 

             

      























 

Housing First Grand Junction

INTRODUCTION

In the summer of 2010 various organizations in the Grand Valley gathered together to consider
crafting a plan to end homelessness in Mesa County Colorado. Karis Inc. joined these efforts
through its participation in the Grand Valley Coalition for the Homeless (GVCH). As part of Karis’
cooperative effort with-in the coalition and as a reflection of Karis’ own commitment to research
based solutions, Karis staff prepared the following report on Housing First, a well research based
solution to homelessness.

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

Karis, Inc.

Summer 2010

   


 

EXECUTIVE SUMMARY

Housing first is a strategy for combating chronic homelessness in the US.1 Housing first
programs are a shift away from linear-housing models (also called “The Continuum of Care Model”)
where clients must successfully complete treatment (for substance abuse, financial sustainability
ext...) as a prerequisite to obtaining services. In a housing first program, individuals are given
housing assistance regardless of substance abuse, financial instabilityor disability. Housing first
programs have been quicklygaining support by government and non-profit agencies. The report
provides a comprehensive reviewof current housing first programs, and begins examining the
possible implementation of such a program in Grand Junction.

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

 Higher retention rates for program participants: individuals and families staye housed
longer

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

 Increased effectiveness in treating substance abuse: individuals are more likely to

effectively address substance abuse concerns in housing first programs.

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

 Economic advantages over traditional sheltering models: housing individuals and

families in housing first programs uses fewer resources than traditional sheltering
models.

In short, there is a growing body of evidence to showthat housing first programs can save
communities considerable resources in a variety of areas by moving program participants into
housing as soon as possible and without prerequisites. There may be a variety of reasons for the
effectiveness of housing first programs but the particular reasons for success has yet to be empirically
identified.

After outlining current critiques of housing first programs, four further steps (determining the
costs of Grand Junction’s current linear housing/continuum of care programs, making personal
contact with smaller Housing First programs, expanding research on best practices and beginning to
identify sub-populations) seem prudent for Grand Junction policy makers.

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


 

HISTORY AND BACKROUND

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

In 1999, the National Alliance to End Homelessness coined the term "housing first," as an
alternate to the linear-housing model. Housing first (or rapid re-housing, as housing first is referred
to by governmental agencies) is based on the philosophical idea that a home is an inherent right, and
it should not come with preconditions. In the past eleven years, housing first programs have
reported major successes, and have gained traction with policy makers and non-profits. In 2008, the
US Conference of Mayors passed two resolutions on housing first. The first resolution endorsed
housing first program’s methodology and the other declared housing first as the only homeless
intervention 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 million
program that provided funding for housing first programs.

On February 17 2009, President Obama signed the American Recovery and Reinvestment Act of
2009, appropriating $1.5 billion for the Homelessness Prevention and Rapid Re-Housing Program
(HPRP). HPRP is facilitated by the US Department of Housing and Urban Development (HUD),
with the goal of homelessness prevention and expansion of rapid re-housing programs.5 The
program gives grants to states, cities and counties to develop housing first programs and is estimated
to help 600,000 Americans avoid homelessness.6 One of the major goals of HPRP to expand the
body of research on housing first, and thus all recipients of grant funding have been required to
report the successes and failures of their programs.

   


 

WHAT IS HOUSING FIRST?

Housing first is a paradigm shift away from traditional linear-housing programs. In linear-
housing programs, clients must successfully complete treatment (for substance abuse, financial
sustainability etc..) as a prerequisite to obtaining services.7 The majority of linear-housing programs
also require continued case management during the transitional housing phase. In contrast, housing
first programs have no requirements with regards to substance abuse or financial sustainability, and
all case management resources are optional.8
The most immediate goal of housing first programs is to move homeless individuals and families
into housing as quickly as possible. For example, The Family Housing Collaborative Program in
Columbus, OH finds housing for 93% of clients within 15 days of referral.9 Such housing can take a
variety of forms. Direct Access to Housing, a San Francisco housing first organization, moves
people into apartments the organization owns, while the Housing Locator Program in Chicago helps
clients move into rentals in the private sector.1011
Funding for housing differs from program to program. Most programs (including programs in
Denver, CO) require clients to pay 30% of their income to stay in subsidized housing, while other
programs (such as San Francisco, CA) require people to pay as much as 50% of their income. A
third type of program provides onetime assistance for housing placement (as in Columbus, OH) and
even further, others give no financial assistance to participants (providing families with case
management and housing placement programs, where the family pays 100 percent of rent) (such as in
Chicago, IL).
All housing first programs offer optional case management services to clients, though each
program provides different resources. Models that provide one-time assistance (Columbus, OH)
provide programs to help participants achieve housing (landlord mediation and housing location
assistance), while other programs provide job placement and training (NewYork City, NY). 12 13 Still
many other programs provide substance abuse assistance (Seattle, WA).14 Some programs have
implemented assertive community treatment (ACT), a comprehensive approach to case management
and client assistance (Denver, CO and NewYork City, NYC).15
The majority of housing first programs are used to target specific segments of the homeless
population. Programs include, but are not limited to foci on: the disabled (Denver, CO), those with
substance abuse problems (Seattle, WA), homeless families (Hennepin Country, MN and Los
Angeles, CA), and survivors of domestic violence (Portland, OR). The Boston Globe reports that all
housing programs target the chronically homeless; however, some housing first programs seem to
also include services for families who are not chronically homeless.16 One program that is not
intended solely for the chronically homeless is the Housing Locator Program (Chicago, IL), which
provides 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 that
while many housing first advocates argue for the strength of the approach on philosophical or
religious grounds (such as: a home is an inherent right), this report restricts its discussion to material
benefits that have been established over time.
High Retention Rates
Perhaps the largest advantage of a housing first program is the high retention rates: individuals
who leave housing first programs are extremely likely to stay housed and out of homelessness. Los
Angeles' housing first program found that 89.5% of people remained consistently housed without
any repeated episode of homelessness between two and seven years after leaving the program, and
only 1% 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 clients
remained housed after five years compared to only 47% of the control group. Even the Milbank
Quarterly, 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 very sickest homeless individuals often find themselves in repeated hospitalization because of
the chaos of life on the street." 20 Housing first programs can effectively mitigate the health risks
associated with homelessness. Participants in housing first programs are more likely to be healthy
because they are staying in a home rather then a shelter, and because they tend to use more
preventative healthcare (which is provided by many housing first programs).
For example, the Denver Housing First found that: "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 quality of
life." 21
Home Again, a housing first program in Worcester MA, reported its participants sawan
average decrease in 1.46 hospital visits every three months in comparison to an increase of
0.62 visits for the control group over the same period.22
Improved health of participants in housing first programs also has a social benefit, because
participants in such programs use less tax dollars for emergency room care and inpatient visits. The
Denver program mentioned above found that in the 24 months that clients participated in housing
first programs, emergency room costs decreased by 34.3% and inpatient nights were reduced by 80%
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 that
38% of homeless persons had problems with alcohol and 46% with drugs."23 Those with addictions
have the hardest time finding services, as they are often turned away by programs that demand
sobriety.24 The Substance Abuse PolicyResearch Program found that “linear-housing programs that
   


 

restricted the consumption of alcohol may prevent those most in need from accepting help.”
Housing first programs avoid this problem by reaching out to all those addicts in need.
While seemingly counterintuitive, studies have showdrastic decreases in substance abuse in
housing first programs, despite substance abuse services being optional. Los Angeles' housing first
program found that, "92.6% of parents (with documented substance abuse histories) reported that
they had continuously maintained their sobriety/abstinence two to seven years after leaving the
program."25
The Journal of the American Medical Association conducted a study on Seattle Washington's
housing first project, the 1181 Eastlake Project. The 1181 Eastlake Project enrolled 75 chronically
homeless, alcohol-dependent individuals in a housing first program. The study found that, "the
longer participants stayed in the housing program, the less they drank"26
In addition to the personal advantages of sobriety/abstinence, decreases in substance abuse
lessen the cost of detoxification programs. The Denver Housing First Collaborative found that
detoxification visits decreased by 82% 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 shown
that housing first programs lead to a decrease in incarcerations, saving the state money. The Denver
Housing First Collaborative found that those who participated in their program sawincarceration
days decrease by 76% over two years, a cost savings of $1,371 per person.28 While the reason(s) for
decreases in incarcerations has not been identified, one might hypothesize that the decreases were
linked to decreases in substance abuse and an increase in stability because of housing.
Economic Advanta ges
While it might seem that a large homeless shelter would benefit from economies of scale and
prove to be cheaper then a housing first program, the opposite is often true. In many cases, it is
cheaper to move individuals into housing rather then keeping them in homeless shelters. A national
survey of 587 programs found that the average yearly costs (per person) at an emergency shelter is
$14,000, a traditional housing program $13,100, and permanent supportive housing $11,560.29 In
comparison 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 family
of four was nearly equivalent to providing a month's rent for the same family. When Home Free
removed all emergency shelters in 2003, and transitioned to a housing first program, they found that
they were able to serve four times as many families.31
The Denver Housing First Collaborative found that total savings (detoxification, incarceration,
emergency room, 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 any given characteristic of the housing first model and the
successes outlined above is beyond the scope of the current literature on housing first. Having said
this 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 January 25 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 housing
first program, parents do not have to worry about housing their children or providing a safe resting
place at night. By removing the "housing question," housing first programs allowindividuals to focus
on other aspects of sustainability, such as employment or education.32 A home can also be an integral
part of securing employment.
Having a home also provides the opportunityfor more successful counseling. "Serving a person
within his/her own environment helps to decrease fear and improve the ‘therapeutic alliance,’ which
results in an increased acceptance of treatment."33 Housing first programs are based on the idea that
a home is a prerequisite to recovery, rather then making recovery a prerequisite for housing (as in a
linear-housing model).
Assistance is Optional
One of the most important parts of housing first programs is that case management assistance is
optional. Because assistance is optional, clients will onlyparticipate in programs that they believe
address 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 in
programming 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 support
systems that are best suited for an individual. Giving the control of the support system to the
participant further enhances his/her ownership of services. Several studies have identified the
optional nature of case management as one of the strengths of housing first programs and as the
reason for effective case management and high retention rates.35
For example, Home Again, a housing first program in Worcester, MA, found that their
participants were nearly twice as likely to have good social support in comparison to those receiving
traditional care.36 Beyond Shelter, another housing first program in Los Angeles, found that after
clients left the program 98% of participants reported to be, "successfully managing the family budget
on their own," and the other 2% reported to be, "successfully managing the family budget with the
help of others." 37 Effectiveness in both these programs has been partially attributed to the optional
nature of case management services. 3839
Assistance in Housing Placement
Finding affordable housing can be an excruciating process for homeless individuals and families.
Not only is there a national shortage of 2.8 million units of affordable housing, but many landlords
are hesitant to rent to homeless individuals because of homelessness' negative connotations: lack of
sustainable income, disabilities, substance abuse, poor credit, and poor rental histories. Housing first
organizations mitigate these negative perceptions by engaging in landlord education and by building
   


 

sustained relationships with landlords. Landlords are also more likely to rent to a homeless person
who has connections to a housing first program because housing first programs are there to support
the renter.40
Housing first services to the client are also a crucial. Services include, but are not limited to:
advocacy with landlords/housing authority, rent assistance, financial management and locating
affordable housing. Such services can be effectives and economical. "Programs like Chicago Illinois’
Housing Locator program capitalize on the housing expertise of community-based providers and
result in agency and system level staffing efficiencies."41
Housing assistance has a successful track record for placing families and individuals in a home
quickly and efficiently. The Family Housing Collaborative Program (FHC) in Columbus Ohio
provides "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 families
that were refereed to FHC were housed within 15 days. For the 143 families that were housed, the
average 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 priority to those with substance abuse problems, some
programs are designated specifically for the addicted (Seattle, WA) and other programs give
preference to an addicted individual over an equally qualified non-addicted person (Denver, CO).4445
Many people are critical of housing first systems because they provide more resources to the addicted
though in many ways addicted support systems in a housing first program would be no different then
a detox program or alcohol anonymous group.46
Lack of Research
The Milbank Quarterly cautions policy makers and non-profits from "overreaching" with
housing first programs. The journal looks through manypopular housing first programs (Pathways
to Housing, NewYork City, or Seattle's program for the addicted) and the research done on those
programs. The journal points out flaws or limitations with existing research on those programs. For
example, the authors explain that similar studies on alcoholism have shown that housing first
programs indicate no marginal advantage compared to linear-housing models. The ultimate thesis is
that there is not enough good research to solidify housing first as the best housing program. The
authors encourage policy makers to continue to develop both linear and housing first models rather
then prioritizing to one over the other. It is worth noting that while the authors reference studies
that assert that housing first and linear-housing programs are equally effective, no examples are given
in which linear-housing programs have been more effective.47
The Oppor tunity Cost is too High
Many critics of housing first are worried that the expansion of housing first models will decrease
resources to homeless shelters. Other critics voice concern that increasing resources for housing first
programs (that are focused on the chronically homeless) will decrease resources for those who are
not chronically homeless.48
Economies of Scale
Leaving aside the considerable non-economic benefits of a housing first model, it maynot be
possible for smaller communities to reap the considerable economic gains garnered by larger
communities. 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 a
disproportionately larger percent of resources. For example, housing first studies have been done in
major cities using very small segments of the homeless population (100 people in Denver, 75 people
in Seattle). This allowed program coordinators to select those individuals who were costing the city
the most money.
While there are a fewsmaller success stories (Lancaster County, PA), the concern becomes
whether or not there are large enough homeless sub-populations in Grand Junction for a housing
first program to have significant financial impact. In addition, even if these individuals are identified,
establishing a housing first program for them may be more costly than 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 take
place in a 16 month housing first program. "Housing specialists at Beyond Shelter's help each family
find and move into permanent, affordable housing in residential neighborhoods thought Los Angeles
County. Housing specialists work closely with each family to overcome barriers to permanent
housing (evictions and bad credit). Specialists help negotiate leases and facilitate access to move-in
resources and housing subsidies when available. Beyond Shelter's case managers provide
individualized, time limited (six months to one year) and intensive home-based, case management
services."
Families for the program were extremely poor. Median monthly income was $1,000, "Assuming
most optimistically that monthly incomes were regular and uninterrupted, estimated annual family
median income was $12,000", well belowthe federal poverty threshold which was $19,223 for a
family of four in 2004. Monthly rent was based on income and ranged from $0-$2,100 per family.
Results
 "89.5% of people remained consistently housed without any repeated episodes of
homelessness two to seven years after leaving the program." Only 1% had two or
more episodes of homelessness.
 72.6% of families reported having no trouble paying rent on time after leaving the
program and only 11% of families were late on their rent more then once.
 98% of families, "reported successfully managing the family budget on their own"
after leaving Beyond Shelter’s, and the other 2% reported receiving help from others.
None of the respondents said that they were unsuccessfully managing their money.
 "92.6% of parents with documented substance abuse histories reported that they had
continuously maintained their sobriety/abstinence two to seven years after leaving
Beyond Shelter’s.
 82.1% of families had health care coverage for all familymembers two to seven years
after leaving the program.
Denver Housing First Collaborative (DHFC) - Denver, Colorado50
Denver Colorado identified the 100 chronically homeless individuals who were costing the city
the most money. All those identified were disabled and many of them had substance abuse problems
prior to entering the program. The group averaged 8 years in homelessness, per person. Tenants
were required to provide 30% of their income towards rent and DHFC paid the balance of the rent to
landlords. "The program used a housing first strategy combined with assertive community treatment
(ACT) services, providing integrated health, mental health, substance treatment and support services"'
Results:
 " The total emergency related costs for the sample group declined by 72.95%, or
nearly $600,000 in the 24 months of participation in the DHFC program
compared with the 24 months prior to entry in the program. The total cost



 

savings averaged $31,545 per participant," and the net savings was $4,745 per
person.
 "Only outpatient health costs increased as participants were directed to more
appropriate and cost effective service by the program."
 "Emergency room visits and costs were reduced by an average of 34.3%.
Inpatient vistas were reduced by 40%, while inpatient nights were reduced by
80%. Overall inpatient costs were reduced by 66% [.…] Detox visits were
dramatically reduced by 82%, with an average cost savings of $8,732 per person,
or 84%."
 "Incarceration days and costs were reduced by 76%, and emergency shelter costs
were reduced by an 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 quality of life."
 Average monthly income of participants increased from $185 at entry to $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 emergency shelter. However, Home
Free recognized that the homeless shelter was not an effective economic model. "Two shelter nights
for a familyof four was nearly equivalent to providing a month's rent for the same family." Home
Free started a housing first program, and has removed their emergency shelter. The group is now
able to provide emergency housing to four times as many families as was possible though its facility-
based shelter"
Home Free typically provides a financial subsidyfor rent during the first six to twelve months
that a family is in the program. Home Free was able to stabilize 25-35 families with one full time
advocate 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, advocacy
with landlords and the housing authority job search and job training referrals, case coordination with
other systems, linkages to legal services, and help with budgeting and goal planning. [...] 50% of
households in the program have a historyof a mental health disability, and nearly one-third have an
alcohol and/or dug history.”
"97% of households enrolled in housing first obtained safe housing, with 86% of these
households remaining stablyhoused one year after exiting services"
Shelter to Independent Living Program (STIL) - Lancaster County Pennsylvania52
Lancaster County is one of the smaller housing first programs in the country. The county has
400,000 individuals and its largest city has a population of 60,000. "In 1988 shelter providers in the
area found that they were spending so much of their time on the day to day business of providing for
people's basic needs that they did not have staff with time to focus on moving families out of the
crisis phase and into permanent housing." In response STIL was created as a "non-facility-based
program to provide" housing first services. STIL's mission is, "to mainstream homeless households
   


 

back into the community into permanent housing through landlord advocacy, housing counseling,
budget counseling and case management and to provide education, resources and accountability to
empower homeless households with the skills and disciplines necessary for long term self
sufficiency."
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 in
homeless 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 eligibility is based on a
determination 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 their
community to place each household in housing that best their needs. On average, housing
placements are made within two weeks of the referral. Since its inception in 2006, the Housing
Locator 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 chronically homeless adults.
Results:
 "Home Again Participants' use of hospital emergency room services decreased by an
average of 1.46 visits per three months, by contrast, the control group reported an
increase of .62 visits per three months."
 "Home Again participants were nearly twice as likely as participants receiving
standard 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 variety of
case management services such as landlord mediation, housing location assistance, home-based
supportive services and financial assistance.” Financial assistance averaged $908 the 143 families
housed in the second half of 2008, and operating costs were $1,064 per family housed. Of those 143
families 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 chronically homeless, alcohol-dependent individuals and put
them through a housing first program. The program only had to ask 79 individuals before they
received 75 volunteers. 1181 Eastlake identified those individuals who were costing the city the most
money, and recruited them for the program. "Each of the participants had cost state and local
governments an average of $86,062 per year before being housed, compared to an average of $13,440
it costs per person per year to administer the housing program."



 

Results
 Residents saved taxpayers more than $4 million dollars because of the housing
first 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 month
per person."
 "The longer the participants stay in the housing program, the less they drink"
Shelter to Housing Pilot - Commonwealth of Massachusetts57
The Shelter to Housing Pilot has an, "aggressive landlord outreach and housing search assistance
program." The program "provides families with up to $6,000 in rental assistance, housing placement
services, and home-based case management." Shelter to Housing Pilot specifically targets, "families
with a working parent or a parent enrolled in an education or training program." "Approximately 85
percent of families housed remained stably housed 18 months after the housing placement [...] The
rate of success parallels what is achieved with a full housing subsidy for homeless families."
Rapid Exit Program - Hennepin County, Minnesota58
"A central intake conducts an assessment of each family's barriers to getting and keeping
housing, and triages the family to a Rapid Exit Agency. Advocates helped the familyfind housing
through their networks of landlords, then offer six months of stabilization and support to achieve
non-recidivism performance targets."59
Results
 "Since 1995, over 8000 families, with more than 20,000 children, have received
Rapid Exit re-housing. One year after case closing, 92% had not returned to
shelter."
 "In a four-year period…shelter admissions declined by 42%, average length of stay
by 47% and total number of purchased bed-nights by 70%."
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 and
assertive community treatment (ACT) services. The municipal costs per capita per night for
Pathways to Housing program is $57. In comparison, the costs at a shelter is $73, jail $164,
emergency room $519, and at a psychiatric hospital $1,185. Participants are required to give 30% of
their income, attend money management program, and meet twice a month with staff. Pathways to
Housing also offers job placement at 5 different offices, will soon be opening a thrift store in Queens
and a bakery in Harlem that will be run by participants.
Results
 "88% of people entering the Pathways Housing remained housed at least five years
after the program, versus 47% of the control group who entered a variety of
residential programs in NewYork City"
 "Reductions in the use of public services averaged $12,146, offsetting most, but not
all, 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 "apartments
in one of several large, multiunit residential buildings." Participants pay “30-50% of their income
for rent, and 80% receive federal Social Security disability benefits.” “Total cost to provide
permanent housing and support services in DAH buildings is approximately $1,200 per month
per resident. The average rent received from residents is $300 per month,therefore requiring a
$900 per month subsidy from governmental sources.”
Results
 Since opening the first DAH site in 1998, almost two-thirds of the residents have
remained housed in the DAH program. Of the remaining one-third of the residents
who moved out of the program, half moved to other permanent housing.
 Only 4% of residents were evicted from the housing facilities.
 Emergency services use was reduced significantly. After leaving the program use of
services declined by 58%. Similarly, in the first two years after entering the
program, there was a 57% reduction in inpatient episodes after entering the program
compared 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 first
program, policy makers need to have a baseline understanding of current costs. This will require all
private, public and non-profit services to report both the number of individuals served and the total
cost of those services. Information needs to range from programs intended for the homeless (Grand
Junction Community Homeless Shelter) as well as programs that are not specifically for designed for
the homeless (services provided at Colorado West Mental Health). In short in order to determine if
we can save money, we must first have a baseline, hard understanding of our current costs.
Make Personal Contact with Smaller Housing First Programs
Policy makers should begin building relationships with other housing first programs that are
serving smaller populations. This will allowthe coalition to better understand housing first in regards
to howit might function in Grand Junction.
Expand Research on Best Practices
HUD provides manuals on best housing first practices. HUD manuals include information on
intake, program operation and monitoring success. This information would be crucial in helping
policy makers design programs that are model best housing first practices.
Begin Identifying Sub-populations
Policy makers should consider what sub-populations of the homeless community would be best
served by a housing first program and begin to gather basic information about these sub-groups. It
may well be that initial housing first efforts should target a large sub-population that is using the
most resources.

CONCLUSION

Housing first programs have significant benefits to society and to the recipients of such
programs. Studies have shown that quality of life for individuals in housing first programs are greatly
improved, and the economic benefits to society are tremendous. Current research points to housing
first methods being the best way to combat chronic homelessness, particularly in sub-populations
such as those using a disproportionate amount of services or those struggling with substance abuse
or addiction. While there are limitations to housing first programs and particular challenges to
implementing housing first programs in smaller communities, it is prudent to assert that housing first
programs showgreat promise, and that there has been a great body of encouraging, if not empirically
conclusive, data to support their effectiveness. At a minimum, it would be prudent to begin gathering
the information necessary to 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 Boston Globe [Boston, MA] 24 June 2007.

2 O'Leary, Keven. "The Feds' Homelessness-Prevention Program." Time 25 Jan. 2010.

3Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health and Health Policy87.2 (2009):
495-534.
4US Conference of Mayors. 2008. Housing First and Rapid Re-Housing as Key strategies in Ending Homelessness and Creating
Results in 10 year plans (2008 adopted resolution).
5Schanes, Christine. "The Homelessness Prevention and Rapid Re-Housing Program (HPRP)." Huffington Post [NewYork , NY] 11
July 2010.
6 O'Leary, Keven. "The Feds' Homelessness-Prevention Program." Time 25 Jan. 2010.
7Ridgway, P., A.M. Zipple. The Paradigm Shift in Residential Services: From the Linear Continuum to Supported Housing
Approaches. Psychosocial Rehabilitation Journal 13:20-31. 1990.
8Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 87.2 (2009):
495-534.

9Barbu, Lianna. Community Spotlight: Homeless Prevention: The community Shelter Board's Family Housing Collaborative (FHC).
US Department of Housing and Urban Development.
10Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health and Health Policy87.2 (2009):
495-534.
11Levy, Leslie. Community Spotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housing
and Urban Development.
Barbu, Lianna. Community Spotlight: Homeless Prevention: The community Shelter Board's Family Housing Collaborative (FHC).
12

US Department of Housing and Urban Development.

13 McCarroll, Christina. "Pathways to Housing the Homeless." The Christian Science Monitor [Boston, MA] 10 May 2002.
14Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearch
Program (2009).
Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,
15

CO: Colorado Coalition for the Homeless, December 2006.

Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending Chronic
16

Homelessness, is gaining ground in Boston." The Boston Globe [Boston, MA] 24 June 2007.

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

18Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-term
Efficacy to End and Prevent Family Homelessness. Policy Brief 1. Los Angeles, CA: Institute for Research, June 2005.
19 "Rapid Re-Housing." National Alliance to End Homelessness (2008).



 


20Kertesz,Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health and Health Policy87.2 (2009):
495-534.
Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,
21

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.
23Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health and Health Policy87.2 (2009):
495-534.
24 McCarroll, Christina. "Pathways to Housing the Homeless." The Christian Science Monitor [Boston, MA] 10 May 2002.

25 McCarroll, Christina. "Pathways to Housing the Homeless." The Christian Science Monitor [Boston, MA] 10 May 2002.
26Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearch
Program (2009).
Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,
27

CO: Colorado Coalition for the Homeless, December 2006.

28 Ibid
29Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy 87.2 (2009):
495-534.

30 Ibid
31 Best Practice: Rapid Re-Housing for Survivors of Domestic Violence:: Volunteers of America's Home Free in Portland, OR.

National Alliance to End Homelessness,

Wherley, Marge. Community Spotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department of
32

Housing and Urban Development.

Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,
33

CO: Colorado Coalition for the Homeless, December 2006

Wherley, Marge. Community Spotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department of
34

Housing and Urban Development.

35Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearch
Program (2009).
36 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.
37Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-term
Efficacy to End and Prevent Family Homelessness. Policy Brief 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.
39Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-term
Efficacy to End and Prevent Family Homelessness. Policy Brief 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,

41Levy, Leslie. Community Spotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housing
and Urban Development.
Barbu, Lianna. Community Spotlight: Homeless Prevention: The community Shelter Board's Family Housing Collaborative (FHC).
42

US Department of Housing and Urban Development.

43 Ibid

   


 

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

Perlman, Jennifer, and John Parvensky. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver,
45

CO: Colorado Coalition for the Homeless, December 2006.

Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending Chronic
46

Homelessness, is gaining ground in Boston." The Boston Globe [Boston, MA] 24 June 2007.
47Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health and Health Policy87.2 (2009):
495-534.
Graves, Florence, and Hadar Sayfan. "First Things First: 'Housing First' A radical NewApproach to Ending Chronic
48

Homelessness, is gaining ground in Boston." The Boston Globe [Boston, MA] 24 June 2007.
49Einbinder, Susan D., and Tanya Tull. The Housing First Program for Homeless Families: Empirical Evidence of Long-term
Efficacy to End and Prevent Family Homelessness. Policy Brief 1. Los Angeles, CA: Institute for Research, June 2005.
Perlman, Jennifer, and John Parvensky. Denver HousingFirst Collaborative: Cost Benefit Analysis and ProgramOutcomes Report. Denver,
50

CO: Colorado Coalition for the Homeless, December 2006.

Best Practice: Rapid Re-Housing for Survivors of Domestic Violence:: Volunteers of America's Home Free in Portland, OR.
51

National Alliance to End Homelessness,

52McDivitt,
Kay M. Community Spotlight: Homeless Prevention: Lessons from Lancaster, PA. US Department of Housing and
Urban Development.
53Levy, Leslie. Community Spotlight: Homeless Prevention: Housing Locator Program in Chicago, IL. US Department of Housing
and Urban Development.
54 Ford, John R. "Support 'Housing First' Model: As I See IT." Telegram [Canada, 7 Apr. 2010.
55 Barbu, Lianna. Community Spotlight: Homeless Prevention: The community Shelter Board's Family Housing Collaborative (FHC).

US Department of Housing and Urban Development.

56Vieira, Carol. "Housing First: Evaluation of Harm Reduction Housing for Chronic Public Inebriates." Substance Abuse PolicyResearch
Program (2009).
57 "Rapid Re-Housing." National Alliance to End Homelessness (2008).
Wherley, Marge. Community Spotlight: Homeless Prevention: Rapid Exit Program in Hennepinn County, MN. US Department of
58

Housing and Urban Development.

59 Ibid
60Kertesz, Stefan G., Kimberly Crouch, Jesse B. Milby, and Robert E. Cusimano. "Housing First for Homeless Persons with Active
Addiction: Are We Overreaching?" The Milbank Quarterly: A MultidisciplinaryJournal of Population Health 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.


