The New York Nonprofit Press April 2014 edition featured Project Renewal as the Agency of the Month!
DHS Commissioner Gilbert Taylor commented: “Throughout its rich and venerable history, Project Renewal has demonstrated great innovation and ingenuity in the field of homeless services, and employs programs that enable more clients to transition back to self-sufficiency."
Project Renewal Blog
The New York Nonprofit Press April 2014 edition featured Project Renewal as the Agency of the Month!
Hey baseball fans. Now there’s a perfect alternative to the rubber chicken charity dinner. It’s happening on Friday, May 9th, at 7:10pm, as the Mets once again go up against their longtime nemesis, the Philadelphia Phillies. It’s simple. May 9th is Project Renewal Night at Citi Field. Buy a ticket to this game (or, better still, buy a block of them, invite your friends and make it a party) and be part of helping thousands of New Yorkers renew their lives at the same time.
It’s all part of the New York Mets' “Fill the Park for Charity” nights initiative, launched last year, in which certain games will have a designated charity associated with them as a way to enable nonprofits to raise money through the sale of discounted tickets for that specific game, and to make their cause visible at Citi Field for a night.
Why not jump-start your summer fun at Citi Field for this game? Order your tickets using the link below and help us help the New Yorkers we serve hit singles, doubles, triples, home runs, and even grand slams in turning their lives around.
The human services non-profit sector is in the midst of a management revolution, a revolution built on measurement.
Words like evaluation, performance management, outcomes measurement, and performance based contracts are now joining the ranks of quality assurance, compliance reviews, and performance audits in the minds of nonprofit leaders. With all of these concepts flying around, many non-profit leaders don’t know the difference between them; they just want to be running effective programs! So let’s say you want to get in on all of this ‘outcomes’ stuff – where do you begin? What does this all even mean?
This post is my attempt to cut through the confusion, and define some of the main differences among the different ways of measuring nonprofits.
Compliance vs. Excellence
One the most important distinctions to make is between measurement for compliance and measurement for excellence. My work at Project Renewal has four main components, which I will use as examples to differentiate those two approaches. Those components are (1) regulatory compliance, (2) quality assurance, (3) performance measurement, and (4) evaluation.
The first two items are about making sure that we are doing the minimum necessary for our nonprofit to be considered doing ‘good’ work. These are more traditional models of measuring the work of a nonprofit, and ones that most leaders should be familiar with.
- Regulatory compliance is about following the rules – if we didn’t meet these criteria, we could be facing some serious penalties. We measure this through activities like doing compliance audits, monitoring activities, and investigating issues as they arise.
- Quality Assurance, in the human services world at least, means making sure that the services that we are providing meet certain quality standards. We measure this through activities like reviewing service documentation and getting feedback from clients and staff.
The last two items on my list aren’t about doing the least that we can do, but about being as excellent as we can be. Instead of just trying to clear the low bar, we strive for the gold metal and setting new world records for how amazing programs can be.
- Performance Measurement and Management is perhaps the most useful measurement solution to nonprofit leaders, and if your organization is not currently doing this, it’s time to fix that. Performance Measurement work involves identifying important performance measures, regular data collection, and using tools like reports and dashboards to monitor performance. Performance Management is then using that data to manage your staff and programs.
- Evaluation is a much more rigorous and well defined set of activities – in fact, there is even a professional association dedicated to this field. Evaluations are generally conducted by professional evaluators to answer specific questions about the effectiveness of various programs, although there are lots of types of evaluations done in lots of different ways. Generally, nonprofit capacity to conduct evaluations comes after capacity to do performance measurement.
The difference between performance measurement, evaluation, and research is often hard to understand, but hopefully the chart below outlines it a little clearer.
Your priorities and resources are will determine which way you want to approach measurement, as will the type of program that you run. You may use one or more of the above types of measurement in your organization, and you might be doing things that I don’t talk about here. There are lots of other ways to think about measurement in nonprofit organizations, but I hope this provided a framework for you to think about measurement in your nonprofit workplace.
As Director of Strategy and Evaluation at Project Renewal, Patrick lGermain leads a team of internal evaluators, conducts a wide range of evaluative activities, and manages any external evaluator relationships. Patrick also runs a professional networking group on issues of performance measurement and management in the non-profit and public sectors which currently has over 120 members and has had ongoing bimonthly events since its inception. Patrick has an MA in Public Administration from NYU Wagner.
Many thanks to everyone who attended the event this morning organized by Patrick Germain, Project Renewal's Director of Strategy & Evaluation and also President of NYCE.
Below find the event info, the Storify feed from the Twitter conversation, and (soon!) the transcript of the event.
Information and Technology in Human Services:
Who's at the Table and How We Can Work Together More Effectively
Cosponsored by the New York Consortium of Evaluators (NYCE)
& NYU Wagner Graduate School of Public Service
Ivy Pool – Executive Director, HHS Connect at the NYC Mayor’s Office of Operations
Marlowe Greenberg - Founder and Chief Executive Officer, Foothold Technology
Brad Dudding – Chief Operating Officer, Center for Employment Opportunity
Derek Coursen, Director of Planning & Informatics at Public Health Solutions
Patrick Germain, Director of Strategy & Evaluation, Project Renewal and President of the New York Consortium of Evaluators
Overview: Different groups of stakeholders in the human service sector (nonprofit leaders, policy makers, government funders, philanthropic funders, evaluators, service delivery staff, clients, etc.) understand the role of information, data, and technology in the human services sector in different ways. Lack of coordination among these various players leads to very concrete challenges in the development of information systems. Nonprofits have a lot of potential in using data and technology in new and innovative ways, but they often struggle with the most mundane challenges of data management, basic technology support, and meeting the requirements of government and philanthropic funders. Government agencies have their own set of complicating factors as well. How can the human services sector push past these basic challenges to benefit from the great potential that data and modern technology hold? The panelists will discuss these challenges with an eye towards solutions that are relevant for both individual organizations/projects as well as the human services sector as a whole.
Transcript of the event will be posted shortly.
- Among industrial nations, the US has the largest number of homeless women and the highest number on record since the Great Depression. 1
- An estimated 50% of all homeless people are women. 2
- Up to 92% of homeless women have experienced severe sexual or physical assault at some point in their lives. 3
- 57% of homeless women cite sexual or domestic violence as the direct cause of their homelessness. 1
- 63% have been victims of violence from an intimate partner. 3
32% have been assaulted by their current or most recent partner. 3
- 50% of homeless women experience a major depressive episode after becoming homeless. 1
- Homeless women have three times the normal rate of Post-Traumatic Stress Disorder. 1
- Homeless women are twice as likely to have drug and alcohol dependencies. 1
- Homeless women between 18 to 44 years old are 5 to 31 times more likely to die than women in the general population. 4
- Homeless women in their mid-fifties are as physiologically aged as housed women in their seventies. 1
- Victims of domestic violence experience major barriers in obtaining and maintaining housing and often return to their abusers because they cannot find long-term housing. 5
1. Colorado Coalition for the Homeless: http://www.coloradocoalition.org/!userfiles/TheCharacteristicsofHomelessWomen_lores3.pdf
2. Homeless Women & Children: The Problem and the Solution http://voices.yahoo.com/homeless-women-children-problem-solution-368646.html
3. National Alliance to end Homelessness http://www.endhomelessness.org/pages/domestic_violence
4. Homelessness in the United States: History, Epidemiology, Health Issues, Women, and Public Policy Med Scape http://www.medscape.com/viewarticle/481800
5. A. Correia, Housing and Battered Women: A Case Study of Domestic Violence Programs in Iowa (Harrisburg: National Resource Center on Domestic Violence, 1999) accessed via "The Dangerous Shortage of Domestic Violence Services"
Our hats are off to Emily Brown, Elizabeth Fasanya, Shanira Griffith, Aluta Khanyile, Jackie Moore, Jana Pohorelsky, Mizraim Reyes, Rosalind Williams, and Brittany Zenner. These nine Project Renewal staffers volunteered to be DHS HOPE surveyors. So, on Monday, January 27th, they were out in the frigid night, traveling some of this city’s meaner avenues, looking for anyone living on the streets.
As Emily Brown, who recruited our volunteers explains, DHS (NYC Department of Homeless Services) purposely chooses January to do the annual HOPE (Homeless Outreach Population Estimate) count, so that they can identify chronically homeless individuals, who tend to tough it out during the colder nights rather than use the shelter system.
HOPE count data factors into how the city allocates resources. An undercount could result in an shortfall of services and/or facilities and supplies on hand. So we are proud of our PRI staffers who braved the chill themselves so that when vulnerable New Yorkers seek help in the future, they will not get left out in the cold.
One of them, Mizraim Reyes, of our Medical Department, went a step further when she encountered a man who hadn’t eaten in a while. “I offered to call the DHS Van for him,” she recalls, “but he didn’t want to go to a shelter and leave behind his two shopping carts full of his possessions, which the shelter can’t accommodate. So I asked him, ‘Well what do you want us to do for you?’ and he said ‘I’m hungry,’ so we went to a deli and got him something to eat.”
A huge thanks to you all, our Project Renewal Champions of HOPE!
Lawmakers did not include an extension of long-term unemployment benefits in the recent budget passed before breaking for the holidays, causing 1.3 million Americans, including more than 127,000 New Yorkers to be cut off. But the effects of this inaction trickle down to those who are most vulnerable.
Last week Labor Secretary Tom Perez told reporters that many of the unemployed who lost their benefits have gone from a "position of hardship" to one that is a "catastrophe."
"They have been looking day in and day out for work," Perez said. "They are trying to feed their families. They are trying to stave off foreclosure. They are making judgments between food and medicine -judgments that no person in America or anywhere should have to make."
The 700 clients served annually by Project Renewal's Next Step Employment Program arrive in need of a full spectrum of employment assistance -- including education and skills training, job placement, and retention support in the comprehensive "one stop shop" setting we provide.
Many Next Step clients have lived for years in a state of crisis similar to the current situation described by Secretary Perez. They face additional hardships to attaining jobs and a steady income stream as many struggle with poor health caused by mental illness or addictions, and according to Project Renewal Deputy Director Stephanie Cowles the recent cut in unemployment benefits will only worsen their situation.
The recent loss of unemployment benefits will clearly affect our work at Next Step. Although very few Next Step clients receive unemployment benefits, we anticipate a large number of people whose unemployment benefits were discontinued will flood the job market causing strong competition for low level jobs and negatively impacting Next Step clients chances for obtaining these jobs.
As we approach the one year anniversary of Sandy Hook, Linda Rosenberg, president and CEO of the National Council for Behavioral Health, calls attention to the need for expanding access to mental health services America:
One in 5 Americans are, right now, living with a mental illness. Nearly half of them go without care, either because they can't afford it or, more often, because they don't know where to go or what to do. We must change that...
One year later, Congress is still debating two pieces of bi-partisan legislation that would go a long way toward ensuring more people get the mental health treatment they need.
The Excellence in Mental Health Act would improve the quality of mental health care and expand access to mental health treatment for hundreds of thousands of people served by community mental health centers.
The Mental Health First Aid Act would expand access to public education programs designed to help the teachers, first responders and others identify, understand and respond to signs of mental illnesses and substance use disorders. People are hungry for these programs. Since 2008, nearly 150,000 people have been trained in Mental Health First Aid – 40 percent of them in just the last year, since the Sandy Hook tragedy.
We met with Ethan Balgley, an intern for the past year with our mobile medical vans. this is part one of a two part series from that interview.
How did you come to Project Renewal?
As an AmeriCorps volunteer through the Avodah (the Jewish Service Corps) I wanted to get hands on front line work with clients and to be in a medical setting close to clinical work before going to medical school next year. Project Renewal was perfect for that.
The point of the AmeriCorps program is to develop leaders in urban poverty programs in the United States. I had focused on health disparities in urban poverty situations abroad so now I got to look at it in this country.
What is one thing you have learned this year?
Lack of housing and not actually a health problem at all because the lack of housing contributes to a host of problems. There is an idea in healthcare for the homeless of "housing as healthcare." This links urban policy at a more macro scale to micro level health problems that we see.
If you were telling a friend about what you do, how would you explain it?
I do outreach with homeless people at a non-profit called Project Renewal in their medical department where I work on mobile medical vans.
This is unique and exciting because it is an incredibly low barrier way to access care and the kind of care a lot of homeless people aren't going to get. Many people are familiar with the fact that they can walk into an emergency room and get care of a certain kind. Even though there is no barrier there in terms of insurance, often times people have to wait for hours and hours unless they are in danger of death.
At Project Renewal we go to the places where homeless people are--clinics in shelters (both our own shelters and others) as well as a mobile medical program that brings vans to where homeless people congregate such as soup kitchens and shelters without clinics inside. We don't require people to have health insurance, and we help them get signed up for Medicaid if they qualify.
We give them kind of medical care that they can't find anywhere else. There are a very limited number of places where homeless people can get primary care at all, there are community health centers, New York City hospitals, and private doctors. Many private doctors will not accept Medicaid, and they certainly won't accept uninsured patients. City hospitals and community health centers by and large have incredibly long wait times to get an appointment with a primary care doctor. To have a service where patients can walk up to the medical van the day of and come in and see a primary care doctor is amazing.
There are a few other organizations where a homeless person can do that but you can count them on one hand in a city the size of New York , so what we are doing is definitely unique and valuable.
The Affordable Care Act redesigned the systems that deliver healthcare to the highest users of Medicaid—often homeless adults with chronic illnesses and serious mental illness that cause frequent emergency room visits.
But many of those men and women are unclear of how to access care now. For example, 41% of our shelter residents are eligible for Health Homes.
A Health Home is a network of caregivers that work in collaboration with one another to help men and women with chronic health conditions and serious mental illnesses.
This coordinated approach to healthcare is designed to improve health outcomes for the highest need patients and reduce costs for taxpayers.
We now have two staff members who work as Health Home Coordinators. By accessing a single network of caregivers, our Health Home Coordinators can refer homeless adults to every service they need – from an eye exam to mental health treatment.
Through participating in the Health Homes program, we’re making healthcare even more accessible for the homeless men and women who need it most.
This year's annual anniversary celebration of the Ft. Washington Men's Shelter had a special guest--the new NYC Department of Homeless Services Commissioner Michele Ovesey.
The New York City Department of Homeless Services (DHS) Commissioner Michele Ovesey (center) with Project Renewal President & CEO Mitchell Netburn (Left) and Dr. Norbert Sander, executive director of The Armory Foundation at The New Balance Track & Field Center.
Commissioner Ovesey commended the width breadth of Project Renewal programs. She said,
"I was amazed that Project Renewal was working on preventing homelessness and treating the underlying causes as early as 1967, a good 20 years before they were widely known."
Congrats staff and clients on 17 years!
What is the HOPE Survey?
In February New York City’s Department of Homeless Services and hundreds of volunteers completed its annual point-in-time HOPE census of the unsheltered homeless population, first conducted in 2005. The report details changes in the count of unsheltered homeless men and women by borough, and identifies whether they are found living in the subway stations and trains underground or at street level.
What does this mean for Project Renewal?
At Project Renewal we focus on serving the hardest to reach homeless men and women—those with mental illness, drug addiction, or both. These clients are most often homeless without shelter (those represented by the HOPE Survey) or are among the 11,000 single adults living in emergency housing.
So what can you do to help?
Four nights every week we partner with Manhattan Outreach Consortium to increase outreach to homeless men and women not in shelters by providing primary care through our medical vans.
These mobile clinics bring healthcare to homeless men and women where they are, delivering primary care to those who are also struggling with mental illness and addiction.
On those nights, healthcare providers seek out street homeless clients in places where they gather including behind the Port Authority Bus Terminal and the Harlem Y. The goal is to treat health needs before they escalate to emergency room visits and to encourage patients to seek ongoing care ideally in a residential treatment program.
What can your gift do today?
Provides needed items such as socks and sweatshirts, which ensures follow-up visits for continued care
Stocks the MedVan with first aid and over-the-counter medications for a week
Covers an OraQuick HIV/AIDS test and counseling
Gives 25 patients access to the MedVan, our mobile clinic that provides healthcare, psychiatry, lab testing, and pharmacy all in one van
Homelessness can rob a person of their sense of independence and self-worth. But as the men and women we work with regain their health, self-sufficiency, and housing we empower them to become their own advocate.
A newly formed coalition—United to End Homelessness—launched their campaign on the steps of City Hall last month, and our clients were there to make their voice heard. Joseph White, Recreation Specialist at Ft. Washington Men’s Shelter, reports on the day:
By: Joseph White
April 9th was a very good day; I and several clients went down to City Hall and joined with the United to End Homelessness campaign to speak about the importance of housing. The steps of City Hall were filled with various organizations that all came together for the same cause.
The Homeless United demonstration held on the steps of City Hall was an inspirational and uplifting event. It was an event that stood for Hope and Fairness, an event that brought different organizations from all over the city together. In a united fashion, over two hundred strong, we stood. We stood and we were heard. THE STEPS OF CITY HALL WILL NEVER BE THE SAME.
Several clients attended; here are their experiences in their own words:
My experience at the demonstration was very fulfilling for myself and the benefit for others that are homeless. I feel like I’m a part of a revolution for the neglected.
It was one of the most uplifting experiences I had in my life. I met very important people who gave me hope. The system works if you work the system. I’m looking forward to housing, and I’m also looking forward to participating in any other future events that support my cause.
I felt like I was a part of something big.
It was hot but I was happy to be here.
It was an honor to be here, I felt like I helped my cause. I gained a sense of what it is like to be in a situation representing the public in a matter of importance to many people.
It was a great day for the men. I always love when the clients feel like they’re a part of the solution and the world.
A special thank you to Ft. Washington Director Etta Graham for setting up and organizing the field trip for us.
United to End Homelessness
United to End Homelessness is a new coalition of advocates, homeless and formerly homeless individuals, service providers, faith leaders, and experts on the issue of homelessness in New York City.
Supportive housing ends homelessness! Geffner House staff members joined City Council Member Annabel Palma at a City Hall rally on March 18 to urge restoration of social service funding slashed in the Mayor’s proposed budget for FY 2014.
Clinical Director Amy DeFilippi (lower left) gave her first-hand account of how case managers help tenants regain health and stay out of shelters, prisons, and emergency rooms. Her work experience is backed up by a 2010 HASA study that found that on-site case managers reduced emergency room visits by 90% and resulted in savings of $80,000 in acute care PER person per year.
In Amy’s own words:
The right to housing and the right to healthcare are necessary, together, to end homelessness in New York. Homelessness and poor health are locked in a cycle of cause and effect. Poor health puts one at risk for homelessness, as it is estimated that one half of the personal bankruptcy cases in the US are caused by health problems. Many of these people, particularly those with mental health and substance abuse problems, end up in the costly shelter system and flood our emergency rooms with needs better served by primary care physicians.
Supportive housing works to end the cycle of homelessness for our city’s neediest people. It is a permanent solution to homelessness that links people with mental illnesses, substance abuse issues, HIV/AIDS to cost affective, affordable and stable homes. With on-site case management and a full time clinical staff, tenants have the support they need to address their ongoing health, mental health, and addiction issues.
I am the Clinical Director Project Renewal’s Geffner House, a 307 unit SRO, or Single Room Occupancy, in Times Square. A large percentage of our clients are from HASA. In New York City alone there are 4,500 tenants with HIV/AIDS living in supportive housing. I have been working as a supervisor and case manager for several years and in this time I have seen the work that on-site case management does to stabilize people which limits their recidivism into the shelter system, prison, and emergency rooms.
In working with one of my clients I have witnessed his four yearly inpatient psychiatric hospitalizations dwindle to two years without any inpatient visits. With my support he has found the right mental health providers to stabilize him psychiatrically, and I have provided him with the consistent reminders necessary to take all of his medications daily. He has now developed a healthy routine that he did not feel was possible from his many years of being street homeless. With my support and encouragement he has established consistent medical services. The stability in his health has given him the courage to battle his 45 year substance abuse and dependence problems. I am happy to say that he is now one year sober and counting. He attributes this to the daily support and encouragement our consistent therapeutic relationship has provided him. To use his words “you have reminded me that I have something to live for”.
I have come here today to say that the proposed budget cuts will not save tax-payers money. Churchill, Truman, Dostoyevsky have all said something along the lines of “A society is indeed measured on how we treat our most vulnerable population”. If we truly believe this as a society, then these proposed budget cuts are preposterous. They won’t save our city money, but they will deprive some of our most needy fellow New Yorkers of the much needed services and support required to live an independent life.
These proposed cuts will not save tax payers money. In 2010 HASA did an analysis of HASA funded supportive housing sponsored by Harlem United. They found that the result of on-site case managers reduced emergency room visits by 90%, and nursing home reliance by 54%. This resulted in a savings of $80,000 dollars in acute care PER person per year.
I am here to thank you for restoring the budget cuts from last year, and to thank the City Council for its ongoing support of HASA programs. But I am here, for the third year in a row, to ask you to continue to make supportive housing programs a priority for some of our neediest New Yorkers and to restore the proposed budget cuts.
More photos from the day
Alarmingly, homeless New Yorkers have a 1.5- to 11.5-times greater risk of dying relative to the general population, depending on age, gender, shelter status, and incidence of disease.
But the causes are changing.
According to this 2012 study by the NYC Department of Homeless Services, the top cause of death for both the NYC homeless population and the general population is heart disease.
Regular visits with a primary care provider are essential to identifying heart disease and helping homeless patients to manage this health condition before it escalates to crisis levels. Our comprehensive services to homeless New Yorkers include integrated healthcare—patients are connected to care through our shelter-based clinics, medical vans, and referrals in our transitional and permanent housing residences.
Prevention begins on the streets where our medical vans are providing critical interventions to assess patients’ heart disease risk: in the past year, we assessed 61% of clients for cardiovascular disease risk. The vans are also reducing patients’ risk by helping them to manage co-occurring conditions which could lead to heart disease, such as smoking and high blood pressure. In the past year, our vans provided tobacco cessation interventions to 77% of patients and helped 60% of hypertensive patients to control their blood pressure levels.
 NYC DHS. Bronx Health and Housing Consortium: Opportunities for Collaboration. Shared Approaches to Death Prevention Among Homeless Individuals. Dec. 2012
Project Renewal: Homeless Patients, High Quality Healthcare February 2013 Quality Improvement Grantee Spotlight
To successfully treat more than 8,600 homeless patients a year, you have to be dedicated and diligent. HRSA-supported health center Project Renewal finds that it also pays to hold yourself to the same quality standards as providers who practice in a less challenging environment.
- Deploy an interoperable electronic health record? Check.
- Qualify for the Federal Meaningful Use incentive program? Done.
- Integrate the principles of the National Quality Strategy? In process.
- Achieve the goals of Healthy People 2020? All on board.
Controlling hypertension is never easy, but when your patients tend to seek care irregularly, move frequently, have a high prevalence of both chronic and acute conditions and distrust the medical system, it seems almost impossible.
But that’s exactly what Project Renewal has done. In 2011, 51 percent of hypertensive patients had their blood pressure under control; a 2012 chart review shows the number has climbed to 60 percent, thanks to close monitoring of medication compliance with an assist from local pharmacy students working with the program.
Go to the Mountain
Knowing that the many homeless patients will not come to Project Renewal, Project Renewal goes to the homeless patients.
Three mobile clinics (CARE – A – VANS), certified by the National Committee for Quality Assurance as Level 1 Patient Centered Medical Homes, regularly and at all hours go to homeless shelters, emergency housing and even New York City parks where homeless people are known to congregate.
They start small, first just walking around and becoming familiar to the homeless people. Over time, their presence in the community earns a level of trust and they begin to offer health services.
Because hypertension is so common and such a health threat, Project Renewal focuses on its prevention and treatment by providing health checks that include blood pressure and cholesterol testing at the first opportunity.
To help ensure patients follow treatment plans and remain in care, Project Renewal connects patients with other resources, verifies their eligibility for Medicaid and uses the electronic health record to schedule follow up appointments, order medications and exchange patient health information across providers.
Patients who later seek care at another Project Renewal mobile or freestanding clinic find providers who have instant access to their full health records and are fully prepared to respond in a patient-focused way that is consistent across providers.
Project Renewal HOPE Survey team took to the New York City streets on Monday, January 28th alongside 3,000 volunteers gathered to count the men and women sleeping there. Starting at 10pm on one of the coldest nights of the year, these volunteers spread out to every corner of the five boroughs, covering 7,000 HOPE areas designated to them includingstreets, subways, parks and even alley ways.
Organized by NYC’s Department of Homeless Services, the Homeless Outreach Population Estimate (HOPE) is a point-in-time estimate conducted every year citywide by the New York City Department of Homeless Services (DHS) since 2005. The survey is conducted in January to produce an estimate of the total number of individuals living unsheltered in New York City. The count helps Project Renewal and other agencies better target healthcare, outreach, and housing services to respond to the needs of unsheltered men and women.
Thousands of volunteers are needed in order to effectively survey the city and gather the most accurate estimate. Many thanks to Team Project Renewal —led by Emily Brown, and including Catalina Gironza, Kelsey Petrone, and Lisa Raffetto, who successfully completed their three areas in the Financial District.
- Housing First emerged because early interventions—focused on services—weren’t seeing results. by the mid-1990s, there were over 40,000 programs addressing homelessness; very few of them focused on housing.
- Housing First says something that is fairly intuitive—that people do better when they are stabilized in housing as soon as possible. Unstable housing impedes the effectiveness of interventions to address people’s problems. Homeless people themselves recognize this and generally identify housing to be their first priority.
- It’s a 3-Step Process:1) Crisis resolution and assessment to address immediate problems and then identify housing needs. 2) Housing placement, including strategies to deal with bad tenant and credit histories, identify units, negotiate with landlords, and access rent subsidies. 3) Service connections to provide housed people with services, or connect them to services in the community.
- It works most effectively for those who are chronically homeless. Chronically homeless people are those who spend years—sometimes decades—homeless. Most also have disabilities like severe mental illness and substance use disorders. Destitute, disabled, and with no place to live, they interact frequently with expensive publicly-funded systems such as jails, emergency rooms, and hospitals. Housing First can save public money as people reduce their use of these acute care systems.
- Rapid rehousing is another name for a Housing First intervention used for families and individuals who become homeless for economic reasons. It provides rent deposits and/or a limited number of months of rent assistance. Sometimes this serves as a bridge to longer-term rental assistance (such as Section 8 or even permanent supportive housing). Rapid rehousing strategies generally address services needed by linking re-housed households to existing services in the community, although direct services are sometimes provided.
- At least among the highest need people, the cost of housing can be offset by significant savings to public systems of care. housing of high-need people may more than pay for itself in savings to publicly supported systems like emergency shelter, medical care, and law enforcement, and is a cost effective way to support children and families.
- The structure of budget-making makes implementing Housing First difficult. Spending money on housing in order to save money on health care, incarceration, and so on, is difficult in a siloed public policy environment with annual appropriations. Savings in one silo (say, health care) do not necessarily accrue to another silo (say, housing). Those responsible for public budgets are not always persuaded by the argument that spending in one fiscal year would result in savings in another if they cannot access those savings to offset the initial spending.
- To succeed, it needs the attention of those concerned with housing and health, not just homelessness. Housing advocates need to build new partnerships with the medical community and business leaders concerned about health care costs. These institutions are also, often, well-positioned in a community to lead or sponsor collaborative solutions, for instance pooling investments in housing and public health infrastructures. It makes sense for housing advocates to continue to build the case that housing is a cost-effective intervention that can improve outcomes in a host of other areas including health care, corrections, employment, and education.