# Presentation: 502570

## Preventing Chronic Homelessness What Works?

- Deborah Dennis
- Policy Research Associates, Inc.
- Delmar, NY
- Policy Academy on Chronic Homelessness
- Olympia, WA
- April 29, 2004

## Why Address Prevention?

-   Until we address the role of mainstream systems in creating and resolving chronic homelessness, we will never be able to end chronic homelessness.

## Why Focus on Mainstream Programs?

- People who experience chronic homelessness are heavy users of expensive mainstream services.
- Levels of disability and poverty make them likely to be eligible for mainstream programs.
- Approaches that work for this subgroup may make mainstream services more accessible for others.

## How Can Chronic Homelessness Be Prevented?

- Identify risk and protective factors to help prevent chronic homelessness among persons at risk.
- Use evidence-based practices to prevent chronic homelessness.

## Some Individual Risk Factors...

- Chronic health conditions, mental illness and/or substance use disorders
- Limited or no social support networks
- Domestic violence and other victimization or trauma-related factors
- Family instability as a child (out-of-home placement, family homelessness, incarceration of a parent)
- Combat experiences for veterans.

## Some System-Based Risk Factors...

- Lack of permanent affordable housing
- Very low or no income
- Discharge from jail, prison, hospitals, detox and residential substance abuse treatment, and foster care.

## Discharge from Institutions

- 	Data from Massachusetts Housing and Shelter Alliance showed that people coming into shelters were well-known to the state’s mainstream systems:
- 18-24 year olds aging out of state services
- Ex-offenders released from state or county facilities with no place to go
- People from detox at the beginning of their recovery
- People with mental or serious physical illnesses released directly from a hospital.

## Discharges from Jails and Prisons

- Arrangements for housing are seldom considered
- Benefits have often been lost
- Inmates with mental illness (16% of all inmates nationally) incarcerated for more than a year must reapply for SSI benefits upon release
- Often lose Medicaid upon incarceration even though federal regulations allow for suspension rather than termination of this benefit.

## Transition from Foster Care

- People who are chronically homeless are 7-13 times more likely to have had an out of home placement than the general population (Burt et al., 2001).
- 30 percent of youth leaving foster care experience homelessness within 2 years of discharge (Schwab Foundation, 2003).

## Evidence-Based Prevention Practices

- Few evidence-based interventions
- Several promising practices
- Housing subsidies
- Eviction prevention
- Discharge/transition planning.

## Housing Subsidies

- Studies find housing subsidies one of the most effective interventions to prevent housing loss.
- Receipt of subsidized housing is the primary predictor of housing stability among homeless families. (Shinn and Weitzman)
- SAMHSA’s multi-site homelessness prevention study found access to housing subsidies or supported housing was the strongest predictor of residential stability for people with mental illnesses or co-occurring disorders.

## A State Example...

*Missouri *Department of Mental Health provides funding for temporary vouchers for people with serious mental illness who are on the Section 8 waiting list.
*Minnesota* Department of Human Services has had a similar program since 1992 that is now providing $1.7M in temporary rental vouchers per year.

## Eviction Prevention

- Promising practices include:
- Representative payees and other money management interventions
- Emergency rent and utility payments
- Landlord/tenant mediation services
- Respite for family caregivers.

## Local and State Examples...

*Pathways to Housing* in NYC, a housing first model, uses money management―one of two key tools (the other being ACT teams)―to keep people who were chronically homeless in housing of their choice.
- In *Minnesota*, the legislature created a $424K annual fund to pay rent, mortgage and/or utilities for up to 90 days while an individual with serious mental illness is in inpatient psychiatric or substance abuse treatment.
- The *Alaska* Department of Mental Health and Developmental Disabilities provides flexible service funds of up to $2,000 per person for any expense needed to keep a client in community-based housing.

## What Mainstream Systems Can Do

- Adopt protocols to assess housing needs and resources of clients
- Adopt practices to help individuals and families in crisis retain their housing through financial assistance, mediation or case management.

## Discharge or Transition Planning...

- Must be linked to affordable housing and aftercare
- Is a strategy to prevent chronic homelessness
- Is critical for people with health and behavioral health disorders.

## Systems Change Examples...

*Massachusetts* uses homelessness and housing outcomes to evaluate contractors in their mental health, corrections, youth services, and substance abuse treatment systems. These outcomes are then tied to contract penalties and incentives in each system.
*Philadelphia* is applying this same principle with shelter providers. Shelters are given incentives to place people in housing and provide services to keep them there―shelter beds have decreased by 5% annually as a result.

## Program-level Examples...

*Critical Time Intervention and Short-term ACT Services**―*are intensive clinical services for 6-12 months during and following transition from shelters, hospitals or jails. Proven effective in maintaining residential stability and linkage to mainstream treatment and support services *after* intervention is scaled back or withdrawn.
*Respite Care**―*Boston Health Care for the Homeless operates 90 recuperative care beds that bridge the period following hospital discharge for people who are homeless. Similar effort in Savannah, GA, is estimated to have saved two local hospitals $1.8 million, more than doubling their individual $250K investments.
*Transition Planning in Corrections***emphasize access to housing and clinical case management upon release.
*Youth in Transition**―*federal Independent Living Program funds can be used to provide housing and services for youth transitioning from foster care until they reach the age of 21.

## Conclusions...

-   Preventing chronic homelessness is not the same as ending poverty or promoting economic self-sufficiency.

## Conclusions...

- Providing housing subsidies that target the worst-case housing needs is an effective strategy.
- Eviction prevention programs and discharge planning efforts are promising practices.
- Services to support people who have been chronically homeless in housing―particularly during periods of transition are critical.