# THE COMMONWEALTH

# OF MASSACHUSETTS

# TEN-YEAR STATE PLAN TO END CHRONIC HOMELESSNESS

A Report of the Policy Academy on Chronic Homelessness

Massachusetts Policy Academy

*Stephanie Anthony, Massachusetts Division of Medical Assistance*

*Joe Finn, Massachusetts Housing and Shelter Alliance*

*Eliza Greenberg, City of Boston*

*Mary Ellen Hombs, Massachusetts Housing and Shelter Alliance*

*Walter Jabzanka, Massachusetts Department of Mental Health*

*Tom Kelley, Massachusetts Department of Veteran Services*

*Paul Nixon, Massachusetts Department of Housing and Community
Development*

*Edward Sanders-Bey, Massachusetts Department of Transitional
Assistance*

*Michael Thompson, Massachusetts Department of Correction*

*Deborah Klein Walker, Massachusetts Department of Public Health*

*Patrick Walsh, Massachusetts Department of Transitional Assistance*

###### CONTENTS

## **INTRODUCTION**

## ** PRIORITY ONE**

Inventory and Coordinate State-level Fiscal and Demographic Data on the
Population of Persons Experiencing Chronic Homelessness

### Strategy 1.1. Identify, compile and share comprehensive state-level data on programs, services and clients

### Strategy 1.2. Streamline the intake process into shelter and mainstream service systems

### Strategy 1.3. Develop reliable methodologies for accurate counts of chronic homelessness on the streets

** PRIORITY TWO**

**Improve Access to and Coordination Across Mainstream Services and
Funding**

Strategy 2.1. Collaborate on interagency efforts for more efficient
delivery of state and federal services

Strategy 2.2. Enhance enrollment into mainstream benefits programs

Strategy 2.3. Coordinate screening and assessment services for mental
health, substance abuse, and Medicaid

Strategy 2.4. Promote involvement of the state and all relevant state
agencies in local jurisdictional planning

Strategy 2.5. Create effective opportunities within existing mainstream
employment services programs for persons experiencing chronic
homelessness at no additional cost

Strategy 2.6. Affirm and expand efforts to seek funding from federal and
state mainstream programs that can be targeted to this goal

** PRIORITY THREE**

#### **Expand Availability of and Access to Extremely Low-Income Housing Opportunities**

Strategy 3.1. Explore and propose enhanced delivery models of housing
homeless people

Strategy 3.2. Define and propose rationale to target resources to end
chronic homelessness

Strategy 3.3. Create and enhance linkages between mainstream benefit
programs and housing programs

** PRIORITY FOUR**

##### Develop the Prevention of Chronic Homelessness

Strategy 4.1. Develop inventory of existing strategies and programs as
baseline for moving forward

Strategy 4.2. Develop housing retention strategies

Strategy 4.3. Review effectiveness of existing discharge planning
policies and develop strategies to improve

**CONCLUSION**

# THE COMMONWEALTH OF MASSACHUSETTS TEN-YEAR STATE PLAN

# TO END CHRONIC HOMELESSNESS

A Report of the Policy Academy on Chronic Homelessness

# 

# VISION STATEMENT

> Massachusetts' vision is to end chronic homelessness by implementing a
> coordinated plan of prevention and expanding access to mainstream
> services and permanent housing for extremely low-income people.

# INTRODUCTION: ENDING CHRONIC HOMELESSNESS

The federal government has made it a top priority to end chronic
homelessness within ten years. This priority is rooted in the sound
analysis of homelessness within our country today. The federal
government defines a person experiencing chronic homelessness as an
unaccompanied homeless individual with a disabling condition who has
either been continuously homeless for a year or has had at least four
episodes of homelessness in the past three years. National research by
Dr. Dennis Culhane, the most widely recognized researcher on the adult
homeless population, has provided a compass for policy and program
development targeted to specific population profiles. Dr. Culhane's data
show that about 10% of homeless adults who use the shelter system over
the course of a year have long stays in homelessness, coupled with deep
levels of mental and physical disability, including addictions. Persons
experiencing chronic homelessness constitute the most costly population,
and would be better served in permanent housing with supportive
services, thus reducing the public expense of acute care and emergency
services such as shelters and providing a path for those served to
achieve more stable and self-sufficient lives.

# PURPOSE AND OVERVIEW OF THIS REPORT

This report was prepared by the Massachusetts Policy Academy on Chronic
Homelessness (the Academy) and is intended as a blueprint for the
Commonwealth's ten-year plan to end chronic homelessness. It is not the
intent here to outline the complex history and factors leading to the
problem of chronic homelessness and its very visible and growing
consequences throughout the communities of the Commonwealth. This report
begins with presenting circumstances, stating the priorities,
strategies, concrete action plans and necessary outcomes to achieve the
ultimate objective: ending chronic homelessness, not managing it. From a
planning perspective, much work remains. The priorities for the
Commonwealth as recommended by the Academy are as follows:

-   To Inventory and Coordinate State-level Fiscal and Demographic Data
    on the Chronically Homeless Population

-   To Improve Access to and Coordination Across Mainstream Services and
    Funding

-   To Expand Availability of and Access to Extremely Low-Income Housing
    Opportunities

-   To Develop and Promote the Prevention of Chronic Homelessness

## ** PRIORITY ONE** 

> Inventory and Coordinate State-level Fiscal and Demographic Data on
> the Population of Persons Experiencing Chronic Homelessness

National research and client-level demographic data, state system-level
program and utilization data, best practices, and measurable outcome
data should guide the development of policy, resource allocation and
program development for the population of persons experiencing chronic
homelessness. The quality and use of data is critical to the successful
abolition of chronic homelessness in the Commonwealth. Such data must be
capable of reliable conversion to practical and applicable information
to guide policy. In order to begin to create a comprehensive picture of
the chronic homeless population and its use of mainstream and homeless
specific resources, basic inventory and coordination activities must be
conducted to create a baseline of information to guide strategic
planning and decision-making. Unfortunately, such a system does not yet
exist in the Commonwealth. To capture the dynamics of the overall
homeless population accurately requires an integrated systems-level
approach (as opposed to simply a services-level approach) that can
identify persons and service use across systems of care.

** **Strategy 1.1. Identify, compile and share comprehensive
state-level data on programs, services and clients**

Ending chronic homelessness will require a consolidated and cooperative
effort. There is presently no greater failure systemically within
Massachusetts than the inability to produce reliable information
regarding persons experiencing homelessness who are accessing
residential, emergency and mainstream services across our state.
Although there may be significant amounts of data within advocacy
organizations and specific agencies, such data is not useful until it is
comprehensive, coordinated and brought into an analytic framework. The
key to ending homelessness, particularly chronic homelessness, is
working together to identify those being served, identify available
programs and their target populations, and establish accountability for
measuring and reporting acceptable outcomes.

> * Action 1.1.1. Identify which provider and state agencies are
> collecting what data*

The first step in the conversion of date to information is the
compilation of various sources and types of data. The EOHHS Data
Subcommittee has already noted that state, local and private agencies
that serve persons experiencing homelessness do not routinely or
consistently collect data about the people they serve. In many agencies
there is currently no means for identifying someone as homeless on
admission or discharge or to track an individual's use of services
within or across services. Many collect no data at all. There are some
provider agencies, however, specifically serving persons experiencing
chronic homelessness (such as Boston's Health Care for the Homeless) who
have access to long-term data sources that they presently utilize. This
data should be reviewed for its value and as potential models for more
comprehensive data collection. The Commonwealth needs a more thorough
statewide effort for describing and capturing existing data collection.
It is recommended that the Commonwealth mandate and authorize an
appropriate process for cataloging and describing data collection about
chronic and other homeless people.

> * Action 1.1.2. Identify common areas, duplication of effort and gaps
> in data*

The EOHHS Data Subcommittee has noted that there is no agency solely
responsible for collecting and reporting data regarding persons
experiencing homelessness and available housing and services. The
Commonwealth needs to make informed decisions about the future
requirements of data collection, recognizing data-rich sources but at
the same time avoiding duplicative processes and overcoming significant
gaps in data.

> * Action 1.1.3. Develop systems for sharing data/information*

There has been a decade-long debate regarding the availability of
information within and outside of government. A much longer debate has
ensued concerning consumer privacy. Sound protocol, regulation and law
have resolved many of the obstacles identified in these debates. Any
true state interagency effort will require the ongoing and continued
analysis and refinement of its information streams and deliberate
decisions regarding the frameworks for communicating and sharing
non-client-identified data, program, utilization and outcome data. Some
public and private agencies have avoided data collection or efforts
aimed at sharing data, perceiving such practices as overly invasive or a
threat to the personal privacy of homeless people**.** These same public
and private agencies however, are often not aware of the critical
resource opportunities lost when data is not collected or shared. Such
data, when collected and shared, can be used to provide more ready
access to housing and critical resources. Given the application of
appropriate technologies and protocols, data can be collected while
still protecting personal privacy rights by employing systems that
health care providers and others currently utilize. The effort to end
chronic homelessness in particular requires shared cross system
information to achieve even the most basic coordination. A good example
of this is the chronic street dwelling homeless population. There are
currently 15 separate programs that conduct street outreach statewide.
This population has the highest utilization of acute services in mental
health, substance abuse and emergency rooms. There is currently no
coordinated information among these programs on this population.

> * Action 1.1.4. Identify various end uses for data (locally and
> federally)*

The objective to end chronic homelessness and the role of appropriate
outcome data should in part define the end uses of any data collection
for this population. Information collection must be linked to
appropriate outcomes. Identification of the end uses of data is a tool
for overcoming and streamlining the multiple jurisdictional, funding,
regulatory and legislative mandates for information. Statewide,
multi-jurisdictional and interagency planning requires leadership and a
clear strategic focus while engaging multiple partners and sources of
information. The articulation and outline of end uses of data are
critical to accomplishing a strategic vision and plan. From a compliance
perspective alone, appropriate data collection will enable the
state-funded homeless service providers and federally funded local
Continuum of Care (CoCs) communities to collect uniform mandatory data
elements, thus creating a more seamless and comprehensive demographic of
the population experiencing chronic homelessness. This in turn can
increase available federal resources allowing the state to realign the
use of its state funds. Other important end uses include: ascertaining
eligibility for various resources, the ability to evaluate the
accessibility of mainstream resources, tracking the movement of
individuals across services systems, and measuring outcomes to determine
the efficacy of certain programs.

###  Strategy 1.2. Streamline the intake process into shelter and mainstream service systems

The Massachusetts system of shelter care is in many ways as fragmented
and disjointed as the mainstream systems of care that feed into it.
Other jurisdictions around the country have uniform or single points of
intake into the homeless shelter and service system for individuals.
Massachusetts does not have a central intake system or uniform agreement
as to what should be included in such an intake process. Critical to
overcoming chronic homelessness will be adapting necessary intake data
and protocols to obtain information that will determine appropriate
responses.

> * Action 1.2.1. Identify and coordinate common data elements and
> processes*

Massachusetts, at minimum, should endorse the HUD Mandatory Data
Elements. The state should also work to establish additional data
elements critical or specific to the chronically homeless population. It
would be helpful to be able to indicate locations and concentrations of
people experiencing chronic homelessness and the various programs
accessed throughout his or her chronic homelessness.

> * Action 1.2.2. Design and create a uniform intake instrument*

The Commonwealth should design and promote a common intake form for
homeless unaccompanied adults that captures mandatory data elements and
make the collection of such data mandatory for all service providers and
a required condition of their pre-qualification for funding.

> * Action 1.2.3. Create a long-term plan for central intake*

If it is determined that service providers for homeless individuals lack
the capacity to collect this important data, then consideration should
be given long-term to the use of central intake centers similar to New
York and Philadelphia models that act as entry points and triage into
the system of shelter and homeless services. In the future, the creation
of such intake centers realistically could, through a triage process,
eventually refer individuals directly to the appropriate housing or
service venue instead of making immediate referrals to shelters. The
other benefit provided by such triage is the ability to distinguish
various homeless emergency responses by need or subpopulation. A benefit
of such an approach, for example, is that it avoids placing young adults
with older adults coming to shelters directly from correctional
institutions. The Commonwealth should examine all possible methods for
securing appropriate data and information available.

**** Strategy 1.3. Develop reliable methodologies for accurate counts
of chronic homelessness on the streets**

President Bush and the U. S. Interagency Council on Homelessness have
made ending chronic homelessness by 2012 a top priority. Accomplishing
that goal will require being able to determine the number and location
of street-dwelling homeless people. A reliable methodology for counting
street-dwelling chronically homeless people will also be critical in
order to determine the efficacy of this effort. Future federal funding
for targeted homeless resources will be contingent upon the capacity of
jurisdictions to provide reliable descriptive counts of street
populations. The Commonwealth should encourage the development of
reliable methodologies for securing data on the street populations of
persons experiencing chronic homelessness.

> * Action 1.3.1. Encourage and implement an annual street count in
> jurisdictions across the Commonwealth*

Although a method of limited capacity, one-night street counts of
unsheltered persons should be developed in various local and regional
jurisdictions across the Commonwealth. Such counts give some indication
of the numbers on any given night of the visible homeless population on
the streets. Communities should be encouraged to do one-night counts to
reach estimated numbers of chronic street populations for the entire
state. Every indication is that the federal government will continue to
stress the importance of an annual street count of chronically homeless
persons as part of a local strategy.

> * Action 1.3.2. Develop working collaborations among various outreach
> and engagement efforts to collect and share common data regarding
> street populations*

There are numerous outreach programs across the Commonwealth that reach
out to homeless people living on the streets of our communities. Health
care, social services, transportation to shelter and other referrals are
often a part of such outreach. However, the notion of "outreach" often
gives an ambiguous meaning to such efforts and resources. It should
never be the objective of such services to merely sustain people on the
streets, but instead, to engage people with the goal of moving toward
housing and appropriate services when necessary. The Commonwealth should
develop strategies of engagement for moving people from streets to
appropriate housing and services. These programs need to be coordinated
at the policy, planning and street level. Outreach programs are in a
unique position to recognize, catalogue and determine the number of
chronically homeless people living on the street. Homeless engagement
programs should be required by the Commonwealth to work in coordination,
target high priority cases, and work in a concerted effort to create
uniform data collection about those living on the street and measurable
outcomes related to the success or failure to move such people to an
appropriate residential setting. Such outcomes need to be tracked across
systems of care.

> * Action 1.3.3. Access other reliable data resources that engage and
> document the population experiencing chronic homelessness*

Persons experiencing chronic homelessness utilize any number of systems
throughout the Commonwealth. Medical resources, substance abuse
treatment, and mental health services are only some of the systems
implicated. It is suspected, and in some cases empirically shown, that
these are some of the most expensive consumers of such mainstream
resources. Other mainstream systems of care and their various data
collection systems should be designed to gather information about
persons experiencing chronic homelessness on the streets while in their
care.

> * Action 1.3.4. Develop longitudinal data of utilization of shelter
> and homeless services*

Point-in-time data collection, such as annual street counts, focuses on
demographic data. Because persons experiencing chronic homelessness
remain homeless in the shelter system longer, this subgroup tends to be
over-represented in point-in-time counts. The Commonwealth should
commission a longitudinal study of shelter clients. Longitudinal data
captures patterns of shelter usage over time. This type of data can help
identify categories of different subgroups of homeless people (chronic,
episodic, and transitional), which can be used to develop targeted
program strategies and direct the allocation of resources.

** PRIORITY TWO**

> **Improve Access to and Coordination Across Mainstream Services and
> Funding**

For nearly 30 years, the emergency and parallel response to chronic
homelessness, despite saving countless lives, has proven itself
incapable of one critical accomplishment: ending homelessness. The
investment of countless resources into an emergency system creates a
system of relief that practically ignores the very pre-condition that
creates homelessness: the inability to access and coordinate the various
services intended by local, state and federal entities to serve the
complex and varied needs of very poor people. "Mainstream services"
refer to various publicly funded resources intended for low-income
households or individuals. A person experiencing chronic homelessness,
by the very fact of being so defined, has already been failed by these
multiple systems of care. The ability to access and benefit from
mainstream resources is required to achieve housing stability and
prevent homelessness in the first place. The ability to access
mainstream resources provides a far less costly way to meet the needs of
persons experiencing chronic homelessness. Ending chronic homelessness
will require a planned and combined effort by every level of government
and communities across the Commonwealth.

**** Strategy 2.1. Collaborate on interagency efforts for more
efficient delivery of state and federal services**

Significant barriers to accessing mainstream services are often the
product of fragmented systems of care. Separate funding streams,
different regulations, and varying definitions of eligibility, create a
difficult system for persons experiencing chronic homelessness to
navigate. The population is defined by complex needs in a system that
requires he or she seek services from multiple sources. Many of these
systems, in turn, serve the same persons, engaging multiple and
sometimes duplicative services, without ever coordinating these efforts.
As a result, mainstream resources have not been fully utilized in
meeting the needs of this specific population or strategically adapted
to create sustainable housing. An interagency effort will be required to
better commit scarce resources to both end and prevent homelessness
amongst the poorest and hardest to serve.

> * Action 2.1.1. Identify a single state entity to coordinate delivery
> of services*

Ending chronic homelessness will require both service integration and
systems integration. Collaborations between service providers alone will
not be sufficient to create the seamless effective delivery of services
necessary or the framework within which to gauge their efficacy. A
single, driving force must oversee ongoing planning, with the authority
to effect policy and practice at both the executive policy level and on
the ground throughout the mainstream service system. A single
coordinating entity is necessary to end the service fragmentation that
results in a separate emergency system that finds it virtually
impossible to move an individual out of homelessness towards some
semblance of stabilization within the community. One entity should have
the primary responsibility for coordinating the various interagency
initiatives and collaborations emerging in response to population of
persons experiencing chronic homelessness.

> * Action 2.1.2. Forming a subcommittee on chronic homelessness:
> bringing key stakeholders to the table*

The single state entity can be the focal point for a systems integration
initiative. Key stakeholders and informants need to continue to be
engaged in the process moving forward. The Academy provided the locus
for important discussions focused on chronic homelessness. Important
stakeholders need to continue with the on-going design and
implementation of the Plan to End Chronic Homelessness. Included in this
subcommittee should be representatives of key advocacy organizations for
persons experiencing chronic homelessness, representative homeless
providers, faith-based organizations, philanthropic organizations and
foundations, and representatives of the corporate and private sector.
Current examples from other communities across the country demonstrate
the wisdom of involving chambers of commerce, The United Way, bids, and
other entities with a stake in this issue. Ending chronic homelessness
will benefit from the broadest expansion of intellectual capital
available in the community.

> * Action 2.1.3. Catalog and review formal state agency plans covering
> policies and programs of relevance to serving and housing persons
> experiencing chronic homelessness, and ensure they explicitly address
> this population*

Several major state agencies, including those operating mainstream
service programs, devise annual or multi-year plans for operating
particular programs in terms of identifying policies, goals, objectives,
timetables, methodologies and target populations to be served. Often
these are required to be filed with federal agencies as a condition for
federal funds being granted to the Commonwealth. A few examples of such
state program plans include the Substance Abuse Block Grant Plan, Mental
Health Block Grant Plan, Workforce Investment Act Plan, HUD\'s
Consolidated Housing Plan, Statewide McKinney Continuum of Care Plan,
Food Stamps, and Rehabilitation Services Plan. Agencies sponsoring such
comprehensive plans should be encouraged, if not required, to document
and address the needs of persons experiencing chronic homelessness. In
many cases, this may already be a federal objective that is not being
properly supported or monitored. In addition, plans should be
coordinated and integrated with local HUD Continuum of Care planning and
with the Commonwealth\'s ten-year plan to end chronic homelessness.

## ** Strategy 2.2. Enhance enrollment into mainstream benefits programs**

Massachusetts has been a national leader in the identification,
development, piloting, and tracking of policies and practices aimed at
accessible and successful enrollment of homeless persons within
mainstream benefits programs. Many successes have been built on
long-term public-private dialogue and cooperation. Enrollment of
chronically homeless individuals into mainstream services presents
unique challenges. The barriers to such enrollment are both due to the
condition of homelessness as well as the various system barriers that
result from fragmented systems of care and delivery of service. Lack of
a permanent address, movement between various programs and lack of
transportation are some of the conditional barriers that often impede
enrollment. Multiple procedures for enrollment, lack of expertise with
homeless persons, and, in some cases, lack of accountability, are only a
few of the systemic barriers resulting from the fragmented access and
delivery of mainstream resources. Enrollment is the first step toward
successful participation. Such enrollment is critical toward the
provision and sustainability of chronic homeless persons in housing.

> * Action 2.2.1. Develop planning and outreach to deliver benefits
> information across all programs*

The Commonwealth can develop a delivery system for state agencies to
ensure that standard information related to eligibility and access to
mainstream resources is provided across all systems of care. Outreach
can focus on bringing stakeholders together to discuss and analyze
barriers to enrollment. The Commonwealth should encourage the adoption
of best practices from across the nation and the state.

> * Action 2.2.2. Analyze eligibility gaps in accessing services*

The Commonwealth can perform analysis to determine specific needs of
persons experiencing chronic homelessness and to study factors across
agencies that determine eligibility for specific resources. Such
analysis will determine not only what resources are available to an
individual, but will also identify shortcomings of such resources in
addressing the specific of the chronically homeless population. This
analysis would also help to develop adequate case management resources
for moving chronically homeless people into mainstream resources.

> * Action 2.2.3. Establish a "no wrong door" approach to enrollment
> for mainstream resources*

The current service and treatment system is fragmented, forcing
individuals to go to various sites to access the resources for which
they are eligible. The basic resources homeless individuals are eligible
for are few. These basic benefits (Food Stamps, MassHealth Essential,
SSI, etc.**)** and the HUD data standard information that will be
required could be accessed under a single point of entry throughout the
delivery system. The "no-wrong" door approach also provides a contact
and reference point of referral for other specific resources that
persons experiencing chronic homelessness may be eligible for based on
disability or other factors.

> * Action 2.2.4. Allow homeless programs as "no wrong door" points of
> entry*

The most efficient and targeted resources that could be utilized by this
population can be most accessible through shelters, day programs, and
health care and outreach services delivered by providers across the
state. A uniform approach and method of enrollment should be integrated
across the homeless service delivery system, ensuring that these basic
services could be provided and unnecessary replication of effort would
not occur.

**** Strategy 2.3. Coordinate screening and assessment services for
mental health, substance abuse, and Medicaid**

Persons experiencing chronic homelessness, by nature of their
homelessness and disabling conditions, are the most difficult to screen
and assess for key mainstream resources. The Commonwealth should
encourage the coordination of these resources to better serve the unique
needs of this population.

> * Action 2.3.1. Create a single uniform screening process*

DMH, MassHealth Standard, EAEDC, SSI and SSDI, allow for enrollment of
persons with chronic disability into both or either services and cash
support. These all require medical substantiation, income eligibility
certification, citizen status and enrollment. This system is very
difficult to navigate for persons experiencing chronic homelessness. A
uniform screening process would more efficiently move appropriate
homeless individuals into these mainstream resources.

> * Action 2.3.2. Create improved screening tools for determining
> eligibility*

New and effective tools should be employed to determine and prioritize a
presumption of eligibility for mainstream resources. A streamlined and
well-designed assessment tool could be employed to direct chronically
homeless people toward the appropriate resource. The efficiency of such
a tool would eliminate much of the frustration homeless individuals and
homeless providers experience in linking persons with disabilities to
the appropriate resource.

> * Action 2.3.3. Coordinate application processes with homeless sites*

The initiative to end chronic homelessness requires a movement away from
parallel systems of separate service and care into more effective use of
mainstream resources. However, if more efficient enrollment and
assessment tools were designed, these would be best implemented at sites
accessible to chronic homeless persons. Moving from parallel systems
will require inreach into existing systems and sites directly serving
persons experiencing chronic homelessness. A streamlined process of
enrollment, eligibility determination and assessment will eventually
lead to ensuring "wrap-around" services necessary for transition to
permanent housing by persons experiencing chronic homelessness.

> * Action 2.3.4. Coordinate Health Care for the Homeless (HCH) and
> Social Security Administration (SSA) programs*

One of the clearest points of transaction with persons experiencing
chronic homelessness occurs through existing homeless health care
services across the Commonwealth through various HCH programs. Benefits
work is a mandated activity for HCH programs, and they represent a key
resource to meet the goal of ending chronic homelessness. The
significant health care and disability issues identified with this
population suggest the strong possibility of eligibility for SSI and
SSDI. A streamlined process would place enrollment capacity in programs
and provide possible strategies for streamlined assessment.

**** Strategy 2.4. Promote involvement of the state and all relevant
state agencies in local jurisdictional planning**

The best plan to end chronic homelessness will not be successful if
there is not local buy-in and investment in the plan and its
implementation. There are presently 22 local and regional CoCs across
the Commonwealth. In the past, the state's federal McKinney application
has focused on the communities that have remained outside of these
existing plans. More recently, some jurisdictions across the state have
begun to plan and implement ten-year plans to end chronic homelessness.
However, the new focus on planning and mainstream resources will require
a connection between local jurisdictions and state systems of care. The
Commonwealth should develop a regular convening process with key
officials of local jurisdictions and existing CoCs to ensure a seamless
approach to the plan to end chronic homelessness. Chronic homelessness
clearly has a regional component, and a statewide approach to this issue
will ensure reliable data related to the cost-effectiveness of such
utilization. It is critical that state agencies collaborate with local
jurisdictions. This will ensure that local communities will have the
necessary linkages to mainstream resources so that their applications
are competitive nationally. Such coordination will be necessary to
guarantee that movement continues to be focused on ending homelessness
and not simply maintaining it.

> * Action 2.4.1. Integrate a state plan to end homelessness with local
> and regional plans*

The trajectory of current federal policy on homelessness will likely
continue to emphasize the use of mainstream resources for the target
population. Future federal funding trends indicate that accessing
mainstream resources will continue to be a top priority. The most
competitive applications for these resources will identify and implement
strategies for accessing mainstream resources. Partnerships between
local decision-makers and communities and the primary state agencies
that administer and oversee these mainstream resources must be created.
The coordination of these communities with the state will be a step
toward the necessary systems integration that must occur for the most
efficient use of state and mainstream resources. The Commonwealth should
work with statewide advocacy groups toward furthering such
collaborations.

> * Action 2.4.2. Develop partnerships that support the implementation
> of this plan among local jurisdictions, and develop working
> relationships among CoCs, towns and municipalities, state agencies and
> the various communities represented*

The CoCs presently represent the key service providers in various
communities around the state wrestling with the problem of homelessness.
Such planning processes involve local governments, faith communities,
philanthropic interests and private sector groups to varying degrees.
Some of these groups have already begun to discuss local plans toward
ending chronic homelessness and to build stronger links to their local
jurisdictions. All of these communities provide linkage to state
legislators and other leaders throughout their communities. Integrating
such local efforts will ensure a systemic approach that avoids
duplication of services and ensures access to all without placing undue
burdens on communities across the state. Statewide advocacy
organizations can be utilized in building such efforts. This will also
ensure that the local planning processes are strongly linked and
knowledgeable about evolving federal policy on homelessness. If the HUD
CoC process changes at the federal level, the Commonwealth will have
built linkages between state and local entities. By partnering with the
state, local jurisdictions will be in a position to receive additional
resources, and the state will be able to leverage these local public and
private resources as well.

> * Action 2.4.3. Seek and develop regional strategies among CoCs*

Homelessness, and particularly chronic homelessness, is clearly a
problem across regions -- a universal popular assertion about homeless
people is that they are always from someplace else. Currently, CoCs
differ on how they view and respond to homeless people who are perceived
as being from other communities. Reciprocity and cooperation amongst
different regions could allow the state and local entities to get a
better handle on the greatest areas of need and a more uniform and
efficient response to the needs of homeless individuals. The result
would be a seamless system of housing and care with no artificial
barriers to access.

**** Strategy 2.5. Create effective opportunities within existing
mainstream employment services programs for persons experiencing chronic
homelessness at no additional cost**

Mainstream employment training and education agencies at the federal,
state and local level, have heretofore, been not very engaged in
strategies to end homelessness. Persons experiencing chronic
homelessness present difficult challenges for re-integration back into
the workforce. Unique characteristics of subpopulations of persons
experiencing chronic homelessness, including level of disability, past
work history, lack of basic skills/training, and criminal history, all
play a part in limiting chronically homeless individuals' work choices.
The Commonwealth should begin a discussion and exploration of
methodologies and appropriate policy for the use of mainstream
employment resources for creating job opportunities and choices for
persons experiencing chronic homelessness.

> * Action 2.5.1. Engage Department of Labor and Workforce Development
> and Division of Employment & Training in dialogue about serving
> persons experiencing chronic homelessness*

As noted earlier, ending chronic homelessness will require systems
integration. The ability to access employment resources and
opportunities for persons experiencing chronic homelessness will depend
a great deal upon the public entities overseeing such programs and
practices. As a first step, the Commonwealth should begin a discussion
with the primary public entities and other mainstream resources intended
to lead toward employment training and placement.

> * Action 2.5.2. Inventory existing mainstream and homeless employment
> programs and their accessibility to persons experiencing chronic
> homelessness*

Employment and placement programs exist throughout the Commonwealth.
Such programs include rehabilitative services, remedial education,
employment readiness, work experience, on-the-job training, employment
preparation training and direct placement. One-stop Career Centers and
Local Workforce Investment Boards have a role and responsibility in
ending homelessness. An attempt to open such programs to persons
experiencing chronic homelessness will require a careful inventory of
existing resources and access and barriers related to the chronically
homeless people. The Commonwealth should commission such an inventory as
part of a comprehensive plan to create greater opportunities for persons
experiencing chronic homelessness.

-   *Action 2.5.3. Inventory most recent research and best practices
    related to utilization of mainstream resources for training and
    placing persons experiencing chronic homelessness*

Communities across the country are implementing plans to end chronic
homelessness. The Commonwealth should explore other systems models for
creating workforce attachments for returning persons experiencing
chronic homelessness to work.

**** Strategy 2.6. Affirm and expand efforts to seek funding from
federal and state mainstream programs that can be targeted to this
goal**

Ending chronic homelessness will not be achieved by creating parallel
and expensive "homeless" programs, but by accessing mainstream resources
intended to serve those in need and overcoming barriers that currently
prevent that from happening. The Commonwealth should make it a matter of
state policy to develop practices of both agencies and vendors to secure
and maximize mainstream funding. Such policy and practice should guide
the response of jurisdictions and CoCs to homelessness across the state.

> * Action 2.6.1. Conduct cost-benefit analysis of impact of accessing
> mainstream resources*

Analysis of the cost of homelessness in Massachusetts indicates that the
state spends nearly a quarter-billion dollars of public money addressing
homelessness. This does not include the incredible amounts of private
money that are expended as well. Also missing in this analysis are the
costs of housing, health care, hospitalization and other resources
provided throughout various systems of care. An analysis of the impact
of mainstream resources can demonstrate both the efficacy of the effort
as well the savings associated across systems. Such information can be
used to further promote the commitment and direction of mainstream
resources toward ending chronic homelessness.

> * Action 2.6.2. Promote national and state models of best practices
> that utilize mainstream resources and reduce the expense of
> homelessness*

An integrated response will encourage best practices that work to link
persons experiencing chronic homelessness to mainstream resources. The
Commonwealth can promote across CoCs and communities those programs and
models that demonstrate success in moving individuals to mainstream
resources and providing less costly services. Again, best practices will
reinforce at state and federal levels the efficacy of such approaches.

> * Action 2.6.3. The Commonwealth's agencies can provide CoCs
> technical assistance for developing plans to access mainstream
> resources*

The strategy of accessing mainstream resources provides a first step
toward the systems integration necessary to more efficiently address
chronic homelessness. Various agencies of the Commonwealth could provide
technical assistance to communities and the CoCs in constructing their
plans to better access mainstream resources. Past federal grants to
address chronic homelessness in Massachusetts have been rejected because
of a failure to demonstrate a relationship between jurisdictions. These
agencies could work with statewide advocacy organizations in order to
disseminate critical technical assistance between state agencies and
local systems of care and build more coordinated attempts to address
chronic homelessness statewide.

> * Action 2.6.4. Encourage the local development of coordinated ten
> year plans to end chronic homelessness*

The Commonwealth should adopt the goal of having all local communities
funded for homeless services design their own jurisdictionally based
ten-year plans to end homelessness. Each plan would include a commitment
to accessing mainstream resources and coordination with the state. The
Commonwealth could sponsor and hold a regular convening process with
these various jurisdictions to ensure the ongoing implementation and
evaluation of a state plan, as well as the linkage of local efforts to
the state's strategy. Again, the Commonwealth could then establish that
it is a shared goal of all in the state to end homelessness, not merely
manage it.

** PRIORITY THREE**

**Expand Availability of and Access to Extremely Low-Income Housing
Opportunities**

A significant number of studies have looked at the housing affordability
crisis in the Commonwealth. Unfortunately, there has been little focus
on persons living on incomes at or below 30% of median income. For this
population, little or no housing exists. Chronic homelessness will not
be overcome if the appropriate and affordable housing is not available.
Housing persons experiencing chronic homelessness will require a
re-visioning on the part of shelter, housing and service providers to
view housing as the initial objective of their efforts rather than the
end product of an extended and successful period of treatment and care.
Rapid re-entry and delivery systems of community-based care will be
necessary to sustain the housing for this subpopulation of homeless
individuals.

###  Strategy 3.1. Explore and propose enhanced delivery models of housing homeless people 

With some notable exceptions here in Massachusetts, the emergency
shelter system has become the expected response to homelessness. This
response is a costly one, and each night the number of persons seeking
these resources grows. National data indicate~~s~~ that the population
of persons experiencing chronic homelessness represents the costliest
use of this resource. Here in Massachusetts and across the nation there
are emerging models that have pioneered new housing approaches that may
prove far less costly and perhaps more effective in ending chronic
homelessness.

> * Action 3.1.1. Investigate converting shelter resources into
> permanent housing*

Nationwide studies of persons experiencing chronic homelessness indicate
that the chronically homeless population represents 10-15 % of the
homeless population and uses more than half of the emergency resources
available. Many of these chronically homeless individuals are in
programs designated as emergency shelters. For all intents and purposes,
they have been "housed" in those programs for years. The Commonwealth
should support flexible use of public resources to create pilot uses of
these resources to provide housing for chronically homeless individuals.
Such flexibility would allow providers to: adopt previously successful
permanent housing models such as the Individual Self-Sufficiency
Initiative (ISSI); use for project-based or scattered-site housing; use
for Single Person Occupancy projects (SPOs) or use as service dollars to
leverage additional federal housing dollars. The key to success for such
a proposal is to limit it initially to well-designed pilots that can
demonstrate successful outcomes for housing chronically homeless people.
Such an approach must also ensure that an emergency shelter resource is
not depleted to a point where it can no longer meet the present
emergency need.

> * Action 3.1.2. Explore Expansion of "Housing First" models for
> effective use*

The continuum approach to addressing homelessness promoted a linear
model that suggested that housing was the end result of a process of an
individual moving from streets, to shelter, to transitional programs, or
to permanent supportive housing. Housing was the prize at the end of the
process for a client who could demonstrate compliance to a system of
care that made any number of demands from sobriety to medication
regimens. The end result of these models was service intensive programs
that put very few resources into actual housing. New models have emerged
that challenge these assumptions. Commonly referred to as "Housing
First," these approaches abandon the linear model of the Continuum of
Care and put housing at the front of the process and seek to place a
person in housing first and then deal with service needs the individual
has. Empirical research has indicated that the mere act of placement in
housing produces a level of stabilization that allows the individual to
address their other needs more effectively. The Commonwealth should
research these models and promote movement away from reliance on linear
models for dealing with the chronically homeless population.

> * Action 3.1.3. Create additional supportive housing*

There are a certain number of persons experiencing chronic homelessness
whose level of disability will require housing with services. The
creation of additional capacity of supportive housing will ensure that
persons experiencing chronic homelessness with severe levels of
disability will have sustainable housing. Such efforts to expand
capacity could include the development of SPOs. An ancillary benefit of
the creation of such capacity is that it will free up existing DMH
transitional housing resources for additional numbers of persons
experiencing chronic homelessness moving into a temporary housing
situation. An immediate strategy for the creation of additional
supportive housing is a commitment from the state and local
municipalities to maximize available McKinney dollars by targeting them
to housing activities and using bonus incentive dollars for housing
persons experiencing chronic homelessness. The Commonwealth should adopt
a policy aimed at ensuring that every jurisdiction applies for all
available housing funds and evolves local applications that increase
their competitiveness by seeking more funds for housing activities, thus
achieving higher scores. Coordination at the state level can improve the
state's ability to use scarce state resources for purposes of achieving
federal requirements for matching funds. Coordination at the state level
can also provide a more comprehensive approach for the numerous local
jurisdictions throughout the state that compete for federal resources.

> * Action 3.1.4. Encourage "Smart Growth" initiative to explore
> opportunities for chronically homeless people*

The concept of "Smart Growth" views the development of housing from a
perspective of sustainability that considers the impact of such
development upon the whole community. Housing is integrated into the
whole community in such a way to control sprawl, density and to ensure
appropriate quality of life issues. Homelessness, with growing numbers
of individuals on the street, has become a quality of life issue in both
urban, urban fringe, suburban and even rural communities. It impacts
communities in many ways. Addressing homelessness ultimately is a matter
of housing capacity. The Commonwealth needs to promote a "Smart Growth"
model that encourages set-asides that benefit persons experiencing
chronic homelessness. All conventional housing programs (state-funded,
quasi-public agencies, and federal-funded) should have set-asides for
extremely low-income individuals (those at or below 30% of median
income)*.* In addition, the Commonwealth should pursue establishing a
requirement that all new housing developments that receive public funds
establish such set-asides*.* A "Smart Growth" approach should also
consider potential opportunities for creating housing for chronically
homeless people as the state and local governments develop proposals for
the use and re-use of surplus state property.

-   *Action 3.1.5. Create incentives to increase affordable housing
    production for persons experiencing chronic homelessness*

The state should create incentives for cities/towns that support housing
developments, which includes a set-aside of units for homeless people.
Financial incentives could include additional local aid and school
funding. Another possible incentive tool would be to allow cities/towns
a 2:1 unit counts for each set-aside unit for persons experiencing
chronic homelessness, for purposes of the state's Affordable Housing
Inventory. The state should also continue efforts to promote less
restrictive local zoning and permitting requirements, which drive up the
costs of housing development.

** Strategy 3.2. Define and propose rationale to target resources to
end chronic homelessness

Although Massachusetts has some of the best housing programs for persons
experiencing chronic homelessness in the nation, such as the Special
Initiative for the Homeless Mentally Ill, there has been no real
comparative study of these efforts against other existing systems to
demonstrate the cost-effectiveness and the societal benefit that comes
from such efforts. There have been significant comparisons of housing
approaches serving persons experiencing chronic homelessness to
traditional approaches of serving homeless people that indicate that
housing is both less costly and more effective in meeting the needs of
persons experiencing chronic homelessness and the various subpopulations
that constitute the chronically homeless population. In turn, these
resources could save additional costs in health, mental health and
substance abuse services. The Commonwealth should begin to develop and
promote the rationale for refocusing homeless housing resources toward
persons experiencing chronic homelessness.

> * Action 3.2.1. Use NY/NY model as a rationale for targeting
> resources for housing persons experiencing chronic homelessness*

Again, although there are successful housing programs serving persons
experiencing chronic homelessness in Massachusetts, there has been
little study of their impact on the problem of homelessness and the
savings that they create. In the New York-New York (NY/NY) model, New
York State and New York City forged an agreement to jointly construct
and provide social services support for 3,300 community-based
single-room occupancy (SRO) residences specifically for persons who had
both experienced long-term homelessness and who were diagnosed as
severely mentally ill. After the formation of this agreement, there was
a marked decline in demand on its adult shelter system. A study of this
initiative indicated significant cost reductions. These cost reductions
were reflected across associated shelter, health and corrections
systems. The associated cost savings, if they can be demonstrated in the
Commonwealth, lay out the best rationale for addressing the issue of
chronic homelessness.

> * Action 3.2.2. Create pilot from single shelter in Massachusetts*

As part of a flexible conversion strategy of providers rededicating
shelter resources toward housing resources, at least one provider should
be identified and encouraged to pursue the NY/NY model as a pilot
program. This model will provide housing to persons experiencing chronic
homelessness up front with supportive services. The creation of a pilot
will give the opportunity to test the viability of this model for
addressing chronic homelessness in Massachusetts.

> * Action 3.2.3. Develop cost containment study similar to NY example*

Controlled scientific studies have been produced to demonstrate the
effectiveness and viability of such "Housing First" models. The
development of a pilot and its eventual efficacy could be tested against
more traditional homeless programs. Included in this study would be the
comparative data on cost as opposed to the traditional models of
shelter, service intensive programmatic transitional housing, and other
housing models dedicated for homeless persons.

# * Action 3.2.4. Conduct educational campaign to obtain support for new housing affordable to persons targeted by this plan*

The Commonwealth should implement an educational campaign consisting of
a series of local and regional workshops. The purpose of the campaign
would be to demonstrate that all share the direct and indirect social
and fiscal costs of the homelessness problem. Education should be aimed
at all stakeholders, including the state legislature, local government
officials, taxpayers, social service and shelter providers, housing
developers, neighborhood organizations, and the business community. All
housing development is a local issue. Local communities could be shown
the importance of including set-asides for persons at or below 30% of
median income. The state can enlist the participation of local existing
agencies that have been dealing with the homelessness problem, as well
as faith-based organizations. These groups can be a valuable resource
for obtaining local support for housing development and in dealing with
the Not In My Back Yard (NIMBY) reaction in many communities.

> * Action 3.2.5. Explore targeting a percentage of rental housing
> development finance programs operated by state housing agencies to
> persons experiencing chronic homelessness*

The state supports a number of market rate and mixed income rental
housing development and rental subsidy programs, primarily through the
state Department of Housing and Community Development and MASS Housing;
other state housing finance-related agencies are also involved. The
Commonwealth should give consideration to having those agencies create
incentives for developers to create affordable rental housing for
persons experiencing chronic homelessness within their projects.
Developers applying for state financing should be encouraged to set
aside a percentage of units in each development for rental by persons
experiencing chronic homelessness. This could be accomplished through
soliciting such activity in formal state application solicitations, and
awarding extra points in the competitive application process to
proposers who address this population. In addition, state housing
finance agencies would be encouraged to provide outreach, information
and technical assistance to potential rental housing developers on the
state\'s objectives, housing models, as well as how the set-aside units
in a larger project could be made affordable to the population
experiencing chronic homelessness.

**** Strategy 3.3. Create and enhance linkages between mainstream
benefit programs and housing programs**

Many housing developers for homeless people have indicated that they
have little difficulty bringing various housing resources to the table
to develop housing for persons experiencing chronic homelessness. What
they indicate is that they have no resources to provide services for
individuals that address their needs and sustain their housing. Given a
resource for services they could begin to put housing on line for
persons experiencing chronic homelessness. By providing the services
necessary for people living with chronic and disabling conditions,
experience nationwide has indicated that supportive housing can reduce
dependence and spending on emergency and acute medical services. Many
states have begun to use Medicaid plans to reimburse supportive housing
providers for such services. The Commonwealth needs to consider linkages
between housing development and mainstream benefit programs.

> * Action 3.3.1. Seek more effective use of Medicaid to enable rehab
> and case management linked to appropriate housing*

The Commonwealth should seek to implement the administrative steps
necessary to adapt Medicaid so that it would allow linkage of case
management and rehab services to housing projects for persons
experiencing chronic homelessness. Such a use of this important resource
could result in some cost reduction for acute traditional health
settings reflected in decreased use of emergency services and shorter
lengths of stay. These services could be provided by non-profit entities
committed to serving persons experiencing chronic homelessness within
housing settings. Other states and agencies in other systems of care
already using Medicaid in this fashion should be examined to develop
such strategies for housing persons experiencing chronic homelessness.

> * Action 3.3.2. Encourage traditional licensed providers to partner
> with housing developers for persons experiencing chronic homelessness*

Many of the providers of residential or housing options for persons
experiencing chronic homelessness are not state licensed treatment
providers. The Commonwealth could encourage and provide incentives for
traditional licensed agencies to partner with providers of housing for
persons experiencing chronic homelessness in order to provide the
necessary "wrap-around" reimbursable services. Such an approach would
integrate the housing component with those agencies traditionally
mandated to serve various subgroups of persons experiencing chronic
homelessness. Community mental health centers, for example, would
achieve their long established goal of providing an appropriate
community-based residential response for those hardest to serve clients.

> * Action 3.3.3. Promote service models with the development of
> housing capacity*

The Commonwealth, the Interagency Council and its constituent members
should encourage the collaborations and partnerships between service
providers and housing developers with the long-term goal of creating
additional capacity for the chronically homeless population.

#  PRIORITY FOUR 

#  Develop the Prevention of Chronic Homelessness 

The Commonwealth's ultimate success and most cost-effective strategy in
the battle to end chronic homelessness will be found in its capacity to
prevent it from occurring in the first place. At a primary level, such
prevention will necessitate the implementation of strategies and
services designed to address short-term housing crises. At the
institutional level, it will require the planning and steps necessary to
stop the flow of individuals from care and service systems into homeless
and emergency care systems. Appropriate discharge policies and practices
and residential capacity will be a critical part of any system committed
to ending chronic homelessness.

**** Strategy 4.1. Develop inventory of existing strategies and
programs as baseline for moving forward**

Massachusetts should be proud of its history of responding to the
present reality of homelessness, including many community and
faith-based groups who have met the needs of those in crisis. It is the
time, values and commitment of these dedicated people and organizations
that have brought us within reach of ending chronic homelessness.
However, Massachusetts has also been a leader in the development of
principles, strategies and practices for preventing the flow of homeless
persons into the front door of emergency shelters. Inappropriate
discharges, lack of appropriate step-down or primary treatment
resources, and again, fragmented separate systems of care often lead
directly to the shelter. The Commonwealth should recognize and create an
inventory of programs and strategies as the baseline for moving toward
ending chronic homelessness.

> * Action 4.1.1. Review the findings and recommendations of the
> interagency policy report "Moving Beyond Serving the Homeless to
> Preventing Homelessness" issued by the Executive Office of
> Administration and Finance*

This seminal report issued by the Commonwealth in October of 2000,
identified a range of service coordination and housing recommendations
that are currently applicable to persons experiencing chronic
homelessness. Its analysis of federal and state agency mainstream
programs relating to homelessness and advocacy for such practices as
discharge planning are quite germane to the Commonwealth\'s work to end
chronic homelessness.

> * Action 4.1.2. Recognize, enhance, and provide continued support to
> existing systems (policies and programs) that serve as homelessness
> preventative measures*

Over the last several years, significant policies and programs have been
developed for preventing chronic homelessness. Discharge planning and
zero tolerance for referral to shelter have been employed with varying
degrees of success throughout state systems of care. In-reach into
various systems of care and into correctional systems to address issues
that create a risk of homelessness have also shown tremendous potential
of cutting down the flow of persons to the front door of shelter or the
streets. Linkage of important services, oftentimes developed originally
within shelter systems of care, provide strategies and models for
prevention of fall-out to shelter. The Commonwealth should identify and
continue to promote such best practices.

> * Action 4.1.3. Develop appropriate transition from emergency shelter
> model to "Housing First" model as a preventative measure*

Many providers of services to homeless adults fear that the overwhelming
demand on their resources will worsen if shelter resources are rapidly
converted to housing alternatives. However, most providers view being
placed in shelter as a failure of the larger system and an inappropriate
outcome. As we move forward toward a housing first strategy, emergency
shelters need to be understood solely as emergency and preventative in
nature keeping individuals from falling into long-term chronic
homelessness. Shelters should never serve as alternatives to treatment
or appropriate residential care. Those that do should be converted
accordingly.

> * Action 4.1.4. Define and describe baseline to create clear
> indicators of success of primary preventative strategies*

Once a thorough inventory of existing preventative programs and
strategies are in place and once emergency shelter has been clearly
demarcated, empirical indicators can be created to measure the efficacy
of such programs in keeping people from homelessness and particularly,
chronic homelessness. At this point, measures can also be developed to
determine the impact of such measures upon the census of emergency
shelter.

###  Strategy 4.2. Develop housing retention strategies

The best preventative strategy in the world is keeping a person in their
housing. Although in all circumstances ensuring housing is an economic
matter and an issue of affordability, in chronic homelessness it is
often complicated by the reality of mental illness, substance
abuse/addiction, domestic violence, and other serious physical
disability. Housing retention, therefore, requires not only ensuring
that the rent is paid, but also ensuring that the necessary services are
in place for sustaining tenancy. The Commonwealth should develop housing
retention strategies that ensure the appropriate linkage of housing to a
systems integrated approach of service delivery that will sustain
tenants in their housing.

> * Action 4.2.1. Review existing projects and explore expansion
> opportunities*

The reality of homelessness throughout the Commonwealth in the past
decade has seen the emergence of creative housing initiatives within the
homeless provider community and certain state systems of care. Shelter
Plus Care, the Special Initiative to House the Mentally Ill, the Tenancy
Preservation Project (Springfield) and other housing initiatives
particularly of the Massachusetts Department of Mental Health, have
pioneered new models of service and housing linkage through the
provision of community-based and tenant-based care in both project-based
and scattered site units. These programs have housed some of the hardest
to serve of the chronically homeless population or those likely to
become homeless and have demonstrated high retention rates. Such models
easily can be promoted as models for replication, not only for moving
homeless people to housing, but as preventative models of housing
retention.

> * Action 4.2.2. Support and expand housing search and stabilization*

Just over a decade ago, many contended that homeless individuals could
never be housed. Over the last ten years, the development by the
Massachusetts Housing and Shelter Alliance (MHSA) of the Greater Boston
Housing Initiative (which later would become the non-profit HomeStart)
and the creation and implementation of the Statewide Mobile Resource
Team~~s~~ would shatter that myth. Homeless adults were not only being
housed through aggressive housing search and stabilization services, but
the majority demonstrated long-term housing retention. Many of these
same tenants were developing long-term retention and transitioning to
mainstream housing resources or independence back in the community.
Clients of these programs have significant incidents of mental illness,
substance abuse, and criminal histories. The Commonwealth should support
existing resources and expand system-wide, appropriate housing search,
and stabilization services as integral to all aspects of this plan.

> * Action 4.2.3. Expand other community-based case management and
> service models*

There are currently models that provide critical support services linked
to a wide array of housing opportunities. Such models include DMH's
Aggressive Treatment and Relapse Prevention Program (ATARP) for homeless
clients who have a co-occurring mental illness and substance abuse
disorder and Programs of Assertive Community Treatment (PACT) teams, a
nationally proven model for service delivery to adult clients with
serious mental illness. The Commonwealth should explore various
community-based service delivery models that can be integrated into
systems of care that retain tenants in their housing.

> * Action 4.2.4. Establish rapid re-entry strategies throughout all
> systems of care*

The Commonwealth should encourage existing systems of care, shelter and
housing providers to develop new models that provide housing placements
more rapidly, which will help reduce emergency shelter costs. Many
homeless persons do not need intensive supportive services. In many
cases, providing housing first will lead to more stability so that
clients can then obtain any appropriate supportive service they need in
order to maintain self-sufficiency. The policy of rapid re-entry to
housing should exist in all systems of care.

> * Action 4.2.5. Monitor emerging federal policy regarding funding
> levels and administration of the national CHOICE rental voucher
> program (Section 8)*

Any housing strategy to assist persons experiencing chronic homelessness
cannot ignore the growing lack of federal deep subsidy intended for
extremely low-income persons. It is an immediate and growing crisis.
Section 8 would no longer be available to persons experiencing chronic
homelessness, it would not continue to function as one of the best
homelessness prevention tools. Although the loss of Section 8 vouchers
would impact other low-income persons, such a loss would present unique
obstacles to housing persons experiencing chronic homelessness. While
there are existing "bridge" permanent housing programs, there are few,
if any, long-term subsidy programs. As the federal government progresses
with its efforts to change funding levels and administrative procedures
concerning the CHOICE-Section 8 voucher program, the Commonwealth should
become involved to ensure that the changes do not negatively impact the
homeless population.

**** Strategy 4.3. Review effectiveness of existing discharge planning
policies and develop strategies to improve**

Discharge planning is the process of preparing a person in an
institution for return or re-entry into the community and the linkage of
the individual to essential community services and supports. The goals
of discharge planning are: linking the consumer to appropriate next step
resources, preventing vulnerable populations from becoming homeless or
criminalized, and assisting the consumer with re-entry to community.
Discharge planning must be tailored for different needs of different
consumers. At the heart of such planning is the creation of an
individual service plan based upon the consumer's needs. Discharge
planning needs to be comprehensive --- all of the consumer's needs,
housing and appropriate services must be addressed in the discharge
plan. Within an appropriate and integrated system of care, discharge
planning is a necessity. However, next-step residential resources are
central to discharge planning. Without these resources, discharge
planning is illusory. The growth of homelessness and the various
subpopulations within homelessness indicates a systems-wide problem:
lack of good discharge planning is often related to lack of appropriate
residential options.

> * Action 4.3.1. Study youth population/programs and develop effective
> strategies*

One of the most disturbing trends in the past several years is the
growing number of young adults ages 18-24 who are homeless on the
streets or in shelters. Oftentimes, such homelessness is the result of
the lack of appropriate services for young people transitioning from the
public services offered to youth. Adolescents who receive various public
services face significant challenges as they "age out" of the youth
system and attempt to secure services within an adult system of care.
They often do not qualify for many of these adult services and agencies
such as the Department of Social Services (DSS), the Department of Youth
Services (DYS) and the Department of Mental Health (DMH) offer few
transitional services or programs. The Commonwealth should study,
develop and promote appropriate strategies for youth that will prevent
young adults from falling into homelessness and potentially chronic
homelessness and review practices that inappropriately place youth in
programs with older adults.

> * Action 4.3.2. Develop continuum of services model for ex-prisoners
> at risk*

Nearly 20,000 persons are released annually from state and county
correctional systems. It is conservatively estimated that 15% of this
population is at risk of homelessness. Intake data collected from
shelters across the state indicates that the actual number may be
higher. Oftentimes at the root of such persons' incarceration is
behavior related to substance abuse or mental health. With the stigma of
coming from prison -- without income, work, housing, food, viable
community and family connections, and health care -- many find
themselves with few alternatives beyond the shelter system and the high
probability of recidivism. One way of breaking this cycle is to connect
ex-prisoners with the appropriate community-based services prior to
release in order to secure appropriate federal and state benefits,
housing, employment and appropriate community-based services. The
Commonwealth should promote the integration of a continuum of services
necessary to prevent released ex-prisoners from falling into
homelessness.

> * Action 4.3.3. Expand and encourage best practices throughout
> systems of care of appropriate discharge planning in policy and
> practice*

Massachusetts is a national leader in developing and implementing
appropriate policies of discharge planning. The prevention of
homelessness is contingent upon closing ~~down~~ the front door of
homeless shelters. Only such discharge practices will lead to the
development of an appropriate delivery of service system that will care
for those at greatest risk of being homeless. Presently in the
Commonwealth, Administration and Finance, the Executive Office of Health
and Human Services, and Office of Service Delivery, all require
appropriate discharge planning language in their contracts. The
Commonwealth should aggressively monitor these existing initiatives and
make appropriate discharge planning the keystone of its efforts to end
chronic homelessness.

> * Action 4.3.4. Review the status of the Commonwealth's pioneering
> experiment to incorporate discharge planning requirements in all human
> and social services Requests for Responses (RFR) and Purchase of
> Service (POS) contracts*

As initiated by the Executive Office of Administration and Finance
(A&F), the Commonwealth has been working to promote discharge planning
through its formal service procurement process. With interagency input,
the Operational Services Division within A&F devised a set of
specifications covering discharge planning along with a process to
incorporate them into relevant agency RFR's and POS contracts. The
status of this pilot effort should be reviewed, refined as necessary and
considered for possible expansion.

# CONCLUSION: THE BEGINNING OF THE END

This document represents the first step of a ten-year plan and the first
step to end chronic homelessness in the Commonwealth. It has outlined
potential strategies and appropriate action steps toward the development
of the necessary policy and practice to end chronic homelessness.
However, much remains to be done. The Policy Academy recognizes that
next steps in the planning process include the designation of
management, a plan for implementing the recommended actions, and a
description of expected outcomes and benchmarks laid out within a
realistic framework of time for completion. It is recommended that the
Interagency Council create a Subcommittee on Ending Chronic Homelessness
consisting of the appropriate advocates, agencies and key stakeholders
of expertise to finalize and implement the plan to end chronic
homelessness.