Effect of an integrated housing intervention for people involved in the criminal-legal system who have housing instability

Abstract Objectives People impacted by the criminal-legal system face significant challenges to securing and sustaining permanent housing. This study was designed to assess housing outcomes of an integrated intervention that offered housing, medical, and behavioral health services to individuals with criminal-legal system involvement. Methods After a baseline needs assessment, participants were linked to services and completed quarterly study visits for up to 12 months. We used descriptive statistics to assess frequency and multivariate logistic regression to assess correlates of being housed at last follow-up. Results Between June 2019 and November 2023, 187 participants were enrolled in Project CHANGE from an area with high incarceration and overdose rates. At baseline, 43% of participants were unstably housed, 37% were homeless, and the remaining resided in a shelter or institution. At the time of last follow-up, 49 participants (26.2%) reported improved housing outcomes, and an additional 121 participants (64.7%) housing situation did not worsen. In multivariate models, individuals who were older (AOR 1.1; 95% CI 1.0-1.1), unstably housed at baseline (AOR 7.2; 95% CI 3.3-16.0), and enrolled in the study for longer (AOR 1.1; 95% CI 1.1-1.3) had higher odds of being housed at last follow-up, whereas those with high severity substance use had lower odds of being housed (AOR 0.3; 95% CI 0.1-0.6.) Conclusions In this comprehensive program, integrated housing/health services were time- and cost-intensive to deliver but led to positive housing outcomes. People involved in the criminal-legal system face unique barriers to housing, particularly when compounded by substance use.