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Monday, July 10, 2017

Rays of Hope for Eliminating Homelessness

You have probably noticed an increase in attention that homelessness has been receiving in the news lately. You may have also noticed an increase in visible homelessness in the community where you live. The problem has escalated to a point that it is difficult to ignore.

The crisis is forcing individuals and institutions to get desperate. And sometimes desperation is just the motivation needed to try something new. We have realized that the status quo was not working. Therefore, new approaches and partnerships are necessary, and with the status quo de-legitimized, some communities have been willing to take some risks and break new ground. This has led to implementation of some innovative new strategies that show promise for moving the needle. Below I summarize four new strategies that a growing number of communities are adopting.

1.  Meet Homeless Individuals Where They Are
Up until about five years ago, the homeless care system in our country was largely built on the premise that homeless individuals must show that they deserve our help by demonstrating sobriety, cleaning up negative housing history, etc. The assumption was that if homeless people were given something they didn't "earn", they would be too dependent on the system and not have the determination to move out of homelessness. This created barriers to entering housing that many homeless individuals were unable to overcome, and exacerbated the problem because studies have shown that the longer someone is homeless, the more difficult it is for him/her to secure housing. As the number of chronically homeless individuals increased, we attempted to address the problem by funding emergency shelters and transitional housing programs instead of permanent housing. While there are many shining examples of these programs moving people out of homelessness, for a large segment of the population, they were temporary band aids or inaccessible, with many individuals cycling in and out of shelters and transitional housing, or avoiding them altogether.

In the early 2000s, a new approach began to show promise. This is an approach of meeting the homeless where they are, and accepting them into housing with drug and alcohol addictions and/or untreated mental illness. The data on outcomes for these programs has shown that once individuals are safely and permanently housed with support services, they are more likely to reduce drug and alcohol use, demonstrate a variety of health improvements, including mental health, and most are able to maintain their housing. This approach has more recently been extended to outreach, where programs are proactively seeking out homeless individuals on the street and in encampments, not to relocate them, but to build relationships of trust and offer help. Some cities have also opened "come as you are" centers in neighborhoods that are more accessible than the typical government institutions, where anyone can get help regardless of whether they have the proper paperwork. Examples of this approach include the 100,000 Homes Campaign and San Francisco's Navigation Centers (see my blog post- A New Strategy to Reduce Homelessness).

2.  Build Housing Authority Partnerships
Housing Authorities have traditionally restricted their role to operating public housing and Section 8 vouchers. However, more housing authorities are beginning to harness their resources in meeting the challenge of homelessness. The most significant way this is being addressed is by prioritizing Section 8 vouchers for homeless individuals and families, and project-basing Section 8 in permanent supportive housing projects. This addresses the most significant barrier in developing and operating permanent housing for homeless individuals- limited operating revenue. It also provides developers of permanent supportive housing with another tool to finance projects. In addition, Housing Authorities are becoming more involved in affordable housing development, bringing their resources to projects, which include buildings, land, property management expertise, and rental assistance. Finally, Housing Authorities are increasingly dedicating their operational and administrative resources to assist with running the local Continuum of Care, which is the local coordinating body that procures federal funding for homelessness.

3.  Collaborate with Health Providers
Hospitals lose hundreds of millions of dollars providing unreimbursed care to homeless individuals every year. Much of this cost is associated with hospital visits that could be avoided if patients had stable housing and supportive services. To address the issue, major health care providers are beginning to invest money in homeless assistance and housing. They have also begun to partner with local governments and local housing trust funds to leverage their investments. As an example, the City of Sacramento recently created a program to keep homeless people out of emergency rooms. To accomplish this, the City received pledges totaling $5.7 million annually over four years from Sacramento Covered, Sutter Health, Dignity Health, Kaiser Permanente, and UC Davis Medical. The City combined this with $2.3 million annually of its own money, which positioned it to receive about $32 million from a State of California pilot program that uses federal Medicare and Medicaid funds. These funds will help homeless individuals move out of homelessness and into permanent housing. Specifically, the program will provide outreach workers to find frequent emergency room visitors and intervene before they use expensive critical care services. The program will also direct the expertise of mental health professionals toward those in need.

4.  Raise New Local Public and Private Investment
There is a growing consensus among government, business and citizens that homelessness negatively impacts the entire community, and that large financial commitments are required to make a difference. Los Angeles, San Francisco, and Sacramento voters have all approved tax increases to fight homelessness. In addition, business leaders are starting to take on a more significant role in many communities; some contributing to local housing trust funds, and others donating to specific projects or donating land. In one example, a business leader in Honolulu is funding the development of an 100-home village to house homeless individuals and families.

I will be tracking the outcomes of these strategies in the coming years. These developments introduce welcome changes to a broken system. The first step is figuring out what works. The second, more important step, is building the political will, and new collaborations, to implement what works. In many communities, that appears to be beginning to happen.