How ten global cities take on homelessness: Excerpts

By Linda Gibbs, Jay Bainbridge, Muzzy Rosenblatt, and Tamiru Mammo

Introduction

• In the United States, 40 percent of people experiencing homelessness were Black in 2019, 22 percent were Hispanic/Latinx, and 3.2 percent were Native-American, even though these races constituted approximately 14 percent, 18 percent, and 2 percent of the general population, respectively.

1. The Transformation of Homeless Services

• [T]he moral authority and financial responsibility for providing shelter was originally in the hands of charitable organizations, with governmental support slow to follow. Homelessness remiandly largely unclaimed as a social problem well into the twentieth century. Without the statutory responsibility to manage the problem, and few financial resources to achieve programmatic goals, municipal players were handicappped in terms of having the knowledge and ability to overcome homelessness.
• Understanding the causes of homelessness is important, and knowing the common pressure points that can dismantle a life or multiple lives enables cities to intervene earlier to forestall more street living.
• If cities lack the legal authority or service capacity to address fully the causes and consequences of homelessness, how can the evidence of what works be leveraged? A better approach would be for cities to move from the disjointed patchwork of often ill-defined services to a coordinated system of care whereby clients rationally receive the most appropriate service through a shared system of assessment and intake, with a commitment to measuring impact backed up with rigorous evaluation.

2. Engaging People on the Streets

• Even in New York City, with its unconditional right to shelter, a right that has led to the creation of a complex network of facilities that safely accommodate more than 70,000 adults and children every night - more than 120,000 different individuals over a year - an estimated 3,588 persons were sleeping rough, according to the city’s 2019 on-night point-in-time street count.
• To put a fine point on it, even in one of the world’s wealthiest and most progressive cities, where any person without a home is entitled to a place to stay, thousands every night choose to sleep rough. How better to underscore that it requires more than simply the availability of shelter to engage effectively those who sleep on the streets or in parks, transit facilities, and other public spaces of the urban landscape.
• Convincing individuals to come inside requires an understanding of what services may be available and, even more important, how these options may best be communicated to those experiencing homelessness. What to the outsider or passerby appears as a crisis demanding immediate action is often accepted as a long-established norm to the person sleeping rough, the disruption of which is anything but desirable.
• For many experiencing homelessness, the root cause of their predicament extends back years, to childhood events associated with the two places that should have provided them safety and helped prepare them for adulthood - home and school. It is all too common in their personal histories for chronically homeless individuals to have not completed high school and, as children, to have experienced trauma - physical or psychological or both - in their home.
• Improving the odds for engaging an unsheltered person requires a willingness to see them not as problems but as people and as clients. Those engaging with them must understand how they view themselves - as resourceful and resilient, innovative and entrepreneurial, capable and independent; but also as untrusting and scared.
• One of the basic tenets of successful engagement of those living unsheltered - critical to building trust - is thus to do what the person asks, within the bounds of clinical appropriateness and professional conduct.
• By walking away, the outreach worker is establishing a relationship that over time will enable them to provide meaningful help.
• Homeless outreach first became a major activity of local governments in the New York City metropolitan area about a decade after the city’s right to shelter was established in 1979. Outreach arose out of an acknowledgement that, although shetler was available on demand, thousands of homeless individuals were voting with their feet and choosing to sleep on the city’s streets, parks, subways, and transit facilities rather than in shetlers. In providing homeless outreach, the city recognized that it had to do more to motivate people to avail themselves of the shelter and services being offered and that, if the customer wouldn’t or couldn’t find the service, the service needed to find the customer - and make the sale.
• Mexico city outreach workers don Day-Glo pink jackets. These easily identified vans, vests, jackets, and other markers help give clients comfort if the face of the worker approaching them is not familiar. Those who wear the special clothing also communicate to the public the extent of efforts to help people on the street.
• Outreach workers typically deploy in teams of two or (at most) three, for safety and effective engagement while also not presenting the client with an overwhelming force. One outreach worker takes the lead in initiating the engagement, while the other listens, observes, and takes mental notes on the client’s appearance, physical condition, and possessions, while also assessing both the environment and the client’s connection to it.
• Studies show that homeless individuals are at greater risk of victimization than the general public, and those living with severe mental illness on the street are more likely to be victims of violence than to be perpetrators.
• While the circumstances in El Brox [Bogota] were unique, in general, once a decision is made to dismantle a particular encampment, a specific date must be set and communicated to the residents. This affords the outreach teams sufficient time to do their work (build relationships, enagem clients, and the like), while confirming to encampment residents that whether they accept services or not, they will have to move by a certain date. In short, it empowers the clients to make choices and feel at least partially in control of their circumstances. Over the weeks leading up to a removal, as outreach teams engage, some clients will accept services. Others will wait to see if the threat is real before pulling up stakes. Credibility is thus critical; it is imperative that once a date is set, it is enforced. On the stated date, with police and property managers present, outreach teams will make one last effort. Most clients who took the wait-and-see approach will leave, either to accept services ro to find a new location. Because of the extensive effort and advance notice, rarely is it necessary to arrest anyone for trespass, though there might be cases of involuntary removals for safety. Once all residents of the encampment have left, the area should be cleaned of any remaining debris by the property manager, secured, and routinely patrolled to ensure the encampment is not reestablished.
• The efforts of homeless outreach teams should become more highly visible to the community at large.
• The culmination of these efforts is to bring these people inside. Months of engagement can be wasted if, at the point the person finally agrees to accept a bed, no placement is available. The ability of outreach workers to coordinate who is prioritized for shelter and housing resources is critical to success. With this final step, much depends on whether the municipality has a range of placement options available for outreach workers to access.

3. Sheltering Options that Work

• Many cities have opted for quick responses to basic needs but have not accepted reality: despite decades of evidence, homelessness is a chronic societal condition and, as such, necessitates a comprehensive, strategic, and permanent response.
• While the goal should be to have housing affordable to all, the reality is that the supply-demand imbalance is extreme and won’t be resolved in the short-term, if ever. Stable housing unquestionably improves an individual’s ability to manage their lives. However, there are individuals sheltered and unsheltered -who have physical or behavioral health issues, or both, that put them at risk, jeopardizing their ability to succeed and thrive in traditional housing. Therefore, it becomes essential that municipalities consider offering forms of transitional living facilities as a bridge between homelessness and home.
• To establish a coordinated approach to a comprehensive service array, local government leaders can use their authority to persuade the community to coalesce around a well-articulated and shared vision for guiding public contracts. Creating such an environment lays the groundwork for negotiating outcome-based contracts that best use public-sector dollars.
• As the name suggests, drop-in centers and service centers are designed to be easily accessible, on a client’s terms. The intent is to offer the client access to the services they want without libgatory engagement in other activities. The model’s objective is to expose clients to other services.
• The expectation is that, after a period of time coming to the center for what they want, the client will be further motivated to seek out what they need.
• Similar to Housing First [NYC], the Safe Haven model applies a come-as-you-are philosophy that does not require, as either a prerequisite or co-requisite, the participation in any form of service or treatment. This is sometimes referred to as a bed-first model.
• Residents seeking admission are assigned a bed and a locker; thus, the program has less of a revolving-door experience than do drop-in and service centers. And because the program is designed specifically for individuals who have been unsheltered for significant lengths of time (the chronically homeless), they are less likely to have other options.
• As Safe Havens are designed specifically for chronically homeless individuals who have been living unsheltered, clients seeking admission cannot simply arrive; instead, they must be referred (and often are brought) by an outreach worker who has verified the client’s chronic homeslssness as well as their appropriateness for the proga. Once admitted, clients are assigned a bed and locker and can come and go freely, leaving their belongings behind and not be subject to a curfew.
• For shelters to succeed, they need to provide structure, ensure safety, and offer an array of services. As shetlers evolve away from emergency response to centers of transformation, attention should be paid to the service model, the physical design, building up an organizational entity qualified to operate the program.
• Some cities have organized certain shelters around specific root-cause issues; for example, designating one or more shelters for individuals focused on finding and retaining employment, living with a mental health disorder, recovering from addiction, or obtaining medical recuperation and support.

4. Developing an Affordable Housing Strategy

• The upswing in urban living follows years of disinvestment in social housing by many national governments, which has put many low-income people at risk of displacement because of escalating costs.
• A Pew Charitable Trusts report in 2018 concluded that 38 percent of rental households in the United States were rent burdened in 2015.
• A 2020 report from the Joint Center for Housing Studies of Harvard University found that nearly 56 percent of renters in Los Angeles in 2018 were rent burdened.
• The higher the housing cost burden, the more tenuous a person’s housing stability becomes, and any sudden change can result in an episode of homelssness.
• With a fixed amount of federal housing development dollars to invest, cities face a trade-off between the size of a subsidy per unit and how many units should be built. Most city housing strategies opt for stretching investment dollars to develop units that require income levels out of reach for many people. Without doubt, these housing projects do provide relief to low- and moderate-income households, but the units built are largely unaffordable for the poorest residents.
• A municipal housing plan that seeks to alleviate the current level of homelessness must set aside protected resources for homeless-system partners to access for their clients.
• Three broad categories of actions have been tried. They are:
• Housing navigation services and supports that ease the process of finding and securing an apartment and address modest barriers to moving
• Rental assistance strategies that help tenants pay for apartments available in the community
• Development solutions that create incentives and set-aside units in new building construction for people who are at risk or formerly homeless
• Over the years, the city [NYC] has implemented various versions of the “broker’s bonus” in an effort to bring more private-market housing to the disposal of homeless clients.
• The city guarantees that landlords are paid the rent and for any damages incurred.
• In the absence of rent-controlled affordable housing, some US cities issue housing vouchers that provide a certain amount of money each month to subsidize market rate rents.
• In Paris, applications for social housing are prioritized through a scoring system, with households receiving points for criteria demonstrating different levels of need, such as the number of persons in the household, forcible eviction, or disability.
• Then-New York City mayor Michael Bloomberg wanted a program that encouraged work, and in 2004, his administration launched Housing Stability Plus (HSP), a five-year housing voucher for shelter residents that decreased in value by 20 percent each year. To help fund the voucher, the city could tap the federal Temporary Assistance for Needy Families (RTANF) program if the shetler resident was on federal public assistance, thus limiting eligibility for the voucher to those qualifying and in compliance with that program. Compliance requires that the resident be employed (at a below-poverty level) or be actively searching for employment. As the name suggests, the program offers time-limited cash assistance.
• During its first nine months, the HSP voucher provided an initial success by 2,850 New York City households in permanent housing. However many tenants did not earn the increase in salary commensurate with making up for the decreasing voucher amount and paying the rent. And those who did increase their income often lost eligibility for public assistance and, therefore, were no longer qualified for the voucher. In addition, the living conditions of the apartment benign rented were not subject to the same controls as in other federally funded rental assistance programs, and substandard units were rented while unscrupulous landlords made side deals with tenants asking for additional rent on top of the voucher.
• After monitoring the impact and results of the housing voucher program, the city changed course, launching a new program in 2008, Work Advantage, that addressed many of the problems with Housing Stability Plus. The new program, targeted toward shelter residents working at least twenty hours a week, was intended to last for one to two years. The city added an inspection mandate for new apartments and required landlords to sign an agreement that rendered side deals illegal. During its tenure from 2007 to mid-2011, the program housed more than 45,000 people. It ended abruptly when New York State governor Andrew Cuomo withdrew the program’s eligibility for matching state and federal funds under TANF….Since then, despite the reintroduction of a rental assistance program and various rehousing efforts, the number of homeless in New York City has remained above 50,000.
• The Low-Income Housing Tax Credit has become the primary source of federal support for affordable housing development, producing over 3 million units since its enactment in the Tax Reform Act of 1986.
• One avenue to securing these funds is local revenue raising.
• Another option is to create public-private partnerships that help fund housing for the homeless.
• Another strategy encourages development through inclusionary housing, which uses building codes or zoning regulations to increase production of affordable housing.

5. Supportive Housing to Target Complex Needs

• A comprehensive housing plan considers both affordability and the many reasons why a person may be living unsheltered. Homelessness brought on by an economic crisis can be solved with affordable housing, but chronic homelessness requires more than simply a place to stay. * It requires additional support to ensure a person stays housed.
• Supportive housing is an evidence-based model of permanent affordable housing that combines on-site services and support to lease-holding tenants who need assistance to live successfully on their own.
• Supportive housing expanded nationally in 1987 after the federal government enacted the Mc-Kinney-Vento Homeless Assistance Action, which authorized more than $1 billion in funding for longer-term comprehensive service and housing dedicated to addressing homelessness.
• Dennis Culhane, a researcher at the University of Pennsylvania, conducted a large-scale analysis in 1999 of homeless people placed in the NY/NY supportive-housing program.
• He found that the homeless were each accruing public costs of more than $40,000 annually by accessing the seven systems. After these residents were placed into supportive housing, their public costs were reduced by $16,282 per person each year.
• Supportive housing comes in two models: congregate and scattered site. Congregate supportive housing generally takes the form of a stand-alone building with a majority of the units reserved for the homeless population, though it may include some low-income residents.
• A less frequently deployed model provides supportive services through a local storefront to scattered apartments - a mix of living spaces in different buildings throughout the community. Under the scattered approach, a nonprofit holds the property lease and subleases to the tenants.
• These results showed that homeless individuals with mental illness could in fact remain in a stable home if given an apartment coupled with voluntary wraparound services.
• Supportive housing works best for people who have multiple needs, such as housing stability, no or low income, serious and persistent health problems, or mental health or drug addiction challenges, or both.
• As the street homeless often do not have health insurance, emergency costs are frequently not reimbursed and public hospitals often bear the cost. If the PSH can reduce costly emergency room visits, a compelling budgetary argument can therefore be made.
• Outcomes for the homeless criminal justice population in supportive housing are also mixed but not promising. For example, a 2012 study of a reentry program in Ohio found that participants were 43 percent less-likely to be rearrested for misdemeanors and 61 percent less likely one year later to be incarcerated than the comparison group, but there were no cost savings. The 2017 RAND study in LosAngeles found decreases in the number of people arrested and jailed, but an overall increase in jail days and costs.

6. Prevention that Works

• Given the rarity of homelessness and its relationship to a certain level of bad luck, ensuring that prevention strategies reach the right household poses a major challenge, because distinguishing the potentially homeless household or person from the rest of those in the neighborhood suffering from the stresses of poverty is difficult.
• Considering that only a small percentage of any one ends up homeless, and given that public resources are limited, programs must be well designed and workers must be efficient at identifying those at risk and choosing the proper services for them. A classic challenge that cities face is structuring service offerings that help individuals within their jurisdiction without luring people from other locations that do not offer such services.
• [P]rimary prevention aims to address the risk factors of homelessness well before they happen.
• The goals of both secondary and tertiary prevention strategies are to ensure that homelessness is brief and does not recur.
• Secondary prevention involves targeting people who are just approaching the crisis response system or are at the shelter door. The aim is to stabilize an individual or family.
• Tertiary prevention seeks to eliminate repeated spells of homeessness, recognizing that those who have been homeless before face the highest risk of homeslssness.

7. Systems-Level Thinking

• Each player with a piece of the solution must be brought to the same table to coordinate a strategic response. Only a complete, coordinated, and well-managed array of programs at scale can deliver on the promise to end homelessness.
• Many cities whose experiences are described in this book have deepened their approach to homelessness by pursuing evidence-based practices and refining models of care. At the core of municipal services, however, remains a siloed array of emergency services and shelters. An overlay of competing political and structural barriers drive fault lines through what should be a coordinated continuum of services.
• A clear articulation of the initial set of actions to be carried out to fulfill the vision statement, set forth in a broadly shared document, creates a road map for partners to rally behind. Ideal homelessness plans include actions on prevention, intervention, and permanency, tackling the challenge from all angles. Winning endorsements from all or most of the organizations that have the potential to impact outcomes will signal that the community is behind the plan.
• Plans require updating as initiatives take hold and as constant monitoring and attention provide evidence of impact.
• This systems-level principle is best applied when broken down into manageable objectives, achievable short-term outcomes that build momentum toward the longer-term goal.

8. Engaging the Community

• Sustained commitment to overcoming homelessness rests strongly on an engaged community that understands, supports, and constructively contributes to the strategy. An effective communications campaign can inform the public in ways that broaden networks, encourage innovation, and focus attention on alleviating the struggles of the homeless.
• Two different but not necessarily separate passions inspire the public’s opinions about homelessness.
• City residents have a deep compassion for those who are homeless and want them to be treated fairly and humanely.
• At the same time, residents value quality of life in their community and places of work. They don’t want to navigate their children around people sleeping in the street, avoid parks that have become de facto open-air shelters, or fear for their safety in passing large street encampments known for drug trade. The same people who want to help the homeless may also have an aversion to the actual homeless person asleep on a bench and to the location of a new shelter next door.
• Strategies for engaging the public concerning the problem of homelessness should acknowledge both the compassionate desire to help and the self-interested desire to have streets available for public enjoyment.
• Leaders need, through their communications, to constantly reinforce the message that living on a cement sidewalk in a cardboard hut is not a choice anyone would truly, willingly make.
• Many takeaways emerge from the Los Angeles model. The campaign rolled out in three stages. The first: educate and communicate. The second state of the campaign was engagement. And the third stage is activation.
• Understanding the Homeless System: Street Counts, By-Name Lists, Agency Databases, and Basic Research
• Data collection enables a city to scope out the situation. For over a decade, US and Canadian cities - use a point-in-time street count or a survey of service users to provide an annual measure of the extent of homelessness. Conducted every year or every other year, these estimates involve a comprehensive survey of how many people are living on the street. These street estimates are simultaneously paired with a summary of the number of people in shelter in order to obtain a complete point-in-time figure. By including basic demographics, such as gender, age, and duration of homelessness, that allow the city to track the size and shape of the problem over time, officials can chart the trajectory of homelessness for the city.
• Street counts are useful tools for providing overall, year-over-year accountability; however, they are not robust enough to manage the daily street outreach operations or track placements from the street into homes and shelters.
• By-name lists are not the equivalent of a count, in that they do not accurately or completely reflect the current status. However, these lists can reflect some of the flow in and out of homelessness and homeless people’s length of stay better than a point-in-time street count.
• Capacity management databases contain a wealth of information on shelter inhabitants since anyone who stays a night or uses a service is logged in.

9. Managing for Results: Performance Management and Modeling

• Collecting data helps in better understanding homelessness, but it is just as important for responsible parties to use information in real time to address problems as they arise, documenting what works - and - what doesn’t - with systems, data and accountability, and solid management.
• Governments and nonprofits interested in managing for results are increasingly using regularly reported indicators or measures, such as outcomes collected in databases, as a way to enhance performance management systems. Pictures and data might not be projected on live screens, as in the Paris crisis center, but they are reviewed at a designated time by top management to assess progress in meeting goals. The information that constitutes performance measures consists of quantitative and qualitative indicators of various aspects of public or nonprofit programs. The measures are tracked and reported at regular intervals, provide objective information to improve decision making as well as accountability, and prove critical to results-oriented management.
• When Bogota broke up trafficking houses in its ground zero for homelessness - El Bronx - citizens worried that poor residents residing in those buildings, many of them drug users, would show up on their neighborhood sidewalks. Through policy analysts’ regular mapping of the geography of homelessness, city workers were able to document that that wasn’t so. Vigilance with tracking allowed city officials to see that the problem resurfaced a few years later in the neighborhood of San Bernardo, which was then targeted for further intervention.
• There is an important distinction between outcome-level change and program effect.
• Program effects are more difficult to assess and require more careful evaluation or research than performance measures provide; yet identifying them serves a vital purpose in understanding the true impact of program operations, achievement, and efficiency.
• Part of what makes performance management successful is tracking and regular review of results. The use of data dashboards - a series of charts or tables with information on key performance measures that is regularly updated and reviewed, whether privately by a provider or in public reports - is an effective tool to keep abstract of developments, to allow mid-course corrections, and to keep staff focused on primary goals.
• To achieve the goal of ending homelessness - or making it only rare, brief, and nonrecurring - officials must agree on a benchmark number that can be tracked to demonstrate the city’s progress.
• In Edmonton, the annual street county and by-name list are used to gauge success, with the latter consisting of both unsheltered and sheltered people known to the system and receiving services.
• Essentially, evolving plans should be viewed as a big math problem; calculating how many people can be served, and for which outcomes, from the full range of initiatives included in the strategy. What level of efficiency will it take to meet the needs of every person on the street and in shelter, such that they can move to permanency?
• From the point when permanency for those currently experiencing homeless is achieved, the scale going forward need only be enough to meet the expected new onset of homelessness. The more that preventive strategies reduce that onset, the less that needs to be retained in the ongoing homeless service system capacity.
• Tracking homelessness system-wide also requires coordinated data systems or matching data between systems, or both, so that partners can understand the interrelationships of service systems that affect the homeless outcome and can detect impact from efforts to improve results.
• Performance monitoring provides an early warning system for changing trends, but it will not necessarily shed light on the causes or solution of the newly identified trend.

10. Managing in Emergencies

• No notes.

11. Conclusion

• Effective outcomes require sustained cross-system collaboration.
• Solutions require the input of systems that produce the problem: hospitals, jails, prisons, behavioral health facilities, child welfare systems, domestic violence systems, housing providers, housing courts, and others.
• Solutions also require input from people who have experienced homelessness.
• Only partners working together can tailor services to effectively serve the complex needs of the homeless individual in their current condition.
• Not every success requires every partner at the table.
• This type of cross-system collaboration works best under the guidance of a trusted convener and strong leader supported by a well-organized governance process.
• The sustaining force of many of these effective collaborations is the committed devotion of frontline managers who have dedicated themselves to the work, often without public attention or fanfare.
• Putting solid partners in place ensures that a prime set of best and emerging practices are followed across jurisdictions in order to effectively reduce homelessness.
• At the core of those best practices are solid data, the glue that holds the collaborative partners together, informing service systems with a better understanding the people they serve.
• Street counts effectively measure change over time and can be energizing points of civic engagement.
• The emergency of by-name lists has demonstrated the ability to galvanize partners around the very concrete lives of those in need.

My thoughts:

• It’s easy to say “our systems don’t work” because we see people on the streets. But when it is working, we aren’t aware because it isn’t as visible. We don’t see how many people are in housing, especially in housing projects that are well-integrated in the neighborhood. We don’t see how many beds are occupied in a shelter or the traffic experienced by social services.

So, just because people remain on the streets doesn’t meant the the city hasn’t taken a bite out of homelessness.

• When it comes to homelessness, there is no one-size-fits-all. Homeless people are not a monolith. Each person has their own history and needs. This needs to be recognized by those addressing homelessness in a city.