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Grantmakers Site Visit in New Orleans Highlights Health Benefits of Supportive Housing for a Cross-Disability Population

After the devastation hurricanes Katrina and Rita waged on housing resources for people with disabilities, homeless and disability advocates, consumers, service providers, and state and local government agencies successfully advocated for the inclusion of 3,000 new Permanent Supportive Housing (PSH) units in Louisiana’s Road Home hurricane recovery plan. The result is the nation’s first state-driven PSH system using integrated, scattered-site housing linked with evidenced-based mobile community supports for the most vulnerable people with disabilities - including people who are homeless and people at risk of unnecessary institutionalization - supported by cross-system partnerships that provide a structure for program design, policy development, and implementation.

Several housing production strategies are being employed to reach the 3,000 PSH unit goal, and intensive efforts were undertaken to successfully obtain rent subsidies from Congress to ensure affordability of PSH. Today 430 out of the proposed 3000 individuals and families have already moved into their new homes. With subsidies now available, that number will likely reach 1000 later this year.

In addition, the state received Community Development Block grant (CDBG) funds for PSH supportive services for five years, after which the state must sustain PSH supportive services using Medicaid and other funding strategies. The Department of Health and Hospitals is exploring various Medicaid options to help sustain services after five years.

The LA Department of Health and Hospitals (DHH) designated six agencies in the hurricane affected areas to work with local homeless, health, behavioral health and youth/family service providers to identify and refer eligible individuals to housing units, and to provide access to basic housing supports and other needed care in the community. The agencies are also working collaboratively to assure the support services embody "best practices" in their outreach, clinical and continuity of care approaches. A best practice approach that has emerged relative to the PSH program is the establishment of an Assertive Community Treatment (ACT) initiative using a "Housing First" approach and a supportive housing intervention in the Greater New Orleans area. DHH is funding the services and a portion of the housing for this initiative which will serve over 300 people this year including 100 people diverted from the criminal justice system.

Today in New Orleans, a group of funders attending the annual conference for Grantmakers in Health will discuss these and other issues on a special site visit hosted by Unity of New Orleans and the Technical Assistance Collaborative on the topic of "Creating a Sustainable System of Housing & Services: Louisiana’s Permanent Supportive Housing Initiative."

2009 American Recovery and Reinvestment Act: Recent Coverage from Funders Together

We've posted links in a special new section of the Funders Together site to key partners' analysis of the 2009 American Recovery and Reinvestment Act as it relates to homelessness and supportive housing. Here are the most recent documents featured:

• What the American Recovery and Reinvestment Act Means for Permanent Supportive Housing Production
• Homelessness Prevention and Re-Housing: Overview of Funds
• Additional ARRA Homelessness Resources
• Legislative Text of Homelessness Prevention Fund
• Steps in Planning: Checklist for Advocates
• Creating A Plan For The Homelessness Prevention Fund
• TANF Emergency Contingency Fund
• Coordinating Prevention and Re-Housing Initiatives: Temporary Assistance for Needy Families (TANF) Programs
• Federal Stimulus Resources
• Using the New Prevention and Re-Housing Funds

The Solosit - Opens April 24th

See below for two video clips from the soon-to-be released move, The Soloist, about the true-life friendship between Los Angeles Times columnist Steve Lopez and Nathaniel Ayers, a mentally ill homeless musician he meets on the streets of Skid Row. The book is both inspirational and true-to-life, describing the gradual trust that builds between the two men, culminating in Ayers finding housing and support in the Lamp Community, a provider of immediate housing and lifelong supportive services in Los Angeles.

Buy the book from Amazon.

Read the LA Times series by Steve Lopez that inspired the Soloist.

Do you have any events or discussions planned in your community to tie-in to the release of this movie? Please let us know in the comment section below.

Steve Lopez and Nathaniel Ayers:



An introduction to the Soloist:

Progress in Addressing Homelessness in Los Angeles?

by Bill Pitkin, Conrad N. Hilton Foundation

Los Angeles has often been referred to as “the homeless capital of the world” and has a reputation as a bit of a basket case when it comes to addressing homelessness. With more than 70,000 homeless persons on any given night (a third of them chronically homeless), a highly visible concentration of street homeless in Skid Row, and famously uncoordinated public safety net systems, Los Angeles County is often thought of as beyond hope when it comes to successfully ending – or even reducing – homelessness. The current economic crisis, in the context of a long-term affordable housing crisis, is placing a severe strain on already overburdened emergency shelters and social safety nets.

Despite these great challenges facing Los Angeles – and probably surprising to many because it is largely happening behind the scenes – there has been progress in addressing homelessness, especially chronic homelessness, in recent years. These advances are due to several factors.

First, there has been increased – if sporadic – public pressure to address the homelessness problem in Los Angeles, due in large part to high-profile coverage in the media. There have been several stories in local media about “dumping” of people onto Skid Row by hospitals and law enforcement, which have led to several mea culpas and policy changes. More significantly, Los Angeles Times columnist Steve Lopez unveiled the horrid conditions and consequences of street homelessness through an in-depth series of articles on Skid Row in 2005, which caught the attention of local elected officials and the public at large. He also wrote a number of columns about the friendship he developed with Nathaniel Ayers, a mentally ill homeless man, which provided a personal look into the challenges of chronic homelessness. That story has been recounted in a book titled The Soloist, which was turned into a movie by the same name starring Robert Downey Jr. and Jaime Foxx that is slated to be released in theaters on April 24, 2009.

Second, the increased public attention to homelessness has opened the door to necessary systems change and innovation. One of the structural barriers in successfully addressing homelessness in Los Angeles County – with a total population of nearly 10 million people – has been the lack of coordination, and even enmity, between the County (with responsibility for health and human services) and its 88 cities (which have jurisdiction over land use and most housing dollars), with the City of Los Angeles obviously the most prominent. Foundation and civic leaders have placed pressure on the county and city to better coordinate their efforts, with some actual progress being made. As documented by the Urban Institute’s Martha Burt in a series of reports on the Conrad N. Hilton Foundation’s grant to the Corporation for Supportive Housing (CSH), public systems are aligning much better to increase the pipeline of permanent supportive housing units, even if not at the scale necessary to address the needs in the short term.

One innovative approach that highlights this trend is “Project 50,” an effort to replicate Common Ground’s “Street to Home” model of outreach in New York City. Employing the Vulnerability Index methodology developed by Jim O’Connell from the Boston Health Care for the Homeless Program, project outreach workers created a registry of the 471 persons sleeping outside in Skid Row on December 7, 2007 and did in-depth surveys over the next several days to measure personal health and disability vulnerabilities. The 50 most vulnerable were targeted to receive housing and supportive services to ensure housing stability. Preliminary results presented at the recent one-year anniversary of the program are impressive: 49 people were placed into housing and 43 remained in housing after the first year. Utilization of major public systems such as ERs and prisons has declined sharply for participants, offsetting costs for taxpayers. And, perhaps most importantly, dozens of county and city agencies have collaborated in new ways for the benefit of the participants. Organizers of Project 50 have called for expanding the program, “turning 50 into 500; and then 500 into 5,000.” This targeted approach is being replicated in various parts of LA County, such as in the City of Santa Monica, which has seen an 8% drop in street homelessness over the last year.

Finally, the capacity of the housing development system and local jurisdictions to build permanent supportive housing has increased substantially, due in large part to the work of CSH providing training and identifying financing opportunities. At the initiation of our most recent grant to CSH in 2005, there were just five nonprofit housing developers engaged in permanent supportive housing in Los Angeles. Over the past few years, dozens of developers and service providers have been trained and received capacity building grants through CSH, bringing thousands more units on line and into the development pipeline. Developers and service providers are learning a common language and approach to ensuring that homeless persons receive the support necessary to access and remain stable in permanent housing. In addition, Los Angeles Homeless Services Authority and community partners have been working with cities and public agencies around the county to build their capacity to address homelessness throughout the region.

With more than 22,000 chronically homeless persons in Los Angeles County according to the 2007 homeless count, the scale of the challenges remain daunting. To meet the need, Los Angeles probably needs to develop around 20,000 permanent supportive housing units. However, the quiet, but significant, progress that has been made in just the past few years provides something on which to build. Community ownership of the problem is an important step in successfully ending homelessness, and residents of Los Angeles are increasingly demonstrating a desire to step up to the plate. Thousands of residents have participated in the past two years in Homewalk, an annual 5k family walk organized by the United Way of Greater Los Angeles to raise awareness and resources to end homelessness in Los Angeles County. Over 3,000 people participated in the Los Angeles Homeless Services Authority’s 2009 Homeless Count. Through these and other educational and volunteer efforts, Angelenos are becoming personally engaged with addressing homelessness and recognizing that with sufficient community and political will, we can end it.

An Illustration of One State’s Analysis of the Resources Available through the American Recovery & Reinvestment Act

On March 9th, Shelly Geballe, co-founder and current Distinguished Senior Fellow at Connecticut Voices for Children, presented an analysis of the “Federal Budget Overview as it relates to Connecticut” to a room full of funders in Hartford attending a summit on “Government and Philanthropy working together.” Her analysis provides a very helpful summary of the purposes, timeline and scope of ARRA, as well as a thoughtful template of considerations for any state thinking about how to quickly grasp and maximize the benefits available through this landmark legislation. View her presentation below - to view full screen version, click on button at lower right.

HUD releases interactive map to view total state allocations under the economic recovery act

(Click on image to access interactive map)

Upping the Odds on Successful Prevention and Rapid Rehousing

By Mary Cunningham, The Urban Institute

Every day I wade through dismal headlines and discouraging data. Perhaps most troubling is that communities that were once reporting declines in homelessness are now reporting significant increases, particularly among families.

I could feed you gloom and doom statistics by the spoonful, but let’s look for something positive instead.

There’s certainly a lot of buzz around the $1.5 billion Congress recently appropriated through the American Recovery and Reinvestment Act of 2009 for homelessness prevention and rapid rehousing. The new fund represents a whopping increase—in some communities, ten times current budgets—for homeless assistance. The scope—prevention and rapid rehousing—is also new to all but a handful of communities across the country. As such, it could both prevent catastrophic increases in homelessness—like those of the 1980s—and transform the homelessness assistance system by building communities’ capacity to shift from sheltering to prevention and rapid re-housing.

While the appropriation of these funds was met with a huge sigh of relief, a lot hinges on the infusion’s success, and since these funds will all but fly out the door, concern about lack of local capacity is well placed. Here’s where philanthropy could help. It’s all about leverage: by supporting program implementation, foundations up the odds that these funds will be used strategically and efficiently. A few ideas that could go a long way:

• Knowledge Building. To implement programs, communities will need concrete tools and templates right away. There are some model practices to emulate, but no accessible “how to” guides. Foundations could support intermediary groups, like the National Alliance to End Homelessness, to write and distribute these guides.


• Technical Assistance. Communities will need ongoing support to help them answer the day-to-day questions of implementation. Besides funding nonprofits that provide nuts and bolts technical assistance, foundations could create a peer-learning network to connect program administrators who are already operating model prevention and rapid rehousing programs to those just starting off.


• Research and Evaluation. Since there’s relatively little empirical data on the long- or short-term efficacy of homelessness prevention, shelter diversion, and rapid rehousing, foundations should support the development of strong performance measures and rigorous research. Why not bring a group of researchers together to identify communities that could serve as “learning laboratories” across the country, feeding policymakers real time data as programs are implemented?

We are still a long way off from truly good news, but implementing this fund wisely could give us the one headline we’re looking for: despite the terrible economic outlook, communities are preventing homelessness and getting people back into stable housing.

Read Mary’s most recent brief on next steps for preventing and ending homelessness.

What do you think of Mary's suggestions for the role philanthropy can play in providing leverage? What other ideas and strategies have you used, or would you suggest?

About the Author

Mary Cunningham is Senior Research Associate for Metropolitan Housing and Communities at The Urban Institute in Washington, DC.

March 4th Audio Conference: Interactive Blog