Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Housing First Model

Grant Period: 
May, 2010 to May, 2012
Project Overview
Mission: 

As originators of the Housing First model, Pathways to Housing seeks to transform individual lives by ending homelessness and supporting recovery for those with psychiatric disabilities. We believe housing is a basic human right, and aspire to change the practice of homeless services by:

 

  • Providing immediate access to permanent independent apartments, without preconditions.
  • Setting the standard for services driven by consumer choice that support recovery and community integration.
  • Conducting research to find innovative solutions and best practices for those who suffer from mental illness and homelessness.
Grant Project Description: 

Pathways to Housing PA sought to assess the effectiveness of its housing first approach in Philadelphia as compared to the traditional service model with a particular focus on the costs and benefits of each approach as measured across the publicly funded homeless, medical, behavioral health, and legal systems.  Pathways engaged an independent consultant, Fairmount Ventures, Inc., to conduct an evaluation of its housing first model. 

Among the questions considered by the evaluation were:

  • Is housing first a more effective way to help this sub-population move from living on the street to living inside and getting appropriate medical care and social services? 
  • How do the success rates of the traditional service model and this approach compare?
  • What are the cost comparisons of the two models to a) the homeless system, per se, and b) other public services (e.g., Emergency rooms, police, etc.) when all costs are considered?
  • What would be the programmatic, financial and societal impact of fully investing in this approach?
  • If warranted, what changes would need to be made in local, state and federal law, policy and regulations to expand this approach or make it more effective?

Fairmount did the following to address these questions:

  1. Met with representatives of the City of Philadelphia, Pathways to Housing and other homeless service provider representatives to get their input on the scope of this inquiry, the set of needed data, criteria which the evaluation should use, information each of these respective parties wanted to see, etc.
  2. Developed a list of key indicators that the study would employ to define and quantify success as relates to the individual’s well-being and costs to the public sector.
  3. Conducted a cursory examination of how the housing first approach is working with similar populations in other cities to determine applicable “lessons learned” and any insights regarding how to approach the evaluation in Philadelphia.
  4. Worked with the City of Philadelphia to identify a group of current and formerly homeless people who have a serious mentally illness, substance addiction or in recovery, and a personality disorder who have received support through the City’s traditional outreach and treatment approach that would serve as a ‘control” group for people participating in the Pathways to Housing PA program. This included both people who had accepted service and those who were still on the street. Data was adjusted to assure privacy of the individuals.
  5. Worked with Pathways to Housing PA to develop a similar set of data for participants in its program, along with costs for the program.
  6. Worked with the City of Philadelphia and its contract agencies to collect cost data regarding outreach, shelter and housing costs, and service costs to the City’s homeless system. Included in the cost of outreach services are the cost of repeated visits to an individual who declines service out of reluctance to accept care in a congregant setting due to his/her mental illness.  At the same time, they identified and sought to quantify other costs to other city agencies (e.g., Police, Fire rescue), and public costs (e.g., non-reimbursed Emergency Room treatment).
  7. Developed a comparison of the two systems as measured by success rate in encouraging someone to accept indoor housing and recidivism rate.
  8. Developed a cost-benefit comparison of the two systems considering direct and indirect costs as well as benefits derived from each system in the form of costs forgone as a result of housing people off of the street.
  9. Made draft recommendations regarding the policy implications of the findings.
  10. Vetted the findings and draft recommendations with city policy makers, Pathways to HousingPA, and other homeless service providers to benefit from their observations regarding the draft findings.
  11. Finalized the evaluation report and presented it to key audiences.
Actual Project Outcomes: 

As detailed in the grant proposal, the purpose of the grant was “to assess the effectiveness of its housing first approach in Philadelphia as compared to the traditional service model with a particular focus on the costs and benefits of each approach as measured across the publicly funded homeless, medical, behavioral health, and legal systems.”  The result of the evaluation is a written report assessing the programmatic and cost-effectiveness of the housing first approach to chronically homeless individuals living on the street.  As proposed in the grant application, Pathways engaged Fairmount Ventures, Inc. (Fairmount) to conduct the assessment and to produce the report. 

Highlights of the Draft Report

  • Pathways to Housing PA is less expensive per person than comparable programs serving the same population.  Pathways is half the cost of other permanent housing programs for chronically homeless individuals and about two-thirds the cost of Residential Drug and Alcohol programs for chronically homeless mentally ill people.
  • The use of publicly funded services decreased for Pathways’ clients in every category:
  • Shelter episodes decreased by 88%.
  • Number of shelter nights decreased by 87%.
  • Crisis Response Center episodes decreased by 71%.
  • Mental Health Court episodes decreased by 11%.

Project Inquiry and Insight

1. What is the underlying theory of change for creating a positive community impact that guides the intended outcomes of your funded project? Click here to read our response.

Our theory of change worked itself around the belief that “information is power” and with good and clear information about Housing First and the Pathways approach, funders in Philadelphia would make better choices about where our collective housing and service dollars are spent.
 

2. How does the work of your funded project address your theory of change? Click here to read our response.

The report that our project generated has provided funders and the city, state and federal levels, as well as the philanthropic community, with information showing incredible outcomes with this model, as very little cost. The information was presented in outcome measure tables as well as in cost analysis data – two types of information that are very important to these groups.

3. Has your funded project produced the outcomes you intended? How do you know? Click here to read our response.

Yes. We hoped that by providing the above mentioned entities with good information about the model and its outcomes, the model would be expanded and/or replicated. Almost immediately after the release of the report, our program began to grow, almost doubling in size.

4. What have been the unintended outcomes of your funded project, both positive and negative? Click here to read our response.

The rate of growth is an unintended outcome. Slow growth is always preferable when delivering services in a healthy atmosphere. Growth brings with it culture change in non-profits. Culture change requires processing and processing requires time. Our growth spurt has left us playing “catch up” on processing and taking care of ourselves, as well as the people we serve

5. Based on both the anticipated and unintended outcomes you have achieved, how would you design the project differently in the future? Click here to read our response.

I don’t know that we would design it differently, as the outcomes have been phenomenal. I believe it is a case of “be careful what you ask for”.

6. Please list any public, private or nonprofit organizations you have collaborated with on this project. Click here to read our response.

Center City District Thomas Scattergood Foundation Fairmount Ventures Philadelphia Department of Behavioral Health Philadelphia Office of Supported Housing Community Behavioral Health

7. Have these questions challenged you to think about your project in new or different ways? If yes, please explain. Click here to read our response.

In reading the evaluation, the impact of how incredible our outcomes have been really hit home. It has been empowering to have the report quickly turn into housing units and service slots at Pathways.

8. What challenges in project implementation or evaluation could the Scattergood community help you address in the future? Click here to read our response.

There were some “access to data” issues with different city departments and other sources. Data access was promised in conversations with one level of a department, and not attainable through another. Scattergood may be able to help by brokering some access to information in the future.

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