Thought Leaders to USICH: How to Accelerate Progress on Chronic Homelessness
As a part of the April 2012 Council meeting on chronic homelessness, USICH sought input from leaders in the field: Professor and Researcher at the University of Pennsylvania School of Social Work Dennis Culhane, President and CEO of the Corporation for Supportive Housing (CSH) Deborah De Santis, President of Community Solutions Rosanne Haggerty, and President and CEO of the Center for Health Care Strategies, Inc. Stephen Somers. Each leader submitted a brief to USICH summarizing his or her expertise on chronic homelessness and recommended actions the country and the Council should take to bend the curve on chronic homelessness by 2015.
Dennis Culhane explains the relevance of the “cohort effect”—the fact that chronic homelessness disproportionately impacts people born between 1954 and 1966—to current and future policy on homelessness. Because of the cohort effect, communities around the country should expect to see increasing medical needs and related costs to help this aging population in the coming years. He points to two evidence-based interventions that can help people experiencing chronic homelessness gain stability and simultaneously reduce these rising costs: permanent supportive housing and critical time intervention.
Deborah DeSantis details lessons learned from several former and ongoing CSH projects. She explains the importance of targeting supportive housing units to people experiencing chronic homelessness as well as the barriers many communities still face to targeting effectively. In order to ensure that targeting is effective, the targeting process should:
- Be based on data and systems utilization by individuals,
- Be managed through either coordinated or centralized assessment,
- Be driven by outreach to various crisis settings beyond just shelters, and
- Repeatedly offer low- or no-barrier housing to targeted individuals.
DeSantis stresses the importance of seeing chronic homelessness as the multi-sector problem it is and the need therefore to involve partners from multiple sectors including corrections, the health sector, substance abuse services, affordable and public housing (especially public housing agencies), among others. CSH’s work on the Frequent Users Systems Engagement Initiatives in sites around the country has shown that creating permanent supportive housing units in concentrated surges instead of in trickles has rapidly housed many people experiencing chronic homelessness and has created greater momentum among key partners.
Rosanne Haggerty makes four recommendations that from her perspective would help the nation reach the goal of ending chronic homelessness by 2015:
- Each person experiencing chronic homelessness should be known by name to the entire homeless response system in that individual’s community.
- Federal resources should be targeted geographically to communities with the highest rates of chronic homelessness.
- Sufficient housing resources, especially HUD-VASH and Housing Choice Vouchers, should be set aside specifically for people experiencing chronic homelessness.
- Communities should embed clear targets into their homeless response systems to move 2.5 percent of the community’s chronically homeless population into permanent housing each month and to shorten the entire housing placement process from first outreach contact to actual placement into permanent supportive housing to 30 days or less.
Stephen Somers focuses on the opportunities to use Medicaid and the changes to Medicaid that will come with full implementation of the Affordable Care Act in 2014 to effectively address chronic homelessness. By 2014, virtually all of the 1.2 million single adults experiencing homelessness which includes many experiencing chronic homelessness, will be eligible for Medicaid coverage. This population has complex health needs. Somers details the two most promising options for states to provide this care: coordinated care for people with multiple chronic conditions (health homes) and managed care.