Supportive Housing 101

1. Supportive Housing 101 Ryan Moser, CSH Katrina Van Valkenburgh, CSH Annual Conference Georgia Supportive Housing AssociationNovember 2012 www.csh.org

4. What Would You Like to Get Out of this Session? • Take 5 minutes • Talk in small groups about what you want to be sure to get out of this session. What do you want to know or understand when the session is over? • Report back on what you want to be sure we cover.

5. Agenda • CSH • What is Supportive Housing? • What is its Impact? • PSH as Evidence Based Practice. • What is the National Context around homelessness? • How to Create PSH? • Examples of PSH Projects.

6. Who is CSH? CSH helps communities throughout the country transform how they address homelessness and improve people’s lives through quality supportive housing. • Project Assistance and Lending • Public Policy and Systems Reform • Industry Leadership and Capacity Building

7. CSH Products and Services • Consulting • Planning • Research and Evaluation • Policy Work • Program Design • Lending • Loan Products • New Market Tax Credits • (CDFI certified) Tools • QAP Survey • Housing Options • Financial Modeling • PHA Toolkit Training • Quality • Technical Assistance • Supportive Housing Institute In everything we do, CSH collaborates with public, private and nonprofit stakeholders to create solutions for communities’ toughest problems.

8. How CSH Works • Driving Systems Change • Influencing Government Affairs and Policy • Advancing the Supportive Housing Industry • Funding the Field • Serving Vulnerable Populations • Building Strong Community Partnerships

9. CSH National Initiatives We pair our national initiatives and expertise with our on-the-ground knowledge and influence. • Keeping Families Together • Returning Home Initiative • FUSE • CSH Charrettes • Social Innovation Fund Initiative

10. CSH Impact: By the Numbers • Catalyst for 143,000 units of PSH • Over 40,500 people living in CSH-backed PSH • Worked in 25 states • 50,000 people trained in last 5 years • Over $200 million in loans • Nearly $100 million in grants • $2.16 billion leveraged by state and local policy efforts in the last 3 years

11. CSH Across the Country

12. What is Permanent Supportive Housing?

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

14. What is Supportive Housing? Case Management Affordable Housing Employment Services Mental Health Services Housing: Affordable Permanent Independent Support: Flexible Voluntary independent Health Care Substance Abuse Treatment Coordinated Services

15. Is Supportive Housing for Everyone? Supportive housing is proven to work best for very vulnerable men, women and families. • Chronically homeless • Frequent users/multiple barriers • Chronic health issues • Substance Use Issues • Mental health issues

16. Who is Supportive Housing 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.

17. Variety of Supportive Housing Types • Scattered Site • Single Family Homes • Apartments • Single Site • Rehab or New Construction • Integrated • Rehab or New Construction • Master Leasing

18. Adaptability: A Solution in Multiple Policy Sectors

19. Who Creates Supportive Housing? • Mental Health and other Service Providers • Homeless Service Providers • Non-Profit and For-Profit Affordable Housing Providers • Public Housing Authorities • Private Developers and Private Landlords • County and Local Governments

20. Principles of Best Practice • Housing costs must be affordable to the tenant (i.e. less than 30% of income towards rent) • Choice and control over one’s environment is essential • Housing must be permanent as defined by tenant/landlord law – and housing is “unbundled” from services • Housing and services roles are distinct • Housing must be flexible and individualized: not defined by a “program” • Integration, personal control, and autonomy • Services are Recovery-Oriented and Adapted to the Needs of Individuals

21. Why Permanent Supportive Housing?

22. Why Supportive Housing? • Research indicates that approximately 10% of people who experience homelessness are chronically homeless • This 10% consumes more than 50% of all homeless services – leaving the homeless services systems struggling to effectively serve those who could exit homelessness relatively quickly. Dennis P. Culhane, University of Pennsylvania

23. How Does Supportive Housing Break the Cycle of Homelessness? • Creates stability • Fosters self-sufficiency • Facilitates the process for securing and retaining employment • Helps tenants maintain and increase wellness and decrease harms through flexible, available, accessible and relevant services • Encourages peer support through tenant associations, peer support groups and other opportunities for community building

24. The Institutional Circuit of Homelessness and Crisis

25. Supportive Housing Reduces Use of and Costs for: • Hospital inpatient care for medical and psychiatric conditions • Hospital emergency room visits – especially for the most frequent users of ER • Psychiatric emergency and institutional care • Residential mental health & substance abuse treatment – especially detox • Jails and prisons • Emergency shelters

26. A Strategy That Works for People Housing is Healthcare • Even when services are not a condition of tenancy, tenants participate at high rates: • 81% health care utilization • 80% mental health treatment • 56% substance abuse services

27. A Strategy That Works for Public Systems (Portland, ME)

28. 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 • “Housing First” models with adequate support services can be effective for people who don’t meet conventional criteria for “housing readiness”

29. Good Tenants

30. Supportive Housing as Evidence Based Practice

31. Why Implement Evidence Based Practices? According to the New Freedom Commission on Mental Health: If effective treatments were more efficiently delivered through our mental health services system … millions of Americans would be more successful in school, at work, and in their communities. — Michael Hogan, Chairman

32. The Evidence Supports Permanent Supportive Housing • Evidence of impact overall on resident stability: “the most potent intervention” • Evidence of greater impact over alternatives • Evidence of cost benefits • Evidence on the core principles (fidelity)

33. Dimensions of Permanent Supportive Housing Fidelity Scale • Choice in housing and living arrangements • Functional separation of housing and services • Decent, safe, and affordable housing • Community integration and rights of tenancy • Access to housing and privacy • Flexible, voluntary, and recovery-focused services

34. National Context Around Homelessness

35. McKinney Vento Act, remember 1987?

36. What is the HEARTH Act?

37. The Past: What the Homeless System has looked like historically

38. As providers shift their philosophy from managing homelessness to ending homelessness… How do we change our models? The Future: What the Homeless System will look like moving forward shifting

39. Key Elements of HEARTH 1) Federal Strategic Plan 2) Modified Definitions of Homeless and At Risk 3) Program Changes 4) Administrative Changes 5) Performance Measures

40. Opening Doors: Federal Strategic Plan to End Homelessness

41. Call to Action “Transform homeless services into crisis response systems that prevent homelessness and rapidly return people who experience homelessness to stable housing.”

42. HEARTH Act Roadmap

43. Old versus New Competitive Grants McKinney-Vento (Old) HEARTH Act (New)

44. Key Changes & Mandated Activities • A change from a focus on individual programs to focus on coordinated local systems. • Coordination with other community plans • Coordinated or centralized intake

45. Key Changes & Mandated Activities • An emphasis on performance measurement and outcomes, measured by data.

46. Key Changes & Mandated Activities • A movement away from “housing readiness” and long periods of transitional services • Focus on homeless prevention whenever possible or the quickest return to housing whenever that’s not possible through rapid rehousing or permanent supportive housing

47. HEARTH Performance Measures • Reduce average length of time persons are homeless • Reduce returns to homelessness • Improve program coverage • Reduce number of families and individuals who are homelessness • Improve employment rate and income amount of families and individuals who are homeless • Reduce number of families and individuals who become homeless (first time homeless) • Prevent homelessness and achieve independent living in permanent housing for families and youth defined as homeless under other Federal statutes

48. Requesting HUD TA • For recipients: technical questions re: CoC Rule • www.hudhre.info: ask a question • HUD TA • www.hudhre.info: request TA • No specific TA provider guaranteed but can suggest or pick relevant topics

50. Creating Supportive Housing:Services, Operating and Capital