2016 Special Recognition: Homeless Intervention Programming

The policy proposal discussed in this blog, from Drs. Dennis Culhane and Thomas Byrne, received Special Recognition in Pioneer’s 2016 Better Government Competition.

The popular image of homelessness in our country is an older man, saddled with bags, begging for change on a city street. He has been there for months or years, and perhaps suffers from mental or behavioral illness. Though many homeless individuals in the U.S. fit this description – living for extended periods without a place of residence – the vast majority of the homeless population is in fact transient. They are driven out of housing for short periods of time by crisis events, including evictions, break-ups, and release from prison or hospitals. The expensive, high-intensity programs designed to assist the long-term homeless do not offer the same utility and value for this much larger “crisis homelessness” group.

In recent years, new evidence has suggested that a specific approach to crisis homelessness, rapid re-housing (RRH), shows promise in reducing the length and severity of short-term homelessness. RRH is distinguished by its emphasis on a return to safe housing as the immediate goal; it is sometimes known as “housing first” intervention. Rapid re-housing involves three main steps: first, providing individuals and families with assistance locating and securing housing; second, temporary financial assistance to cover move-in costs and several months of rent; and finally, case management services, which ensure that participants connect effectively to the community and become self-sufficient in their new homes.

This system has had notable impact among crisis homeless populations, and studies show that it reduces the likelihood of a return to homelessness later on. In a test case run by the Department of Veterans Affairs, just 15% of participants in a rapid re-housing test program returned to homelessness within a year–a great improvement over the success rate of other housing programs.

Rapid re-housing can be difficult to apply to vulnerable individuals – especially those with mental and behavioral illness, who are more likely to be homeless but less capable of handling a transition to self-sufficiency. Building on the structure of rapid re-housing, Professor Dennis P. Culhane of the University of Pennsylvania and Assistant Professor Thomas Byrne at Boston University propose a hybrid system that would combine rapid re-housing with critical time intervention (CTI) – a separate system first developed in New York City in the 1980s. This, they suggest, could enable a wider population to reap the benefits of rapid re-housing.

CTI was designed specifically to help vulnerable, mentally ill people find security and safety in their communities as they exit institutional settings, such as prisons, mental hospitals, substance abuse treatment, and halfway homes. The intervention fosters community-based support for these individuals under the management of case workers.

During what is known as the transition phase, case workers ensure that individuals moving out of institutional structures have a solid base of support on the outside, including housing, healthcare, and employment opportunities. Next, individuals in CTI programs enter housing and begin to acclimatize to their new lives, drawing on the community support that has been developed with the help of their case worker. Gradually, as the individual finds his or her footing, the case worker is no longer needed.

The utilization of CTI allows vulnerable populations to make better use of rapid re-housing. The professors’ proposal suggests that a combination of these two evidence-based programs could be extremely effective in helping to reduce crisis homelessness among the mentally ill. Forthcoming Medicaid funding could feasibly cover a major expansion of rapid re-housing if coupled with CTI, as the authors propose. They also project that hospitals and governments would recognize significant savings, as the costs of housing interventions would ultimately be offset by a decrease in the hospitalization and incarceration of the mentally and behaviorally ill.

An implementation of this policy in Massachusetts could help the Commonwealth’s most vulnerable citizens, placing them in safe and secure housing and fostering community connections. This, in turn, will reduce the social and economic costs of homelessness and mental illness in the Commonwealth. Healthcare and housing policymakers should strive to make this promising new intervention a priority for Massachusetts.