1 Housing Strategies For the CSAT Treatment for Homeless Persons Grantee Meeting June 2, 2003 Carol Wilkins Corporation for Supportive Housing

2 MISSION CSH helps communities create permanent housing with services to prevent and end homelessness. For more information and resources to help in your community visit our web site

3 Why Do People Become Homeless?  Poverty  Poor health  Mental illness  Drug use  Multiple evictions  Past abuse, domestic violence  Little education  Unemployed / Underemployed  Children with behavioral problems

4 People Disabled by Mental Illness and/or Substance Abuse Problems Are Priced Out of Housing In 2000, people with disabilities receiving SSI needed to pay – on a national average – 98% of their SSI benefits to rent a 1- bedroom apartment In 2000, there was not one single housing market in the country where a person with a disability receiving SSI benefits could afford to rent a modest efficiency or 1-bedroom unit Because of their extreme poverty, the 3.5 million non-elderly people with disabilities receiving SSI benefits cannot afford decent housing anywhere in the country without some type of housing assistance Source: Technical Assistance Collaborative Priced Out in 2000: The Crisis Continues

5 WHAT IS SUPPORTIVE HOUSING? Supportive Housing is PERMANENT AFFORDABLE HOUSING combined with a range of SUPPORTIVE SERVICES that help PEOPLE WITH SPECIAL NEEDS live stable and INDEPENDENT lives.

6 COMBINES HOUSING AND SERVICES HOUSING –PERMANENT: Not time limited, not transitional; –AFFORDABLE: For people coming out of homelessness; and –INDEPENDENT: Tenant holds lease with normal rights and responsibilities. SERVICES –FLEXIBLE: Designed to be responsive to tenants’ needs; –VOLUNTARY: Participation is not a condition of tenancy; and –INDEPENDENT: Focus of services is on maintaining housing stability.

7 SUPPORTIVE HOUSING TYPES Apartment buildings exclusively housing formerly homeless individuals and/or families. Rent subsidized apartments leased in open market. Apartment buildings with mixed income households, including the formerly homeless. Long-term set aside of units within privately owned buildings. Services integrated within existing affordable housing developments. Single family homes, including shared housing environments.

8 WHO IS SUPPORTIVE HOUSING FOR? People who are homeless or at-risk for homelessness - and - face persistent obstacles to maintaining housing, such as mental health issues, substance use issues, other chronic medical issues, and other challenges.

9 SUPPORTIVE HOUSING IS FOR PEOPLE WHO: BUT FOR HOUSING cannot access and make effective use of treatment and supportive services in the community; and BUT FOR SUPPORTIVE SERVICES cannot access and maintain stable housing in the community.

10 A range of services to support tenants in their goals A broad array of services available –Mental health and substance use management and recovery –Vocational and employment –Money management & benefits advocacy –Coordinated support / case management –Life skills –Community building and tenant advocacy –Medical and wellness

11 “Services are voluntary for the tenants – not the staff” Tenants choose as much or as little services as they desire – without having to move as their service needs change Engagement is an ongoing activity to establish and sustain relationships Begin with tenants’ practical needs and personal goals Help tenants recognize the connection between recovery and getting what they want out of life Housing is the base for engaging tenants in treatment and supports that can help achieve the primary goal of housing stability The tenant is the host; service providers are guests

12 Service strategies anticipate and help to manage the risks and consequences associated with substance use and relapse Building or program design facilitates informal engagement with service providers and social activities that support recovery Creating a strong and safe community to reinforce norms of behavior and hope for recovery and growth Supportive housing tenants must pay rent and meet other lease obligations –Participation in services can help tenants meet their obligations, solve problems, and avoid eviction –Evictions are for failure to pay rent or for problem behavior – not for choices about participation in services

13 Supportive housing provides opportunities for tenants to Access appropriate care for and manage chronic health and mental health conditions Take steps toward achieving and maintaining sobriety Achieve housing stability Work Socialize Be leaders in their community Connect with the wider world Pursue goals and interests

14 “ The day I walked into Hudson View Commons with the keys to my own apartment was the first time I could see light at the end of a long, dark tunnel. Each day that light becomes brighter and brighter. Supportive housing is a true stepping stone.” Mark Stavola, Tenant Broad Park, CT

15 “I have 2 years clean and sober, a steady job, I pay my own rent – all of which I could not have done without supportive housing.” Charlie Miller, Tenant Canon Kip, CA

16 WHY SUPPORTIVE HOUSING? Current approach is not solving the problem for many homeless people This 15% consumes more than half of all homeless shelter services – leaving the homeless services systems struggling to effectively serve those who could exit homelessness relatively quickly. Dennis P. Culhane, University of Pennsylvania Research indicates that approximately 15% of people who experience homelessness are chronically homeless

17 SUPPORTIVE HOUSING WORKS As documented by researchers across the country 80% of tenants coming from streets and shelters achieve housing stability for at least a year. Emergency room and hospital visits drop by more than 50%. Decreases in tenants use of emergency detox services by more than 80%. Increases in use of preventive health care services, primary care and services to address substance abuse.

18 SUPPORTIVE HOUSING IS COST EFFECTIVE New York / New York Cost Study Study: The Impact of Supportive Housing for Homeless Persons with Severe Mental Illness on Use of Public Services in New York City The cost of homelessness for persons with serious mental illness was more than $40,000 per year – with 86% of costs in health care and mental health systems.

19 SUPPORTIVE HOUSING WORKS As documented by researchers across the country Positive impacts on employment status. Increases of 50% in earned income and 40% increase in rate of participant employment when employment services are provided in supportive housing. Significant decrease in tenant dependence on entitlements.

20 Roles in Supportive Housing DEVELOPER RENT SUBSIDY PROGRAM MANAGERS OWNER PROPERTY MANAGER SERVICE PROVIDER(s) TENANT COMMUNITY…

21 Approaches: HOUSING SIDE Services linked to existing housing projects for similar target population(s) Leasing housing units in the private market (tenant, sponsor, or project based subsidies or “master lease”) Set asides of units within other projects Developing or purchasing housing

22 Approaches: SERVICE SIDE Services located on-site with housing Services located off-site and coordinated with housing Services formally coordinated and delivered by multiple providers Linkages to existing services in the community Set asides or priority for supportive housing project residents at service delivery location

23 Supportive Housing Models  Scattered-site  Single-site  Clustered  Shared housing  Mixed populations

24 Housing Provider Service Provider Partnerships in Supportive Housing

25 Benefits of Partnerships in Supportive Housing  Responds to the Need for Housing with Services in your Community  Capitalizes on the Expertise of Housing Providers and Service Providers  May Provide Access to Specialized Funding Sources  Opportunity for Creative Tension Between Service Provider and Property Manager 25

26 The Challenges of Creating and Operating Supportive Housing Finding and securing capital funding for projects with little or no excess cash flow to cover debt Securing operating and service funding, or rent subsidies Scarce resources & increasing competition Financing Supportive Housing: Piecing together several funding sources for one development – or to provide housing & services to the same person / target population

27 The Challenges of Creating and Operating Supportive Housing Sustaining Supportive Housing: Maintaining and renewing operating and service funding over the long haul Creating and fostering good working partnerships between property managers and service providers Improving and adapting services to increase tenant access, needs and interest

28 PHASES OF HOUSING DEVELOPMENT CONCEPT PRE-DEVELOPMENT / FEASIBILITY DEVELOPMENT OPERATIONS

29 TYPES OF FUNDING: 1.PRE-DEVELOPMENT 2.PERMANENT - CAPITAL 3.OPERATIONS 4.SUPPORTIVE SERVICES

30 DEVELOPMENT-OPERATING LOOP DEVELOPMENT (1 - 4 years) OPERATIONS ( years) SOURCES: Federal, State, Local, Private, Other USES: Site Acquisition; Construction, Permits, Professional Fees, Soft Costs SOURCES: Tenants Rents, Reserves, Rental Subsidies USES: Maintenance & Repairs, Taxes, Insurance, Utilities, Other

31 SUPPORTIVE HOUSING AS A NATIONAL STRATEGY TO END CHRONIC HOMELESSNESS –Millennial Housing Commission Report –Continuum of Care and HOPWA Programs –10-Year Plans to End Homelessness –US Conference of Mayors Recommendations –President’s Interagency Council on Homelessness and Collaborative Initiative to Help End Chronic Homelessness –President’s New Freedom Mental Health Commission –HHS Ending Chronic Homelessness: Strategies for Action

32 “As a nation, we must confront this problem and work to provide shelter and assistance to those in need. To enhance the quality of life for our citizens, my Administration remains committed to ending chronic homelessness…” President George W. Bush March 18, 2003

33 Focus on Ending Chronic Homelessness As defined by HHS, HUD, and the VA for collaborative initiatives: An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or has had at least four (4) episodes of homelessness in the past three (3) years

34 Expanding housing opportunities for people with mental illness and/or substance abuse problems Eligibility criteria for the housing (or subsidies) targets people with disabilities and those who are homeless for the long-term Outreach, marketing and tenant selection procedures and program rules facilitate access Supportive services and property management practices are designed to help people achieve housing stability and reduce reliance on emergency care Requires strategies for effectively engaging and housing people with ongoing or relapsing substance use problems

35 CSH, National Alliance to End Homelessness, working with providers, state and local governments, and advocates are spearheading a national initiative the Compact to End Long-Term Homelessness that calls for the creation of 150,000 new units of supportive housing nation-wide over the next 10 years.

36 COMPACT TO END LONG-TERM HOMELESSNESS - GOALS Creating and sustaining at least 150,000 units of permanent supportive housing over the coming decade for people who are experiencing long-term homelessness. Ending the practice of discharging large numbers of people into homelessness from hospitals, mental health and chemical dependency treatment facilities, jails, and prisons; and Secure investments in additional affordable and supportive housing alternatives from mainstream systems, so that supportive housing is available to those who are homeless, or would likely be homeless without it.

37 COMPACT TO END LONG-TERM HOMELESSNESS - STRATEGIES Renew – with predictability and stability – funding for rent or operating subsidies and services that sustain the supportive housing that now exists. Focus resources from mainstream and targeted programs to create and sustain supportive housing. Integrate and coordinate investments for housing and services to use resources efficiently and make it possible to take supportive housing to a much larger scale.

38 COMPACT TO END LONG-TERM HOMELESSNESS - STRATEGIES Increase resources to create and maintain supportive and affordable housing. Invest in building the capacity of community groups and government to create and sustain high-quality supportive housing.