Access: The TAC Blog
The destructive nature of substance use disorders and the influence of active addiction on people’s behavior can often lead to homelessness. In fact, The Substance Abuse and Mental Health Administration (SAMHSA) estimates that 38 percent of individuals experiencing homelessness are dependent on alcohol, while 26 percent abuse other drugs, including opioids. With growing recognition of housing as a critical determinant of health and recovery, we must thoughtfully consider what kinds of housing can best help people with addictions optimize their potential for recovery and re-stabilize their lives.
Two recognized housing approaches intended to help people with substance use disorders (SUDs) transition from homelessness are “recovery housing” and Housing First. These approaches operate differently and have unique histories — yet rather than advocate for one over the other, I suggest that fully supporting both approaches should be our priority.
Alcohol and drug-free (recovery) housing is a critically important and currently under-resourced intervention. It can be operated with tiered levels of supports that are matched with the needs of residents, including more intensive supportive services for those exiting homelessness to self-governed Oxford Houses or Recovery Homes. Many residents of recovery housing attest to their need for this safe and supportive living environment in order to promote their long-term recovery from addiction, their health and wellness, and their ability to stay stably housed.
In the Housing First model, the top priority for service providers is to help individuals and families secure permanent housing. Often the term “low-barrier” is applied in this model, indicating that there are no conditions on tenancy, such as sobriety or participation in treatment. Housing First is based on evidence that stable, lease-based housing plus voluntary acceptance of services can help people make progress on addressing their mental health and addiction disorders.
My advocacy for both models is rooted in 17 years of work on programs designed to help this population. Indeed, my work starting Housing First programs at Central City Concern (CCC) in Portland, Oregon and at Colorado Coalition for the Homeless in Denver was inspired in part by wanting to make sure we were "throwing everything that worked” at ending chronic homelessness and addiction. At CCC, the idea of adding Housing First programming was initially met with some resistance, especially by colleagues who were themselves in long-term recovery. Over time, however, people began to see the value and successful outcomes of offering housing that was paired with individuals’ choices.
Recovery housing can be very effective for clients who are self-initiating detox and treatment. When evidence-based supported employment services, peer recovery mentors, and coordinated outpatient treatment were incorporated into CCC’s recovery housing, we found that high percentages of individuals with primary SUDs who had been homeless completed treatment and remained housed and employed one year post-exit.
With evidence supporting both approaches to housing for people with SUDs, providers and policymakers must be open to a range of approaches to address the diverse preferences and needs of the individuals they hope to serve. For this reason, when I shared the effectiveness of CCC’s recovery housing programs with federal agencies and stakeholders around the country, I also spoke (and still do) about the importance of ensuring housing choice for homeless people with SUDs.
Likewise, the Department of Housing and Urban Development (HUD) discussed in its 2015 Recovery Housing Policy Brief the value of promoting individual choice among housing options for homeless individuals. The brief encouraged expanding the supply of permanent supportive housing and other models that use a low-barrier, Housing First approach, so as not to exclude a large number of people who are unprepared to meet sobriety or abstinence requirements. But HUD also affirmed the importance of providing recovery housing options for people who want and need a sober-living environment. HUD’s Policy Brief outlines the characteristics, practices, and outcomes it expects from recovery housing funded with its homeless dollars.
The expansion of recovery housing received broader federal support in the 2016 Surgeon General’s Facing Addiction in America report, and in another report issued in 2017 by the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Earlier this year, the National Council for Behavioral Health (NCBH) issued a Recovery Housing Guide to help states include high-quality recovery housing among the options offered by their behavioral health systems. NCBH followed this guide with a letter to every Single State Agency, alerting them to SAMHSA’s unprecedented decision to allow State Opioid Response Grants ($930 million) to fund supportive services for individuals with opioid use disorders in recovery housing.
Research is needed on the long-term effectiveness of both recovery housing and Housing First programs for people with primary SUDs. For now, states and local jurisdictions can use the practices described in the HUD and NCBH policy briefs to expand the capacity of recovery housing and improve the practices of existing programs. Recovery housing can promote housing tenure, long-term recovery, reunification with families and children, economic and educational advancement, improved health and wellness, and community involvement. Many of my colleagues whose experience of recovery housing helped cultivate my understanding of the model also report perhaps the most significant outcome of all: They say they owe their lives to it.
Current legislation in Congress addressing the nation’s opioid crisis has wide bipartisan support and includes several provisions to provide housing-related assistance for people in recovery from SUDs. As the final bill becomes law, states and communities working to combat both addiction and homelessness will become better able to offer housing choice that includes robust recovery housing programs.
FAIRBANKS IS THE REGIONAL HUB for interior Alaska, an area larger than the state of Texas. The city’s need for supportive housing is amplified by its remote rural and frontier location and extreme arctic conditions. Although the number of people experiencing homelessness in Fairbanks — approximately 250 people at any given time — seems small compared to what other major U.S. cities report, the impact of homelessness in this community is an important factor: Even during bouts of -50° Fahrenheit temperatures, Fairbanks routinely has more than 50 people trying to survive in local encampments. There have been times when dramatic temperature changes caught encampment residents off guard, resulting in numerous cold weather injuries and even some deaths.
Since 2014, TAC has worked with state and local partners on strategies to create permanent supportive housing and rapid re-housing opportunities for Alaskans. Last December, TAC was invited to facilitate the Fairbanks Symposium on Homelessness, with the goal of generating momentum toward a community planning strategy for tackling homelessness in some of the most diverse geography and climate in the United States. As in other cities and towns across the country, both the cost of housing and a lack of available units present significant challenges. But the "must do" attitude of the local Fairbanks community has already resulted in remarkable progress, and can serve as a beacon for those working in other rural communities to prevent and end homelessness.
The Fairbanks Housing and Homeless Coalition is leading the charge, representing more than 20 local organizations that provide shelter, support, and opportunities for community members struggling with housing barriers. Since the Symposium, the city’s housing and homelessness coordinator has brought local agencies together for more planning. Collectively, the group has contributed an estimated $58,360 worth of in-kind donations to initiate a program that can quickly connect families and individuals experiencing homelessness to permanent, private market housing through intensive case management, applicable employment services, and tapering financial support. Just this month, the Alaska Mental Health Trust announced that it will fully fund this local rapid re-housing program!
The Fairbanks Rescue Mission, which is already implementing rapid re-housing for Veterans through a federal Supportive Services for Veteran Families grant, has been designated as the lead agency for the award. The funding provided by the Trust will allow the new program to hire two full-time staff members and assist approximately forty families a year with housing, case management, and landlord support. The Trust has given a further boost to efforts in the region by providing funding for the Alaska Coalition on Housing and Homelessness to hire a rural housing planner who can help build local coalitions in rural Alaska and improve the region’s readiness to apply for funding to meet its needs.
Fairbanks’ challenging environmental conditions and extremely rural setting make providing effective and targeted services to the community’s most vulnerable individuals a high priority. Fortunately, the community’s determination to make life better for its least advantaged members is just what is needed.
VA Awards TAC a New Supportive Services for Veteran Families Contract
THROUGH THE SUPPORTIVE SERVICES FOR VETERAN FAMILIES PROGRAM, the U.S. Department of Veterans Affairs (VA) helps service providers across the country to strengthen the housing stability and independent living skills of very low-income veteran families occupying or transitioning to permanent housing. TAC is honored to have been awarded a new five-year grant from the VA to continue and deepen the technical assistance we have provided to SSVF grantees since the program was launched in 2011. Joining us on the TA team are our longtime partners Abt Associates, the National Alliance to End Homelessness' Center for Capacity Building, the National Coalition for Homeless Veterans, Policy Research Associates, Inc., and Atlas Research.
Nearly 400 SSVF grants fund nonprofit organizations and consumer cooperatives across the country. TAC coordinates and provides specialized TA to all these grantees through in-person trainings, regional gatherings, program site visits, carefully designed products and tools, one-on-one consultation, webinars, and online group learning. By focusing on crisis intervention and housing stability, targeting practices to ensure effective delivery of resources, and using permanent supportive housing to improve both housing stability and behavioral health outcomes, we help communities develop system-level capacity to meet the unique needs of veterans and their families.
TAC Staff in Action
Ashley Mann-McLellan, TAC Associate, led community-wide rapid re-housing (RRH) trainings in Maricopa County, AZ and Orange County, CA (where she also led an accompanying executive-level training), kicking off efforts to use RRH as a system-wide strategy; Ashley also presented on decision-making and accountability frameworks at a Seattle CoC summit on governance, strategic planning, and racial equity, and gave a workshop on landlord engagement at this month's Housing First Partners conference in Boulder, CO; Executive Director Kevin Martone wrote about the importance of new affordable housing resources in the National Association of County Behavioral Health and Developmental Disability Directors newsletter, drawing on a widely read Access blog post by Senior Associate Gina Schaak and Senior Policy Advisor Lisa Sloane; Lisa was also invited to present on "Housing First and Permanent Supportive Housing 101" to the Oregon Housing and Community Services Department; at a March event, Associate Douglas Tetrault co-presented with the New Hampshire Interagency Council on Homelessness at a discussion on the state's efforts - supported by TAC since 2016 - to end veteran homelessness.
Providers Gather to Focus on Rapid Re-Housing
At the end of October, 800 service providers and Continuum of Care leaders focused on making rapid re-housing (RRH) a key component in their efforts to prevent and end homelessness came together for two intensive days of workshops, presentations, and teamwork. Two Rapid Re-Housing Institutes were held a few days apart in Duluth, GA and Los Angeles, CA, coordinated by TAC in partnership with the Department of Veterans Affairs' Supportive Services for Veteran Families program, the Department of Housing and Urban Development, Abt Associates, the National Alliance to End Homelessness, and the National Coalition for Homeless Veterans. The U.S. Interagency Council on Homelessness and the Department of Labor were also represented at the Institutes.
At each gathering, a Practice Track offered service practitioners direct training in the core components of RRH and effective service delivery strategies. Concurrently, a System Track designed for leaders with planning and implementation responsibilities covered community-wide practices relevant to RRH as a primary response to homelessness. Along with working sessions, Nan Roman, president and CEO of the National Alliance, and Elisha Harig-Blaine, Principal Housing Associate for the National League of Cities, gave plenary addresses - and for a little extra fun, groups competed in rapid re-housing Mad Libs and bingo! For more highlights, check out #RRHI2017.
TAC Staff in Action
Senior Policy Advisor Francine Arienti and Senior Associate Gina Schaak traveled to Hickory, NC to train providers on assessing people's needs and preferences before helping them move into supportive housing; Senior Associate Jon Delman presented on "Improving Work Conditions for Peer Specialists" at the annual gathering of the International Association of Peer Supporters; Jon also joined Associate Jenn Ingles, Senior Associate Melany Mondello, and Senior Consultants John O'Brien and Jim Yates in Montgomery, AL to help launch a statewide strategic housing initiative; In October, Managing Director Marie Herb and consultant Jake Mihalak facilitated the first on-site meeting of the Violence Against Women Act - Housing Opportunities for Persons With AIDS (VAWA-HOPWA) Demonstration Program initiative; Senior Consultant Sherry Lerch presented to the National Coalition of State Housing Agencies on "The Supportive Housing/Health Care Nexus"; Executive Director Kevin Martone brought a national perspective to a recent article in Mental Health Weekly on New York state's efforts to fund supportive housing; Senior Consultant John O'Brien gave the opening presentation at the National Dialogues on Behavioral Health conference, and spoke on "Strategies for Outcomes and Value-Based Payment" at an American Public Health Association roundtable on systems transformation; and Associates Phillip Allen, Lauren Knott, Ashley Mann-McLellan, and Douglas Tetrault, Senior Associates Melany Mondello, Gina Schaak, and Liz Stewart, consultant Naomi Sweitzer, TA & Training Coordinator Kyia Watkins, Federal Contracts Assistant Kim Wilder, and Housing Intern Madison Tallant all hit the road to put on the first Rapid Re-Housing Institutes in Duluth, GA and Los Angeles, CA (see above).