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The Cost-Effectiveness of Critical Time Intervention
 

The Cost-Effectiveness of Critical Time Intervention

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Presentation given by Lars Benjaminsen, Denmark, at the 2013 FEANTSA Research Conference, Alice Salomon Hochschule Berlin, 20th September 2013

Presentation given by Lars Benjaminsen, Denmark, at the 2013 FEANTSA Research Conference, Alice Salomon Hochschule Berlin, 20th September 2013

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    The Cost-Effectiveness of Critical Time Intervention The Cost-Effectiveness of Critical Time Intervention Presentation Transcript

    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 The Cost-Effectiveness of Critical Time Intervention (CTI) Lars Benjaminsen* SFI – The Danish National Center for Social Research *with Morten Holm Enemark (SFI), David Rosdahl (Rambøll) & Majbritt Skov (Rambøll) Insert your logo here
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 The Danish Homelessness Strategy  Housing First as overall principle  Housing and floating support after evidence- based methods  Critical Time Intervention (CTI)  Intensive Case Management (ICM)  Assertive Community Treatment (ACT)
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Critical Time Intervention (CTI)  Target group: Those who need support in a critical transition period from shelter to housing, but after that either do not need further support or can use support from existing services  3 phases: 1)Establishing a relation while still in a shelter 2) Support when moving into housing – establishing contact/relations to network and community services 3) Passing on support relations to network and community services  Low caseload – max 1:12
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Methodology of study  Individuals receiving CTI under the homelessness strategy and with start-up in 2010 as intervention group  Matched to control group of shelter users on a range of variables (administrative data – linked by personal numbers)  Use of public services in 2011 (administrative data) compared to the control group
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Matching design Matching year (Year before intervention) Start up year (Start of intervention) Measurement year (Year after start of intervention) CTI-citizens (2011) CTI-citizens (2010) Costs and savings (2011) Control group (2006) Control group (2007) Costs and savings (2008) Intervention group in year before start up matched to control group year before homeless Intervention group – start up in 2010 Control group – shelter users in 2007 Use of public services measured in the following year
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Attrition  Number of CTI start-ups 2010: 77  Number of personal numbers received: 66 CTI-start ups must also be shelter users in either 2009 or 2010 There must be ‘common support’ in matching model =>  Number of CTI-citizens in matched intervention group: 47
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Significant matching variables  Days in a shelter  In addiction treatment  On early retirement pension  Living in Aarhus or Esbjerg municipalities  Average salary from ordinary wage job
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Effects, first year after intervention Variable Intervention group Control group Shelter use, days 49 81 Psychiatric hospital days 0.32 3.3 Psychiatric outpatient treat. days 6 43 Psychiatric emergency ward 0.4 0.3 Addiction Treatment, days 0.0 1.5 Addiction Treat. outpatient days 13 34 Somatic hospital days 7 9 Somatic outpatient contacts 1.98 0.90 Somatic emergency ward 1.38 1.20 Expenditure GP, specialists etc. 240 € 251 €
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Effects, continued Variable Intervention group Control group Burglary and theft sentences 0.04 0.26 Violence sentences 0.09 0.17 Prison days 0,0 13 Prison sentences 0,00 0,08
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Total, public costs and benefits (€) Intervention Control First year benefit Floating support -4.133 -411 -3.723 Shelters -7.493 -12.264 4.771 Mental illness -1.466 -11.428 9.962 Addiction -498 -1.602 1.108 Somatic healthcare -2.200 -2.651 452 Crime -629 -1.609 980 Income support -9.377 -8.904 -473 Tax on working income 465 444 21 Total -25.332 -38.429 13.097
    • EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Conclusion  CTI is cost-effective already in the first year  Net cost savings (first year benefit): 13.097 €  Cost of CTI: 4.133 €  Savings mainly from less use of psychiatric treatment and shelters