of work is that the studies use comprehensive data collection methods, and include rigorous evaluation designs, both of which enhance the credibility of the findings. However, the reviewed studies have a limited scope, focusing on one or two interventions. The proposed assessment seeks to evaluate the HSP, which incorporates a range of diverse interventions targeted at homeless people. Moreover, the reviewed studies do not focus specifically on Maryland, and it would be interesting to check whether the findings of studies conducted in other environments could be replicated in the state of Maryland.

Section 2: Program or Policy Description: This section provides detailed information about the program/policy that you are evaluating. This section should include the following elements: (4-8 double spaced pages):

1. Program or Policy Purpose (Goals and Objectives)

a. What are the goals and objectives of the program/policy that you are evaluating? What are the goals and objectives of your evaluation? Goals are broad statements of what you want to achieve with the proposed evaluation. Objectives are specific steps that establish how the goal will be achieved. Objectives should be specific, measurable, achievable, relevant, and time-based (i.e., SMART). Both goals and objectives should be aligned with the main evaluation question(s).

Example of Goal and SMART Objective

Goal 1: Increase health educator knowledge about obesity among Hispanic

youth.

Objective 1.1: Conduct obesity training classes resulting in 80% of health educators completing the course Obesity in among Hispanic adolescents by May 31, 2021.

Note: Repeat this format if you have more goals/objectives.

The program to be evaluated is the Homelessness Solutions Program (HSP), which is administered by the Maryland Department of Housing and Community Development (DHCD) as a statewide response to the homelessness issue that continues to affect the state (HSP Policy Guide, 2022). The program provides funding and technical support to Local Homeless Coalitions (LHC) and Continuums of Care (COCs), coordinating resources and funding for local service providers serving the homeless population. To qualify for a grant under the HSP, an applicant must be a local government or non-profit entity offering a client-centered approach to homeless services and compliant with anti-discriminatory policies (HSP Policy Guide, 2022). HSP grantees and sub-grantees must also implement formal grievance procedures, prove sound financial management of resources, and implement a sound homeless management information system (HMIS) (HSP Policy Guide, 2022).

The HSP pursues the following goals and objectives as stated in the HSP Policy Guide (2022) and the DHCD Consolidated Plan (2020), respectively:

Goal 1: Reduce the number of families/individuals at risk of homelessness by providing homeless prevention assistance and shelter diversion.

Objective 1.1: At least 50 percent of unsheltered homeless families/individuals reached through outreach programs exit to safe emergency shelters by the end of 2024.

Objective 1.2: 100 percent of households/individuals who fall homeless as a result of losing their permanent residence successfully exit to safe shelters by the end of 2024

Goal 2: Reduce the duration an individual or household remains homeless by supporting them in accessing permanent housing.

Objective 2.1: At least 80 percent of previously homeless individuals/households held in emergency shelters and interim housing options will transit