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“In Order to House Everyone, We Must Tear Down Some Walls…”

In this speech delivered at the Georgia Supportive Housing Association annual conference, USICH Policy Director Richard Cho discusses the importance of breaking down silos between sectors and systems to end homelessness.  He discusses how permanent supportive housing embodies the notion of “silo-busting” and creating inter-subjectivity between sectors, and challenges the State of Georgia to create a supportive housing policy for all—people with disabilities under the Olmstead community integration mandate, people experiencing chronic homelessness, and people with chronic health conditions leaving correctional settings.  

Thank you Paul for your introduction, and thanks to the Georgia Supportive Housing Association for inviting me to join your event. Richard Cho

I’m here today representing the United States Interagency Council on Homelessness, and bring greetings from our Executive Director Barbara Poppe, from our Council Chair VA Secretary Eric Shinseki, Council Vice Chair HUD Secretary Shaun Donovan, and the 17 other agencies that comprise our Council.  I want to acknowledge Alvera Crittendon and Mykl Asante from HUD’s Atlanta office and Aileen Bell Hughes from the Department of Justice who are here today.

I’m here to deliver a message today.  And my message to you is, that in order to house everyone, we need to tear down some walls.  Let me repeat that, in order to house everyone, we need to tear down some walls.

Now, you have probably figured out that I am not referring to actual walls or buildings, but rather to the figurative walls that separate our efforts into silos, into isolated and fragmented efforts.  If we want to make sure that everyone in America, especially those who are most vulnerable, have a safe and stable place to call home, we must break down silos and work across sectors, systems, and even the policy and population constructs under which we operate.

This idea of breaking down silos underpins the very premise of USICH.  USICH’s role is not to be the sole Federal department responsible for ending homelessness, but rather, to foster a sense of shared responsibility across the 19 Federal agencies that make up our Council, and build collaborative solutions across department boundaries.

The thread of breaking down of silos runs through Opening Doors, the Federal strategic plan to end homelessness.  Adopted in 2010, Opening Doors set forth the Administration’s vision that no one should experience homelessness in America, and that no one should be without a safe and stable place to call home.  It lays out the Administration’s goals of ending chronic and Veterans homelessness by 2015 and homelessness among families, children, and youth by 2020.

To achieve these goals, the Federal strategic plan lays out 58 strategies organized around five themes.  And the very first of the five themes is to build collaboration between Federal, State, and local government, across the public, non-profit, and private sector, and between sectors like housing, health, social services, employment, justice and more.

Underlying Opening Doors is the recognition of three fundamental truths about ending homelessness:

1) That homelessness is a problem that is too complex to be the sole responsibility of any one agency, sector or system.

2) That solutions to homelessness—like permanent supportive housing—require the coordination of the housing, health, behavioral health, and other service systems.

3) That the collective knowledge and expertise of multiple agencies, sectors, and systems results in solutions that are better than what any one of those agencies, sectors, and systems could create on their own.

I face these three truths every day in my role as a Policy Director for USICH.  My role and portfolio entails working with HUD on housing policy, working with HHS to encourage states to use Medicaid to help create and finance services that support housing stability, working with the Social Security Administration and SAMHSA to improve access to SSI/SSDI benefits for people experiencing homelessness, and working with the Justice Department to align our efforts to end homelessness with efforts to enforce the community integration mandate under Olmstead and efforts around prison and jail re-entry.

Managing a portfolio that encompasses all of that would seem impossible.  But what makes this mix not only manageable, but fruitful, is that the solutions that emerge when we work across agencies and silos are always better than what any one of us could create or achieve on our own.

That idea is also what makes supportive housing such an effective solution for helping those with the most complex social and health needs achieve stability, dignity, and independence.  What makes supportive housing work is not just that it’s a combination of affordable housing and supportive services.  Those of us who have worked to make supportive housing available over the years know that it’s so much more than just a layering of those two components.  What makes supportive housing work is that it brings together the expertise of the housing and community development sector and the expertise of the social, behavioral health, and health services sectors to help troubleshoot the challenges that its tenants have in achieving that stability, dignity, and independence.

And we are seeing the supportive housing at work all across the country.  In places like Seattle, where supportive housing—using a Housing First approach—has been shown to decrease emergency room and alcohol crisis services use among people experiencing chronic homelessness, translating to a Medicaid savings of 41%.  We see it in New Orleans, where investments in permanent supportive housing made possible because of the Hurricane Katrina relief package, and targeted at the most vulnerable people experiencing chronic homelessness, has enabled the city to achieve an 85% decrease in chronic homelessness since 2010.   New Orleans is now housing people at a rate of two people a day.  I think Atlanta can beat that, right?

Supportive housing is a testament to the power of inter-subjectivity, which is another way of saying that only through the merging and negotiation of multiple vantage points can true solutions be found.

Folks in this room have probably witnessed that inter-subjectivity in action.  When a case manager works with a landlord to prevent eviction by allowing the tenant to pay rent arrears on an installment plan.  That synergy that enables a property manager and services provider to come up with a plan to address the victimization of a tenant by a drug dealer.  It’s inter-subjectivity that enables a supportive services provider to come together with public housing agencies to find creative ways to speed up the time from engagement to housing placement by helping people complete their voucher applications and even conduct apartment inspections.

Supportive housing has been a lever for creating change and inter-subjectivity at the systems-level as well.  Numerous states and municipalities including Georgia have inter-agency councils and funder collaboratives to coordinate funding across the housing, services, and health silos, to engage in multi-year planning with the non-profit and private sectors, to set unit creation goals, and troubleshoot barriers to supportive housing creation and implementation.  At their best, these inter-agency and public-private collaborations bring together the ideas and ingenuity of all of the agencies and organizations that participate.

It’s that inter-subjectivity that makes supportive housing such a powerful, silo-busting tool.  It’s why increasing supportive housing is a key objective of Opening Doors and a centerpiece of our strategy for ending chronic homelessness.  It’s also why supportive housing is a key part of efforts by numerous states including Georgia to comply with the Olmstead community integration mandate for people with disabilities and an increasing part of State and community efforts to ensure that people leaving prisons and jails are able to stay in the community and avoid returns to incarceration.

We need to take that silo-busting inter-subjectivity to the next level and fully realize the potential of supportive housing as a tool for solving all of the complex social problems that affect vulnerable people who need housing and services to achieve stability, dignity and independence.  That means breaking down the silos between our own policy and population constructs to create solutions that work to help all of the vulnerable people for whom those constructs mean little. 

I want to share a story to illustrate this further.

About 14 or so years ago, I was working in the State of Massachusetts on a project to assess the needs of people living with HIV/AIDS who were leaving prisons and jails.  As part of a focus group I had held, one of the participants told the group that he had figured out a solution that could make sure that people like him got the quickest access to affordable housing.  It went something like this: “If you have a serious mental illness, you can get special access to some housing. If you have an AIDS diagnosis, you can also get special access to other types of housing.  If you have both, you win the lottery.”  (Again, these were his words, not mine.)  “If you are in a shelter, you also get a point.  But if you are coming out of jail or prison, all of that gets closed off to you.”

This brief statement has stayed with me over the years. It’s a concise summary of all the problems and challenges that still lie ahead of us. That the ways that we have set up access to housing and services have created a kind of perverse puzzle and contest for people, where people have to struggle to fit into the categories we have set up through our well-intentioned policies.

Access to supportive housing should not be a puzzle or a game show, where people with real needs, disabilities, and life-threatening conditions should be forced to find ways to “game the system.”  Access to supportive housing should be a right and a natural part of an effective response to people with disabilities and chronic health challenges.  Time and time again, we’ve shown that supportive housing is not only the right thing to do, it’s the smarter and fiscally sound thing to do. 

 

This view is reflected in this conference, where the agenda spans topics related to ending homelessness, prison and jail re-entry, and community integration for people with disabilities.  You have gotten this very right in scoping this event and in the kind of cross-sector and cross-population dialogue that is happening over these past two days and in the days that come in the State of Georgia.  And I think it reflects the fact that the State of Georgia is on the verge of being a national innovator in breaking down the silos to create a statewide supportive housing delivery system that works for all.

In so doing, you have a chance to fix a problem that dates back decades.

Chronic homelessness and the institutionalization of people with disabilities are two legacies of what has been a fragmented and inadequate system of care for nearly four decades.  They stem from the failed promise to create a true mental health care system.  They stem from decades of criminal justice policies that have relied on prisons and jails to address social and mental health needs, resulting in the warehousing of thousands of people with mental illness and other disabilities.  They stem from the failure to create a comprehensive affordable housing policy for all, and especially those at the lowest ends of the income spectrum.

We’ve responded to these problems often on the tail end, only once people have reached a state of crisis.  And so emerged the separate policy arenas of our effort to end homelessness, efforts to ensure the right of community integration for people with disabilities under Olmstead, and efforts to address prison and jail re-entry.

We’ve been like the proverbial people in the dark touching an elephant and thinking that we are touching a tree trunk, a snake, or a palm leaf.

But I think the time has come to recognize the elephant, to rejoin these three arenas and create a comprehensive solution to the needs of people with disabilities and chronic health challenges who have in common the need for an affordable place to live, adequate incomes, access to services that can help them achieve maximum independence, and which prevent the over-reliance on the most expensive crisis systems.

When we begin dialogue across these arenas, we realize that although our frameworks and lenses have evolved differently, and our population and eligibility definitions are slightly different, overall we share more in common than not.

We’ve been engaging in that cross-agency dialogue in Washington, between DOJ, HUD, and USICH.  And through that dialogue we have had several insights.

We realize we have a shared population, and perhaps even more than we’ve realized.  Whereas Olmstead encompasses people with disabilities leaving or at-risk of entering institutional/segregated settings, our effort to end homelessness, especially chronic homelessness focuses on people with “disabling conditions.”  And while there are certainly differences between the ADA and HUD definitions of disability, there is more overlap than not.  And while Olmstead focuses on people either at-risk of institutionalization or in institutional settings, we know that many people experiencing chronic homelessness cycle in and out of institutional settings.

We realize that we have shared goals, that is, to maximize affordable housing opportunities, access voluntary supportive services, and support the ability to live independently.

We have shared values of supporting people to be able to have access, choice, be integrated in the community.

And we share a common solution, namely, permanent supportive housing.

Now I know there have been many discussions and concerns around housing models, particularly with regard to single-site supportive housing.  And questions have been raised about whether or not single-site supportive housing is consistent with community integration.

DOJ’s perspective, is that their focus of Olmstead enforcement is on increasing most integrated housing options, and not decreasing or taking down community housing options.  HUD’s guidance makes clear that certain HUD programs (e.g. CoC, Section 811) are statutorily permitted to target people with disabilities.

USICH believes that communities should include a range of PSH models that increase housing opportunities for people experiencing chronic homelessness.   At the same time, we should challenge ourselves to think about who the design of our models is benefiting, and whether the choice of models is for the benefit of tenants or are for the convenience of programs.

Perhaps the question we should be asking is not, is single-site supportive housing a permissible model, but rather, how we are going to create enough permanent supportive housing to meet the needs of all populations—people with disabilities leaving institutional settings, people experiencing chronic homelessness, and the subset of people involved in the justice system who have chronic health and behavioral health challenges?

And how are we going to leverage all available resources and funding, including mainstream housing resources, to increase permanent supportive housing?  We cannot rely on just the targeted homeless programs like the Continuum of Care program to create supportive housing. We need to leverage mainstream resources as well.  Housing Choice Vouchers, Section 8 Project Based Rental Assistance, HOME, low-income housing tax credits, bond financing.

And how do we strike the right balance between our two values of maximizing housing opportunities and access and ensuring community integration?

Neither value should supercede the other.  A housing policy that focuses on increasing housing opportunities at the expense of integration will not meet our goals.  A housing policy that focuses on community integration, but which decreases housing options also does not meet our goals.  We need a housing policy that can achieve both.

The opportunities that come from tearing down the walls, breaking down the silos between homelessness, Olmstead, and prison and jail re-entry are enormous.

Here in Georgia, that cross-sector dialogue is taking place, that creative inter-subjectivity is being unleashed, and the silos are being broken down.  Georgia was a participant in SAMHSA Policy Academy on Olmstead, and is now a participant in the Policy Academy on ending chronic homelessness.  Georgia’s a recipient of HUD’s Section 811 Project Rental Assistance Demonstration.  Terrific progress is being made to leverage mainstream affordable housing resources, namely Housing Choice Vouchers, for permanent supportive housing.  There is new energy and enthusiasm behind the state interagency council on homelessness.

The time is now to tear down the walls between our separate efforts and create a unified statewide supportive housing policy and plan focused on addressing the needs of all of the most vulnerable Georgians.  The time is now to bring supportive housing to scale, taking into consideration the right to integration among tenants.  To clarify the overlap in populations through data integration. To leverage mainstream housing resources alongside targeted programs like CoC and Section 811. To fix the front door to supportive housing through assertive and coordinated outreach.  To use targeting approaches that will ensure that the highest need, most chronic, and highest cost people experiencing chronic homelessness will get priority access to housing.  To adopt a Housing First approach that reduces barriers and pre-conditions to entry and helps people obtain housing as quickly as possible.

I, and the US Interagency Council, applaud and support you in this work.