Housing First

The following report appeared in the Sunday, July 1, 2012 edition of The Dallas Morning News. "Housing first" and the work of CitySquare's Homeless Outreach Team is the focus. Not mentioned in the report are the details of a very creative, innovative alliance that involves Downtown Dallas, Inc. and CitySquare's Social Work Services department and our AmeriCorps team. Lots to think about here. As always, I'm eager to read your reactions!

Housing first, treatment later: Dallas homeless agencies experiment with new approach

CHRISTINA ROSALES

Grant Wells often wakes up on the back porch of his social worker’s house in East Dallas, having slept off a half-liter of vodka.

He is among the hardest of the hard-core homeless, an alcoholic who has been on the streets 20 years. And soon, he’ll move into his own, publicly subsidized apartment, without any prior obligation to get counseling or quit drinking. “We want to get him a home that’s near the bar,” said the social worker, Jonathan Grace, who has been on the case eight months. “It sounds strange, but that’s his comfort zone and those people there are his support system.” Wells is being placed through a method called “housing first,” in which people are moved directly from the streets into homes.

Advocates argue that housing is a basic human right — not a reward for getting sober. Critics say it’s unfair to charge people with the responsibility of caring for their own homes before helping them overcome demons such as alcohol and drug abuse. Several studies done in Seattle, New York and Denver showed the method ultimately saved taxpayers money by cutting the amount of emergency and legal services needed to care for the homeless. According to a study published in the Journal of the American Medical Association, the Seattle participants in a housing-first program cost taxpayers more than $4,000 a month. After six months in a housing-first program, the 95 participants cost an average of $1,500 monthly. After a year, they cost about $950 per month. The researchers showed costs eventually dropped off the longer participants stayed in permanent housing — and took advantage of support services.

The approach has been adopted by several local advocacy groups for the homeless, but others remain unconvinced, saying they don’t have enough caseworkers to constantly monitor a population placed in housing before treatment. “I can’t get too excited about the idea,” said Liam Mulvaney, president and chief executive of LifeNet, a nonprofit that provides supportive housing for those who suffer from mental illness. He acknowledged that the housing-first approach works in Seattle and Los Angeles, but he says that’s because those cities have more resources. “If we constantly have to deal with someone being drunk or smoking pot or hearing voices, it’s distracting,” Mulvaney said. “That doesn’t seem like the best use of our already scarce resources.”

‘Washing Christ’s feet’

Wells, 59, and his caseworker make an unlikely pair: Grace, with long hair and a love for heavy metal; Wells, a homeless former Marine. Grace’s employer, the nonprofit group CitySquare, took on Wells’ case after watching him fish through trash bins in Deep Ellum for meals. Wells hasn’t read the research on housing first. He’s unaware of the method, other than it’ll help him settle into a home. Until then, he often finds a bed on Grace’s porch, usually barefoot after losing his shoes. Grace doesn’t seem to mind. He drags Wells inside to clean him up for his next appointment at the Veterans Affairs office, washing his bruised and battered feet.

“It’s the closest I’ll come to washing Christ’s feet,” Grace said. “It’s this disgusting, humbling thing. But I realize taking care of Grant is not a chore. It’s a blessing. “There shouldn’t be any degradation,” Grace said. “They are our neighbors and our friends.”

Wells could be just days away from moving into his new apartment through the Housing First Program with Veterans Affairs of North Texas. After that, according to the plan, he’ll get treatment to wean him from vodka. No matter how long that takes, he will have a home, said Teresa House-Hatfield, director of the Comprehensive Homeless Center at the Dallas VA Medical Center.

Nontraditional model

The housing-first approach was developed by New York researchers and social workers in the 1990s to target mentally ill and chronically homeless people. Since then, several nonprofits have adopted the method across the country, from New York to Los Angeles. In traditional models, the homeless are moved from the streets to shelters, shelters to transitional housing, and, finally, into permanent housing.

The Department of Housing and Urban Development allocated $1.5 billion in grants for a three-year program to end homelessness through prevention and “rapid re-housing.” They called housing-first methods among the best for communities to end homelessness.

“We have to find ways to have less transition time before permanence,” said Mike Faenza, president and chief executive of the Metro Dallas Homeless Alliance. “The value in this is people are best served when they are secure, when they are in permanent housing.” A few organizations have adopted variations of housing first, including Metrocare Services in 2006. The VA first received funding for its program late last year, but started providing vouchers about a month ago.

In the spring, a housing campaign called 100,000 Homes linked several local homeless advocacy groups to identify some of those “vulnerable” homeless men and women who would benefit from housing first. The groups went to homeless encampments to find those who refuse shelter and treatment.

Advocates and social workers such as Grace have worked to connect those hard-core homeless to the VA or other nonprofits, some of which use housing first as a method. House-Hatfield said about 50 out of the 740 housing vouchers issued by the Dallas VA are going toward housing-first approaches. Most of the men and women who are part of the effort were using no veterans’ services or benefits previously.

“If you think about it, it makes all kinds of sense,” said Larry James, president of CitySquare. “How do you get control of your life if you’re still on the street? You spend so much of your time and energy figuring out where you can sit and where you can eat.”

Wells agreed. Giving up drinking while sleeping on the streets “doesn’t seem to work,” he said. In exchange for his housing, he’ll sign a lease and prove that he is chronically homeless and agree to weekly visit from social workers or nurses. Wells also will pay a maximum 30 percent of his monthly income for the apartment, or at least $50 a month. The rest will be covered by the Dallas Housing Authority. The staff of counselors and nurses cannot discharge veterans if they relapse, though veterans involved in illegal activity can face consequences with police or landlords.

“We continue to work with them despite their use or relapse,” House-Hatfield said. “Even if they fail to be successful at one apartment location, it doesn’t mean we’d give up on them. As long as they’d be willing to try.”

Different approaches

At other agencies, the approach remains traditional. At The Bridge, the city’s downtown homeless assistance center, social workers continue to use a recovery-based approach. Someone who walks into The Bridge isn’t given a set of keys. “It could take two months or it can take two years,” said Jay Dunn, president of The Bridge.

The homeless are given support to deal with mental illness, addictions and legal issues before they are eligible for housing. And once they do get permanent housing, data show a 90 percent rate of success.

“There isn’t a competition between the two approaches,” Dunn said, referring to housing models for the homeless. “I think we need all of these approaches for different people.”

AT A GLANCE: A picture of the homeless in Dallas

The Metro Dallas Homeless Alliance conducts an annual census of the homeless population. The most recent count found:
• 407 individuals classified as “chronically homeless,” meaning they’ve been on the streets longer than one year and have a disability.
• 3,447 total individuals who were homeless.
• 496 adults who responded to surveys said they had children living with them on the night of the count.
• 8 families counted were identified as “chronically homeless” and include a parent with a disability. • 25 percent of those surveyed reported becoming homeless in the past year.

ANOTHER LOOK: Cheaper alternative

A recent study of the cost of caring for the homeless in Dallas found:
• It costs an average of about $39,000 annually to care for homeless individuals who require the most attention. That includes emergency treatment and trips to jail.
• A person can be housed and treated for $15,000 a year under housing-first methods.