Supportive Housing 101

• Ryan Moser, CSH

• Katrina Van Valkenburgh, CSH

Annual Conference

Georgia Supportive Housing AssociationNovember 2012

www.csh.org

What Would You Like to Get Out of this Session?

Take 5 minutes Talk in small groups about what you want to be sure to get

out of this session. What do you want to know or understand when the session is over?

Report back on what you want to be sure we cover.

Agenda

CSH What is Supportive Housing? What is its Impact? PSH as Evidence Based Practice. What is the National Context around homelessness? How to Create PSH? Examples of PSH Projects.

Who is CSH?

CSH helps communities throughout the country transform how they address homelessness and improve people’s lives through quality supportive housing.

•Project Assistance and Lending

•Public Policy and Systems Reform

•Industry Leadership and Capacity Building

CSH Products and Services

Tools QAP Survey Housing

Options Financial

Modeling PHA Toolkit

Training Quality Technical

Assistance Supportive

Housing Institute

In everything we do, CSH collaborates with public, private and nonprofit stakeholders to create solutions for communities’

toughest problems.

Consulting• Planning

• Research and Evaluation

• Policy Work• Program

Design

Lending• Loan Products

• New Market Tax Credits

(CDFI certified)

How CSH Works

Driving Systems Change Influencing Government Affairs and Policy Advancing the Supportive Housing Industry Funding the Field Serving Vulnerable Populations Building Strong Community Partnerships

CSH National Initiatives

We pair our national initiatives and expertise with our on-the-ground knowledge and influence.

Keeping Families TogetherReturning Home InitiativeFUSECSH CharrettesSocial Innovation Fund Initiative

CSH Impact: By the Numbers

Catalyst for 143,000 units of PSH

Over 40,500 people living in CSH-backed PSH

Worked in 25 states 50,000 people trained in last

5 years

Over $200 million in loans Nearly $100 million in

grants $2.16 billion leveraged by

state and local policy efforts in the last 3 years

CSH Across the Country

What is Permanent Supportive Housing?

What Is Supportive Housing?

A cost-effective combination of permanent, affordable housing with services that helps people live more stable, productive lives

What is Supportive Housing?

Affordable Housing

Health Care

Mental Health

Services

Case Management

Substance Abuse

Treatment

Employment Services

Coordinated Services

Housing:Affordable

PermanentIndependent

Support:Flexible

Voluntaryindependent

Is Supportive Housing for Everyone?

Supportive housing is proven to work best for very vulnerable men, women and families.•Chronically homeless•Frequent users/multiple barriers•Chronic health issues•Substance Use Issues•Mental health issues

People Who:

BUT FOR HOUSING cannot access and make effective use of treatment and supportive services in the community;

and

BUT FOR SUPPORTIVE SERVICES cannot access and maintain stable housing in the community.

Who is Supportive Housing For?

Variety of Supportive Housing Types

Scattered Site– Single Family Homes– Apartments

Single Site – Rehab or New Construction

Integrated – Rehab or New Construction

Master Leasing

Adaptability: A Solution in Multiple Policy Sectors

Social Services

Housing/Community

Development

Health/ Hospitals

Behavioral Health Child Welfare

Aging

Veterans Affairs

Employment

Corrections/ Criminal Justice

Supportive Housing

Mental Health and other Service Providers

Homeless Service Providers

Non-Profit and For-Profit Affordable Housing

Providers

Public Housing Authorities

Private Developers and Private Landlords

County and Local Governments

Who Creates Supportive Housing?

Housing costs must be affordable to the tenant (i.e. less than 30% of income towards rent)

Choice and control over one’s environment is essential Housing must be permanent as defined by tenant/landlord law –

and housing is “unbundled” from services Housing and services roles are distinct Housing must be flexible and individualized: not defined by a

“program” Integration, personal control, and autonomy Services are Recovery-Oriented and Adapted to the Needs of

Individuals

Principles of Best Practice

Why Permanent Supportive Housing?

Research indicates that approximately 10% of people who experience homelessness are chronically homeless

This 10% consumes more than 50% of all homeless services – leaving the homeless services systems struggling to effectively serve those who could exit homelessness relatively quickly.

Dennis P. Culhane, University of Pennsylvania

Why Supportive Housing?

How Does Supportive Housing Break the Cycle of Homelessness?

Creates stability

Fosters self-sufficiency

Facilitates the process for securing and retaining employment

Helps tenants maintain and increase wellness and decrease harms through flexible, available, accessible and relevant services

Encourages peer support through tenant associations, peer support groups and other opportunities for community building

The Institutional Circuit of Homelessness and Crisis

Detox

Emergency Residential

Program

Jail

Shelter

Psychiatric Hospital

EmergencyRoom

Hospital inpatient care for medical and psychiatric conditions

Hospital emergency room visits – especially for the most frequent users of ER

Psychiatric emergency and institutional care Residential mental health & substance abuse treatment

– especially detox Jails and prisons Emergency shelters

Supportive Housing Reduces Use of and Costs for:

Housing is Healthcare

Even when services are not a condition of tenancy, tenants participate at high rates:o 81% health care utilizationo 80% mental health treatmento 56% substance abuse services

A Strategy That Works for People

A Strategy That Works for Public Systems (Portland, ME)

More than 80% of supportive housing tenants are able to maintain housing for at least 12 months

Most supportive housing tenants engage in services, even when participation is not a condition of tenancy

Use of the most costly (and restrictive) services in homeless, health care, and criminal justice systems declines

Nearly any combination of housing + services is more effective than services alone

“Housing First” models with adequate support services can be effective for people who don’t meet conventional criteria for “housing readiness”

Consistent Findings

Housing + Services Make a Difference

Good Tenants

Supportive Housing as Evidence Based Practice

According to the New Freedom Commission on Mental Health:

If effective treatments were more efficiently delivered through our mental health services system … millions of Americans would be more successful in school, at work, and in their communities.

— Michael Hogan, Chairman

Why Implement Evidence Based Practices?

The Evidence Supports Permanent Supportive Housing

Evidence of impact overall on resident stability: “the most potent intervention”

Evidence of greater impact over alternatives Evidence of cost benefits Evidence on the core principles (fidelity)

Dimensions of Permanent Supportive Housing Fidelity Scale

Choice in housing and living arrangements

Functional separation of housing and services

Decent, safe, and affordable housing

Community integration and rights of tenancy

Access to housing and privacy

Flexible, voluntary, and recovery-focused services

National Context Around Homelessness

McKinney Vento Act, remember 1987?

What is the HEARTH Act?

The Past: What the Homeless System has looked like historically

The Future: What the Homeless System will look like moving forward shifting

As providers shift their philosophy from managing homelessness to ending homelessness…– How do we change our models?

Key Elements of HEARTH

1) Federal Strategic Plan2) Modified Definitions of Homeless and At

Risk3) Program Changes4) Administrative Changes5) Performance Measures

Opening Doors: Federal Strategic Plan to End Homelessness

Call to Action

“Transform homeless services into crisis response systems that prevent homelessness and rapidly return people who experience homelessness to stable housing.”

HEARTH Act Roadmap

Old versus New Competitive Grants

McKinney-Vento (Old) HEARTH Act (New)

Key Changes & Mandated Activities

A change from a focus on individual programs to focus on coordinated local systems.– Coordination with other community plans– Coordinated or centralized intake

Key Changes & Mandated Activities

An emphasis on performance measurement and outcomes, measured by data.

Key Changes & Mandated Activities

A movement away from “housing readiness” and long periods of transitional services– Focus on homeless prevention whenever possible or the

quickest return to housing whenever that’s not possible through rapid rehousing or permanent supportive housing

HEARTH Performance Measures

Reduce average length of time persons are homeless Reduce returns to homelessness Improve program coverage Reduce number of families and individuals who are homelessness Improve employment rate and income amount of families and

individuals who are homeless Reduce number of families and individuals who become homeless

(first time homeless) Prevent homelessness and achieve independent living in permanent

housing for families and youth defined as homeless under other Federal statutes

Requesting HUD TA

For recipients: technical questions re: CoC Rule– www.hudhre.info: ask a question

HUD TA– www.hudhre.info: request TA– No specific TA provider guaranteed but can suggest

or pick relevant topics

Creating Supportive Housing:

Services, Operating and Capital

Five Elements of Successful Supportive Housing Projects

People

Place

Support Services

Money

  Organization

Supportive Housing: Making the Pieces Fit

Organization

Services

Place

Money

Peop

le

The Development Process

Can be confusing!

Not necessarily linear

No standard model

Tasks are interdependent

Multiple players

TWO: Feasibility

ONE: Concept

THREE: Dealmaking

FOUR: Construction

FIVE: Operations

Go?No Go?Go?

Go?

No Go?Go?

Five-Phase Development Timeline

Phase 1 – Concept Phase Threshold

Project concept clearly defined

– Population to be served

– Scattered-site vs. project-based

– What types of services will be needed

– On-site services vs. off-site services

– What is the best location?

Phase 1 – Concept Phase Threshold

Financing sources identified– Capital, operating, and services

Assessment of organizational capacity

Core development team identified

Phase 2 – Feasibility Phase Thresholds

Site is selected based on size, location, cost, and environmental conditions

Analysis of regulatory restraints (zoning, etc.)

Schematic design – space allocations consistent with income projections

Cost estimates

Phase 2 – Feasibility Phase Thresholds

Detailed development and operating budgets

Solidify market data

Identified financing sources and constraints

Finalize development team

Phase 3 –Dealmaking Phase Thresholds

Negotiate financial commitments

Develop contract documents

Bidding, contractor selection and construction management procedures

Preliminary management plan

Preliminary service delivery plan

Phase 4 - Construction

The most expensive and riskiest part of the process

Limited control and the least involvement day to day

Mitigate risk by:– Insisting on detailed contract documents– Establishing clear owner, architect, and contractor

roles– Establishing construction period protocol.– Hiring an owner’s representative / construction

manager who is a licensed contractor or architect

Phase 5 - Operations

Open for business!

– Tenant selection and building lease-up– Begin services and property management functions– Work with tenants to build community, tenant

leadership opportunities– Refine plans, policies, procedures as needed– Monitor asset, budgets, and ensure compliance with

all funding sources

Who’s On the Team?

Development Team – a group of professional consultants, service vendors,

and other nonprofit organizations that collectively bring all of the skills,

expertise, knowledge, and experience to bear on the development and operation

of a project.

Key to Success: Partnerships

Developer Service Provider Property Manager

Strong partnerships between the Developer, Service Provider, and Property Manager are the key to a successful supportive housing project

Thinking Through Your Team

• What is my self-interest?• What outcome do we want from the collaboration?• What resources can our organization bring to the table?• What will my organization need from others?• Who will represent our organization in the collaboration?• What is our collaboration skill?• Who are the potential partners in the collaboration?

Exercise: Partnership Factors

Think of a partnership that you have participated in… – What are the factors that made it successful?– What were the challenges that made it

unsuccessful?– What can partners do to avoid difficulties?

Keys to Success?

Similar mission and goals Earn trust over time Everyone contributes to the partnership Clear and constant communication In it for the long-haul Sharing and collaboration Mutual respect

Who’s On the Team?

Owner

Property manager

Service provider

Neighbors

Building residents

Funders/lenders

Licensing/regulatory agencies

Developer

Development consultant

Architect/engineer(s)

Attorney(s)

Contractor

Surveyor

Environmental investigator

Marketing consultant

Community relations specialist

LONG-TERM INTERESTS SHORT-TERM INTERESTS

Owner: the buck stops here– Long-term control and legal responsibility

Developer: from idea to occupancy – Very different from management and services

Property manager: real estate operations– Lynchpin of financial and physical viability

Service provider– The “support” in supportive housing

Selecting Key Partners

Experience– Similar projects– Same funding sources– Integrating services with housing

Track record– Time/cost/communication

Style/approach– Knowledge transfer

Funder Requirements

Selecting Consultants

Funding to Develop Permanent Supportive Housing

Capital– Bricks and Sticks– One time funds

Operating– Funding to support building operations– Typically a Subsidy

Supportive Services– Grants to fund staff salaries

Services Make the Difference

Flexible, voluntary Counseling Health and mental health services Alcohol and substance use services Independent living skills Money management / rep payee Community-building activities Vocational counseling and job placement

Housing First

Philosophy: Safe, affordable housing is a basic human right and a prerequisite for effective psychiatric and substance abuse treatment.

Key components: – Simple application process that does not require numerous site

visits and excessive documentation; – Harm reduction approach in which tenants are not required to be

clean and sober in order to obtain or keep their housing; and – No conditions of tenancy that exceed the normal conditions under

which any leaseholder would be subject, including participation in treatment or other services.

Housing First Research

Research has demonstrated the effectiveness of this model, particularly among people who have been homeless for long periods of time and have serious psychiatric disabilities, substance use disorders, and/or other disabilities.

These studies of housing first models have a number of similar findings: – Housing First leads to higher rates of housing retention– There is very little difference in the level of tenant substance use and

psychiatric symptoms between Housing First and Non-Housing First models.

– Participation in services is still relatively high in housing first models, but lower than in non-housing first models where services are required as a condition of tenancy.

Examples of Permanent Supportive Housing

Rebecca Johnson Apartments

Learning Center

Humanities Curriculum

Rebecca Johnson Apartments

archi-treasures: Arts-based community development organization reducing social isolation by creating grassroots partnerships to build public spaces, empowering individuals to shaper their future and the future of their community

Alethiea House’s Avondale Gardens

64 2, 3, and 4 bedroom units in Birmingham Alabama

Began developing housing when graduates of their Substance Abuse program couldn’t access housing.

15% of the units are set aside for people who are homeless and are recovering from substance abuse or mental illness

Fannie Mae Maxwell Award winning project.

Massac County Mental Health

Crane Ordway – Integrated Housing

St. Paul, MN 70 affordable

Units, 14 for people who are chronically homeless

Harm reduction service model

SERV – Integrated Housing

Bergenline Ave (Union City, NJ) and Boulevard East (North Bergen, NJ)– Each building has12 units that include 5 PSH units and 7 affordable

units Guttenberg, NJ

– 14 unit property that offers 6 PSH units and 8 affordable units PSH units serve people with serious mental illness. All units serve

people at 50% and below AMI

Heartland Housing – Leland Apartments -- Chicago, IL

137 affordable units of which 50 are supportive housing.. Historic building. 17 types of funding.

25 PSH units are part of a federal safe haven for people leaving the streets needing support.

Developer - Heartland Housing

Service Provider Heartland Health Outreach – 2 Floors

Housing Opportunities for Women

Christian Community Health Center

300+ Scattered Site Housing on the South Side of Chicago

Serve individuals and families Harm Reduction Model More than 90% of their tenants remain housed

after 12 months FQHC look-alike Separate Case Management and Property

Management staff

Resources

http://store.samhsa.gov/product/Permanent-Supportive-Housing-Evidence-Based-Practices-EBP-KIT/SMA10-4510

CSH Resources

On the CSH Website: www.csh.org PHA Toolkit Dimensions of Quality Toolkit for Developing and Operating Supportive Housing Report on the State of the Supportive Housing Industry Publications and Toolkits Link to Stories of Home: Video Channel with Tenant Stories

We’ve talked about PSH, how to create it,

Evidence Based Practice, National

context and impact.

Listeners’ Goal1

I don’t know what I would do without the services here.

-Denise,Supportive Housing

Tenant