Moving "Hard to House" Residents to Work: The Role of Intensive Case Management

Abstract

The Chicago Family Case Management Demonstration was an innovative effort to test the feasibility of providing wraparound supportive services, including work supports, for vulnerable public housing families. This brief explores the employment experiences of Demonstration participants. Surprisingly, despite an extremely difficult labor market, employment increased. Further, the intensive Transitional Jobs program appears to have contributed to these employment gains. Yet, despite increases in employment, the economic situation for most Chicago Housing Authority families remains tenuous. For those who remained unemployed, the Demonstration's services failed to address a multitude of personal and structural barriers to work.

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Introduction

In 2009, the Urban Institute followed up with the Chicago Panel Study respondents to assess how they were faring as the Chicago Housing Authority’s (CHA) ambitious Plan for Transformation completed its first decade.1 Respondents’ well-being had improved in important ways: they were living in substantially higher-quality housing in much safer neighborhoods (Buron and Popkin 2010; Popkin and Price 2010). Given that respondents’ lives had improved, it seemed plausible that their mental and physical health might have gotten better as well. However, the Panel Study respondents’ health had actually worsened in the four years since they were last interviewed. In fact, the levels of reported health problems for the CHA Panel Study sample in 2009 were stunning, far higher than national averages, and the mortality rate was shockingly high. The only positive health news was that CHA Panel respondents reported significantly lower levels of anxiety than they had before relocation (Price and Popkin 2010). These findings clearly indicated the need for innovative strategies to address the health challenges facing CHA families.

The Chicago Family Case Management Demonstration ran from March 2007 to March 2010, overlapping with the 2009 CHA Panel Study (Popkin et al. 2010). The Demonstration—a partnership of the Urban Institute, the CHA, Heartland Human Care Services, and Housing Choice Partners— intended to test the feasibility of providing wraparound supportive services for vulnerable public housing families (Popkin et al. 2008). The Demonstration provided residents from the CHA’s Dearborn Homes and Madden/ Wells developments with intensive case management services, transitional jobs, financial literacy training, and relocation counseling. The Urban Institute conducted a rigorous evaluation, including a baseline and follow-up survey, administrative interviews, focus groups with service providers and program administrators, in-depth resident interviews, and analysis of program and administrative data (see text box on page 8). Where possible, outcomes for the Demonstration were compared with those from the 2009 CHA Panel Study.

As a result of the findings from the five-site HOPE VI Panel Study research, one key goal of the Demonstration was to improve participants’ mental and physical health. The Demonstration’s baseline participant survey in 2007 reinforced the decision to increase the focus on mental health; high levels of crime and fear were adversely affecting respondents’ general well-being, with those who were more fearful also reporting higher levels of anxiety and physical mobility problems (Roman and Knight 2010). Heartland incorporated health services into intensive case management (along with transitional jobs, financial literacy, and relocation counseling) rather than creating a separate service. As Heartland staff began implementing this model, lowering caseloads and increasing engagement, case managers quickly identified a critical need for additional services to address participants’ deep mental illness and substance abuse challenges (Popkin et al. 2008). While Heartland was unable to offer other health services directly, the agency partnered with a local hospital to arrange for a visiting nurse to come to the sites and provided periodic health screenings, such as checking blood pressures.

The Demonstration intentionally targeted vulnerable public housing families—that is, those facing multiple, complex challenges. Given the results from previous research, we expected their health trajectory would be similar to—or even worse than—the CHA Panel Study sample. But results from the 2009 follow-up survey painted a much different picture than we had anticipated: in contrast to the Panel Study sample, Demonstration participants’ health did not deteriorate over time, and their anxiety levels improved as much, or more, in a shorter time. While some signs are positive, rates of chronic illness and mortality for the Demonstration population are extremely high, and substance abuse and mental illness remain serious problems for many participants.

This brief reviews the findings from the Demonstration on physical and mental health, considers the possible explanations for the differences from the Panel Study, and discusses the implications for policy and practice.

(End of excerpt. The entire brief is available in PDF format.)

This brief is part of the Supporting Vulnerable Public Housing Families: An Evaluation of the Chicago Family Case Management Demonstration series.

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