1. The Research Behind Successful Supportive Housing September 2016

2. Overview We will present research on and policy implications of: Cost of homelessness vs. supportive housing Housing First model The most effective interventions for homeless families

3. ALBUQUERQUE HEADING HOME COST STUDY

4. Albuquerque Heading Home Initiative A private-public initiative to identify and house people in Albuquerque who are both chronically homeless and medically vulnerable Heading Home leads the initiative in partnership with the City of Albuquerque and other nonprofit service and housing providers The initiative began in 2011 To date, Albuquerque Heading Home has provided permanent supportive housing to 938 people

5. What is Permanent Supportive Housing? Permanent Supportive Housing = Long-term assistance paying for housing (i.e. through rental vouchers) + Case management services to help participants stabilize, be good tenants and connect to needed resources and services in the community

6. Albuquerque Heading Home Cost Study The City of Albuquerque hired the UNM Institute for Social Research to conduct a rigorous and objective study on the cost effectiveness of providing permanent supportive housing The study was published in September 2013

7. AHH Cost Study Participants Any participant who had been housed through AHH for 1 year or more was eligible to participate in the study Out of the 90 eligible participants, 48 choose to participate in the study Of these 48 study participants: 60% were male; 40% were female 35% were Hispanic; 35% were White; 13% were Native American and 7% were African- American

8. AHH Cost Study Methodology The Cost Study compared participants use of these services 1 year before and 1 year after entering permanent supportive housing: Jail Emergency Shelter Ambulance Outpatient Behavioral Health Mental Health Inpatient Medical Outpatient & Inpatient Emergency Room Cost of providing permanent supportive housing (housing assistance & case management)

9. AHH Cost Study Results One year post-Heading Home study group member costs were $615,920.49 or 31.6% less than the one year pre-Heading Home study group member costs This amounted to an average savings of $12,831.68 per study group member

10. AHH Cost Study Results Emergency room costs decreased by 13% Jail costs decreased by 64% Inpatient hospital costs decreased by 84% Outpatient medical costs decreased by 39% Outpatient behavioral health costs decreased by 33% Mental health inpatient increased 148% Social services costs increased 469%

11. OTHER COST STUDIES Emergency room costs decreased by 13% Jail costs decreased by 64% Inpatient hospital costs decreased by 84% Outpatient medical costs decreased by 39% Outpatient behavioral health costs decreased by 33% Mental health inpatient increased 148% Social services costs increased 469%

12. New York Cost Study – The First Study Studied 10,000 people and the effect of providing 3,700 units of supportive housing to some of them. $40,500 cost of homeless people with mental illness not housed $41,500 cost of homeless people with mental illness with housing Net cost of housing was $1,000 per year per person Some costs of being homeless were not captured by the study

13. Denver Cost Study Compared the cost to society of 19 people before and after being provided supportive housing in a housing first project over 2 years. 34% reduction in emergency room visits and costs 66% reduction in hospital inpatient costs 84% reduction in detox costs 76% reduction in incarceration costs 100% reduction in emergency shelter costs Net savings of $4,745 per person (would save $2,434,131 for 513 people)

14. What Changes in Policy Would You Recommend?

15. Policy Implications Cost savings or at least offsets to the cost of housing are one more reason to house homeless people Moral reasons are of course even stronger: housing provides people a much improved quality of life The cost savings are realized by several parts of the service system: Medicaid, hospitals, County jails, emergency shelters, detox programs Each level of government should be encouraged to help fund supportive housing and realize some of the savings.

16. RESEARCH ON HOUSING FIRST

17. What is Housing First? Prioritizes providing housing as a first step for homeless people Client choice in housing No requirement to address mental health or substance abuse issues prior to housing No requirement to participate in services to keep housing Participants are offered an array of services that they can take advantage of including mental health care and substance abuse treatment Target population is homeless people with mental health disabilities

18. Pathways to Housing Outcomes Sam Tsemberis at Pathways to Housing developed the Housing First model In 2000 Pathways compared 242 housing first participants with 600 people provided the standard residential treatment 88% of housing first participants retained their housing after 5 years 47% of those in the residential treatment system remained housed after 5 years Housing first almost twice as effective at keeping people housed

19. Housing First for Homeless Veterans Compared 177 homeless veterans provided with a housing first program to a control group Housing first reduced the length of time it took to house the veterans from 223 days on average to 35 days. Also showed better retention among housing first participants and lower emergency room use Montgomery, A.E., Hill, L., Kane, V., & Culhane, D. Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH. 2013.

20. Cost Effectiveness of Housing First Another Pathways study found that a Housing First Program costs $23,000 less per person per year than a shelter program Tsemberis, S. & Stefancic, A. Housing First for Long-Term Shelter Dwellers with Psychiatric Disabilities in a Suburban County: A Four- Year Study of Housing Access and Retention. 2007.

21. What Changes in Policy Would You Recommend?

22. Policy Implications of Housing First Research Since housing is cheaper and better than shelter, we should emphasize expanding housing opportunities. New housing programs for homeless people should be housing first programs. Existing housing programs that are not completely housing first still need to reduce barriers to entry.

23. FAMILY OPTIONS STUDY

24. Study Objectives The purpose of this study was to compare different interventions for homeless families with children: Project-based transitional housing Rapid ReHousing Housing subsidy only (no services), i.e. a Housing Choice Section 8 Voucher Usual care (defined as any housing or services that a family accesses in the absence of immediate referral to the other interventions).

25. Study Participants & Timeframe Between September 2010 and January 2012, a total of 2,282 families (including over 5,000 children) were enrolled into the study from emergency shelters across twelve communities nationwide and were randomly assigned to one of the four interventions Families are being tracked for a minimum of three years HUD released an interim report in July 2015 that documents the impacts of the various interventions and their relative costs at the 18-month follow-up period

26. Housing Stability Outcomes Housing Stability Outcomes: Those assigned to the Housing Subsidy Only had the fewest returns to homelessness Those assigned to Rapid ReHousing returned to homelessness at about the same rate as those assigned to Usual Care Those assigned to Project-Based Transitional Housing returned to homelessness at a lower rate than those assigned to Usual Care

27. Family & Child Well Being Outcomes Family & Child Well Being Outcomes: Families offered housing subsidies experienced many substantial improvements in adult and child well-being compared to families receiving usual care. Families offered Rapid ReHousing had mixed results compared to families receiving usual care. Families offered transitional housing did not achieve better outcomes in the domains of family preservation, adult well-being, child well-being and self- sufficiency compared to families receiving usual care.

28. Cost Effectiveness Outcomes Average program cost per stay during follow-up period: Housing Subsidy Only $18,821 Rapid ReHousing $6,578 Project Based Transitional Housing $32,557 Emergency Shelter $16,829

29. Cost Effectiveness Outcomes However, the costs changed when the researches included other services that the participants used outside of the assigned interventions: Housing Subsidy Only $30,832 Rapid ReHousing $27,605 Project Based Transitional Housing $30,817 Usual Care $30,629

30. Concerns with the Family Options Study HUD and other advocates of Rapid ReHousing have used this initial report to bolster support for Rapid ReHousing However, other groups have questioned HUD’s interpretation of the study results, including the Institute for Children, Homelessness & Poverty

31. Concerns with the Family Options Study Institute for Children, Homelessness & Poverty points out: Families were not required to accept the intervention that was offered to them Families were not guaranteed admission by the local agency providing that intervention All interventions were necessarily available All families had the option to changes programs. As a result, many families used more than one type of intervention

32. What Changes in Policy Would You Recommend?

33. Policy Implications of HUD Family Options Study The best way to help families exit homelessness permanently is through affordable permanent housing The results so far do not clearly show that Rapid ReHousing or Project Based Transitional Housing improve housing outcomes and family well-being, or that they are more cost effective, than usual care The final study, which will be out in 2017, may provide a clearer picture of the benefits of Rapid ReHousing and Transitional Housing.