There are indications that HELP USA’s program of enhanced services for single adults in our permanent supportive housing (PSH) facilities is reducing the comparative mortality rate of this population (table 1). Staff began implementing this program in February 2024. As two new buildings had recently come under HELPs management, leadership prioritized the need to respond to the high risk of premature death faced by this population that researchers had found to particularly occur the early tenancy period (Henwood et al; 2015; Raven et al, 2020).
Table 1: Comparative mortality rates: PSH & populations experiencing homelessness (PEH)
| population | crude mortality rate* | person years^ |
| PSH – Philadelphia | 3916 | 1045 |
| PEH-NYC (’90-’08) | 2170 | – |
| PEH-NYC (’22-’23) | 2144 | 16558 |
| PSH – HELP high-single adult risk tenants | 2028 | 148 |
| PSH- HELP single adult tenants | 1161 | 688 |
*= crude mortality is the number of deaths per person year in a population of 100,000
^ = person years is the duration (in years) that a sample population is observed for a study period. Person years for HELP PSH clients is derived from the time of admission to August 31,2024 for 216 clients, inclusive of exits, such as deaths.
bold = p<0.01 compared to Philadelphia PSH population (Henwood et al, 2015).
note: Data on PEH-NYC (‘90-08) refers to middle aged men and is also from Henwood et al (2015). The mortality rate of PEH-NYC (‘22-’23) refers to middle aged men. HELP Research calculated this rate based on local and federal government data (HUD, 2023; DOHMH, 2024).
HELP Research evaluated the performance of the first six months of this one-year program. It proceeds in three parts. First it elaborates on the problem of high mortality rates in the PSH single adult population by identifying the vulnerable time period and tenant characteristics that yield the risk profile for this population.
Second, it discusses HELP USA’s response to this problem: the design and implementation of the PSH mortality risk identification and reduction program among 216 single adult tenants across four PSH sites. This section details the point-based risk assessment tool designed by HELP Research that staff use to identify the mortality risk in the population. They provide these tenants and all single adult tenants a set of enhanced services under the Critical Time Intervention (CTI) model. These services include expedited completion of service plans and referrals to healthcare and substance services, and more frequent wellness checks. Staff also create and enroll tenants into workshops and activities that are held on-site.
Lastly, this brief details the initial outcomes and impacts of this program. High rates of early service engagement; and increased physical healthcare access and wellness check rates coincided with reduced comparative mortality rate in the single adult tenant population. Decreased use of substance use services in this period is potentially explained by the increased provision of on-site harm reduction resources, such as Narcan, drug testing strips and safe use kits.
HELP Research and Supportive Services teams presented findings from this intervention at the 2024 Canadian Alliance to End Homelessness Conference in Ottawa on October 29, 2024.
