Weihao Zhou

Youth comprise one-third of the U.S. homeless population. However, little is known about how homelessness affects health care utilization. Authors examine associations of homelessness with hospitalization, primary care, and emergency department (ED) visits, varying by race/ethnicity, among Medicaid-enrolled youth.

Findings: Approximately 17% of sampled youth experienced homelessness in 2018 (N=90,202). Compared with their housed counterparts, youth experiencing homelessness had a 1.9 percentage point (pp) higher likelihood of frequent ED visits but a 2.9 pp lower probability of any primary care visits. Homelessness was associated with 221 more ED visits, 100 more preventable ED visits, 19.9 more hospitalizations, but 56 fewer primary care visits, per 1,000 youth. The associations of homelessness with total ED visits, preventable ED visits, and needed and nonpreventable ED visits were all higher among whites and, particularly, Blacks, than for Hispanics and Asians.

Medicaid-enrolled youth who experienced homelessness had more overall ED, preventable ED, and hospital visits, but fewer primary care visits than their housed peers. Results suggest promoting primary care use should be considered among strategies to improve health and reduce costs.
 

Summary: In this infographic brief, the UCLA Center for Health Policy Research summarizes information from their evaluation of the 2022 Parks After Dark (PAD) program in Los Angeles County. PAD is a county initiative led by the Department of Parks and Recreation in partnership with other county departments and community-based organizations. PAD programming — including sports, entertainment, activities, and more — was offered for eight weeks on Thursday, Friday, and Saturday evenings at 34 parks between June and August 2023.

Findings: Evaluators found that PAD has made significant progress in achieving its intended goals through the provision of quality recreational programming in a safe and family-friendly environment. Besides ensuring participant’s sense of safety at parks while attending PAD programming, evidence indicates that PAD may have reduced crime in PAD parks and their surrounding areas since its inception in 2010. In addition, PAD encouraged meaningful collaboration between participating county departments and community-based organizations; contributed to participant’s feelings of well-being, family togetherness, and social cohesion; and involved a diverse range of participants in community-driven programming in a meaningful way. PAD may also have reduced the burden of disease for those that engaged in exercise opportunities.

Read the Publications:

• Evaluation Brief: 
  • Parks After Dark Evaluation Brief, May 2024 (English) 
  • Parks After Dark Evaluation Brief, May 2024 (Spanish)
• Full Evaluation Report: Parks After Dark Evaluation Report, May 2024
   

Previous years:

• Parks After Dark Evaluation Brief, July 2023 
• Parks After Dark Evaluation Report, July 2023 
• Parks After Dark Evaluation Brief, July 2018 
• Parks After Dark Evaluation Report, July 2018 
• Parks After Dark Evaluation Brief, May 2017 
• Parks After Dark Evaluation Report, May 2017 

Summary: In this report, the UCLA Center for Health Policy Research provides information from their evaluation of the 2023 Parks After Dark (PAD) program in Los Angeles County.

PAD is a Los Angeles County initiative led by the Department of Parks and Recreation (DPR) in partnership with other County departments and community-based organizations. Thirty-four DPR parks hosted PAD between June and August 2023. PAD was offered three nights a week for eight weeks, on Thursday, Friday, and Saturday evenings. In 2022, PAD expanded to include one-day events around spring and winter school breaks.

Select 2023 evaluation findings include:

• Difference-in-difference (DD) analysis indicated a reduction in crime rates in PAD parks after implementation of PAD when compared to similar parks that did not implement PAD, with 74 fewer Part I crimes and 43 fewer Part II crimes between 2010 and 2023 in all PAD parks. As indicated in 2023 PAD participant surveys, among PAD attendees who expressed not feeling safe in their neighborhood, 64% felt safe at PAD.
• In key informant surveys, PAD partners strongly agreed that PAD improved collaboration between County departments and community-based organizations (9.3 of 10).
• In 2023 PAD participant surveys, attendees overwhelmingly reported that PAD increased quality time with family members (96%), provided a sense of belonging within the community (96%), and improved their relationship with their neighbors (94%).
• Of attendees who did not meet the recommended activity guidelines for their age, 76% participated in physical activity at PAD. Using a modified version of the Integrated Transport and Health Impacts Model (ITHIM), the level of physical activity at PAD, if sustained year-round, would primarily reduce stroke and ischemic heart disease and lead to an overall decline of 20 years of life lost, 20 fewer years of disability adjusted life years, and avoidance of two premature deaths for the entire PAD population in 2023.
• A vast majority of attendees expressed high levels of satisfaction, with 97% saying they would attend PAD again and 97% also said they would recommend PAD to others. 

The 2023 evaluation findings demonstrate that PAD has made significant progress in achieving its intended goals through the provision of quality recreational programming in a safe and family-friendly environment. Evidence indicates that PAD may have reduced crime in PAD parks and their surrounding areas since its inception in 2010, while also ensuring participant’s sense of safety. Findings further indicate that PAD encouraged meaningful collaboration between participating County departments and community-based organizations; contributed to participant’s feelings of well-being, family togetherness, and social cohesion; and meaningfully involved a diverse range of participants in community-driven programming (including youth and seniors). PAD offered sports, entertainment, and other activities for children and adults with no barriers to participation and may have reduced the burden of disease for those that engaged in exercise opportunities. Overall, participant satisfaction levels at PAD remain high each year.

Read the Publications: 

• Evaluation Report: Parks After Dark Evaluation Report, May 2024
• Appendix A: Evaluation Methods
• Appendix B: Additional Data
• Appendix C: Service Use in ZIP Codes around PAD Parks
• Evaluation Brief: Parks After Dark Evaluation Brief, May 2024

Previous years:

• Parks After Dark Evaluation Brief, July 2023 
• Parks After Dark Evaluation Report, July 2023 
• Parks After Dark Evaluation Brief, July 2018 
• Parks After Dark Evaluation Report, July 2018 
• Parks After Dark Evaluation Brief, May 2017 
• Parks After Dark Evaluation Report, May 2017 
   

Summary: In this report, the UCLA Center for Health Policy Research provides analysis and findings from their evaluation of the Housing for a Healthy California (HHC) program. HHC was implemented by the California Department of Housing and Community Development (HCD) under the statutory authority of California Assembly Bill (AB) 74. The goal of HHC was to improve access to supportive housing, improve access to primary and behavioral health care services, and to reduce inappropriate utilization of emergency departments, hospitals, nursing homes, and correctional resources for eligible Medi-Cal beneficiaries who are  a high-cost health user and experiencing chronic homelessness. 

HHC funds were allocated through competitive awards to counties through Article I, which consisted of funds for acquisition or development of new construction projects or grants for project-based operating assistance, and Article II, which consisted of funds for long-term rental assistance, capitalized operating subsidy reserves, and acquisition, new construction or rehabilitation of a project. As of December 2022, none of the Article I awardees had completed construction or started housing, and therefore only Article I project descriptions and intentions are detailed in this report. Similarly, two Article II grantees had not yet completed their HHC projects and therefore were not included in the analyses presented in this report. This report primarily focuses on the implementation and outcomes of Article II funding in Kern, Los Angeles, Marin, and Sacramento counties from January 2021 (when the first beneficiary was housed) through December 2022. HHC continued after December 2022, but the evaluation findings do not reflect beneficiaries that were housed later on or the potential changes in their outcomes following being housed.

The HHC evaluation findings demonstrate notable progress in identifying scattered site and project-based rental units by four Article II grantees that led to housing of Medi-Cal beneficiaries experiencing homelessness. Evidence showed that HHC participants were referred to and often received an array of supportive services designed to address their medical and social needs, promote retention, prevent incarcerations or involvement with law enforcement, and improve health and well-being. Findings further indicated declines in short-term use of acute services, including emergency department visits and hospitalizations, and estimated Medi-Cal payments that were attributable to housing individuals under HHC.

Additional information on the program can be found at California Department of Housing and Community Development: Housing for a Healthy California Landing Page.

Read the Publication

• Report: Evaluation of California’s Housing for a Healthy California Program, January 2024