A new comprehensive study from UNC Charlotte’s Urban Institute, College of Health and Human Services and School of Social Work shows an effective approach to ending chronic homelessness that helps those in need and benefits communities.
The Housing First Charlotte-Mecklenburg initiative, an innovative multi-sector collaboration that’s been working to end chronic homelessness in Charlotte for five years, has placed more than 1,000 people in the Charlotte community in stable housing. This is the largest and most comprehensive local effort to address chronic homelessness. Nationwide, on any given night, more than 550,000 Americans are experiencing homelessness, and this research could offer guidance to cities around the U.S. struggling with this issue.
“The Housing First Charlotte-Mecklenburg effort led to major housing wins during a time of increasing housing scarcity, and the vast majority of those who were able to access housing through the effort did not return to emergency shelters,” said Lori Thomas, associate professor at UNC Charlotte’s School of Social Work and Director of Research and Faculty Engagement at the UNC Charlotte Urban Institute.
Thomas has completed an evaluation of the first phase of the program, the most rigorous and in-depth study to date in Charlotte and one of the few reports in the country that examines a community’s overall response to chronic homelessness. Findings highlighted in Thomas’ research may have a significant impact throughout the country in other cities working to expand Housing First programs such as Atlanta, Denver, San Francisco and Washington, D.C.
Key findings from the first phase of the Housing First program include:
Housing First works. Almost three quarters (73%) of study participants housed through the Housing First program either retained their housing or moved into other housing during the study period. Those enrolled in permanent supportive housing, such as Moore Place, which provides wrap-around services and a permanent subsidy, did even better, with 80% housing retention. Simply put, that means a large majority of people who get housed, stay housed.
Housing First impacts participants. Clients who gained housing showed reduced trauma symptoms (down 26%), fewer mental illness symptoms (down 35%) and reduced substance use (drug use down 37%, and 3 days fewer using alcohol to intoxication). Additionally, housed participants scored significantly higher on standardized overall quality of life indicators (up 30%).
Housing First impacts the community. People who were housed were less likely to be arrested (the percentage of individuals arrested fell 59%), while the average number of visits to the Mecklenburg County Health Departments fell 71%. The number of emergency department visits fell 58%, while the average number of nights in emergency shelters fell 93%.
Costs of housing are partially offset through other community services. Based on the changes in service utilization, there is a $2.54 reduction in community services for every $10 invested in housing first permanent supportive housing. This savings reduces the average annual cost of housing first permanent supportive housing from $17,256 to $12,688.
There were also lessons learned that can improve the initiative. Among those:
Housing First participants experienced persistent and worsening food insecurity. Rates of food insecurity remained high for clients who gained housing, at 83%. In particular, participants in permanent supportive housing saw a 32% increase in their rate of food insecurity. That suggests people might have more difficulty accessing food once they gain housing, perhaps because they do not have transportation to free resources where they previously got food, or because they now live in a “food desert.”
Housing First participants continued to report poor perceptions of physical health. And despite the drop in emergency and health department visits, rates of inpatient and outpatient health services remained unchanged. The impact of years without housing and access to preventative care, as well as the fact that the majority of study participants have two or more disabilities, may account for this finding.
Housing First and the focus on homelessness highlighted the need for better coordination, representation and communication among stakeholders across various sectors (government, nonprofit, academic and business). Additionally, the initiative drove home the need to connect homelessness to the community-wide affordable housing challenges facing Charlotte and Mecklenburg.
“With the release of the Housing First Evaluation report, we are able to share information with the community about the results and impact of a public-private, community initiative to end chronic homelessness,” said Stacy Lowry, director of community support services for Mecklenburg County. “In addition to outcomes, this report also provides an in-depth analysis of the initiative, itself. By looking at the relationship between outcomes and process, Charlotte-Mecklenburg can use this report to expand and strengthen existing efforts to prevent and end homelessness as well as inform new, systemic solutions to address complex problems comprehensively and effectively.”
Erica M. is one of the more than 1,000 people who have gained a place to live through the Housing First Charlotte Mecklenburg initiative. For years, Erica was stuck in a cycle of desperation, as she bounced between a house unfit for human habitation, friend’s couches, shelters and the streets.
“I was displaced. Just floating around the city,” said Erica, 51. But that all changed about three years ago when she was able to move into Moore Place, a development that follows the “Housing First” approach to homelessness. Now, she has a stable place to live, a permanent subsidy that allows her to afford it, and access to medical care and social services that she previously lacked.
“I’m very grateful here that they have a physician,” she said. “They have a library. They give furniture. They have nice windows to look out..When I got here, I realized hey, I’m strong.”
Many echoed her comments.
As another housed study participant noted, “Everything has changed. I just feel like a big boulder has fallen off my shoulders. I have a sense of belonging, I actually have keys, it is just awesome.”