United States
Interagency Council on Homelessness
e-newsletter

Reprinted from: 
USICH's December 30, 2008 e-newsletter
Innovations 08 in 08 series (No. 4)

• What's new with the field-tested, evidence-based practice of Housing First?
• The consumer-centric, field-tested, and evidence-based Housing First technology pioneered by Dr. Sam Tsemberis in Pathways to Housing in New York City has achieved housing stability and recovery for persons experiencing chronic homelessness through a strategy of immediate housing opportunity to end homelessness, with consumer choice in services and without treatment or sobriety requirements.

Read on to learn more ...

	WHAT IS THE INNOVATION AND HOW DOES IT WORK?

Housing First was named this year as an evidence-based practice by the United States Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), National Registry of Evidence-based Programs and Practices (NREPP).

The consumer-centric, field-tested, and evidence-based Housing First technology pioneered by Dr. Sam Tsemberis in Pathways to Housing in New York City has achieved housing stability and recovery for persons experiencing chronic homelessness through a strategy of immediate housing opportunity to end homelessness, with consumer choice in services and without treatment or sobriety requirements.

Housing First has been adopted in sites around the country and internationally and implemented by a majority of federal awardees in targeted interagency permanent supportive housing collaborations. Housing First is designed to end homelessness and support recovery for individuals who are homeless and have severe psychiatric disabilities and co-occurring substance use disorders. Without traditional linear or sequential program constraints or requirements, individuals cam be engaged directly from the streets and shelters for the move to housing.

Pathways' Housing First model emphasizes both consumer choice for housing, along with consumer preference in accessing and sequencing services. The permanent supportive housing model addresses homeless individuals' needs from their perspective, encouraging individuals to define their own needs and goals. Housing First provides immediate housing opportunity in the form of apartments located throughout the community in scattered sites where residence is not conditioned on treatment or sobriety requirements.

A key element of the innovation is response to the preference of the consumer, a recognition that "business as usual" was not working. As Pathways' most recent annual report observes, fifteen years ago, it was unforeseen that the most vulnerable, most complex individuals experiencing long-term homelessness would provide the answer to chronic homelessness. States Dr. Tsemberis, "Fifteen years ago, who would have imagined that the most humane and effective solution for ending homelessness would come directly from the people who were living on the streets - people who were, by all accounts, helpless, disoriented, and vulnerable? We first had to learn to stop letting our assumptions get in the way of their needs. Then ask and listen to what they were telling us."

The scattered site, private market rental strategy means that Pathways has quick startup times for units, expansive partnerships with landlords, and none of the real estate challenges that accompany development and management. In emphasizing its commitment to housing integration in the community for its clients, Pathways will not rent more than 20% of units in a given site.

Treatment and support services are available 24/7 through a multi-disciplinary Assertive Community Treatment (ACT) team consisting of social workers, nurses, psychiatrists, vocational and substance abuse counselors, peer counselors, and other professionals. Services may include psychiatric and substance use treatment, employment, illness management, and recovery services. Teams make weekly house calls. 
 

	top
	WHO BENEFITS FROM THE INNOVATION?

A successfully housed consumer wrote to Dr. Tsemberis enumerating the ways in which housing had changed his life: "Thank you for saving my life. Thank you for allowing me to be a father to my children and for having a place for them to come and visit me. Thank you for the longest period without going to the hospital since I can remember. Thank you for my sobriety. Thanks you for having a place to shower, a stove to cook on, a bed to sleep in, a warm place to go when its cold. Thank you for not having to take my possessions everywhere I go. Thank you for my home."

Taxpayers and the community benefit when the most vulnerable and costly population of people experiencing chronic homelessness move from streets and shelters to the stability of housing, ending their costly random ricocheting between acute treatment systems and law enforcement.

Public systems benefit as they partner for housing solutions that move their systems from demoralization and costly frequent use by people experiencing chronic homelessness.

Landlords benefit from having new tenants who are supported in the goal of housing retention by their ACT Team partners, as well as benefiting from Pathways' approach of partnering to upgrade properties to accelerate move-in and contribute to improved neighborhoods. 

	top
	WHAT RESULTS ARE BEING ACHIEVED AND REPORTED FROM THE INNOVATION?

More than 85% of Housing First participants in most sites remain stably housed. Data examined for the SAMHSA evidence-based practices registry showed a high rate of success for participants after two years, versus 30% for participants in the comparison group who were assigned to traditional programs that made treatment and sobriety prerequisites for housing. SAMHSA's National Registry, a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers, examined four outcomes for the Pathways program: residential stability; perceived consumer choice in housing and other services; cost of supportive housing and services; and use of support services.

Since its inception in New York in 1992, a year in which Pathways housed 50 people, the innovation has expanded, housing on average a person per week since. In addition to the expansion of Pathways to DC (see Innovation #2), Pathways' Housing First strategy has a new home in Philadelphia with the opening of an initiative for 125 chronically homeless individuals. In May 2008, the City of Philadelphia announced a $7 million plan to house 700 homeless individuals and families - 125 of them through Pathways. Marcella Maguire, Director of Homeless Services for the Philadelphia Department of Behavioral Health, called Pathways "the gold standard" for the Housing First strategy, which in Philadelphia is using a list of 300 mentally ill people identified by the Department to move people from the street to housing. In Center City Philadelphia, 85 percent of the street population suffers from mental illness, addiction, or both.

Research through more than 65 cost studies - many conducted in conjunction with jurisdictional Ten Year Plans and Housing First initiatives - has demonstrated the success and cost-effectiveness of the Housing First strategy. Clients have shown a significant decrease in both the use of and cost of psychiatric hospitalization, ER services, incarceration, and other expensive acute care. Residents also demonstrate a dramatic increase in health and well-being. More than 30% of residents have made the transition to employment.

	top
	WHO IS THE INNOVATOR?

Pathways to Housing Founder Dr. Sam Tsemberis and his diverse staff of implementers helping to establish Housing First sites and providing technical assistance at every step.

80% of the 11 federal sites funded in the $55 million Collaborative Initiative to Help End Chronic Homelessness coordinated by the U.S. Interagency Council on Homelessness and the investments of the U.S. Departments of Health and Human Services, Housing and Urban Development, and Veterans Affairs employed a Housing First strategy. Over 635 units were created in Chattanooga, Chicago, Columbus, Denver, Ft. Lauderdale, Los Angeles, Contra Costa, New York, Philadelphia, Portland, and San Francisco. Newly housed individuals had an average of over 8.5 years of homelessness.

Denver and Los Angeles sponsors have recently been recognized by MetLife Foundation and Enterprise for excellence in their accomplishments with MetLife Foundation Awards for Excellence in Affordable Housing. First Place was awarded to the Colorado Coalition for the Homeless, Denver, Colorado and Second Place was presented to Skid Row Housing Trust, Los Angeles, California. In partnership with the MetLife Foundation, Enterprise offers the awards to recognize non-profit community-based or regional nonprofit organizations that excel in property and asset management or provide housing to people with special needs.
  

	top
	WHERE CAN I LEARN MORE ABOUT THE INNOVATOR?

Learn more about Pathways to Housing, including published research and partnerships at their web site: www.pathwaystohousing.org

Learn more about evidence-based practices at SAMHSA's web site: www.samhsa.gov

Learn more about innovations to end homelessness at: www.usich.gov