Tuesday, 12 May 2015

The outsider who is solving chronic homelessness across America

 Terrence McCoy                     Washington Post                    12 May 2015

Those most likely to innovate are rarely the experts. They’re outsiders who see things freshly. Meet Sam Tsemberis. According to academics and advocates, he’s all but solved chronic homelessness. His research, which commands the support of most scholars, has inspired policies across the nation, as well as in the District. The results have been staggering. Late last month, Utah, the latest laboratory for Tsemberis’s’ models, reported it has nearly eradicated chronic homelessness. Phoenix, an earlier test case, eliminated chronic homelessness among veterans. Then New Orleans housed every homeless veteran.

Homelessness has long seemed one of the most intractable of social problems. For decades, the number of homeless from New York City to San Francisco surged — and so did the costs. At one point around the turn of the millennium, New York was spending an annual $40,500 on every homeless person with mental issues. Then came Tsemberis, who around that same time unfurled a model so simple children could grasp it, so cost-effective fiscal hawks loved it, so socially progressive liberals praised it.

 “See that sign over there? It says, ‘Now Leasing.’ That’s what we look for.” It’s that simple, he said. Give homes for the homeless, and you will solve chronic homelessness. To the uninitiated, this may sound strange. Homeless services once worked like a reward system. Kick an addiction, get a home. Take some medication, get counseling. But Tsemberis’s model, called “housing first,” said the order was backward. Someone has the best chance of improving if they’re stabilized in a home.

It works like this: First, prioritize the chronically homeless, defined as those with mental or physical disabilities who are homeless for longer than a year or have experienced four episodes within three years. They’re the most difficult homeless to reabsorb into society and rack up the most significant public costs in hospital stays, jail sentences and shelter visits.

Then give them a home, no questions asked. Immediately afterward, provide counseling, a step research shows is the most vital. Give them final say in everything — where they live, what they own, how often they’re counseled. “People thought this was crazy,” said Tsemberis, “They said, ‘You mean even when someone relapses and sells all the furniture you gave them … you don’t kick them out?’ And I said, ‘No, we do not.'”

Tsemberis was never trained in how to treat the homeless. “I’m a psychologist,” he said. “I’m a clinician.” And so, it perhaps came as a surprise when, in the early nineties, he took a job in New York City doing outreach for the mentally ill, which brought him into close contact with the homeless. He soon sank into their hidden world, noting the complexity of its social rules and survival tactics. How some experts perceived homelessness, he said he realized, was fundamentally flawed. This world’s denizens, in fact, were profoundly resourceful.

There was need of a change. So he assembled a very small, very unusual team. None of them had any training in homelessness. They, too, were outsiders. One was a recovering heroin addict. Another was a formerly homeless person. Another was a psychologist. And the last, Hilary Melton, was a poet and a survivor of incest.

Tsemberis soon received $500,000 in federal funding, which he used to track what happened to 139 chronically homeless people who were immediately housed and offered counseling. In 1997, the results arrived. It showed a retention rate of nearly 85 percent. The next best model’s retention rate? Sixty percent. Word spread. Bebout, the Washington homelessness expert who now leads Green Door, a mental-health center, couldn’t understand why Tsemberis cared so much about housing aesthetics. Isn’t most important to just find a house, any house? “I said, ‘We’re not in the business of running pretty houses,'” remembered Bebout, who today is a fierce proponent of housing first. “The whole thing sounded nutty to us. … But the data became so overwhelming.”

Inconsistency, Tsemberis and other experts say, can devastate the program. “We committed,” said Utah’s Gordon Walker, explaining how his state succeeded at eliminating homelessness — and saved millions. “It was costing us in state services, health-care costs, jail time, police time, about $20,000 per person. Now, we spend $12,000 per person.” [Abridged]


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