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Housing first

May 1, 2006
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A program to help people move off the streets and into treatment

In 2004, 57% of the U.S. homeless population reported having a mental health problem at some point during their lifetime, according to a study from the National Law Center on Homelessness and Poverty. Throughout the country the number of homeless people living with a severe mental illness (SMI) has continued to rise. In 2004, Maricopa County, Arizona, had approximately 8,312 homeless people according to the same study. Many of these individuals are coping with SMI that often traps them in a cycle of homelessness—from the streets to shelters, where they receive stop-gap assistance that does not address their fundamental needs, and back to the streets.

Providing services to this population continues to be a challenge; however, some states and behavioral health organizations are partnering to develop effective programs to stop the cycle of homelessness.

Using the “Housing First” model, Value- Options of Arizona has shown that it is possible to halt the revolving door of homelessness. The premise is simple: The quicker a person moves into housing, the sooner he will be able to address his behavioral health issues. Housing is the first priority, followed by case management, mental health, substance abuse, employment, and other services that help sustain stability and self-sufficiency.

With the Washington House Clinic in Phoenix, ValueOptions has created a direct service site for the chronically homeless that is part of its network of services (Value-Options is the Regional Behavioral Health Authority for Maricopa County, which serves more than 58,000 county residents and approximately 12,000 homeless persons). The program serves consumers who are homeless upon intake to ValueOptions and individuals who have been homeless based on HUD guidelines for the past year or longer. Washington House currently serves 217 individuals. The average person has been homeless for approximately three years before coming to the clinic.

Pat, 51, who has suffered from severe depression for years, lived a life of one setback after another since she was a teenager. She began to use drugs at a young age and served 12 years in prison. About three years ago, a friend referred her to the Washington House program. Now a Washington House employee, Pat believes the program saved her life. “This program is like an octopus reaching out to help those who can't help themselves,” says Pat. “There are so many arms aching to be held; if we could get to more people, there isn't anyone who couldn't do what I have done.”

In partnership with case managers, Washington House begins treatment with the involvement of psychiatrists, nurses, rehabilitation specialists, housing specialists, and benefits specialists. The consumer is assessed for ongoing treatment needs. Washington House then makes the necessary referrals to help establish the services needed to assist the consumer in establishing his independence.

Clients at Washington House graduate after an average of three months after they are successfully housed, and they then are transitioned to other ValueOptions direct service sites to continue receiving care. If the clinical team determines that the individual cannot live independently, a residential program is identified for that person, and he is transferred to the closest clinic. ValueOptions, alongside ABC, a nonprofit provider partner, assists people in finding housing and provides financial assistance to ensure that no more than 30% of a client's income is spent on housing.

“A typical person enrolled in our network of care is receiving an income of $587 per month through Social Security's Supplemental Security Income,” says Liz Smithhart, regional director of Washington House. “Of course, most people can't maintain an independent lifestyle on that kind of budget, so they inevitably end up homeless.”

Washington House recently tracked the progress of 99 individuals, previously homeless for an average of 3.8 years, who graduated and transferred out of the program during the past 12 months. Of this number, 91 were still successfully living independently a year later. Over the past 2½ years, more than 365 clients have graduated and about 90% still are living independently.

“This clearly demonstrates the success of our Housing First philosophy…. Making sure people are in a comfortable, stable environment is our first priority. Only then are we able to effectively treat and assist them in their recovery,” says Vivianne Chaumont, CEO of ValueOptions of Arizona.

Under ValueOptions’ management, the Maricopa County housing program for persons with SMI has increased the number of its units by 64%, adding 2,300 in the last six years. Maricopa County's housing program has received praise from both the state auditor general's office and the White House. In 2002, Philip Mangano, executive director of the federal government's Interagency Homeless Council, recognized ValueOptions of Arizona's housing program as a national best practice.

The Housing First model has been tested for the past several years in New York City, Washington, D.C., Seattle, and several California cities with similar results and is currently being implemented across the nation.

Suzanne Legander, SA, MAOM, is the Site Administrator at the Washington House Clinic for ValueOptions of Arizona.