From Housing First to Housing Readiness

iAUDIT - This is part two of a two-part review of Housing First.

Last week, I reviewed how badly Housing First has failed. Now it’s time to move beyond bemoaning failure and plan for success, for moving from “Housing First” to “Housing Readiness.”

The first step to permanently reducing homelessness is to identify the goal.  The overarching goal should be to move people from homelessness to permanent housing, whether independent or supportive, based on individual needs.  Where this goal deviates from Housing First is the meaning of “housing”.  To a Housing First advocate, ‘housing” means a private home for everyone who wants one, preferably provided by new construction and financed by a public agency. Everything else, including supportive services, is subordinate to giving a person a home, even if the person is incapable of living on their own, or whose circumstances don’t require a new home.  Most government agencies, including Los Angeles, use the No Barrier version of Housing First, meaning people can enter housing with no commitment to changing the behaviors that may have caused their homelessness.  Advocates justify the No Barrier model based on two beliefs: first, that mental illness and addictive behaviors are largely a result of, rather than the cause of, homelessness.  Second, services are more likely to be successful if they are provided in a stable home-like environment. There is very little empirical evidence for either of these beliefs, but any effective solution needs to address the real problem of mental illness and substance abuse among the unhoused, regardless of its origin.

Many government agencies misapply the Housing First model. It was created for a relatively narrow segment of the unhoused population, the chronically homeless who need wraparound services.  The allure of supposed lower costs and faster results drove political leaders to expand the model to almost all the unhoused, many of whom could resolve their situations on their own or with minimal assistance.  Under Housing First, the one-size-fits-all solution is to provide a private home for every homeless person.

Housing Readiness takes a more nuanced approach than Housing First. The goal is the same: to move people from homelessness to permanent housing.  Rather than treating the unhoused population as a monolith, Housing Readiness focuses on individual behaviors and needs, with the object of ensuring the person has the skills needed to stay housed before moving into a home of their own.  For many unhoused people, homelessness is a temporary situation rather than a chronic problem. The McKinsey & Co.’s March 2023 report on homelessness in LA estimates that 144 (69 percent) of the 207 people who exit homelessness each day “self-resolve”; that is, they need little or no support, and certainly do not need a publicly provided home.  As Chris LeGras in his All Aspect article on a tiered approach to homelessness intervention describes, this group’s needs are a combination of supportive and preventive services. They may need temporary shelter or relatively inexpensive financial assistance, like rent subsidies, until they can stabilize their living situation.  To prevent falling back into homelessness, as about 7.7 percent of them do, they might benefit from job training, or classes in financial management. Most  people in this group do not need intensive mental or medical therapeutic services.

At the opposite end of the homeless spectrum are the chronically homeless, who have been on the streets for a year or more. Many are no longer able to care for themselves, nor make sound decisions about their own well-being.  Depending on the survey, as little as 30 percent or as much as 75 percent of the chronically homeless have serious untreated mental illness and/or substance abuse problems, and therefore require intensive, focused recovery services.  Many may also suffer from persistent or life-threatening medical conditions requiring hospitalization or regular outpatient care. Traditional housing will not benefit most of these people unless they participate in closely supervised recovery programs.

Between these two ends of the homeless spectrum is a large population of people who need more focused support but may or may not need Housing First’s emphasis on permanent supportive housing (PSH).  These may be people who’ve been homeless for so long, they need to relearn skills to live in traditional housing.  They may have mental or substance abuse problems caused by their precarious lives on the street, (as opposed to those who became homeless because of their behavioral issues).  They may be able to live on their own if they receive proper support early in the rehousing process and obtain the skills and stability needed to live independently.  Providing the proper services with needed follow-up and tracking is the key to successfully reintegrating this group into mainstream society.

Of course, because they consist of individuals, these groups are not mutually exclusive.  There is no predictor of when one life crisis becomes one too many for someone, and a formerly stable person falls into the abyss of mental illness or drug abuse.  Others who appear beyond hope may reconnect with family who provide the stability they need to overcome their issues. The key to a successful intervention program is to meet each person where he or she is on that spectrum, and then give them the services they need to support their recovery to the degree possible. Nowhere in this model is the mere provision of a place to live sufficient to lift them permanently out of homelessness.

There are several examples of organizations successfully providing the types of comprehensive and flexible services I just described.  Beyond Homeless.org sponsored a comprehensive report on the causes and solutions to homelessness, and cited Step Denver in Colorado, Solutions for Change in Vista, (near San Diego), and Haven for Hope in San Antonio as three of the most successful. Locally, organizations like SOFESA and the Union Rescue Mission have successfully broken the Housing First mold.  Although this column is too short to detail each organization’s program, they share some common characteristics:

• They Offer Residential Services. Most of these programs offer residential services to those who need them.  By living on a campus, residents can receive the services they need on a regular basis. They also relearn how to live in a community, and to release some of the defensive behaviors they need to survive on the streets.

• Individual Responsibility: By focusing on the individual, these programs give people the dignity to participate in their own social reintegration. Housing First advocates insist we regard the homeless as our “unhoused neighbors” but do little to make that a reality.  Advocates prefer to treat the homeless as symbols of larger economic and social ills, and allow them no part in forming the programs meant to help them, a view the Rev. Andy Bales from Union Rescue Mission calls “paternalistic”.  To assist people with reentering mainstream society, some successful programs charge residents a token rent once they get a job, to get them used to paying bills and prioritizing expenses.  Individuals are accountable for following the agency’s rules and their recovery paths. As Jess Echeverry, SOFESA’s Executive Director puts it, if we are expected to treat the homeless as equal members of our communities, they must act like responsible neighbors.

• A Commitment to Change: This is the biggest difference between Housing Readiness and Housing First. New residents must commit to try to overcome the behaviors that made them homeless in the first place. This may be sobriety or mental health services or relearning basic life skills.

• Peer Counseling Coupled with Professional Services: Many of these organizations hire current or former residents as peer counselors for new entrants. Relating with someone with the same lived experiences can help tremendously with recovery and reintegration.  Properly trained peer counselors can serve as mentors, helping residents navigate the path to success.  In this case, peer counseling should not be confused with third party service providers like the questionable Urban Alchemy, whose peer counselors receive minimal training and whose CEO charges the City millions in contracts with little accountability. In successful organizations, peer counseling augments professional medical and psychological services.  Peer counselors can help residents follow-up with the help they get from these professionals by ensuring they practice recovery behaviors.

• Comprehensive Individualized Services: If someone needs job training, and only job training, they receive job training. They may also need help looking for a job, especially if they’ve lost hope and abandoned the search. Whereas Housing First starts by giving someone a “home”, Housing Readiness starts by giving them the skills they need to succeed in living on their own.

Of course, Housing Readiness isn’t the cure-all for homelessness any more than Housing First. For one thing, most of these programs are relatively small, serving hundreds of clients at one time; that is the key to their success, since they offer individualized services.  There are almost 76,000 unhoused people in LA County.  Switching to Housing Readiness would require massive upscaling by creating a large network of similar programs throughout the County.  Housing Readiness cannot address the needs of the severely mentally disturbed or profoundly addicted.  Some people are so mired in untreated mental illness and additive behavior, they need institutional care, at least until they’re stabilized.  The new CARE court is a small first step in that direction. Housing Readiness cannot address the affordability crisis facing many of the working poor.  Our local governments must adopt reasonable, community-appropriate affordable housing polices, as described here. Finally, Housing Readiness cannot address that segment of the population who choose to be homeless, the co-called urban campers.  For any homeless program to be successful, there must be a coercive element to make people either accept shelter/housing or move on. This is not “criminalizing homelessness”, but ensuring people get the help they need and that public spaces are available to the entire community.   Human nature prefers the status quo, and if you choose to define a derelict RV parked a mile from the beach as your home, the City has a moral and legal duty to offer you alternatives, but also to make you move from the public right of way.

Adopting a Housing Readiness policy would require a fundamental restructuring of our current programs and putting Housing First in its proper relation to other programs in a comprehensive toolbox of solutions. Housing First has been used for 30 years, with no or mostly negative results.  Billions of dollars have been spent, and homelessness continues to increase.  Housing First was developed before the opioid and fentanyl epidemic, and its No Barrier policy simply doesn’t work in the face of the incredibly addictive nature of the drug.

Political leaders would also have to commit to holding service providers and their own agencies accountable for outcomes rather than workloads.  Using a more flexible intervention policy would require judging success or failure (and therefore funding) by long-term outcomes instead of easier measures like contact hours or clients referred to other organizations.  Obviously, this model is an existential threat to large corporate providers like St. Joseph Center and PATH, with their eight-figure contracts with LAHSA and the City.  It is also a threat to builders and developers who have created an efficient cash pipeline by convincing leaders homelessness is a housing problem that can be cured by massive building projects.

In future columns, I’ll dive into more detail on some of the problems Housing First has created, and how alternatives can solve them.  But for now, ordinary citizens must be willing to demand more from our leaders and ask why a 30-year-old model that has shown no success continues to be the primary way we respond to a crisis that worsens by the day.

(Tim Campbell is a resident of Westchester who spent a career in the public service and managed a municipal performance audit program.  He focuses on outcomes instead of process.  Tim is a regular contributor to CityWatchLA)