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Executive Director Barbara Poppe Keynote at 2012 Housing First Conference: Housing First Across America

3/22/12

New Orleans, LA

Good afternoon. It is terrific to see so many friends and colleagues gathered together. Thanks Bill for that very generous introduction and all you’ve done to further Housing First across the country and especially in Los Angeles.I also want to thank Bill and Sam Tsemberis for creating the vision and then hosting this historic conference. It’s an honor to precede Assistant Secretary Mercedes Marquez who has been such an exceptional leader on supportive housing at HUD, as well as a Housing First pioneer in her hometown of Los Angeles.

Two years ago, with the help of many of you, we launched Opening Doors. The first ever comprehensive federal strategic plan to prevent and end homelessness builds upon and leverages the innovative efforts underway in communities across the country. Many of these efforts are showcased in the impressive array of workshops that have been put together for this conference.

There are four goals in Opening Doors, but most significantly, for today’s purposes, I want to focus on our work together to finish the job of ending chronic homelessness by 2015.

Opening Doors calls out that permanent supportive housing implemented by using Housing First principles is the primary solution to end chronic homelessness. The Plan highlights key strategies to increase the availability of housing and supportive services. Taking permanent supportive housing to the scale necessary to end homelessness requires a deep understanding of the population of people experiencing chronic homelessness. 

Fortunately, there are new and promising practices to better inform communities about the types of services and housing interventions that are needed. The 100,000 Homes Vulnerability Index survey based on Jim O'Connell's research or DESC's Vulnerability Assessment Tool are good examples of assessment tools.

Equipped with this information, communities can map the mainstream and targeted housing programs that exist in your community that can be brought to bear on these needs, and identify the gaps then create alignment to form a system of care. Supportive housing at a scale sufficient to meet the housing needs of the most vulnerable is the centerpiece of a community strategy to end chronic homelessness.

The key supporting strategies are integrating primary and behavioral health care services and increasing access to mainstream programs. We also need to stop the flow from publicly supported institutions that discharge to homelessness – hospitals, jails, and prisons. The final key ingredient is leadership.

For those with serious mental illness, chronic addiction, and traumatic brain injury, integration of primary and behavioral health care not only gets better results, it is also a promising practice to reduce overall health care costs. When you think about the people you work with who have multiple health conditions, say schizophrenia and diabetes or depression and heart disease, you just cannot deal with one without knowing something about what’s going on with the other.When we hosted a group of people doing integrated care in Baltimore with the Center for Medicaid back in the fall of 2010, one of the providers said it best, “We started doing this because our clients led us there.”

We know that when care is practiced in silos, people with mental illness do not get preventive health care, they do not get good care for chronic medical conditions, and they do not get good dental care. As a result, people with mental illness will die 25 years earlier than others, largely from medical conditions that went untreated.

Helping supportive housing tenants to access disability benefits whether through the VA, Social Security Administration, or state programs will increase their economic security and housing stability. Adoption of SOAR practices has been shown to expedite and increase to SSI/SSDI and other benefits.

One of the most important mainstream programs that chronically homeless people need to access is Medicaid. The Affordable Care Act provides tremendous lift to our work in ending chronic homelessness through vehicles such as Medicaid expansion and Health Homes.  Right here, the state of Louisiana is building permanent supportive housing into its behavioral health managed care contract. We are cheering for your success. Other great efforts are happening in New York, Illinois, Minnesota, Connecticut, and Los Angeles.

To take this to scale, States will need to re-design their Medicaid plans to pay for some services that are part of the Housing First approach - AND - supportive housing providers  will need to  either partner with organizations that can provide Medicaid eligible services or transform their agency to become a provider of Medicaid eligible services.

To stem the flow of individuals from jails and prisons into homeless services systems, public institutions working alongside community based and mainstream organizations need to align efforts to provide housing stabilization and supports to men and women who are re-entering the community. 

In order to improve chances of keeping the most vulnerable individual from experiencing homelessness, permanent supportive or affordable housing along with the right mix of services is believed to be the best response for those with prior histories of homelessness.  While resources are scarce, we need to be as creative as ever and use these precious resources wisely while balancing with the housing needs of those already homelessness on the streets or in shelters.

The final key ingredient is Leadership. Change is difficult.  Breaking down the silos and working collaboratively requires commitment. Interdisciplinary, interagency, and intergovernmental action is required to effectively create comprehensive responses to the complex problem of homelessness.  We have seen this type of transformation in HUD-VASH as a result of the leadership by VA Secretary Eric Shinseki and HUD Secretary Shaun Donovan.  

As the business experts would note, this is an adaptive, not a technical problem. So participatory leadership is required.

  • We need to build broad support for Housing First in every community, organize a community response, and then hold each other accountable for achieving the results. 
  • It will take leadership to be sure that permanent supportive housing is truly targeted to those who are most vulnerable, most in need of it.
  • It takes leadership to address NIMBY and build allies rather than opponents. It takes collaborative leadership to prioritize and align resources.

So back to our primary solution – Housing First permanent supportive housing. If it’s a proven and cost effective solution, then why aren’t we at scale? 

First there are considerable challenges in assembling the financing and funding sufficient to make your projects work. Expertise in everything from Low Income Housing Tax Credits to the Federal Home Loan Bank to Housing Choice Voucher to Medicaid is required to bring together the resources for development, operations, and services.

As if the financing weren’t complex enough the rest is equally challenging.  Here’s my running list of clinical practices that are useful to know: ACT team, Critical Time Intervention, Harm reduction, IDDT, Motivational interviewing, Peer support, SOAR, and Trauma informed care. 

And to make a Housing First program work you’ve got to ensure all these service needs are met:  Outreach and engagement, case management, care coordination – health care access, housing retention, benefits acquisition, financial management/payee services, treatment, family reunification, employment and vocational services.

To be successful you need to cultivate myriad relationships from the CoC and other homeless providers to Public Housing Agencies, VA, community mental health centers, Federally Qualified Health Centers to name a few. 

And then you also need to pay attention to community building within program and into the community, manage data collection and evaluation, be effective in public advocacy and education, of course be exceptional in administration…from compliance to staff training to accounting. And too often you have to deal with NIMBY and those who don’t believe in harm reduction and housing first.

Super powers are needed just to understand every acronym let alone to master everything you need to pull off a successful project. You are my super heroes for taking on this challenge. I want to applaud each of you in this room for stepping up and into this great mission.

Given the immense complexities of this work, it’s really no wonder that we sometimes get lost among the trees and can’t tell the story of how we end chronic homelessness in ways the ordinary person can understand. To create the political will this movement needs, we must be able to convince the American public that it’s possible to end chronic homelessness. We cannot only afford to end it but that we can’t afford not to.

Home for Good in Los Angeles has just created a PSA to break it down in a clear and compelling story.

Let's take a moment to watch it:

Our window of opportunity is now. We all need to be aligned and pushing harder. Harder than we thought when we all signed up for this. We won’t be able to achieve these goals without you.

On behalf of President Obama and Council Chair, HHS Secretary Kathleen Sebelius, thank you for all of the hard work you do and for being our partner in this mission.

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