Housing First Grand Junction

INTRODUCTION

In the summer of 2010 various organizations in the Grand Valleygathered together to considercrafting a plan to end homelessness in Mesa CountyColorado. Karis Inc. joined these effortsthrough its participation in the Grand ValleyCoalition for the Homeless (GVCH). As part of Karis’cooperative effort with-in the coalition and as a reflection of Karis’ own commitment to researchbased solutions, Karis staff prepared the following report on Housing First, a well research basedsolution to homelessness.

We offer this report in the hope that as we move forward we will do so with intention, withcommitment and with our eyes and minds wide open to all that is possible.

Karis, Inc.

Summer 2010

EXECUTIVE SUMMARY

Housing first is a strategyfor combating chronic homelessness in the US.1 Housing firstprograms are a shift awayfrom linear-housing models (also called “The Continuumof Care Model”)where clients must successfullycomplete treatment (for substance abuse, financial sustainabilityext...) as a prerequisite to obtaining services. In a housing first program, individuals are givenhousing assistance regardless of substance abuse, financial instabilityor disability. Housing firstprograms have been quicklygaining support bygovernment and non-profit agencies. The reportprovides a comprehensive reviewof current housing first programs, and begins examining thepossible implementation of such a program in Grand Junction.

The core of the report’s findings is the considerable benefits of housing first programs which canbe summarized as follows:

Higher retention rates for program participants: individuals and families staye housedlonger

Improvements in the health of participants and decreased health care costs: individualsand families are in better health while using less health care resources.

Increased effectiveness in treating substance abuse: individuals are more likelytoeffectivelyaddress substance abuse concerns in housing first programs.

Reduction in incarceration rates: individuals in housing first programs spend less time injail.

Economic advantages over traditional sheltering models: housing individuals andfamilies in housing first programs uses fewer resources than traditional shelteringmodels.

In short, there is a growing bodyof evidence to showthat housing first programs can savecommunities considerable resources in a varietyof areas bymoving program participants intohousing as soon as possible and without prerequisites. There maybe a varietyof reasons for theeffectiveness of housing first programs but the particular reasons for success has yet to be empiricallyidentified.

After outlining current critiques of housing first programs, four further steps (determining thecosts of Grand Junction’s current linear housing/continuum of care programs, making personalcontact with smaller Housing First programs, expanding research on best practices and beginning toidentifysub-populations) seem prudent for Grand Junction policymakers.

In Karis’ opinion these are prudent steps to take on the wayto implementing, at a minimum, atrail housing first programs in the Grand Valley.

HISTORY AND BACKROUND

Everynight, there are an estimated 672,000 people that are homeless in the US, and over thecourse of a year between two and three million people will experience homelessness for at least aweek.2 Historically, American homeless programs have followed a linear-housing model (oftenreferred to as “The Continuum of Care Model”) to combat homelessness. In the linear-housingmodel, participants follow“a sequence of programs (shelter, transitional housing, permanenthousing)," with the hopes of eventual self-sustainability.3

In 1999, the National Alliance to End Homelessness coined the term "housing first," as analternate to the linear-housing model. Housing first (or rapid re-housing, as housing first is referredto bygovernmental agencies) is based on the philosophical idea that a home is an inherent right, andit should not come with preconditions. In the past eleven years, housing first programs havereported major successes, and have gained traction with policymakers and non-profits. In 2008, theUS Conference of Mayors passed two resolutions on housing first. The first resolution endorsedhousing first program’s methodologyand the other declared housing first as the onlyhomelessintervention program that is an "evidence-based practice."4 In addition, the US Federal Government(USFG) passed the McKinney-Vento Homeless Assistance Grant Program of 2008, a $25 millionprogram that provided funding for housing first programs.

On February17 2009, President Obama signed the American Recoveryand Reinvestment Act of2009, appropriating $1.5 billion for the Homelessness Prevention and Rapid Re-Housing Program(HPRP). HPRP is facilitated bythe US Department of Housing and Urban Development (HUD),with the goal of homelessness prevention and expansion of rapid re-housing programs.5 Theprogram gives grants to states, cities and counties to develop housing first programs and is estimatedto help 600,000 Americans avoid homelessness.6 One of the major goals of HPRP to expand thebodyof research on housing first, and thus all recipients of grant funding have been required toreport the successes and failures of their programs.

WHAT IS HOUSING FIRST?

Housing first is a paradigm shift awayfrom traditional linear-housing programs. In linear-housing programs, clients must successfullycomplete treatment (for substance abuse, financialsustainabilityetc..) as a prerequisite to obtaining services.7 The majorityof linear-housing programsalso require continued case management during the transitional housing phase. In contrast, housingfirst programs have no requirements with regards to substance abuse or financial sustainability, andall case management resources are optional.8

The most immediate goal of housing first programs is to move homeless individuals and familiesinto housing as quicklyas possible. For example, The FamilyHousing Collaborative Program inColumbus, OH finds housing for 93% of clients within 15 days of referral.9 Such housing can take avarietyof forms. Direct Access to Housing, a San Francisco housing first organization, movespeople into apartments the organization owns, while the Housing Locator Program in Chicago helpsclients move into rentals in the private sector.1011

Funding for housing differs from program to program. Most programs (including programs inDenver, CO) require clients to pay30% of their income to stayin subsidized housing, while otherprograms (such as San Francisco, CA) require people to payas much as 50% of their income. Athird type of program provides onetime assistance for housing placement (as in Columbus, OH) andeven further, others give no financial assistance to participants (providing families with casemanagement and housing placement programs, where the familypays 100 percent of rent) (such as inChicago, IL).

All housing first programs offer optional case management services to clients, though eachprogram provides different resources. Models that provide one-time assistance (Columbus, OH)provide programs to help participants achieve housing (landlord mediation and housing locationassistance), while other programs provide job placement and training (NewYork City, NY). 12 13 Stillmanyother programs provide substance abuse assistance (Seattle, WA).14 Some programs haveimplemented assertive communitytreatment (ACT), a comprehensive approach to case managementand client assistance (Denver, CO and NewYork City, NYC).15

The majorityof housing first programs are used to target specific segments of the homelesspopulation. Programs include, but are not limited to foci on: the disabled (Denver, CO), those withsubstance abuse problems (Seattle, WA), homeless families (Hennepin Country, MN and LosAngeles, CA), and survivors of domestic violence (Portland, OR). The Boston Globe reports that allhousing programs target the chronicallyhomeless; however, some housing first programs seem toalso include services for families who are not chronicallyhomeless.16 One program that is notintended solelyfor the chronicallyhomeless is the Housing Locator Program (Chicago, IL), whichprovides services to families who are in imminent danger of becoming homeless.17

WHY HOUSING FIRST?

This report identifies five advantages of housing first programs, each explained below. Note thatwhile manyhousing first advocates argue for the strength of the approach on philosophical orreligious grounds (such as: a home is an inherent right), this report restricts its discussion to materialbenefits that have been established over time.

High Retention Rates

Perhaps the largest advantage of a housing first program is the high retention rates: individualswho leave housing first programs are extremelylikelyto stayhoused and out of homelessness. LosAngeles' housing first program found that 89.5% of people remained consistentlyhoused withoutanyrepeated episode of homelessness between two and seven years after leaving the program, andonly1% of people had two or more episodes of homelessness over the same period.18

"Since 1995, Rapid Exit Re-Housing (Hennepin Count, MN) has housed over 8,000 families,with more than 20,000 children, through housing first programs. One year after case closing, 92%had not returned to shelters."19

Pathway's to Housing, NewYork City's housing first program, reported that 88% of their clientsremained housed after five years compared to only47% of the control group. Even the MilbankQuarterly, in a skeptical article about housing first, conceded that these programs were unmatched by traditional programs in retention rates for participants after programming ended.

Health Improvements

"The verysickest homeless individuals often find themselves in repeated hospitalization because ofthe chaos of life on the street."20 Housing first programs can effectivelymitigate the health risksassociated with homelessness. Participants in housing first programs are more likelyto be healthybecause theyare staying in a home rather then a shelter, and because theytend to use morepreventative healthcare (which is provided bymanyhousing first programs).

For example, the Denver Housing First found that: "50% of participants havedocumented improvements in their health status, 43% have improved mental health status,15% have decreased their substance use, and 64% have improved their overall qualityoflife."21

Home Again, a housing first program in Worcester MA, reported its participants sawanaverage decrease in 1.46 hospital visits everythree months in comparison to an increase of0.62 visits for the control group over the same period.22

Improved health of participants in housing first programs also has a social benefit, becauseparticipants in such programs use less tax dollars for emergencyroom care and inpatient visits. TheDenver program mentioned above found that in the 24 months that clients participated in housingfirst programs, emergencyroom costs decreased by34.3% and inpatient nights were reduced by80%compared to the 24 months prior to entering the program.

Substance Abuse

Substance abuse remains a crucial issue within the homeless population: national data shows that38% of homeless persons had problems with alcohol and 46% with drugs."23 Those with addictionshave the hardest time finding services, as theyare often turned awaybyprograms that demandsobriety.24 The Substance Abuse PolicyResearch Program found that “linear-housing programs that

restricted the consumption of alcohol mayprevent those most in need from accepting help.”Housing first programs avoid this problem byreaching out to all those addicts in need.

While seeminglycounterintuitive, studies have showdrastic decreases in substance abuse inhousing first programs, despite substance abuse services being optional. Los Angeles' housing firstprogram found that, "92.6% of parents (with documented substance abuse histories) reported thattheyhad continuouslymaintained their sobriety/abstinence two to seven years after leaving theprogram."25

The Journal of the American Medical Association conducted a studyon Seattle Washington'shousing first project, the 1181 Eastlake Project. The 1181 Eastlake Project enrolled 75 chronicallyhomeless, alcohol-dependent individuals in a housing first program. The studyfound that, "thelonger participants stayed in the housing program, the less theydrank"26

In addition to the personal advantages of sobriety/abstinence, decreases in substance abuselessen the cost of detoxification programs. The Denver Housing First Collaborative found thatdetoxification visits decreased by82% in two years, accounting for a savings of $8,732 per person.27

Incarceration Rates

In addition to the savings from healthcare and substance abuse noted above, studies have shownthat housing first programs lead to a decrease in incarcerations, saving the state money. The DenverHousing First Collaborative found that those who participated in their program sawincarcerationdays decrease by76% over two years, a cost savings of $1,371 per person.28 While the reason(s) fordecreases in incarcerations has not been identified, one might hypothesize that the decreases werelinked to decreases in substance abuse and an increase in stabilitybecause of housing.

Economic Advantages

While it might seem that a large homeless shelter wouldbenefit from economies of scale andprove to be cheaper then a housing first program, the opposite is often true. In manycases, it ischeaper to move individuals into housing rather then keeping them in homeless shelters. A nationalsurveyof 587 programs found that the average yearlycosts (per person) at an emergencyshelter is$14,000, a traditional housing program $13,100, and permanent supportive housing $11,560.29 Incomparison the Housing First Collaborative (Columbus, OH) houses families for an average cost of$1,972 per family.30

Home Free, a housing first program in Portland, OR, found that two shelter nights for a familyof four was nearlyequivalent to providing a month's rent for the same family. When Home Freeremoved all emergencyshelters in 2003, and transitioned to a housing first program, theyfound thattheywere able to serve four times as manyfamilies.31

The Denver Housing First Collaborative found that total savings (detoxification, incarceration,emergencyroom, outpatient, inpatient and shelter costs) totaled a saving of 72.95% over two years,or an average of $31,545 per person.

WHY IS HOUSING FIRST SUCSESSFUL?

Establishing a direct cause between anygiven characteristic of the housing first model and thesuccesses outlined above is beyond the scope of the current literature on housing first. Having saidthis belowis a list of possible reasons for the success of the housing first model:

A Home Provides an Environment for Success

Time Magazine noted on January25 2010, "Having a place to live is the base for everything else -for employment, for keeping kids in school, for your health and for your well-being.” In a housingfirst program, parents do not have to worryabout housing their children or providing a safe restingplace at night. Byremoving the "housing question," housing first programs allowindividuals to focuson other aspects of sustainability, such as employment or education.32 A home can also be an integralpart of securing employment.

Having a home also provides the opportunityfor more successful counseling. "Serving a personwithin his/her own environment helps to decrease fear and improve the ‘therapeutic alliance,’ whichresults in an increased acceptance of treatment."33 Housing first programs are based on the idea thata home is a prerequisite to recovery, rather then making recoverya prerequisite for housing (as in alinear-housing model).

Assistance is Optional

One of the most important parts of housing first programs is that case management assistance isoptional. Because assistance is optional, clients will onlyparticipate in programs that theybelieveaddress their needs. Allowing the individual to decide, "their own priorities, sequencing and timing,"creates an assistance package that the individual is invested in.34 Such investment and trust inprogramming is essential to effective case management and services.

Optional assistance is also beneficial because it allows individuals to customize their treatment.Rather then using a homogenous set of requirements to treat a heterogeneous homeless population(like a linear program might), housing first programs allowfor a unique combination of supportsystems that are best suited for an individual. Giving the control of the support system to theparticipant further enhances his/her ownership of services. Several studies have identified theoptional nature of case management as one of the strengths of housing first programs and as thereason for effective case management and high retention rates.35

For example, Home Again, a housing first program in Worcester, MA, found that theirparticipants were nearlytwice as likelyto have good social support in comparison to those receivingtraditional care.36 Beyond Shelter, another housing first program in Los Angeles, found that afterclients left the program 98% of participants reported to be, "successfullymanaging the familybudgeton their own," and the other 2% reported to be, "successfullymanaging the familybudget with thehelp of others."37 Effectiveness in both these programs has been partiallyattributed to the optionalnature of case management services. 3839

Assistance in Housing Placement

Finding affordable housing can be an excruciating process for homeless individuals and families.Not onlyis there a national shortage of 2.8 million units of affordable housing, but manylandlordsare hesitant to rent to homeless individuals because of homelessness' negative connotations: lack ofsustainable income, disabilities, substance abuse, poor credit, and poor rental histories. Housing firstorganizations mitigate these negative perceptions byengaging in landlord education and bybuilding

sustained relationships with landlords. Landlords are also more likelyto rent to a homeless personwho has connections to a housing first program because housing first programs are there to supportthe renter.40

Housing first services to the client are also a crucial. Services include, but are not limited to:advocacywith landlords/housing authority, rent assistance, financial management and locatingaffordable housing. Such services can be effectives and economical. "Programs like Chicago Illinois’Housing Locator program capitalize on the housing expertise of community-based providers andresult in agencyand system level staffing efficiencies."41

Housing assistance has a successful track record for placing families and individuals in a homequicklyand efficiently. The FamilyHousing Collaborative Program (FHC) in Columbus Ohioprovides "case management services such as landlord mediation, housing location assistance, home-based supportive services, and financial assistance."42 In the second half of 2008, 93% of familiesthat were refereed to FHC were housed within 15 days. For the 143 families that were housed, theaverage financial assistance was $908, and the administrative costs were $1,064. 43

LIMITATIONS OF A HOUSING FIRST MODEL

While housing first programs have the above advantages, there are limitations to such programs.Beloware explanations of some of the more common criticisms of housing first programs.

Putting the Addicted First

While not all housing first programs give priorityto those with substance abuse problems, someprograms are designated specificallyfor the addicted (Seattle, WA) and other programs givepreference to an addicted individual over an equallyqualified non-addicted person (Denver, CO).4445

Manypeople are critical of housing first systems because theyprovide more resources to the addictedthough in manyways addicted support systems in a housing first program would be no different thena detox program or alcohol anonymous group.46

Lack of Research

The Milbank Quarterlycautions policymakers and non-profits from "overreaching" withhousing first programs. The journal looks through manypopular housing first programs (Pathwaysto Housing, NewYork City, or Seattle's program for the addicted) and the research done on thoseprograms. The journal points out flaws or limitations with existing research on those programs. Forexample, the authors explain that similar studies on alcoholism have shown that housing firstprograms indicate no marginal advantage compared to linear-housing models. The ultimate thesis isthat there is not enough good research to solidifyhousing first as the best housing program. Theauthors encourage policymakers to continue to develop both linear and housing first models ratherthen prioritizing to one over the other. It is worth noting that while the authors reference studiesthat assert that housing first and linear-housing programs are equallyeffective, no examples are givenin which linear-housing programs have been more effective.47

The Oppor tunity Cost is too High

Manycritics of housing first are worried that the expansion of housing first models will decreaseresources to homeless shelters. Other critics voice concern that increasing resources for housing firstprograms (that are focused on the chronicallyhomeless) will decrease resources for those who arenot chronicallyhomeless.48

Economies of Scale

Leaving aside the considerable non-economic benefits of a housing first model, it maynot bepossible for smaller communities to reap the considerable economic gains garnered bylargercommunities. Most housing first programs are in major cities (Los Angeles, NewYork City, Denver,Chicago, etc.) which allowservice providers to target specific sub-populations that are using adisproportionatelylarger percent of resources. For example, housing first studies have been done inmajor cities using verysmall segments of the homeless population (100 people in Denver, 75 peoplein Seattle). This allowed program coordinators to select those individuals who were costing the citythe most money.

While there are a fewsmaller success stories (Lancaster County, PA), the concern becomeswhether or not there are large enough homeless sub-populations in Grand Junction for a housingfirst program to have significant financial impact. In addition, even if these individuals are identified,establishing a housing first program for them maybe more costlythan the savings benefit.

CASE STUDIES

Beyond Shelter's - Los Angeles California49

Between 1997 and 2001, 1,600 families were selected by60 non-profits in Los Angeles to takeplace in a 16 month housing first program. "Housing specialists at Beyond Shelter's help each familyfind and move into permanent, affordable housing in residential neighborhoods thought Los AngelesCounty. Housing specialists work closelywith each familyto overcome barriers to permanenthousing (evictions and bad credit). Specialists help negotiate leases and facilitate access to move-inresources and housing subsidies when available. Beyond Shelter's case managers provideindividualized, time limited (six months to one year) and intensive home-based, case managementservices."

Families for the program were extremelypoor. Median monthlyincome was $1,000, "Assumingmost optimisticallythat monthlyincomes were regular and uninterrupted, estimated annual familymedian income was $12,000", well belowthe federal povertythreshold which was $19,223 for afamilyof four in 2004. Monthlyrent was based on income and ranged from $0-$2,100 per family.

Results

"89.5% of people remained consistentlyhoused without anyrepeated episodes ofhomelessness two to seven years after leaving the program." Only1% had two ormore episodes of homelessness.

72.6% of families reported having no trouble paying rent on time after leaving theprogram and only11% of families were late on their rent more then once.

98% of families, "reported successfullymanaging the familybudget on their own"after leaving Beyond Shelter’s, and the other 2% reported receiving help from others.None of the respondents said that theywere unsuccessfullymanaging their money.

"92.6% of parents with documented substance abuse histories reported that theyhadcontinuouslymaintained their sobriety/abstinence two to seven years after leavingBeyond Shelter’s.

82.1% of families had health care coverage for all familymembers two to seven yearsafter leaving the program.

Denver Housing First Collaborative (DHFC) - Denver, Colorado50

Denver Colorado identifiedthe 100 chronicallyhomeless individuals who were costing the citythe most money. All those identified were disabled and manyof them had substance abuse problemsprior to entering the program. The group averaged 8 years in homelessness, per person. Tenantswere required to provide 30% of their income towards rent and DHFC paid the balance of the rent tolandlords. "The program used a housing first strategycombined with assertive communitytreatment(ACT) services, providing integrated health, mental health, substance treatment and support services"'

Results:

"The total emergencyrelated costs for the sample group declined by72.95%, ornearly$600,000 in the 24 months of participation in the DHFC programcompared with the 24 months prior to entryin the program. The total cost

savings averaged $31,545 per participant," and the net savings was $4,745 perperson.

"Onlyoutpatient health costs increased as participants were directed to moreappropriate and cost effective service bythe program."

"Emergencyroom visits and costs were reduced byan average of 34.3%.Inpatient vistas were reduced by40%, while inpatient nights were reduced by80%. Overall inpatient costs were reduced by66% [.…] Detox visits weredramaticallyreduced by82%, with an average cost savings of $8,732 per person,or 84%."

"Incarceration days and costs were reduced by76%, and emergencyshelter costswere reduced byan average of $13,600 per person."

80% of participants remained housed six months after the program ended.

"50% of participants have documented improvements in their health status, 43%have improved mental health status, 15% have decreased their substance use,and 64% have improved their overall qualityof life."

Average monthlyincome of participants increased from $185 at entryto $431.

Home Free - Portland Oregon51

Home Free provides housing first programs for families that are survivors of domestic violence.Prior to 2003, Home Free provided families with housing in an emergencyshelter. However, HomeFree recognized that the homeless shelter was not an effective economic model. "Two shelter nightsfor a familyof four was nearlyequivalent to providing a month's rent for the same family." HomeFree started a housing first program, and has removed their emergencyshelter. The group is nowable to provide emergencyhousing to four times as manyfamilies as was possible though its facility-based shelter"

Home Free typicallyprovides a financial subsidyfor rent during the first six to twelve monthsthat a familyis in the program. Home Free was able to stabilize 25-35 families with one full timeadvocate and $50,000, less than $2,000 per family. Case management programs include but are not:“limited to, direct services to children, domestic violence and parenting support groups, advocacywith landlords and the housing authority job search and job training referrals, case coordination withother systems, linkages to legal services, and help with budgeting and goal planning. [...] 50% ofhouseholds in the program have a historyof a mental health disability, and nearlyone-third have analcohol and/or dug history.”

"97% of households enrolled in housing first obtained safe housing, with 86% of thesehouseholds remaining stablyhoused one year after exiting services"

Shelter to Independent Living Program (STIL) - Lancaster County Pennsylvania52

Lancaster Countyis one of the smaller housing first programs in the country. The countyhas400,000 individuals and its largest cityhas a population of 60,000. "In 1988 shelter providers in thearea found that theywere spending so much of their time on the dayto daybusiness of providing forpeople's basic needs that theydid not have staff with time to focus on moving families out of thecrisis phase and into permanent housing." In response STIL was created as a "non-facility-basedprogram to provide" housing first services. STIL's mission is, "to mainstream homeless households

back into the communityinto permanent housing through landlord advocacy, housing counseling,budget counseling and case management and to provide education, resources and accountabilitytoempower homeless households with the skills and disciplines necessaryfor long term selfsufficiency."

Results:

84% of newly-homeless households were able to obtain permanent housing.

87% of newhouseholds placed in housing paid rent and utilities on time.

80% of clients were able to remain in the program and maintain housing for one year.

Housing Locator Program - Chicago Illinois53

The Housing Locator Program provides housing first services to: "families who reside inhomeless shelter and relocation services for families who are at imminent risk of becoming homeless[...] The program is limited to providing one-time rental assistance, so eligibilityis based on adetermination that the household has sufficient income to sustain housing without a subsidy.Housing Locator staff conducts a housing assessment and then works with landlords in theircommunityto place each household in housing that best their needs. On average, housingplacements are made within two weeks of the referral. Since its inception in 2006, the HousingLocator program hags housed more than 845 households. In 2008, 279 households were housed.”Of those 845 families housed, 84% of them are still housed today.

Home Again - Worcester Massachusetts54

Home again started in 2006 to provide housing first services to chronicallyhomeless adults.

Results:

"Home Again Participants' use of hospital emergencyroom services decreased byanaverage of 1.46 visits per three months, bycontrast, the control group reported anincrease of .62 visits per three months."

"Home Again participants were nearlytwice as likelyas participants receivingstandard care to have good social support (34% vs 19%)."

Family Housing Collaborative (FHC) - Columbus Ohio55

FHC is a one-time housing first program for families. "The program provides a wide varietyofcase management services such as landlord mediation, housing location assistance, home-basedsupportive services and financial assistance.” Financial assistance averaged $908 the 143 familieshoused in the second half of 2008, and operating costs were $1,064 per familyhoused. Of those 143families housed 93% of them were housed within 15 days of being refereed to the program.

1181 Eastlake project - Seattle Washington56

The 1181 Eastlake project took 75 chronicallyhomeless, alcohol-dependent individuals and putthem through a housing first program. The program onlyhad to ask 79 individuals before theyreceived 75 volunteers. 1181 Eastlake identified those individuals who were costing the citythe mostmoney, and recruited them for the program. "Each of the participants had cost state and localgovernments an average of $86,062 per year before being housed, compared to an average of $13,440it costs per person per year to administer the housing program."

Results

Residents saved taxpayers more than $4 million dollars because of the housingfirst program.

"Reported an average cost-savings of 53% in health and social services,compared to the costs of a control group, a savings of nearly$2,500 per monthper person."

"The longer the participants stayin the housing program, the less theydrink"

Shelter to Housing Pilot - Commonwealth of Massachusetts57

The Shelter to Housing Pilot has an, "aggressive landlord outreach and housing search assistanceprogram." The program "provides families with up to $6,000 in rental assistance, housing placementservices, and home-based case management." Shelter to Housing Pilot specificallytargets, "familieswith a working parent or a parent enrolled in an education or training program." "Approximately85percent of families housed remained stablyhoused 18 months after the housing placement [...] Therate of success parallels what is achieved with a full housing subsidyfor homeless families."

Rapid Exit Program - Hennepin County, Minnesota58

"A central intake conducts an assessment of each family's barriers to getting and keepinghousing, and triages the familyto a Rapid Exit Agency. Advocates helped the familyfind housingthrough their networks of landlords, then offer six months of stabilization and support to achievenon-recidivism performance targets."59

Results

"Since 1995, over 8000 families, with more than 20,000 children, have receivedRapid Exit re-housing. One year after case closing, 92% had not returned toshelter."

"In a four-year period…shelter admissions declined by42%, average length of stayby47% and total number of purchased bed-nights by70%."

Pathways to Housing - New York City, New York60

Pathways to Housing, which started in 1992, is one of the countries first housing first programs.The program nowsupports 500 individuals. Pathways to Housing provides housing placement andassertive communitytreatment (ACT) services. The municipal costs per capita per night forPathways to Housing program is $57. In comparison, the costs at a shelter is $73, jail $164,emergencyroom $519, and at a psychiatric hospital $1,185. Participants are required to give 30% oftheir income, attend moneymanagement program, and meet twice a month with staff. Pathways toHousing also offers job placement at 5 different offices, will soon be opening a thrift store in Queensand a bakeryin Harlem that will be run byparticipants.

Results

"88% of people entering the Pathways Housing remained housed at least five yearsafter the program, versus 47% of the control group who entered a variety ofresidential programs in NewYork City"

"Reductions in the use of public services averaged $12,146, offsetting most, but notall, housing costs (net cost $1,425 per placement).

Direct Access to Housing (DAH) -San Francisco CA61

Direct Access to Housing identifies homeless individuals and moves them into "apartmentsin one of several large, multiunit residential buildings." Participants pay“30-50% of their incomefor rent, and 80% receive federal Social Securitydisabilitybenefits.” “Total cost to providepermanent housing and support services in DAH buildings is approximately$1,200 per monthper resident. The average rent received from residents is $300 per month,therefore requiring a$900 per month subsidyfrom governmental sources.”

Results

Since opening the first DAH site in 1998, almost two-thirds of the residents haveremained housed in the DAH program. Of the remaining one-third of the residentswho moved out of the program, half moved to other permanent housing.

Only4% of residents were evicted from the housing facilities.

Emergencyservices use was reduced significantly. After leaving the program use ofservices declined by58%. Similarly, in the first two years after entering theprogram, there was a 57% reduction in inpatient episodes after entering the programcompared to the two years prior to housing placement.

RECOMMENDATIONS

Outline Costs of Current Programming

In order to access whether or not Grand Junction can reap financial benefits from a housing firstprogram, policymakers need to have a baseline understanding of current costs. This will require allprivate, public and non-profit services to report both the number of individuals served and the totalcost of those services. Information needs to range from programs intended for the homeless (GrandJunction CommunityHomeless Shelter) as well as programs that are not specificallyfor designed forthe homeless (services provided at Colorado West Mental Health). In short in order to determine ifwe can save money, we must first have a baseline, hard understanding of our current costs.

Make Personal Contact with Smaller Housing First Programs

Policymakers should begin building relationships with other housing first programs that areserving smaller populations. This will allowthe coalition to better understand housing first in regardsto howit might function in Grand Junction.

Expand Research on Best Practices

HUD provides manuals on best housing first practices. HUD manuals include information onintake, program operation and monitoring success. This information would be crucial in helpingpolicymakers design programs that are model best housing first practices.

Begin Identifying Sub-populations

Policymakers should consider what sub-populations of the homeless communitywould be bestserved bya housing first program and begin to gather basic information about these sub-groups. Itmaywell be that initial housing first efforts should target a large sub-population that is using themost resources.

CONCLUSION

Housing first programs have significant benefits to societyand to the recipients of suchprograms. Studies have shown that qualityof life for individuals in housing first programs are greatlyimproved, and the economic benefits to societyare tremendous. Current research points to housingfirst methods being the best wayto combat chronic homelessness, particularlyin sub-populationssuch as those using a disproportionate amount of services or those struggling with substance abuseor addiction. While there are limitations to housing first programs and particular challenges toimplementing housing first programs in smaller communities, it is prudent to assert that housing firstprograms showgreat promise, and that there has been a great bodyof encouraging, if not empiricallyconclusive, data to support their effectiveness. At a minimum, it would be prudent to begin gatheringthe information necessaryto implement some housing first trail programs in the Grand Valley.

END NOTES

1 Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending Chronic Homelessness,is gaining ground in Boston." The BostonGlobe [Boston, MA] 24 June 2007.

2 O'Leary, Keven. "The Feds' Homelessness-Prevention Program." Time 25 Jan. 2010.3 Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.4 US Conference of Mayors. 2008. Housing First and Rapid Re-Housing as Keystrategies in Ending Homelessness and CreatingResults in 10 year plans (2008 adopted resolution).5 Schanes, Christine. "The Homelessness Prevention and Rapid Re-Housing Program (HPRP)." HuffingtonPost [NewYork , NY] 11July2010.6 O'Leary, Keven. "The Feds' Homelessness-Prevention Program." Time 25 Jan. 2010.7 Ridgway, P., A.M. Zipple. The Paradigm Shift in Residential Services: From the Linear Continuum to Supported HousingApproaches. Psychosocial Rehabilitation Journal 13:20-31. 1990.8 Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 87.2 (2009):495-534.

9 Barbu, Lianna. CommunitySpotlight: Homeless Prevention: The communityShelter Board's FamilyHousing Collaborative (FHC).US Department of Housing and Urban Development.10 Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.11 Levy, Leslie. CommunitySpotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housingand Urban Development.12 Barbu, Lianna. CommunitySpotlight: Homeless Prevention: The communityShelter Board's FamilyHousing Collaborative (FHC).US Department of Housing and Urban Development.13 McCarroll, Christina. "Pathways to Housing the Homeless." The ChristianScience Monitor [Boston, MA] 10 May2002.14 Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearchProgram (2009).15 Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 2006.

16 Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending ChronicHomelessness, is gaining ground in Boston." The BostonGlobe [Boston, MA] 24 June 2007.

17 McDivitt, Kay M. Community Spotlight: Homeless Prevention: Lessons from Lancaster, PA. US Department of Housing andUrban Development.

18 Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-termEfficacyto End and Prevent FamilyHomelessness. PolicyBrief 1. Los Angeles, CA: Institute for Research, June 2005.19 "Rapid Re-Housing." National Alliance to End Homelessness (2008).

20Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.21 Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 2006.22 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.23 Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.24 McCarroll, Christina. "Pathways to Housing the Homeless." The ChristianScience Monitor [Boston, MA] 10 May2002.

25 McCarroll, Christina. "Pathways to Housing the Homeless." The ChristianScience Monitor [Boston, MA] 10 May2002.26 Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearchProgram (2009).27 Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 2006.28 Ibid29 Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 87.2 (2009):495-534.

30 Ibid31 Best Practice: Rapid Re-Housing for Survivors of Domestic Violence:: Volunteers of America's Home Free in Portland, OR.National Alliance to End Homelessness,32 Wherley, Marge. CommunitySpotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department ofHousing and Urban Development.33 Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 200634 Wherley, Marge. CommunitySpotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department ofHousing and Urban Development.35 Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearchProgram (2009).36 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.37 Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-termEfficacyto End and Prevent FamilyHomelessness. PolicyBrief 1. Los Angeles, CA: Institute for Research, June 2005.38 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.39 Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-termEfficacyto End and Prevent FamilyHomelessness. PolicyBrief 1. Los Angeles, CA: Institute for Research, June 2005.40 Best Practice: Rapid Re-Housing for Survivors of Domestic Violence:: Volunteers of America's Home Free in Portland, OR.National Alliance to End Homelessness,41 Levy, Leslie. CommunitySpotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housingand Urban Development.42 Barbu, Lianna. CommunitySpotlight: Homeless Prevention: The communityShelter Board's FamilyHousing Collaborative (FHC).US Department of Housing and Urban Development.43 Ibid

44 Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearchProgram (2009).

45 Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 2006.

46 Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending ChronicHomelessness, is gaining ground in Boston." The BostonGlobe [Boston, MA] 24 June 2007.47 Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.48 Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending ChronicHomelessness, is gaining ground in Boston." The BostonGlobe [Boston, MA] 24 June 2007.49 Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-termEfficacyto End and Prevent FamilyHomelessness. PolicyBrief 1. Los Angeles, CA: Institute for Research, June 2005.50 Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,CO: Colorado Coalition for the Homeless, December 2006.51 Best Practice: Rapid Re-Housing for Survivors of Domestic Violence:: Volunteers of America's Home Free in Portland, OR.National Alliance to End Homelessness,52McDivitt, KayM. CommunitySpotlight: Homeless Prevention: Lessons from Lancaster, PA. US Department of Housing andUrban Development.53 Levy, Leslie. CommunitySpotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housingand Urban Development.54 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.55 Barbu, Lianna. CommunitySpotlight: Homeless Prevention: The communityShelter Board's FamilyHousing Collaborative (FHC).US Department of Housing and Urban Development.56 Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearchProgram (2009).57 "Rapid Re-Housing." National Alliance to End Homelessness (2008).58 Wherley, Marge. CommunitySpotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department ofHousing and Urban Development.59 Ibid60 Kertesz, Stefan G., KimberlyCrouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with ActiveAddiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of PopulationHealth and Health Policy87.2 (2009):495-534.

61 "Direct Access to Housing." Corporation for Supportive Housing. Corporation for Supportive Housing, 1 Aug. 2008. Web. 1 June 2010.