In 2003, the City of Chicago launched its ambitious, ten-year Plan to End Homelessness in partnership with advocates and service providers from across the city. SSA’s Emily Klein Gidwitz [the late] Professor Michael Sosin is working with Christine George, an assistant research professor at the Loyola University Chicago Center for Urban Research and Learning, and Susan Grossman, a professor at the School of Social Work of Loyola University Chicago, on a multipronged effort to measure the plan’s progress, including a survey of existing shelter options, a longitudinal study of individuals in the system and a qualitative analysis of services.
For this issue’s Conversation, Sosin sat down with Nancy Radner, A.M. ’93, the chief executive officer of the Chicago Alliance to End Homelessness, which, in partnership with the City of Chicago, implements the Plan to End Homelessness and commissioned its evaluation. Sosin and Radner talked about different ways of understanding the causes of homelessness, the latest research and what it takes to help those who’ve experienced homelessness.
Sosin: Let’s start by talking about what homelessness is.
Radner: Sure. The stigma around homelessness is very extreme in our country. The feeling that it’s all a matter of bad decisions and personal failings, and that these people don’t want to help themselves, is very pervasive.
Sosin: There’s two ways of thinking about the problem. One way is thinkingabout it as a circumstance, as a situation. And the second way of thinking about it is as a series of attributes in some people that make them more likely to become homeless. And I think the stress probably should be on the first rather than the second. Some attributes are important correlates of homelessness, but the relationships tend to be loose, making intervention difficult. For that reason, recent policies are placing more emphasis on reversing the situation, first, and only then dealing with personal problems and other attributes that contribute to the situation.
Our report found there were three major reasons people are homeless, although this set of reasons doesn’t cover everything. We found that a little less than half [of the homeless people we surveyed] had a place to stay and lost their source of income and simply can’t handle rent—the classic way you think of someone falling into homelessness.
Radner: Pure economics.
Sosin: Right. The group that’s maybe even slightly larger are those who basically had others who they were depending on and no longer can. There are people who had arguments, people who live with their parents and that relationship ended, people who actually lived alone but had income sources from others that dried up.
And then the third group, which is thought about less frequently but probably is equally important, had their expenses increase.
Radner: Interesting. Yes, we as a society don’t think about that as much.
Sosin: That can be a rent increase, but as important is an increase in medical expenses. And these things work together. So, for example, if you can’t work and you lose your home, maybe you wouldn’t be homeless if you had relatives who could take you in. So for most people, two or three of these things occur at the same time.
Radner: The truth is that most homeless people are trying the best that they can to survive. People do recover from homelessness and go on. And so the trick is to help change the circumstances. We just want to make sure that can happen.
Sosin: What do you think of the new policy, the Housing First policy?
Radner: Housing First was a theory that started with practice in the field rather than research. We were finding that when we got someone into permanent housing as fast as possible, that we were very successful at keeping them there— their homelessness would be ended, usually for good.
The theory used to be that in order to be in housing, you had to be ready for housing, you had to have all of your problems under control. We found that, no, get someone into housing, they’ll learn all those things. People who’ve been homeless say that when they can shut the door and have a key to the lock, there’s a sense of security that is so important. It’s Maslow’s hierarchy of needs. Once they had the food and shelter taken care of, then they could start to think about how to get back on their feet and become independent.
Sosin: So you don’t ignore services. It’s an order thing, right?
Radner: Right. Chicago’s Plan to End Homelessness was founded on two principles: Get someone into permanent, affordable housing and wrap services around them as much as they need them. And that’s proving to have great success. And there’s a third principle: homelessness prevention. Keep someone out of the homeless system altogether as much as possible, whether they are being discharged from a hospital or mental institution, or facing a short-term loss of money.
Sosin: So it would be nice if we could say that the model meant that if someone’s homeless, everyone gets a house. But it’s not quite that simple.
Radner: No, it’s not. The resources available don’t necessarily match the need, which is true with every poverty policy. So then the question becomes: How do you target resources?
Permanent supportive housing is one of our most precious resources, costing anywhere from $8,000 to $15,000 a year for an individual. Studies have found that this type of housing is actually much cheaper for society than if an individual is on the streets, where they use emergency rooms or end up in mental institutions. So there’s major cost savings with permanent supportive housing. But we didn’t start with the idea that we would be saving money. We started with the idea that we would be saving lives.
Sosin: So about how many of those units do you have?
Radner: Chicago has 6,600 units of permanent supportive housing. Since we created the Plan to End Homelessness, we’ve added over 3,000 units. We have one of the largest stocks of this housing in the country.
Sosin: So if there aren’t enough resources, how does the system decide who gets housing?
Radner: The housing that we build is primarily HUD-funded housing. HUD has prioritized people with disabilities, because that’s the housing that existed in the least numbers.
For other folks, folks who are not disabled, we have to piece together different types of housing. So with a number of our advocacy partners we created the rental housing support program, which is a state-funded program that has funded up to 4,000 units across the state for people who are rent distressed, some of whom are homeless. Someone has to have an income to use this housing.
Then we have a third model, which is called permanent housing with short-term support, usually for families that have an employment history but need some time to get to a greater income source. We provide two years of rental support and services wrapped around them, and then they assume the lease of the place that they’ve been living in.
Sosin: So if I read this right, the model and the research first considered the benefits of supportive housing. Several studies conducted in New York City tested the benefits, first using statistical matching and later conducting random sample experiments. Generally, the New York experiments focused on people with serious mental health problems. Those experiments suggest that supportive housing seemed to increase stability remarkably. There are other cities running experiments where the housing stability of those placed in supportive housing is similar to that found in New York, but where the control group doesn’t fare as poorly. That is, post experiment, the New York control group was as bad off as you can imagine a control group being.
Radner: It proved that you can house people who we previously thought were difficult to house.
Sosin: But there is very little research on models that don’t supply supportive housing.
Radner: I think that’s right. That’s the state-of-the-art in homeless services, to figure out how best to target the resources.
Sosin: Then there are programs like rapid rehousing. You recruit people who are homeless out of shelters who meet the criteria, who you think, again, have or can get some income so they’ll be able to sustain housing. I know there’s a national federal experiment going on that’s trying randomly controlled experiments: One group will get rapid rehousing and another will get a two year program that’s like the type that you described. But it will be the end of this year at best before we know anything.
Radner: [Programs like rapid rehousing] get people through the crisis that you were describing initially. They were able to maintain housing before something happened to them. They don’t need to be in our shelter system and they don’t need long-term rental support and supportive services. The economy has really put a lot of folks into that situation that they wouldn’t have been in before.
What we don’t know about rapid rehousing is do people need three months of help? Do they need six months? So we’ve been slowly doling out the money to try and figure it out over time. Now, again, with this economic situation, it’s unclear how long it will take before people get back on their feet.
Sosin: Plus, many of these are special demonstration programs. And then the question becomes, what do you do when you have these models? How do you get from these models to citywide programs?
Radner: I think in Chicago we tend to take big bites. When we said we were going to end homelessness, we didn’t say we were going to end it for chronically homeless people, which some cities did, we said we were going to end it for everyone. Bringing a big initiative like this to scale is more about political will than anything else. That’s where my organization comes in, to say, “We have the five or six interventions and we have the evidence to prove that those interventions work.”
We have more homeless prevention money than we’ve had in the past. And that was because we were able to make an argument to the Obama administration that it was what we needed in this economic crisis. So part of the economic stimulus package was over a billion dollars of homeless prevention funding nationwide. We’re always looking for that window of opportunity.