Crisis Response, Durable Lessons: A Mixed Methods Examination of a Large-Scale Hoteling Intervention for People Experiencing Homelessness During the COVID-19 Pandemic

PROJECT SUMMARY Over 1.4 million people experience homelessness in the U.S. each year. A large body of evidence has demonstrated the bidirectional relationship between homelessness and substance use (SU), and overdose is the leading cause of death among people experiencing homelessness. The COVID-19 pandemic has greatly exacerbated the existing and overlapping crises of homelessness and SU. Localities across the U.S. have taken drastic steps to mitigate risk of COVID-19 among their homeless populations-including mass movement of tens of thousands of homeless individuals to hotels-but there has not yet been research on how these efforts have affected SU. We propose to conduct community-partnered, mixed methods research to examine SU and related health impacts of a large-scale initiative to place people experiencing homelessness into commercial hotels during the COVID-19 pandemic. The proposal leverages a natural experiment in New York City, where 9,500 homeless individuals were moved to hotels during the pandemic. Aim 1 is to explore how SU behaviors and treatment access changed for people experiencing homelessness who were placed into hotels during the COVID-19 pandemic, using in-depth interviews with homeless services clients and staff. Aim 2 is to examine effects of hotel placement on SU-related and other health care outcomes using a difference-in- differences approach with linked homeless services and Medicaid data. Aim 3 is to understand effects of hotel placement on SU-related outcomes and to identify strengths, gaps, and best practices to inform future efforts, using merged findings from Aims 1 and 2 as well as a national environmental scan of COVID-19 hotel strategies relevant to SU disorders. The research will be conducted by a transdisciplinary investigator team in partnership with the NYC Department of Social Services and Project Renewal, Inc., a nonprofit homeless and health services provider. The research team will work together with a Stakeholder Advisory Board that includes individuals with lived experience of homelessness to maximize the practical impact of the research, which has been designed to inform local and national programmatic and policy interventions. The study will identify challenges, assets, and innovations with durable lessons for the future that will be critical not only to prepare for future pandemics, but also to inform future programs and policies to better respond to the overlapping crises of homelessness and substance use disorder. This research is especially important as the pandemic is expected to bring with it large increases in homelessness, as well as worsening SU and overdose nationally. The pandemic has spurred communities to rapidly change how they address homelessness, including by permanently converting unused hotels for long-term shelter and housing. It is therefore critically important to understand the benefits and potential unintended consequences-and how to best mitigate them-of such initiatives. We have a unique, time-limited opportunity to study this topic of large national importance.