{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T14:19:53Z","timestamp":1780496393976,"version":"3.54.1"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Health Share of Oregon"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Urban Health"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Housing insecurity and substance use disorder (SUD) are critical public health issues in the USA, with significant implications for health outcomes. This study evaluated the intersection of housing insecurity, SUD, and psychosis among Medicaid enrollees in an urban center in Oregon. Using data from Health Share of Oregon, we identified three distinct cohorts\u2014individuals with housing insecurity, those with SUD\/psychosis, and those with both conditions. Key outcomes included inpatient admission rates, average lengths of stay, and 30-day readmissions. The findings indicate that housing-insecure individuals with SUD\/psychosis show greater acute care utilization than the other two cohorts. Inpatient admissions for housing-insecure individuals with SUD\/psychosis were over twice as high as those without housing insecurity (29.7% vs. 12.4%), nearly three times as high as those without SUD\/psychosis (29.7% vs. 9.5%), and almost ten times higher than those without either (29.7% vs. 3.0%). There were likewise corresponding increases in ambulatory-sensitive hospitalizations, 30-day readmissions, and longer hospital stays. Effective interventions should address both housing and healthcare needs, including comprehensive case management and improved access to physical, behavioral, and mental health services integrated with housing programs and services. These strategies could mitigate acute care utilization and improve overall health outcomes for these vulnerable populations.<\/jats:p>","DOI":"10.1007\/s11524-026-01073-3","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T18:53:27Z","timestamp":1777316007000},"page":"323-333","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Housing Insecurity, Behavioral Health Disorders, and Acute Care Utilization: A Cross-Sectional Study of Medicaid Members in the Portland, Oregon Metropolitan Area"],"prefix":"10.1007","volume":"103","author":[{"given":"Megan","family":"Holtorf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Fish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A.","family":"Lacijan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Gronowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Bouldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Mendenhall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Doren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4607-8762","authenticated-orcid":false,"given":"Hannah","family":"Cohen-Cline","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine J.","family":"Livingston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"1073_CR1","unstructured":"American Public Health Association. Housing and homelessness as a public health issue [Internet]. 2017 Nov. Available from: https:\/\/www.apha.org\/policy-and-advocacy\/public-health-policy-briefs\/policy-database\/2018\/01\/18\/housing-and-homelessness-as-a-public-health-issue. Accessed 3 Feb 2025."},{"key":"1073_CR2","unstructured":"De Sousa T, Andrichik A, Prestera E, Rush K, Tano C, Wheeler M, et al. The 2023 Annual Homelessness Assessment Report (AHAR) to congress part 1: point-in-time estimates of homelessness [Internet]. 2023. Available from: https:\/\/www.huduser.gov\/portal\/\/portal\/sites\/default\/files\/pdf\/2023-AHAR-Part-1.pdf."},{"key":"1073_CR3","unstructured":"Soucy D, Janes M, Hall A. National Alliance to End Homelessness. State of Homelessness: 2024 Edition; 2024. Available from: https:\/\/endhomelessness.org\/state-of-homelessness\/. Accessed 3 Feb 2025."},{"key":"1073_CR4","unstructured":"Zapata M, Greene J, Niehaus C, Sharygin E, Holcomb Spurbeck F, Wei C. 2023 Point in time findings report: count of people experiencing homelessness in Clackamas, Multnomah, and Washington Counties, Oregon [Internet]. Portland; 2024. Available from: https:\/\/pdxscholar.library.pdx.edu\/hrac_pub\/45\/."},{"key":"1073_CR5","unstructured":"De Sousa T, Henry M, Global Abt. The 2024 Annual Homelessness Assessment Report (AHAR) to Congress.\u00a02024. Available from: https:\/\/www.huduser.gov\/portal\/publications\/2024-ahar-part-1-pit-estimates-ofhomelessness.html. Accessed 3 Feb 2025."},{"key":"1073_CR6","unstructured":"United States Census Bureau [Internet]. 2024. QuickFacts Clark County, Washington; Clackamas County, Oregon; Multnomah County, Oregon; Washington County, Oregon. Available from: https:\/\/www.census.gov\/quickfacts\/fact\/table\/clarkcountywashington,clackamascountyoregon,multnomahcountyoregon,washingtoncountyoregon\/AGE295218. Accessed 3 Feb 2025."},{"key":"1073_CR7","unstructured":"Zapata M, Niehaus C, Holcomb Spurbeck F, Cho M. 2025 point in time count findings\u00a0summary report count of people experiencing homelessness in Clackamas, Multnomah, and Washington Counties, Oregon. 2025 Nov. Available from: https:\/\/drive.google.com\/file\/d\/1dKBpA0yHlzA-_k1M9toJn5HGk4KDvCZG\/view. Accessed 29 Dec 2025."},{"key":"1073_CR8","unstructured":"The Homeless Services Department. Multnomah County. 2025. Data Dashboard. Available from: https:\/\/hsd.multco.us\/data-dashboard\/. Accessed 29 Dec 2025."},{"key":"1073_CR9","unstructured":"Housing and community development division-Clackamas County. Clackamas County. 2025. How Many People are Homeless in Clackamas County? Available from: https:\/\/www.clackamas.us\/homelessness\/homelesscount.html. Accessed 29 Dec 2025."},{"key":"1073_CR10","unstructured":"Washington County Oregon. Homeless Count shows progress in homeless services, while need outpaces funding resources. 2025. Available from: https:\/\/www.washingtoncountyor.gov\/housing\/news\/2025\/05\/08\/homeless-count-shows-progress-homeless-services-while-need-outpaces-funding-resources. Accessed 29 Dec 2025."},{"key":"1073_CR11","unstructured":"Yamhill Community Action Partnership. Point-in-time homeless count. 2025. Available from: https:\/\/yamhillcap.org\/homeless-count. Accessed 29 Dec 2025."},{"key":"1073_CR12","doi-asserted-by":"crossref","unstructured":"Richards J, Kuhn R. Unsheltered homelessness and health: a literature review. AJPM Focus. 2022 Oct 29;2(1):100043.","DOI":"10.1016\/j.focus.2022.100043"},{"key":"1073_CR13","doi-asserted-by":"publisher","unstructured":"Stablein G, Hill B, Keshavarz S, Llorente M. Homelessness and substance use disorders.\u00a02021. https:\/\/doi.org\/10.1007\/978-3-030-70135-2_12.","DOI":"10.1007\/978-3-030-70135-2_12"},{"issue":"4","key":"1073_CR14","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1176\/appi.ps.201600125","volume":"68","author":"T Ayangbayi","year":"2017","unstructured":"Ayangbayi T, Okunade A, Karakus M, Nianogo T. Characteristics of hospital emergency room visits for mental and substance use disorders. Psychiatr Serv. 2017;68(4):408\u201310.","journal-title":"Psychiatr Serv"},{"key":"1073_CR15","unstructured":"Azar AM. Report to congress innovative state initiatives and strategies for providing housing-related services and supports under a state Medicaid program to individuals with substance use disorders who are experiencing or at risk of experiencing homelessness [Internet]. 2020. Available from: https:\/\/www.medicaid.gov\/medicaid\/benefits\/downloads\/rtc111320-1017.pdf."},{"issue":"5","key":"1073_CR16","doi-asserted-by":"publisher","first-page":"e2512405","DOI":"10.1001\/jamanetworkopen.2025.12405","volume":"8","author":"M Gill","year":"2025","unstructured":"Gill M, Craigie A, Holtorf M, Gronowski B, Livingston CJ. Participant needs, service utilization, and costs in a Medicaid housing pilot program. JAMA Netw Open. 2025;8(5):e2512405.","journal-title":"JAMA Netw Open"},{"issue":"13","key":"1073_CR17","doi-asserted-by":"publisher","first-page":"2953","DOI":"10.1007\/s11606-023-08161-z","volume":"38","author":"C Loyd","year":"2023","unstructured":"Loyd C, Blue K, Turner L, Weber A, Guy A, Zhang Y, et al. National norms for hospitalizations due to ambulatory care sensitive conditions among adults in the US. J Gen Intern Med. 2023;38(13):2953\u20139.","journal-title":"J Gen Intern Med"},{"issue":"9","key":"1073_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v111.i09","volume":"111","author":"V Arel-Bundock","year":"2024","unstructured":"Arel-Bundock V, Greifer N, Heiss A. How to interpret statistical models using marginal effects for R and python. J Stat Softw. 2024;111(9):1\u201332.","journal-title":"J Stat Softw"},{"issue":"12","key":"1073_CR19","doi-asserted-by":"publisher","first-page":"2796","DOI":"10.1007\/s11606-019-05251-9","volume":"34","author":"H Englander","year":"2019","unstructured":"Englander H, Dobbertin K, Lind BK, Nicolaidis C, Graven P, Dorfman C, et al. Inpatient addiction medicine consultation and post-hospital substance use disorder treatment engagement: a propensity-matched analysis. J Gen Intern Med. 2019;34(12):2796\u2013803.","journal-title":"J Gen Intern Med"},{"key":"1073_CR20","unstructured":"National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder. Medications for Opioid Use Disorder Save Lives. Mancher M, Leshner AI, editors. Washington (DC): National Academies Press (US); 2019 Mar 30."},{"issue":"16","key":"1073_CR21","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1001\/jama.2015.3474","volume":"313","author":"G D\u2019Onofrio","year":"2015","unstructured":"D\u2019Onofrio G, O\u2019Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine\/naloxone treatment for opioid dependence. JAMA. 2015;313(16):1636\u201344.","journal-title":"JAMA"},{"key":"1073_CR22","unstructured":"Prepared by the Office of the Assistant Secretary for Planning and Evaluation. Contingency management for the treatment of substance use disorders: enhancing access, quality, and program integrity for an evidence-based intervention [Internet]. 2023. Available from: https:\/\/aspe.hhs.gov\/reports\/contingency-management-treatment-suds."},{"issue":"2","key":"1073_CR23","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/10852350902735734","volume":"37","author":"SG Kertesz","year":"2009","unstructured":"Kertesz SG, Posner MA, O\u2019Connell JJ, Swain S, Mullins AN, Shwartz M, et al. Post-hospital medical respite care and hospital readmission of homeless persons. J Prev Interv Community. 2009;37(2):129\u201342.","journal-title":"J Prev Interv Community"},{"key":"1073_CR24","unstructured":"Pfefferle SG, Karon SS, Wyant B. Choice matters: housing models that may promote recovery for individuals and families facing opioid use disorder. 2019 Jun. Available from: https:\/\/aspe.hhs.gov\/reports\/choice-matters-housing-models-may-promote-recovery-individuals-families-facing-opioid-use-disorder-0. Accessed 3 Feb 2025."},{"issue":"12","key":"1073_CR25","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-021-01788-7","volume":"45","author":"JR Vest","year":"2021","unstructured":"Vest JR, Wu W, Mendonca EA. Sensitivity and specificity of real-world social factor screening approaches. J Med Syst. 2021;45(12):111.","journal-title":"J Med Syst"}],"container-title":["Journal of Urban Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11524-026-01073-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11524-026-01073-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11524-026-01073-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:33:00Z","timestamp":1780493580000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11524-026-01073-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["1073"],"URL":"https:\/\/doi.org\/10.1007\/s11524-026-01073-3","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7274049\/v1","asserted-by":"object"}]},"ISSN":["1099-3460","1468-2869"],"issn-type":[{"value":"1099-3460","type":"print"},{"value":"1468-2869","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"27 April 2026","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}]}}