Chronic Homelessness

26th August
2011
written by Anna Blasco

Our Friday news Roundup is broken down today by some of the issue areas the Alliance works on:

Chronic Homelessness

Families

  • The Reading Eagle out of Pennsylvania took an in-depth look at the rise in family homelessness, and the barriers some families face in finding affordable housing.
  • Annie Lowrey suggests one way to help the long-term unemployed is to bring back the Temporary Aid to Needy Families (TANF) Emergency Contingency Fund (ECF). The program expired last September, which this very blog called “a low down dirty shame.”

Youth

  • This week, the Annie E. Casey Foundation released a report finding that the child poverty rate increased 18% between 2000 and 2009, returning to the level of the early 1990s.
  • Monday will be back to school for many students across the country. The Tallahassee Democrat looks into what that means for students who don’t have a place to call home.

Did we miss any important news this week? Tell us in the comments!

15th August
2011
written by Catherine An

This morning, I got a call from a reporter curious about cost studies.

Which got me thinking about chronic homelessness.

It’s one of the things I learned quickly at the Alliance: permanent supportive housing ends chronic homelessness. Permanent supportive housing provides housing stability (permanent housing) + supportive services (medical, mental, physical, etc.) to homeless people with the highest needs who are often struggling with mental illness, substance abuse, and/or physical issues.

In the last decade or so, we’ve implemented permanent supportive housing across the country and measurably reduced chronic homelessness in the United States. Chronic homelessness was the focus of many of the first community Ten Year Plans. The federal strategic plan to end homelessness, Opening Doors, aims to end chronic homelessness in five years.

And the outcomes are reflective of the effort: from 2005 to 2008, chronic homelessness in the country decreased approximately 28 percent.

While the cost of incarceration, institutionalization, hospitalization, etc. vary from state to state, many cost studies have found  that providing chronically homeless people permanent supportive housing is more cost-effective than incarcerating, institutionalizing, hospitalizing, etc. them.

Below is a smattering of some cost studies:

  • Seattle, WA (2009)
    • A Housing First facility in Seattle, WA served chronically homeless people with severe alcohol problems who had previously incurred multiple and expensive mental health care and medical costs.
    • Housing First participants had median costs of $4,066 per person per month. Median monthly costs decreased to $1,492 and $958 after 6 and 12 months in housing, respectively. The total cost rate reduction was 53 percent for housed participants relative to wait-list controls over the first 6 months. The total cost offsets for Housing First participants relative to controls averaged $2,449 per person per month after accounting for housing program costs.
  • Los Angeles, CA (2009)
    • This study examined four people with substance abuse, physical health, mental health, and criminal justice issues.
    • The study found that the the total cost of public services spent on [four individuals] over two years on the streets was $187,288.
    • The study also found that the total cost of public services for these four individuals living in permanent housing with support services for two years was $107,032.
  • Portland, ME (2009)
    • This project provided an opportunity to review the current permanent supportive housing options in Maine as well as to examine the cost of permanent supportive housing as compared to the cost of a life lived in homelessness.
    • Urban Maine (greater Portland)
      • 50% reduction in Service costs during the second year of permanent supportive housing;
      • 46% reduction in Health Care costs representing a $264,046 decrease in health costs;
      • Permanent supportive housing placements continued to reduce costs in the following areas: emergency room by 49%, incarceration by 87%, ambulance transportations by 53%, and police contacts by 51%.
    • Rural Maine
      • 37% reduction in service costs by providing continued permanent supportive housing to people with disabilities experiencing homelessness in rural areas;
      • 54% reduction in Mental Health costs representing a $389,977 decrease in mental health costs;
      • Permanent supportive housing placements continued to reduce costs in the following areas: emergency room by 15%, incarceration by 91% and ambulance transportations by 16%.

Permanent supportive housing is ending chronic homelessness. By providing the most high-need homeless people with housing stability coupled with the supportive services they need, we can not only end homelessness for those individuals but relieve some of the financial burden on the municipalities serving them.

We can end chronic homelessness by committing to this effective strategy. To find out more and how to get involved, please visit the Alliance website and sign up to advocate.

9th August
2011
written by Catherine An

Today’s guest post is written by Alliance senior policy analyst and resident healthcare expert Lisa Stand.

Kaiser Health News recently reported: “The administration of [Kansas] Gov. Sam Brownback continues to solicit ideas from the public on how to reform the Medicaid program. … The Medicaid Reform Working Group, as the task force is called, is looking for ways to cut $200 million or more in state Medicaid spending in time for fiscal 2013, which begins July 1, 2012.”

My first reaction was: Oh no, FY2013, already?! And Medicaid is on the chopping block in states, again, so soon?

But my second thought was more action-oriented. So states are looking for ways to save health care dollars … do they know that permanent supportive housing (PSH) does just that? Do state leaders understand that expensive hospital costs are reduced when the most vulnerable homeless people are housed and given access to the services they need – like medical treatment, behavioral health recovery, and long-term community supports?

This seems well enough understood in communities working to end homelessness – thanks to advocates and researchers who have done the studies and shared the results. And of course everyone wants to see scarce dollars used in the most effective ways when people need help living and thriving independently. But state Medicaid leaders might not be aware how much effective PSH is in their fiscal interest, even though Medicaid does not pay for housing.

Here is an opportunity, in one state, where homelessness advocates can reach out to a key decision-maker with important information about health care. The Kansas Department of Health and Environment even has a website with a simple form, ready to take consumer suggestions. And, no doubt, with budgeting for Fiscal Year 2013 coming around already, such opportunities in exist in other states.

You can check out the best way to contact your state healthcare leaders by looking on a few state government websites –  for instance, the sites for the Governor, Medicaid director, and the chief budget officer.

The Alliance has a one-page briefing paper that lines up the advocacy with the facts about PSH and healthcare costs – written for a health policy audience. This can help you craft your message, and you can attach it to correspondence if you think it would help your state leaders make decisions about services in PSH. Keep your state legislators in the loop, too. They will appreciate the information when they have to vote on tough budget proposals.

For more information about how Medicaid can play a role in ending chronic homelessness, visit the Alliance website or contact us at healthcare@naeh.org.

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4th August
2011
written by Catherine An

Nan Roman, president and CEO of the National Alliance to End Homelessness, penned this piece on Housing First for FEANTSA (the European Federation of National Organisations Working with the Homeless) which is an umbrella of not-for-profit organisations which participate in or contribute to the fight against homelessness in Europe.

What Is Housing First?

Housing First is an approach that is built on the principle that a short experience of homelessness and rapid stabilization in housing are best for homeless people and most effective in ending homelessness.  Housing First places homeless people in housing quickly and then provides or links them to services as needed, rather than the more customary approach of services first, then housing. While not assuming that housing is sufficient to solve all the problems that people have, Housing First does assume that housing is a necessary platform for success in services, education, employment, and health:  in short for achieving personal and family well-being. It also has the benefit of being consumer-driven: housing is what homeless people want and seek.

The Housing First approach focuses on a few critical elements.

  • There is a focus on helping individuals and families access housing as quickly as possible and the housing is not time-limited (it is not shelter, transitional housing, etc.).
  • While some crisis resolution and housing search services might be delivered in the process of obtaining housing, core services to promote well-being and housing stability (treatment, education, child development, etc.) are primarily delivered following housing placement.
  • The nature and duration of services depend upon individual need and services are voluntary.
  • Housing is not contingent on compliance with services; however consumers must typically comply with standard requirements of tenancy (paying the rent, etc.).

Housing First has most often been used to describe an approach for assisting homeless people with serious mental health and substance abuse disorders.  In this context it has been contrasted with a “housing readiness” approach in which people are required to achieve sobriety or treatment compliance as a pre-condition of receiving housing.  However, the principle of Housing First is also applicable to people with less significant or more temporary problems, such as families or individuals who are homeless for economic reasons.  Typically such people are temporarily housed in shelters or transitional housing, often at relatively high cost and for relatively long periods of time (up to two years), while they receive services that will make them “ready” for housing.  However, an increased focus on housing placement, even with relatively small amounts of housing subsidy and linkage to community-based services, is a more effective strategy with a lower cost for this population as well.

What Does a Housing First Approach Entail?

While there is a wide variety of program models, Housing First programs or systems typically include the following activities.

Assessment and Targeting

Individuals and families receive an in-depth, up-front assessment before being referred to or receiving services from a Housing First provider. This allows providers to ascertain both the needs of the consumer, and whether the available program(s) can meet those needs.   The level of assistance programs are able to provide most often shapes who a community can target for Housing First services.

Evidence indicates Housing First is appropriate for most, if not all, homeless people. The combination of housing linked to services can help a wide variety of people exit homelessness more rapidly. This is supported by research that demonstrates that most formerly homeless families, including those with significant challenges, will retain housing with the provision of a long-term housing subsidy. It is also supported by evaluations of Housing First interventions with chronically homeless individuals, which have found that many who have remained outside of housing for years can retain housing with a subsidy and provision of wraparound supports. Finally, it is supported by emerging research that lower-need individuals and families who become homeless can exit homelessness rapidly and avoid repeat episodes with even small amounts of housing subsidy and linkage to community services.

Permanent Housing

There is substantial variation in how Housing First providers meet the housing needs of the individuals and families they serve.

  • Some Housing First programs provide only minimal financial assistance, such as assistance with security deposits and application fees. Other programs are able to provide or access longer term or permanent housing subsidy.
  • Some Housing First programs rely solely on apartments in the private rental market. Others master-lease apartments that they then sub-let to program participants, or purchase or develop housing themselves for sub-lease to participants.
  • There are models in which the Housing First program is the legal lease holder for some initial period of time in which the individual or family is involved with the program.  When program services end, the tenant takes over the lease.  In other program models, the family or individual holds a lease with a public or private landlord from the onset.

To get people housed, Housing First programs have to help people overcome barriers to accessing permanent housing. This includes helping them to resolve outstanding credit issues, address poor tenant histories, collect needed paperwork, etc.  It also involves actively helping them identify housing by reaching out to landlords, housing management companies, public housing authorities, civic organizations, and religious congregations.

To gain access to scarce housing units, Housing First programs must be responsive to the concerns of landlords, housing operators, and developers. Strategies include giving landlords 24/7 access to program staff to address tenant problems; provision of enhanced security deposits; and commitment to quickly re-locate tenants who are in violation of the lease.  Some landlords end up prioritizing Housing First tenants because of the financial and administrative benefit they realize from the partnership with Housing First organizations.

All Housing First providers focus on helping individuals and families move into permanent housing as quickly as possible, based on the premise that social service needs can best be addressed after they move in to their new home.

Low, Moderate or High Intensity Supportive Services

The services provided to Housing First participants vary according to need.  Sometimes Housing First programs assist only with crisis intervention and re-housing, and then link the new tenants to services in the community.  On the other end of the spectrum, those tenants with more intensive and chronic problems may require long-term, housing-based services.  The goal is to provide just enough services to ensure successful tenancy and promote the economic and social well-being of individuals and families. The capacity of programs to provide supportive services following a housing placement is largely determined by, and determines, who is targeted for Housing First services.

Outcome Measures

Determining the effectiveness of Housing First programs relies on capturing outcome data. Among the primary outcomes that should be assessed in a Housing First program are individual or family housing outcomes. How rapidly are families being re-housed? Are individuals and families remaining housed? Do families or individuals re-enter shelter?

Programs may want to capture outcomes on family or individual well-being. Programs serving families may include employment and earning outcomes and school performance of children. Programs serving chronically homeless individuals might examine increases or decreases in hospital stays, involvement with law enforcement, or engagement in employment.  Cost reduction can also be an important metric.

It is also critical to examine the impact of Housing First in reducing overall homelessness in the community or city.  This can be done through regular counts of homeless people.  Another possible metric is to assess whether the average length of a homelessness episode is being reduced.

Moving Forward

A growing body of research documents the effectiveness of the Housing First approach when used in working with homeless people who have serious behavioral health and other disabilities. This research indicates that the approach is effective both at placing and retaining people in permanent housing and at reducing the costs associated with these individuals within the health care and judicial systems.

Housing First also works for people with less intensive needs.  Recent research in the United States demonstrated the high cost of shelter and transitional housing stays for homeless individuals and families, especially relative to the cost of housing.  A significant recent U.S. investment in Rapid Re-Housing[1] (a variation on Housing First that does not typically include long term rent subsidy but rather short term infusions to quickly return households to housing) will provide much more information on the efficacy and cost of this intervention for a wider group of homeless people.  The Housing First approach, across all populations and categories of need, is clearly having an influence, and communities across the United States are beginning to re-engineer their homeless and mainstream systems to focus on the promotion of housing stability.

Moving forward, we continue to embrace the Housing First approach as one that will help us end homelessness much more rapidly for individuals, families and the nation.


[1] $1.5 billion over three years for the Homelessness Prevention and Rapid Re-Housing Program.

Image courtesy of aechempati, C.P.Storm

3rd November
2010
written by Catherine An

Today’s guest post comes from Alliance research associate Pete Witte: homelessness researcher, urban planner, and brand new dad.

Last week I attended a meeting with the local D.C. chapter of the American Planning Association. Xavier Briggs – urban planner, academic, and current Associate Director at the Office of Management and Budget – spoke to the group.

Briggs is most acclaimed for his work on the concept of “geography of opportunity,” the idea that race and class segregation affects the well-being and life potential of people with fewer means. As a former urban planner turned homelessness researcher, Briggs caught my attention when he dropped the h-word into the conversation:

“…and planning for low-income housing and for those who are homeless.”

One of the things that I quickly learned in my post at the Alliance is that there is plenty of overlap between my former role as an urban planner and my current role as a homelessness researcher. Namely, I still spend my time asking one central question: what does it mean to improve our communities?

As an urban planner, that meant considering the best way to incentivize “green space,” or deciphering what the zoning code had to say about “FAR,” pondering what it meant to “rethink the auto” and encourage “TOD.”

As a homelessness researcher, it means new and different things.

I’ve learned that one way to improve communities would be to increase the amount of permanent supportive housing options for persons who are chronically homeless. We could also rapidly re-house individuals who, under incredibly difficult circumstances, have lost their home. We could make small changes that could better our homelessness system – by creating a central point of contact, coordinating services, and targeting homelessness prevention programs.

As an urban planner, I often thought about what it meant to improve our communities. I rarely thought about what it meant to end homelessness or what ending homelessness might look like. Today, I still identify as an urban planner, only now I think about community improvement in at least one more significant and important way: through ending homelessness.

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29th October
2010
written by Catherine An

Happy Halloween, everyone! We’ve got tricks and treats for this week’s Friday News Roundup!

A great editorial from the New Sentinel in TN about the Housing First approach (don’t know what Housing First is? Check out our blog archives!). Knox County Mayor Tim Burchett threatened to withdraw $50,000 from the county’s Ten Year Plan unless housing units banned alcohol. But, as the editorial thoughtfully points out, “To demand abstinence or psychological treatment before housing is like having your doctor tell you that you can’t have life-saving heart surgery until after you’ve changed your diet and started exercising.” Stable housing is the foundation – the very first step – to recovery of all kinds for people experiencing chronic homelessness. Kudos to the News Sentinel Editorial Board for recognizing this important fact.

You know who else knows this fact? The good people of Bergen County, NJ. In Bergen County, advocates are embracing the Housing First model to help chronically homeless people find permanent housing. Despite barriers – including, as the writer points out, alcoholism, drug abuse, mental illness, or physical disability (and frequently a combination) – housing is the number one priority for advocates working to end homelessness. And of the 102 homeless people the county has helped house since March 2009, not a single person has ended up back on the street. Hip hip hooray!

A hop, skip, jump away from New Jersey, our friends at Hearth in Boston are working to end elder homelessness – and it’s a good thing, too. According to our demographics brief, elder homelessness will grow by a third in ten years; double by 2050. Between the size of the baby boomer population and the current rate of elder homelessness, we’re looking at an impending crisis. Hearth can’t do it alone – we’ve all got to do our part.

And finally: the illustrious Rosanne Haggerty! The brains behind Common Ground New York and the new 100,000 Homes Campaign (and MacArthur Fellowship recipient!) shares with the Alliance her vision for ending homelessness in this month’s Take Five! interview. Take a minute to check it out!

27th October
2010
written by Catherine An

Today’s guest post comes to us from Rosanne Haggerty,founder of Common Ground New York and the 100,000 Homes Campaign.

What is the newest issue emerging in homelessness policy?
One issue with large potential impact is that more communities are using data to redesign their response to homelessness. Communities with the most information on who is homeless are in the best position to help people out of homelessness. Better data means being able to use mainstream programs more effectively— for instance, if we know who exactly is a veteran, or who qualifies for senior housing, our options for housing those people expand significantly. Along with many partners, we recently launched the 100,000 Homes Campaign to help communities across the country identify, house and support their most vulnerable homeless residents. Participating means having help in gathering person-specific data on who is homeless and in the most fragile health; creating a successful housing placement system; and being part of and learning from a network of others working collectively to house 100,000 vulnerable people by July 2013.

What issue in homelessness policy should everyone be reminded of?
I think many of us were inspired after Hurricane Katrina when over 80,000 people took to craigslist to offer housing to those made homeless by the storm. It jolted me into realizing that people naturally take care of each other in moments of crisis. The homeless never forget that homelessness is an urgent problem, but I think the rest of us often do.

The 100,000 Homes Campaign recaptures this sense of urgency by bringing individuals face to face with the homeless in their communities. It gives people a chance to respond directly and immediately to the task of moving people out of homelessness and into stable homes. The Campaign helps communities to make the best use of all their resources, including drawing on community members to play an expanded role in providing housing and support for vulnerable people. Government resources are critical, but there is a great deal of untapped capacity among community residents and institutions that can be put to use getting more people housed.

How did you start working about the field of homelessness (or housing)?
My first job out of college was as a full time volunteer at a shelter for homeless and runaway kids. There was a great staff, and the organization had the best of intentions, but over and over, the same kids came in for a few weeks, were discharged to the street, and returned a few weeks later to start the cycle again. It was clear that we weren’t having much of an impact. In talking to the young people I worked with, while they needed every type of service, it was obvious that nothing else would stick if they didn’t have stable homes. That’s what convinced me to focus on affordable housing and to go to work for a not for profit developer.

Where do you draw your inspiration?
Growing up, my parents took us to church in downtown Hartford, CT. It was an unusual congregation: just us, a few other families and several elderly residents of Hartford’s downtown SRO hotels. My parents befriended them, and they became part of our extended family. They came to our house in the suburbs every holiday, and we’d visit them if they were sick or to deliver food. We saw how important SROs and rooming houses were as housing for poor people without families.

My parent’s example of taking personal responsibility for people who had very little and seeing that they never lost their housing reminds me of our tendency to overcomplicate homelessness. We assume that it’s the job of not for profits or government agencies to handle the issue, and we forget that it’s actually the most natural thing in the world to help the people around us if we know what they need. We tend not to take into account the capacity and willingness of citizens to help end homelessness in their communities. This is why the Campaign has potential for shifting our mindsets; it draws on the energy and concern of ordinary people to become vital resources for ending homelessness in their communities.

Why do you think ending homelessness is possible?
When “homelessness” is not abstract, when it has a name and a face, it is less overwhelming and more solvable. We observe that as the Campaign helps more and more communities learn who the homeless are and discover the other dimensions of their lives— that they are elderly, or veterans, or grew up in foster care, or have cancer— they view their resources differently and realize they can draw on mainstream programs for solutions. There’s something about focusing on individual people that restores a sense of urgency to homelessness and gets us focused on solutions.

To see this profile – plus other profiles of leaders in the homeless assistance field, please visit our website and check out past Take Five! Expert Q & As.

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31st August
2010
written by Marisa Seitz

Hello everyone! I can’t believe my internship at the Alliance is over, but I can definitely say I am so glad I came here! When I interviewed for this job, I just wanted to work for a good cause and I didn’t know anything about homelessness. That certainly isn’t the case now!

I have learned so much about homelessness since I came to the Alliance, my perceptions have been completely changed. I have learned about the struggles the people endure and the causes that force people into homelessness. I have learned that the stereotype I had before I came here was just not in line with reality. The biggest misconception I had? That the people I see on the streets are the majority of the homeless population. Chronic homelessness only makes up 20 percent though! After working here, I will definitely do my best to help change people’s perceptions, because I can see that this is the most important step in affecting change.

It has also been great blogging with you! I had never worked on a professional blog or ran social media for an organization before, but the experience has shown me how such tools can really be great ways to get information out to people. Running social media like Facebook and Twitter has also shown me how we can develop communities of people who really care, to help spread information and start to affect real change.

I am so happy to have been able to work with all the staff here at the Alliance, it has truly been a blast. Everyone was so eager to tell me anything I wanted to know, and it is great to find a group so dedicated to ending homelessness. They are all truly an inspiration.

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13th August
2010
written by Marisa Seitz

This week, we heard a lot about the troubles people are having in housing. In Boston, we read about how rentals are becoming harder to find and afford, while in Atlanta, we saw the commotion caused by crowds gathered in an attempt to sign up for Section 8 assistance. What a state things are in when over 20,000 brave the heat in order to seek help!

However, we have also heard good news coming out of places like Arkansas, where they are using HPRP funds to help house people in their population who are experiencing homelessness.

In USA Today, they even examined the possibility that home ownership might not be the best thing for the federal government to push.

Finally, in the LA Times this week they talked about Project 50, a pilot program to house some of Los Angeles’ most vulnerable citizens experiencing homelessness. This program, they explain, could be the start of housing not only 50 of the most vulnerable people, but 10,000. Shelter Partnership also wrote a blog, examining Project 50 on a deeper level.

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4th June
2010
written by naehblog

This is my last Friday news roundup at the Alliance. I’ve been really inspired by all the fantastic work that’s happening, both locally and at the federal level, and I’m so glad I got to help spread the word. Hearing stories from community across the country has made me believe that ending homelessness really is possible.

Catherine’s back at the helm of the About Homelessness blog and soon she’ll be joined by a NEW new media intern. Thanks for reading!

Memorial Day brought some attention to veterans experiencing homelessness. An in-depth piece from the Arizona Star takes a look at the divide between the VA’s plan to end homelessness within 5 years and the attitudes of some vets who are chronically homeless.

Change.org’s Poverty in America blog features Swords and Plowshares, a facility that combines housing and services to get former soldiers back on their feet.

The Corporation for Supportive Housing’s Deborah DeSantis shares a recent report that shows there are three times more mentally ill people in jail than in hospitals. The solution is not only humane, but cost-effective: Permanent Supportive Housing.

Speaking of cost-effectiveness, the Providence Journal discussed the benefits of the Housing First model by telling the story of Bill Victoria, who was homeless for 30 years before finally finding stable housing: “I thought I’d be homeless forever,” he says.

Not so.

About the Housing First approach, Eric Hirsch, a sociology professor at Providence College, says:

It’s definitely cost-effective, especially for people who have been homeless for a long time. This is how you end homelessness.

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