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

1. 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)
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2. 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)

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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 €

9. 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

10. 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

11. 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