1. Supportive Housing Strategies: AB 2034 Evaluation -- Implications for the MHSA
Emphasize that these are PRELIMINARY results; we wanted to share them at the conference, but we intend to do more work reviewing and analyzing the findings
Final evaluation results will be available on our website
Presented by the Corporation for Supportive Housing
Jonathan Hunter, California Director
October 26: Los Angeles

2. Our Mission CSH helps communities create permanent housing with services to prevent and end homelessness.

3. Why We Need Supportive Housing
As many as 250,000 American households have nowhere to call home for years on end - many with mental illnesses
For decades, communities have “managed” homelessness without addressing the underlying causes
Government is spending hundreds of millions of dollars per year, yet homeless rates are growing

4. What Is Supportive Housing
What Is Supportive Housing? A cost-effective combination of permanent, affordable housing with services that helps people live more stable, productive lives.

5. Defining Supportive Housing
Permanent affordable housing with combined supports for independent living
Housing is permanent, meaning each tenant may stay as long as he or she pays rent and complies with terms of lease or rental agreement
Housing is affordable, meaning each tenant pays no more than 30% to 50% of household income
Tenants have access to an array of support services that are intended to support housing stability, recovery and resiliency, but participation in support services is not a requirement for tenancy
May be site-based or scattered site
Options available for adults who are single, those who choose to share housing, and families with children
From the 5/18/05 draft Program and Expenditure Plan Requirements for MHSA Community Services and Supports

6. 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.

7. 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.

8. Supportive Housing Types
Dedicated buildings
Rent-subsidized apartments
Mixed-income buildings
Long-term set asides
Single-family homes

9. Strategies for Creating More Housing Options for Consumers
Development of new buildings
Acquisition and renovation of existing buildings
Long-term lease agreements with private landlords for single units or entire apartment buildings (master-leasing)
Identifying private landlords who rent directly to consumers

10. Services Make the Difference
Flexible, voluntary
Counseling
Health and mental health services
Alcohol and substance use services
Independent living skills
Community-building activities
Vocational counseling and job placement
the services that make the difference in being housed versus homeless
services such as these, in combination with a decent place to live, provide the support system people need to break out of the cycle of long-term homelessness

11. Cost effectiveness - NY/NY Cost Study U
Cost effectiveness - NY/NY Cost Study U. Penn study of 5,000 mentally ill homeless people in New York
Facilitated by CSH
Conducted by Dennis Culhane, Stephen Metraux, Trevor Hadley
Tracked costs for two years while subjects were homeless, two years after they were housed
The most comprehensive case for supportive housing is made by a recently released study from the University of Pennsylvania's Center for Mental Health Policy and Services Research.  Researchers tracked the cost of nearly 5,000 mentally ill people in New York City for two years while they were homeless and for two years after they were housed.  They concluded:
+ Supportive and transitional housing created an average annual savings of $16,282 per unit by reducing the use of public services: 72% of savings resulted from a decline in the use of public health services; 23% from a decline in shelter use; and 5% from reduced incarceration of the homeless mentally ill.
This reduction in hospitalizations, incarcerations, and shelter costs nearly covered the cost of developing, operating and providing services in supportive housing.  After deducting the public benefits, the average NY/NY supportive housing unit cost only $995 per year.
In other words, based on the most conservative assumptions - without taking into account the positive impacts on health status and employment status, or improvements to neighborhoods and communities - it costs little more to permanently house and support people than it does to leave them homeless.
The reduction in hospitalizations, jail time, and shelter costs nearly covered the cost of building, operating and providing services in supportive housing

12. NY/NY Findings
Homeless mentally ill people are heavy service users (37% of last 2 years spent in institutional settings)
Providing a mentally ill person with permanent supportive housing costs only $995 per year more than allowing that person to remain homeless

13. Consistent Findings Housing + Services Make a Difference
More than 80% of supportive housing tenants are able to maintain housing for at least 12 months
Most supportive housing tenants engage in services, even when participation is not a condition of tenancy
Use of the most costly (and restrictive) services in homeless, health care, and criminal justice systems declines
Nearly any combination of housing + services is more effective than services alone

14. AB 2034 Evaluation Sponsors
California Institute of Mental Health
Conrad N. Hilton Foundation
Thanks to both organizations for supporting this work. Particularly important timing, given the opportunities presented by MHSA for housing consumers.

15. Purpose of Evaluation
Identify the range of housing strategies implemented by the 34 counties that have received AB2034 funding;
Determine if there is any correlation between the housing strategies or range of strategies that a county (or program within a county) employed and successful housing outcomes for AB2034 participants;
Begin to calculate the immediate and projected long-term costs associated with each housing strategy.
We have gathered data related to the first two bullets so far.

16. There is a wide range of experience in:
Major Findings
Lots of differences among counties (and among programs within counties)
There is a wide range of experience in:
Enrolling and serving homeless people
Implementing a wide range of housing strategies
Achieving housing outcomes

17. Major Findings Consumer Preferences
Most consumers want their own apartment without roommates
Majority of consumers don’t want the structure and rules associated with “clean and sober” housing, but program staff think consumers need a mix of housing models (including “clean and sober” and “low demand” housing)
Nearly all counties report that there is not enough affordable housing available in their community
Survey responses:
Affordability is top concern, followed by a need for housing that offers supportive services and housing providers that are tolerant and understanding of the consumers served by AB2034 programs.

18. Housing is Really Important!
Major Findings
Housing is Really Important!
If you give consumers housing, they are MUCH more likely to stay enrolled in the program.

19. Who is Being Served by AB2034?
Major Findings
Who is Being Served by AB2034?
CSH identified 4 indicators of counties/programs that are
serving people with the most barriers. These indicators are:
At least 70% of consumers were homeless at the time of enrollment
At least 60% of consumers were on the streets at the time of enrollment
Average length of time homeless in past 12 months was more than 180 days
Average length of time incarcerated in past 12 months was more than 50 days, or at least 40% of consumers were incarcerated during the 12 months before enrollment
All of these indicators relate to consumers currently enrolled in the AB2034 program.

20. Major Findings Housing Outcomes
Programs that enroll “more challenging” consumers (those that have had longer histories of homelessness or more barriers to housing stability) are not getting worse results in terms of housing outcomes, in fact sometimes the results are better
“Housing readiness” is not a good predictor of housing outcomes
For the first bullet, for programs that serve consumers with average of 6 months or more of homelessness before enrollment, there are better housing outcomes (higher % of consumers get into housing and stay there)
Second bullet: This is especially true if housing options are available to meet the needs of consumers with multiple barriers to housing

21. Major Findings Housing Strategies
Some strategies are being used by nearly every county – and offered to virtually every consumer. These include:
Advocacy on behalf of individuals to help them find and get housing
Supportive services to help people keep housing
Back-up problem-solving help for landlords

22. Housing Strategies, cont’d
Major Findings
Housing Strategies, cont’d
Other widely implemented housing strategies include:
Assist consumers to apply for housing subsidies
Provide short-term subsidies or help with move-in costs
Provide long-term rent subsidies to some consumers
Provide temporary or transitional housing to get people off the streets and/or for respite/crisis
Second bullet (short term subsidies)
Nearly all programs offer this help – at least to some consumers
Some programs offer this help to nearly all consumers
Third bullet (long-term subsidies)
11 programs use AB2034 funds to provide long-term subsidies to 30-50% of consumers
6 more programs use AB2034 funds to provide long-term subsidies to more than half of consumers
And many other programs provide rent subsidies to a smaller number of consumers
Fourth bullet (temporary or transitional housing):
Large counties are more likely to use transitional housing or residential treatment programs and small counties are more likely to use hotels/motels

23. Housing Strategies, cont’d
Major Findings
Housing Strategies, cont’d
Some strategies are used in about half of the counties/programs:
Actively recruiting landlords, systematically finding available units, making arrangements with landlords to secure the next vacant unit
Master-leasing buildings or apartments within buildings and sub-leasing units to consumers
Use AB2034 funds to secure dedicated or set-aside units for consumers
First bullet - 44% of programs do this, more often the large counties
Second bullet – 46% of programs do this, more often in Los Angeles
Third bullet – 41% of programs do this, more often in small counties

24. Housing Strategies, cont’d
Major Findings
Housing Strategies, cont’d
Strategies more likely to be implemented in large/urban counties:
Administer Section 8 or Shelter + Care rent subsidies that are available to consumers
Partner with Housing Authority or other public agencies that control rent subsidies
Work with other supportive housing providers

25. Housing Strategies, cont’d
Major Findings
Housing Strategies, cont’d
A small, but growing number, of counties/programs are getting involved in developing or operating permanent supportive housing.
Nearly 1/3 of all counties – both large and small counties
Fewer programs in L.A. where programs are more likely to work with existing supportive housing providers
Strategies include using AB2034 funds (especially one-time funds) to buy or master-lease and renovate apartments or buildings that will be rented to consumers

26. Overall Focus of Housing Strategies
Major Findings
Overall Focus of Housing Strategies
About a third of counties/programs report that the primary focus of their housing activities is on helping INDIVIDUALS
About two-thirds report that their housing activities focus on BOTH helping INDIVIDUALS and EXPANDING HOUSING OPPORTUNITIES by working to develop housing and/or build partnerships with landlords
Small/rural counties are more likely to report their primary focus is helping individuals
Large/urban counties are more likely to report their primary focus is on increasing the availability of housing or both helping individuals and expanding housing opportunities

27. Effective Strategies
The most successful counties/programs are using a range of housing strategies including:
Partnering with housing providers
Recruiting landlords
Securing rent subsidies or set-aside units
Counties/programs that have been less successful have focused primarily on individuals and have not (yet) expanded the supply or range of housing available to consumers
Second bullet:
Possible reasons include
Some communities have limited resources (such as a very limited supply of rental housing and/or housing subsidies from other sources, and few developers of affordable housing)
Some counties are developing projects and new partnerships to address the need, but the housing is not yet available

28. MHSA Capital Facilities and IT
Approximately $325 million will be available for “capital facilities and technological needs” to implement plans for mental health services over 4 years (FY 05 through FY 08)
Funding to implement local plans for services for children, transition-aged youth, adults and older adults, including prevention and early intervention services
Cost of IT infrastructure has not yet been determined so it is not known how much funding will be available for other capital needs

29. Other Capital Facilities Priorities Housing is essential – but not the only need
Consumer / peer operated wellness & recovery support centers
Family Resource Centers
Crisis stabilization and residential care as alternative to hospitalization
Mental health services co-located with community-based services including schools, primary care clinics

30. Resources available for housing include:
MHSA Funds Can Leverage Other Sources of Funding for Capital Facilities
Resources available for housing include:
MHP Supportive Housing and Special Needs Programs (Prop 46 Housing Bond) administered by Department of Housing and Community Development (HCD) (through 2007)
Special needs loan program from California Housing Finance Agency (CalHFA)
Low Income Housing Tax Credits
Federal funding from US Department of Housing and Urban Development (HUD) including Homeless Assistance Programs coordinated through local “Continuum of Care” and resources administered by public housing authorities (PHAs)
Other resources controlled by City and County governments, which may be coordinated through 10-Year Plans to End Homelessness” or other inter-agency collaborations

31. Challenges to Creating Supportive Housing
Integrated services & supportive housing are products with proven effectiveness ending chronic homelessness – but without a system to produce them
Homeless people must hunt for and combine discrete services for their needs
Every project is a patchwork of authorizations and funding
Often, success means using money for purposes that weren’t officially intended

32. A Vision for a Better Future
Reliable sources of funding
New sources of funding
Supportive housing as “normal response”
Streamlined process for approving service and housing funds

33. To learn more
about supportive housing
visit our website