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Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness (2018)

Chapter: Appendix D Examples of Homeless Service Programs in Denver and San Jose

« Previous: Appendix C Counting the Number of Individuals Experiencing Homelessness
Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
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Appendix D

Examples of Homeless Service Programs in Denver and San Jose

The committee visited several homeless service programs in Denver and San Jose, including rapid re-housing and permanent supportive housing programs. Below are summaries of what the committee learned during these visits.

SITE VISIT: DENVER, COLORADO

As part of the committee’s work, two cities were selected for site visits. One of these cities was Denver, Colorado. The committee visited a permanent supportive housing (PSH) facility with an onsite health clinic and met with a number of officials working to reduce homelessness in the Denver metropolitan area.

Denver had an estimated median household income in 2015 of $58,000 (City-Data, 2017). This is lower than the state estimated median household income of $63,900. The estimated median house/condo value in 2015 was $316,700; this is slightly higher than the Colorado median value at $283,800. Whites are the largest population group, with Latinos the second largest group at over 30 percent of the population. About one-fifth of the residents in Denver speak Spanish at home.

Denver’s 2016 point-in-time count indicated no change from the previous year. However, the number of veterans experiencing homelessness increased (Metro Denver Homeless Initiative, 2016) and the number of homeless students increased (according to the McKinney-Vento definition of homelessness, which is different from the HUD definition).

In 2012, Denver passed an ordinance that bans camping on public or private land. The ordinance targets individuals experiencing homelessness without shelter. According to critics of the ordinance, it criminalizes homelessness by enforcing bans against sleeping in cars, lying down in public areas, and taking shelter in bus stations.

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Stout Street Clinic & Housing Center and Colorado Coalition for the Homeless

The Colorado Coalition for the Homeless (CCH) provides PSH and onsite medical and dental care in downtown Denver via the Stout Street Health Center, established in 2014. According to CCH, more than 13,000 individuals experiencing homelessness receive care at this facility each year (CCH, 2017). All services are provided regardless of immigration status, housing status, or ability to pay.

The Stout Street Health Center introduces a model of integrated health care targeted to the needs of homeless patients. It incorporates patient-centered, trauma-informed medical and behavioral health care, substance treatment services, dental and vision care, social services, and supportive housing to more fully address the spectrum of problems adults and children experiencing homelessness bring to medical providers.

Staff from CCH and from the Metro Denver Homeless Initiative spoke about the importance of Medicaid expansion for helping individuals experiencing homelessness. They also mentioned the problem of competing definitions of “homelessness” and “chronic homelessness.” Finally, the role of transportation and the role of the criminal justice system and their intersections with homelessness were discussed by the group.

Volunteers of America Colorado Branch

The Volunteers of America Bill Daniels Veteran Services Center opened in August of 2015. The facility is housed within the Volunteers of America (VOA) Colorado Branch offices. Although no health care services are provided at this site, the facility serves veterans and their families to access opportunities for housing, employment, and benefits and support from a variety of veteran-serving programs in one location. There is also a major focus on putting low-income veterans into rapid re-housing projects. Staff member Shea Leibfreid noted that outreach to women veterans is poor and that more attention needs to be paid to their mental health. Also coordinated at the Veterans Service Center are bridge-housing programs, as well as low-barrier housing programs.

A major topic of discussion focused on the Homeless Management Information System (HMIS), a technology system mandated by HUD to collect and track client-level data. There were a number of problems mentioned by the VOA staff, including the poor system quality and the fact that there is no cross-operability across data systems. For example, the HMIS system likely does not interact with a local database for client services.

Finally, several staff members described frustration with the fact that funding streams are siloed and disconnected. This was a common theme across the site visits in both locations.

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Department of Local Affairs, Division of Housing Office

The meeting with the Division of Housing and other staff members working on homelessness focused primarily on transitional housing. They noted that individuals experiencing homelessness in the Denver area had addiction and mental health problems. In particular, anxiety and depression were mentioned.

Echoing other conversations, staff noted the lack of interoperability between HMIS data and other data sources as a barrier. They also mentioned the lack of adequate resources and challenges with accessing adequate mental health services for clients.

Social Impact Solutions: Denver Social Impact Bond Initiative

Social Impact Solutions is a Denver-based organization that is working with the City of Denver, the Corporation for Supportive Housing, and Enterprise Community Partners to create a supportive housing initiative. Early supporters of the Social Impact Solutions include the Piton Foundation, Kaiser Permanente, the Denver Foundation, the Colorado Health Foundation, the Rose Community Foundation, the Nonprofit Finance Fund, the Corporation for National and Community Service, and the Urban Institute (City and County of Denver, 2017). The Bond Initiative is a 5-year project that targets heavy utilizers of emergency care, police, and detox services. The initiative plans to produce a PSH scattered-site program in the short term to provide housing and supportive services for the top 250 heaviest utilizers. New PSH units are planned for the long term. The Urban Institute is conducting an independent evaluation of the project.

Summary

Denver is experiencing increases in homelessness and is using a variety of different methods to reduce homelessness, including new facilities (Stout Street), transitional housing, and innovative funding strategies. Issues raised by program staff include frustration with the HMIS system and its lack of interoperability, siloed funding streams, and recognition of the critical role played by the Medicaid expansion in Colorado.

SITE VISIT: SAN JOSE, CALIFORNIA

As part of the committee’s work, two cities were selected for site visits. One of these cities was San Jose, California. The committee visited several permanent supportive housing facilities (PSH) and met with Santa Clara County officials working in homelessness.

San Jose is California’s third-largest city and the tenth-largest city in the United States in terms of population size. Its population is growing, and the city has a large percentage of foreign-born residents, considerably higher than the state’s figures. Asians and Latinos are the largest population groups, with whites

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

third. The city is perhaps best known for its motto that it is “the Capital of Silicon Valley.”

San Jose is also quite expensive; housing costs are beyond what many can afford. The National Low Income Housing Coalition estimates that Santa Clara County (where San Jose is located) is the fifth most expensive county in the United States. There is a lack of affordable housing and very low rental vacancy rates.

According to Jacky Morales-Ferrand, director of housing for the city of San Jose, “homelessness and the lack of available housing for extremely low-income populations continues to be a pressing issue” for both the city and Santa Clara County. U.S. Department of Housing and Urban Development (HUD) data indicate that among 48 major cities, Santa Clara County has the highest rate of unsheltered homelessness and the third-largest number of individuals experiencing chronic homelessness.

In November 2016, Santa Clara County Measure A passed to provide $950 million for the creation of affordable housing over 30 years. Passed by nearly 68 percent of the voters, this will increase the creation of new affordable housing.

Onizuka Crossing

The committee first visited two new PSH projects, Onizuka Crossing and Parkside Studios. Onizuka Crossing, built in 2016, has 58 units for individuals and families experiencing chronic homelessness. The residents came from a list of 140 high utilizers of county services, including hospitals, jails, and shelters. Onizuka Crossing is managed by MidPen Housing. There are one-, two-, and three-bedroom units; all 58 units are filled. The total cost of the development was more than $32 million, and financing was provided by a number of different state, city, and county agencies. This facility is California’s first Pay For Success project. Supportive services are provided on site.

In describing policy barriers, Helen Tong-Ishikawa of MidPen Housing noted that the lack of affordable housing is a major barrier for individuals experiencing homelessness. She said that “as a result of being homeless, individuals [experiencing homelessness] are less likely to seek preventative medical care.” Tong said that as a result of living in PSH, she has seen increases in the use of preventative services by residents.

Parkside Studios

Parkside Studios is a three-level building with 59 studio apartments for individuals experiencing homelessness, as well as couples and single parents with one child. Eighteen of the units are set aside for special-needs households, 11 with mental illness and 7 households with individuals experiencing chronic homelessness. All units are currently occupied, and the waiting list is closed. The building

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

was constructed using modular construction, which helped accelerate the construction schedule by approximately 3 months. Parkside Studios was tax credit-financed.

Services provided include service coordination and intensive case management, including mental health services, for the 18 special needs households (one unit is for the site manager for a total of 59 units). The intensive case management and mental health services are provided by a nonprofit service partner, whose funding is provided by Santa Clara County’s Office of Supportive Housing.

Much like the previous discussion of barriers at Onizuka Crossing, Kathy Robinson of Charities Housing noted that a major barrier to reducing homelessness is a lack of housing. She said that there is only a 2 to 3 percent vacancy rate for housing in Santa Clara County. She also noted that she has seen an increase in the population of women experiencing homelessness.

Office of Supportive Housing, Santa Clara County, and Destination: Home

The committee met with Ky Le, director of the Office of Supportive Housing for Santa Clara County, and Jennifer Loving, executive director of Destination: Home, a public-private partnership focusing on addressing homelessness in Santa Clara County.

The Community Plan to End Homelessness reports that in 2016, 81 percent of veterans experiencing homelessness were using their Section 8 vouchers, with 138 new landlords committed to housing these veterans. In all, 244 referrals to PSH were made, and 567 referrals were made to rapid re-housing.

In 2015, Santa Clara County began collaborating with Abode Services on a project called Project Welcome Home. Funded via a Pay for Success model, the funders include a number of foundations, and funding is included for an independent evaluator. The two primary measures of interest include number of months of tenancy (stably housed) and improvements in health and well-being for individuals being served. Project Welcome Home targets the 150–200 individuals experiencing chronic homelessness who are the most frequent users of county systems.

Also of interest is whether the costs of services delivery is reduced for Santa Clara County. The evaluation is designed to be a randomized controlled trial, with the control group receiving usual care. Unfortunately, no data are available to date; the first interim report is due in October 2018, and the final results from the RCT will be available in October 2021.

The 18-month update from Project Welcome Home shows that 128 of the county’s “most vulnerable patients” are now in PSH. The project so far indicates reductions in the use of county services by 88 percent. The results are exceeding the targets set with the Pay for Success funding and the project is expecting to earn its success payments.

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×

Bill Wilson Center: Peacock Commons

The committee visited the Bill Wilson Center in Santa Clara, a nonprofit organization providing services to children, youth, young adults, and families. A short drive away is Peacock Commons, a PSH project for youth and young adults experiencing homelessness (ages 18–25). Named Peacock Commons and painted in “peacock” colors, there is housing for 45 youth/young adults in the 28-unit apartment building. According to Lorraine Flores, senior director of program development and impact for the Bill Wilson Center, Peacock Commons is an effort to provide PSH for youth.

It took 6 years for Peacock Commons to complete the rehabilitation of an apartment building. The funding is complex and comes from 11 different sources. Most residents, a number of whom are youth who have aged out of the foster care system, stay at Peacock Commons for 1.5 to 2 years before moving out. Thus, Peacock Commons is more of a “transpermanent” housing program. A majority of residents have a need for affordable/subsidized child care, and although some support services are available on-site, others require transportation to access off-site. A unique feature of Peacock Commons is that low-income adult mentors live in six of the apartments and provide 10 hours per week of mentoring to the youth living at Peacock Commons. A site manager also lives on site.

Summary

One of the major takeaways from the San Jose site visits is that it is complex to create housing, provide supportive services, and braid together funding streams. There is also a gap in the assessment of outcomes. Finally, efforts to scale up PSH programs seem difficult at best, given the complexities of funding, building, and managing PSH programs.

REFERENCES

CCH (The Colorado Coalition for the Homeless). 2017. Health Services. Online. Available at http://www.coloradocoalition.org/health-services. Accessed August 15, 2017.

City and County of Denver. 2012. Denver Social Impact Bond Initiative: Permanent Supportive Housing. Online. Available at https://www.enterprisecommunity.org/sites/default/files/2017-06/Denver%20SIB%20Summary.pdf. Accessed May 4, 2018.

City-Data. 2017. Online. Available at www.city-data.com. Accessed August 15, 2017.

Metro Denver Homeless Initiative. 2016. Online. Available at http://www.mdhi.org. Accessed August 16, 2017.

Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Page 191
Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Page 192
Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
Page 193
Suggested Citation:"Appendix D Examples of Homeless Service Programs in Denver and San Jose." National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: 10.17226/25133.
×
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Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed.

Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

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