WHAT IS HOUSING FIRST Housing First is an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness

HOUSING FIRST IS… Immediately helping individuals and families get housing Services are voluntary and are not a condition for retaining housing Motivational interviewing Tenants hold a lease for their housing, and have the normal rights and responsibilities Work to “screen in” people with significant challenges Establishing good relationships with local landlords More effective and less expensive than traditional housing programs

HOUSING FIRST DOES NOT REQUIRE… Sobriety Income Good credit Participation in Treatment or Case management Services Never having been evicted before Employment Clean criminal background check

Five Core Principles of Housing First: 1. Immediate access to permanent housing with no housing readiness requirements. providing clients with assistance in finding and obtaining safe, secure and permanent housing as quickly as possible not required to first demonstrate that they are ‘ready’ for housing Housing is not conditional on sobriety or abstinence Program participation is also voluntary 2. Consumer choice and self-determination Housing First is a rights-based, client-centered approach Clients are able to exercise some choice regarding the location and type of housing they receive (e.g. neighborhood, congregate setting, scattered site, etc.). Clients have choices in terms of what services they receive, and when to start using services.

4. Individualized and client-driven supports. 3. Recovery orientation A recovery orientation focuses on individual well-being, and ensures that clients have access to a range of supports that enable them to nurture and maintain social, recreational, educational, occupational and vocational activities. Harm reduction aims to reduce the risks and harmful effects associated with substance use and addictive behaviors for the individual, the community and society as a whole, without requiring abstinence. 4. Individualized and client-driven supports. A client-driven approach recognizes that individuals are unique, and so are their needs. Some people will need minimum supports while other people will need supports for the rest of their lives. Individuals should be provided with a range of treatment and support services that are voluntary, individualized, culturally-appropriate, and portable. Income supports and rent supplements are often an important part of providing client-driven supports and should ensure that individuals do not pay more than 30% of their income on rent.

5. Social and community integration help people integrate into their community and this requires socially supportive engagement and the opportunity to participate in meaningful activities Key features of social and community integration include: Separation of housing and supports (except in the case of supportive housing) Housing models that do not stigmatize or isolate clients. This is one reason why scattered site approaches are preferred. Opportunities for social and cultural engagement are supported through employment, vocational and recreational activities.

Maslow's Hierarchy of Needs

The only lasting solution to homelessness is permanent housing!! Far too often we attempt to treat the symptoms of homelessness instead of its root cause. The bottom line is that it is just too difficult to battle addiction, take care of serious physical and mental health conditions or find steady employment while simultaneously battling homelessness. Contrary to popular opinion, these things are not precursors to housing. Instead, they stem from the safety and stability that comes from having a permanent home in the first place.

Domestic Violence The Washington State Coalition Against Domestic Violence (WSCADV) launched a five year pilot program testing the success of a survivor- centered, Housing First approach to preventing homelessness for survivors of domestic violence and their families. 96% of pilot participants remain stably housed after 18 months. 84% of survivors reported an increase in safety for themselves and their children. Program cost went down 76% since survivors received only minimal services from the domestic violence agencies.

Housing First Reduces Re-offending among Formerly Homeless Adults with Mental Disorders: Results of a Randomized Controlled Trial; Julian M. Somers , Stefanie N. Rezansoff, Akm Moniruzzaman, Anita Palepu, Michelle Patterson; Published: September 4, 2013 This trial found that: Housing First programs—particularly scattered site Housing First programs— reduced re-offending and reconviction among people with mental illness; The presence of a substance use disorder had no impact on re-offending or reconviction; and Both scattered site and congregate Housing First programs reduced re- offending regardless of the severity of the individuals’ mental illness.

Behavioral Health At Home/Chez Soi project, by the Mental Health Commission of Canada, is the world’s most extensive examination of Housing First. It conducted a randomized control trial with 1000 people in Housing First and 1000 who received 'treatment as usual‘ Over 80% of those who received Housing First remained housed after the first year. For many, use of health services declined and overall health improved. Involvement with the law declined. Many people were helped to make new linkages and to develop a stronger sense of self.

Drug and Alcohol Collins et al. (2012) Alcohol Use Quantity Form Addiction Severity Index Short Inventory of Problems Alcohol Dependence Checklist *Both conditions experienced statistically significant positive outcomes over time, but the HF condition experienced positive outcomes at a statistically significantly higher and faster rate. Tsai, Mares, & Rosenheck (2010) 7-item Therapeutic Alliance Scale Addiction Severity Index Medical Outcomes Study Short Form-12 Brief Symptom Inventory *The HF group stayed in permanent housing for statistically significant more days than the RTF group

National Cost Studies Studies also show that Housing First approaches involving permanent supportive housing tend to be much cheaper for taxpayers than allowing people to remain homeless. As homeless individuals with the highest health and service needs benefit from the stability of housing, they are better able to tend to their needs in productive, self-driven and long-term ways. As a result, they make less frequent use of expensive, publicly funded services like emergency rooms, shelters and jails Homelessness causes existing mental and physical illnesses to worsen, leading to expensive treatment and medical services. Permanent supportive housing improves physical and mental health, which reduces the need for these services, particularly expensive inpatient mental health care and hospitalization.

DENVER HOUSING FIRST COLLABORATIVE COST BENEFIT ANALYSIS AND PROGRAM OUTCOMES REPORT The total emergency related costs (24 months prior to entry) $821,539. The total emergency related costs for the same group after entering the program was $222,186. a reduction of $599,356 or 72.95%. an average of $31,545 per participant. costs savings over the two year period would amount to $4,731,734 513 additional chronically homeless individuals in Denver = $16,182,531

Portland, OR Portland’s Community Engagement Program provides housing and intensive services to homeless individuals with mental illness and addictions. The program reduced the cost of health care and incarcerations from $42,075 to $17,199. Adding into that number the investment housing costs of $9,870 = a total cost per person of $27,069 This represents a 35.7% ($15,006 per person) annual cost saving

Lancaster Co. Cost Analysis

Lancaster County PIT Count Totals

Lancaster Co. Veteran PIT numbers

Lancaster Co. Chronic Definition PIT Numbers

Strategies Trainings Funders Forum CoC Leadership Board National Alliance to End Homelessness or Independent TH & ES Effectiveness/Cost vs. PSH & RRH Effectiveness/Cost Board of Directors Funders Forum CoC Grant ESG/CDBG HAP/State Block Grant United Way & Private Foundations Housing Authorities CoC Leadership Board One on one discussions with provider Board presidents Have providers bring presentation of how to convert from TH to PSH Ask “why”? Why do you require income? Why do you require sobriety?

Coordinated Assessment Data Publish Outcome Measurements System Evaluator Tool (effectiveness vs. cost) Inclusion CEO/Board President of each provider at CoC meeting Staff level information meetings and trainings Coordinated Assessment Single Point of Entry MOU >50% of clients must be HUD defined homeless to be a recognized provider in coalition Diversion/Prevention Pay for Performance Prioritization (VI-SPDAT?)

HOUSING FIRST PRINCIPLES Homelessness is first and foremost a housing problem and should be treated as such Housing is a right to which all are entitled People who are homeless or on the verge of homelessness should be returned to or stabilized in permanent housing as quickly as possible and connected to resources necessary to sustain that housing Issues that may have contributed to a household’s homelessness can best be addressed once they are housed

Housing First Service Delivery Components Emergency services that address the immediate need for shelter or stabilization in current housing Housing, Resource, and Support Services Assessment which focuses on housing needs, preferences, and barriers; resource acquisition (e.g., entitlements); and identification of services needed to sustain housing Housing placement assistance including housing location and placement; financial assistance with housing costs (e.g., security deposit, first month’s rent, move-in and utilities connection, short- or long-term housing subsidies); advocacy and assistance in addressing housing barriers (e.g., poor credit history or debt, prior eviction, criminal conviction) Case management services (frequently time-limited) specifically focused on maintaining permanent housing or the acquisition and sustainment of permanent housing