Approaches to Primary and Secondary Prevention of Homelessness

1
Approaches to Primary and Secondary Prevention of
Homelessness

• Martha R. Burt, Urban Institute
• Carol Pearson, Walter R. McDonald Assoc.
• COHHIO Annual Conference, April 15, 2008

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Strategies for Preventing Homelessness

• Looking first at people with SPMI, second at
  families
• Based on Strategies for Preventing
  Homelessness, Burt, M.R., Pearson, C., and
  Montgomery, A.E. (see www.urban.org or
  www.huduser.org).
• Conducted by Walter R. McDonald Associates,
  Inc. and the Urban Institute
• Conducted from October 2003 through April 2005

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What are primary and secondary homeless
prevention strategies?

• Primary prevention strategies
• Prevent new cases of homelessness and stop people
  from ever becoming homeless
• Secondary prevention strategies
• Focus on intervening early during a first spell
  of homelessness to help the person leave
  homelessness and not return
• Tertiary prevention strategies
• Seek to end long-term homelessness, thus
  preventing continued homelessness

4
What makes a good prevention strategy?

• Identify risk factors for homelessness
• Improves odds of designing effective
  interventions
• Research identifies antecedents, but hard for
  communities to eliminate risk factors
• Communities can use knowledge of risk factors to
  screen individuals or families for high
  homelessness risk to target resources toward
  those at highest risk

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Creating effective prevention strategies

• Offer effective prevention activities efficiently
• Effective activities stop homelessness (primary
  prevention) or end it quickly (secondary
  prevention)
• Efficient systems target well, delivering
  effective activities to people most likely to
  become homeless without help

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Approach Field Research

• Identify communities with
• Conscious, organized, community-wide prevention
  approach AND
• Data to document the effects of prevention
  efforts in reduced or avoided homelessness
• Describe these strategies and component
  activities
• Review community data that
• Measure achievements in preventing homelessness
• Provide evidence that prevention activities were
  effective

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Approach Field Research

• Conducted canvass to identify six communities
  that met the study criteria reasonably well, but
• We found very few such communities, despite
  considerable effort
• The have data criterion was the real killer
• But it was not that easy to identify communities
  that had thought through and were executing a
  systematic community-wide effort, either

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Communities Highlighted For This Talk

• Massachusetts, and DMH in particular, to examine
  efforts to prevent homelessness for people with
  severe and persistent mental illness (SPMI)
• Hennepin County, Minnesota, to examine family
  homelessness prevention efforts

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Limitations of the Data Available from Study Sites

• None of the communities in our study had a
  control or even a comparison group, with one
  small exception (Mass. DMH - Tenancy Preservation
  Project)
• One had time series data (Mass. DMH)
• All the family sites and one of the SPMI sites
  had the ability to see whether the people who
  received prevention assistance showed up later in
  their homeless programsbut only one routinely
  did so (Hennepin County, MN)

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Massachusetts DMH Prevention Efforts for Its SPMI
Clients

• 48,000 people with SPMI in Massachusetts
• DMH serves the poorest and neediestaverage
  income around 15 of poverty level
• 2 decades of focus on preventing homelessness
  among DMH clients and people who are DMH
  eligible, even if not already clients

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Massachusetts DMH Prevention Efforts for Its SPMI
Clients

• State funding specifically for purposeSpecial
  Homelessness Initiative (HI)
• Began in SFY 1992 at 1 million
• Has been about 22-24 million a year for the past
  5 or 6 years. Do what it takes flexible funds
• Urban Institute recently completed a 3-stage
  larger-scale evaluation of HIs impact, so
  information for this talk comes from both studies
• This is on top of basic departmental budget that
  had begun to shift toward community-based
  residential and support options several years
  before HI

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Massachusetts DMH Prevention Efforts for Its SPMI
Clients

• Key elementHousing development
• From about 2,700 units of community housing in
  1991 to over 7,600 in 2005, and increasing
• From mostly group homes to mostly independent and
  semi-independent living
• New Safe Havens and beginning direct access to
  housing
• Key elementcommunity supports
• Strong ACT, Clubhouse, employment, peer-to-peer,
  and other supports for maintaining housing

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Massachusetts DMH Prevention Efforts for Its SPMI
Clients

• Key elementrecognition that housing is a
  clinical issue
• Doing the ongoing staff training that is needed
  to shift a largely clinical endeavor to including
  housing status as a matter of their concern
• Developing thorough discharge planning protocols
  and assuring that the housing would exist to make
  them likely to succeed

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Growth in DMH Community Housing Capacity
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Reduced Proportion Homeless at Admission and
Discharge

• Due in part to deliberate and sustained efforts
  to increase housing capacity and supportive
  services,
• Reduced the proportion of people being admitted
  to state continuing care facilities who were
  homeless
• Reduced the proportion of people being discharged
  to homelessness from state continuing care
  facilities
• True over and above drastic drop in overall
  admission levels due to hospital closures

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Reduced Proportion Homeless at Admission and
Discharge
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Homeless at Admission and Discharge in Relation
to Housing Capacity Growth
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Special Case Tenancy Preservation Project

• DMH contracts with CBO to work with local housing
  courts, to prevent evictions of people with
  behavioral health problems
• 51 tenancy preserved, compared with 24 for
  people waitlisted and never servedand probably
  none of the latter moved to alternative housing.

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Massachusetts DMH Prevention Efforts for Its SPMI
Clients

• So, against ideal prevention research design,
  Massachusetts
• Doesnt have a true control group only TPP could
  generate a comparison group
• But does have change over time in homelessness
  tracked against changes in housing capacitynot
  perfect, but suggestive
• Targeting is probably pretty good, as housing
  basically goes to people who have no other viable
  housing alternativesand DMH does search for
  those alternatives
• TPP targeting is to people with a filed eviction
  action

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Hennepin Countys Rapid Exit (RE) Strategy for
Families

• Background
• 1993, HSD/MHFA created Family Homeless Prevention
  and Assistance Program (FHPAP) legislation
• FHPAP provides flexible outcome-based funding
• 2001 crisis level increase in homeless families
  led to creation of screening, admission, and
  rapid exit system

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Homelessness Prevention for Families

• Operates through 17 nonprofit agencies
• Offers emergency assistance and other services
• Criteria for receiving help funded by FHPAP are
  uniform
• Organized by geographical catchment area

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Key Elements of Rapid Exit (RE) Strategy

• Screening and Diversion
• Established priorities for families to be placed
  in shelter
• Screened families to be placed in shelter to
  determine on greatest need, literal homelessness
• Increased number of families able to secure
  alternative housing

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Key Elements of Rapid Exit (RE) Strategy

• Rapid Exit Coordinator/Screener assesses housing
  barrier levels (4)
• Level 1 No Barriers except economic ones
• Level 2a Has some of the following barriers
• No rental history No HS/GED Physical Dis HH
  lt 18
• No more than one eviction No criminal No
  drug/alch
• Level 2b Has some of the following barriers
• Up to 3 evictions DV recent minor drug, crim,
  jail hist
• Mild beh probs No current CD Male teen Open
  CPS

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Key Elements of Rapid Exit (RE) Strategy

• Housing barrier levels assessment (cont.)
• Level 3 Has some of the following barriers
• Actively using drugs
• Recent serious criminal history
• Adult with severe behavior problems
• Current sexual abuse in the family unit
• 4 or more evictions
• Current battering with the abuser in the family
  unit
• Children with severe behavior problems
• Has recent record of property damage to rental
  housing

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Key Elements of Rapid Exit (RE) Strategy

• Separating sheltering and move em out
  casework/supportive services
• Conditioning continued shelter stay on progress
  toward exit (vouchered three days at a time)
• Casework agency performance is monitored contract
  renewal depends on performance

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Changes in Hennepin County Family ES Outcomes

• Cut average shelter LOS by one-half (from almost
  60 days to approximately 30 days)
• Eliminated use of motels
• Reduced the number of families in shelter from
  317 to fewer than 116 at any given time
• Reserves shelter resources for families with the
  most serious housing barriers (Level 2b and lower
  Level 3).

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Client Difficulty of Families Admitted to Shelter

• Has changed drastically from 1995, when concerted
  efforts began, to 2003

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OutcomeReturn to Shelter

• Family prevention95 percent of families did not
  use shelter within 12 months 5 percent did
  (based on 1,170 families receiving assistance)
• Family rapid exit from shelter88 percent did not
  return to shelter within 12 months 12 percent
  did (based on 1,024 families using shelter)
• Thats WITHOUT a subsidy
• Family transitional housing96 percent did not
  return to shelter within 12 months after their
  case was closed 4 percent did (based on 47
  families).

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Documenting Prevention Effectiveness

• Matching against shelter records
• Changes over time documented within a single
  database
• Special data collection/longitudinal follow-up

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Discussion Implications for Policy and Practice

• Offer only prevention activities that research
  documents as effective
• Services should be targeted
• Organize the community
• Develop data systems that reflect and improve
  system performance