SEATTLE, WASHINGTON. "Findings suggest that permanent, rather than temporary, housing may be necessary to fully realize these cost savings because benefits continued to accrue the longer these individuals were housed," reads the dispassionate research finding in the new issue of the Journal of the American Medical Association focused on evaluation of Seattle's 1811 Eastlake Housing First initiative for chronic inebriates. But the rather dry observation about "what works" to end homelessness is newly supported by a documented cost savings of over $4 million for the 95 individuals who were the subject of the study and who had previously cost local taxpayers $8.2 million in hospitalizations, emergency services, jail time, detox, and sobering center visits.

After one year in housing, the same individuals cost taxpayers only $4 million, and researchers also found that residents drank less the longer they remained housed, and their cost to public systems continued to decline. After being housed, the per person costs per month declined to $1,492 after six months and $958 after one year. The total cost for all 95 participants for one year was $4,094,291, a reduction of more than $4 million.

"The evidence continues to indicate that the Housing First model is better for the homeless person, better for the community, and better for the taxpayer," indicated Philip Mangano, United States Interagency Council on Homelessness Executive Director. "You don't need to be Warren Buffet to understand the wisdom of this initiative."

The new research was unveiled at a press conference in Seattle this week, where Downtown Emergency Service Center Executive Director Bill Hobson, whose agency operates 1811 Eastlake, stated: "The Housing First model was developed in response to the problem of long-term homelessness among those living with severe mental illnesses and substance abuse problems."

"In most US cities, people with behavioral health disabilities die on the streets far more frequently than any other subset of the homeless population," he said. "Before they die, they use large amounts of taxpayer-funded services in our healthcare and criminal justice systems. " The 1811 Eastlake study, funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation, represents the first U.S. controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics.

Mr. Hobson, with lead researcher Mary E. Larimer, PhD, professor of psychiatry and behavioral sciences and adjunct professor of psychology at the University of Washington, was joined by outgoing King County Executive Ron Sims, who has been nominated by President Obama to be Deputy Secretary of the U.S. Department of Housing and Urban Development. Mr. Sims, who has been widely recognized during his three terms as County Executive and served as Co- Chair of the Committee to End Homelessness in King County, acknowledged that he had been skeptical of the Housing First strategy for chronically homeless alcoholics.

"This is an extraordinarily successful program," said Mr. Sims at the press event, noting, "Our return on investment has exceeded any expectation." Pictured above are (left to right) Mr. Sims, Dr. Larimer, and Mr. Hobson.

BOSTON, MASSACHUSETTS. When the Massachusetts Legislature passed a FY 2007 line time to invest state resources in a new statewide pilot Housing First program for chronically homeless individuals, the expectation was that the Home & Healthy for Good (HHG) initiative would replicate the national success rate of Housing First and end the costly random ricocheting of chronically homeless individuals through state systems. New state data released last week from an unprecedented state research initiative relying on Medicaid claims data show a 67% decrease in annual health care costs per person after housing placement.

The Massachusetts Medicaid system tracked chronically homeless individuals successfully stabilized through the statewide initiative and used individual state Medicaid health care payment data to identify annual health care costs per person that decreased from an average of $26,124 before housing placement to $8,500 after housing placement, a savings of $17,625 per person. The Legislature requested that an evaluation of the pilot program be performed with a focus on the cost per participant and projected cost-savings in state-funded programs.

"Home & Healthy for Good continues to lead the housing revolution in Massachusetts, moving the Commonwealth ever closer to a humane, efficient, and cost-effective solution to chronic homelessness," said Massachusetts Housing and Shelter Alliance Executive Director Joe Finn. Resources for this program - operated by MHSA with twelve partner agencies around the state - were increased to $1.2 million in FY 2008, and level funded at $1.2 million for FY 2009.

"Congratulations to the Massachusetts Housing and Shelter Alliance and the Massachusetts Behavioral Health Partnership for partnering in an initiative that changes the equation of homelessness and demonstrates that housing for our homeless neighbors makes common sense and dollars and sense," indicated United States Interagency Council on Homelessness Executive Director Philip Mangano.

The research component of Home & Healthy for Good has been funded in large part by a grant from the Massachusetts Behavioral Health Partnership, a for- profit behavioral health care organization that has been instrumental in promoting a Housing First approach for chronic homelessness in Massachusetts.

As of February 23, 2009, 357 formerly chronically homeless people have been housed in the program. 217 people have remained housed in the Home & Healthy for Good program, 8 people have died while participating in the program, and 74 people have moved on to other permanent housing, resulting in a residential stability rate of 84%.

According to MHSA's report on the new data, actual Medicaid costs pre-housing and post-housing were obtained from MassHealth for the first 96 HHG participants. The Medicaid analysis is limited to these 96 participants because these are the participants who have been in housing long enough so that medical claims data are complete for an entire year after moving into housing. Total Medicaid costs reported include any medical service that was paid for by MassHealth, including inpatient and outpatient medical care, transportation to medical visits, ambulance rides, pharmacy, dental care, and more.

SIOUX FALLS, SOUTH DAKOTA. The Sioux Falls ArgusLeader editorialized this week under the headline "Helping homeless boosts bottom line: County's use of resources efficient, smart" as it underscored the good news of what's working in Sioux Falls and Minnehaha County's 10 Year Plan, which has reported new cost savings from its pilot Housing First initiative.

Project Safe Home, a permanent supportive housing pilot for 20 individuals, documented a 50% decrease in per person costs for health care, detox, law enforcement, and other county services - costs dropped from $32,000 per person to $16,529. The most dramatic decline was in health care costs, which fell from a total of $109,109 in the first quarter of the initiative to $12,730 in the last quarter of the pilot program, according to data presented to Minnehaha County commissioners by Human Services Director Hugh Grogan.

"The City and County were early partners in the creation of a 10 Year Plan and now the evidence is in, showing a cost effective investment in solutions," indicated United States Interagency Council on Homelessness Executive Director Philip Mangano, who was present for the launch of the Plan. "Mayor Munson, Director Grogan, and Sioux Falls and Minnehaha County leaders are to be commended for their results in their community and nationally." Director Mangano is pictured above (at right) with Mayor Munson at the Mayor's homelessness forum.

The ArgusLeader further noted how jurisdictional leaders developed their results strategy using the Council-encouraged approach of "legitimate larceny" in identifying and adopting what's working in other cities and counties: "Minnehaha County officials deserve credit. This program wasn't some haphazard shot in the dark. The county took time to study other communities across the nation that found effective ways to help homeless people."

The commission approved Safe Home in 2007, and it became operational in January 2008. Minnehaha County voted in December 2008 to acquire property that it hopes to develop as additional housing for people experiencing chronic homelessness, under the 10 Year Plan in implementation for Sioux Falls and the county. In 2005, under the leadership of Mayor Munson, the city became the first jurisdiction in South Dakota to develop and adopt a 10 Year Plan to end homelessness. Mayor Munson was recognized by the U.S. Interagency Council with its "Home for Every American" Award in 2007. The Plan, developed by a Blue Ribbon Task Force appointed by Mayor Munson 10 months earlier, offered a measured and realistic data and research based approach to homelessness in this predominantly rural state. The Blueprint to Eliminate Homelessness called for the creation of 150 new housing units and emphasized strengthening partnerships among all the community stakeholders including 55 city, county, state, and federal entities, non profit service providers, faith based and civic organizations, and the Sioux Falls United Way.

Earlier cost analysis by Minnehaha County focused on the eleven most frequent users of detox and the local jail, using data from the Avera and Sioux Valley Hospitals, county facilities including the jail, Mental Illness Board, Health and Human Services), and local providers. An initial analysis revealed that at least $338,585 was spend for the eleven individuals. Noted the county report: "We are a community who care . . . We can do better." Added the report: "Why should we care about this group of homeless drunks? What does it matter if they drink themselves to death? When you consider how much is spent under the current system and the fact that shelter is nearly impossible to find and the fact that people continue to be homeless, the response is obvious. There must be a better way."

OMAHA, NEBRASKA. Creighton University was the site of last week's second Project Homeless Connect in Omaha, Nebraska, where over 400 volunteers - including Nebraska First Lady Sally Ganem, and event co-chairs Omaha Mayor Mike Fahey and Douglas County Commissioner Mary Ann Borgeson - welcomed 500 homeless neighbors to the one-stop of resources and opportunities.

"Mayor Fahey has been a stout supporter of Omaha's homeless programs and the agencies that provide services to the homeless," noted Connect organizer Ed Shada of Bellevue University in his welcome remarks at the opening rally for volunteers. "Commissioner Mary Ann Borgeson is well known among those who work with the homeless for her tireless advocacy. She became intimately involved in addressing the issues of mental illness, addiction, and homelessness in our community."

United States Interagency Council on Homelessness National Team Leader Michael German represented the Council at the event, and told the officials and volunteers that Omaha had much to be proud of. "Today we are here in a partnership of the federal. State, and local government with the private sector, educational institutions, and volunteers from all walks of life to welcome our homeless neighbors, dispelling the myths and stereotypes of homelessness and understanding the humanity and neighborliness of those without a home. " Pictured here are (left to right): Mayor Fahey, Commissioner Borgeson, Ms. Ganem at podium, Mr. Shada, and Mr. German.

Federal partners present included the U.S. Departments of Veterans Affairs and Housing and Urban Development, and the Social Security Administration. Community partners welcoming guests and volunteers included Douglas County Commissioner Chris Rodgers, Marty Conboy, City Prosecutor; Carol Leonhardt, Coordinator of Service Learning, Nebraska Wesleyan University; Senator Heath Mello; Heather Bradley-Geary, Manager, Missouri Housing Development Commission Trust Fund and Community Initiatives; and Scott Bradley, President, Pinnacle Bank, who has offered support for the next Omaha Connect event. Pictured here are (left to right): Mayor Fahey, Ms. Ganem, Mr. German, and Commissioner Borgeson.

Medical and dental services were a key feature, based on last year's inaugural event. 328 medical professionals volunteered covering the full spectrum of services including medical exams. On site that day consumers received the same services they would if they had gone to a permanent facility including treatment, blood tests, immunizations, screenings, and more. On site were physicians nurses, lab technicians, occupational and physical therapists, ophthalmologists, and a full scale pharmacy. Omaha organizers have tracked an 80% follow-up rate for guests last year.

Last year 68 consumers needed acute dental care, and, through the follow-up program involving the dental school at Creighton, 58 have received treatment since the first Connect event. $60,000 was raised for dental care materials. This year's event saw 200 individuals who needed acute dental care - they will now be accommodated through a tiered approach beginning with consumers who are living on the streets or in shelters.

In the Council-encouraged spirit of committing "acts of legitimate larceny" by making pilgrimages to see firsthand what's working, Omaha hosted several communities that are launching their first Connect events. First Lady Ganem and Mr. German visited with the guests from Lincoln, Nebraska and Columbia and Kansas City, Missouri.

Among the medical providers at the event were Creighton University Schools of Medicine, Dentistry, Nursing, Pharmacy, Physical and Occupational Therapy, Health Sciences, Graduate School, and Creighton University Family Practice, University of Nebraska Medical Center, Charles Drew Clinic, Metropolitan Community College Nursing School, Iowa West Community College Nursing School, Nebraska Wesleyan Nursing School Visiting Nurses Association, State of Nebraska Immunization and Toxicology, Douglas County Health and Human Services, Douglas County Region VI Mental Health, EMS from Creighton University, and City of Omaha Fire and Ambulance. Pictured here are (left to right): Commissioner Borgeson, Mayor Fahey, Mr. Shada, Mr. German, and Ms. Ganem.

Educational opportunities were given focus this year, with research indicating that this would be a better strategy while hiring and employment are down. Resources were set up with a triage point where consumers could be targeted to resources responsive to their needs and skills.

WASHINGTON, DC. The U.S. Department of Veterans Affairs has announced five new opportunities under its Mission Homeless Enhanced Use Lease program (EUL) at campuses across the nation. VA is seeking qualified entities for long-term ground lease redevelopment opportunities at five VA campuses in Georgia, Wyoming, Maine, Connecticut, and Illinois.

To address the needs of homeless veterans, VA, as part of its Capital Asset Management Program, seeks to more effectively leverage its underutilized real property assets on VA medical and National Cemetery campuses under its EUL authority to build needed homeless housing facilities. VA's primary objective in leasing the properties is for selected developers to establish and thereby increase the number of housing units with on-site supportive services available to homeless Veterans, including those at imminent risk of homelessness, and eligible non-Veterans.

Under the leadership of Secretary and current United States Interagency Council on Homelessness Chair Eric K. Shinseki, VA will also be advancing new homelessness prevention and housing opportunities with the completion of the FY 2009 budget, which included $75 million for an additional 10,000 HUD- VASH housing vouchers and a new $10 million federal interagency collaboration on prevention for the Departments of Veterans Affairs, Housing and Urban Development, and Labor.

According to VA's Director of Homeless Veterans Program Pete Dougherty, new campuses with property available for Mission Homeless EUL redevelopment include: Charlie Norwood VA Medical Center - Uptown Division Campus (Augusta, GA); Cheyenne VA Medical Center (Cheyenne, WY); Edward Hines, Jr. VA Hospital (Hines, IL); Connecticut Healthcare System, Newington Campus (Newington, CT); and Togus VA Medical Center (Augusta, ME).

At the Charlie Norwood site, for example, VA seeks to competitively select a private developer to lease up to 68,288 square feet of vacant space in two buildings located on approximately seven acres of land. The successful private EUL bidder(s) will provide VA with in-kind consideration that includes the development and operation of new supportive housing units with on- site supportive services for individuals and/or families. Such units and services will be provided to Veterans, who are homeless or at imminent risk of homelessness, on a priority basis.

According to VA, eligible applicants for Mission Homeless are "offerors (including team members as appropriate) with a proven track record of developing affordable housing and providing support services to the homeless, including homeless Veterans. Teams could include one or more development/service organizations." Both transitional and permanent housing models are allowable uses, though some sites have a preference. Projects can serve both homeless Veteran singles and families.

VA requests proposals in which homeless Veterans would have priority placement. Mixed-income projects are acceptable as long as homeless Veterans are given priority placement for a mutually agreed upon number of units in the project. VA will permit limited commercial and/or retail uses as a mechanism to enhance the economic viability of the project, but these uses must not interfere with VA's patient care mission. If a retail use is proposed, VA's Canteen service must be given right of first refusal to provide sundry services.

While no funding is tied to the proposals, interested applicants are encouraged to apply for federal, state and local capital and operating funding. Funding sources could include Low Income Housing Tax Credit equity, Historic Preservation Tax Credit equity (for buildings or land parcels with historic considerations), HUD Supportive Housing Program funds, Federal Home Loan Bank funds, VA's Grant & Per Diem program and HUD VA Supporting Housing (HUD-VASH) vouchers.

The final Request for Proposals (RFP) for Mission Homeless was released on Monday, March 30, 2009 and responses are due to VA by May 29, 2009 at 12 p.m. EDT. The RFP for each campus is available for download after a brief online registration on the appropriate project website. For additional information about redevelopment opportunities at these sites, please visit the Mission Homeless web site.

Questions regarding these development opportunities may be sent to missionhomeless@va.gov. The Interagency Council web site has also posted a new link to the Mission Homeless site.

WASHINGTON, DC. More than $600 million in new resources from the American Recovery and Reinvestment Act (ARRA) have been announced by the U.S. Department of Health and Human Services (HHS) as part of President Obama's commitment to expedite resources to communities.

HHS will distribute $338 million for the Increased Demand for Services (IDS) program for community health centers, through which 1,128 centers will create or sustain an estimated 6,400 health center jobs over the next two years.

Grantees submitted plans explaining how the IDS funds would be used. Strategies to expand services may include, but are not limited to, adding new providers, expanding hours of operations or expanding services. The funds will provide care to an additional 2.1 million patients over the next two years, including approximately 1 million uninsured people.

Health centers deliver preventive and primary care services to patients regardless of their ability to pay; charges for services are set according to income. Health centers served more than 16 million patients in 2007, about 40 percent of whom had no health insurance.

The IDS awards are the second set of health center grants provided through the Recovery Act. On March 2, President Obama announced grants worth $155 million to establish 126 new health centers. Those grants will provide access to health center care for 750,000 people in 39 states and two territories.

In addition, building on President Obama's efforts to ensure access to health care for millions of uninsured Americans, HHS announced an additional $268 million now available to the states through ARRA to help pay hospitals to treat their most vulnerable patients. So-called "Disproportionate Share Hospitals" (DSH) are eligible since they serve a disproportionate share of low-income or uninsured individuals. States receive an annual allotment to make payments to DSH hospitals to account for higher costs associated with treating uninsured and low-income patients. The annual allotment is calculated by law and includes requirements to ensure that the DSH payments to hospitals are not higher than the actual costs incurred by the hospital to provide the uncompensated care. HHS' Centers for Medicare & Medicaid Services (CMS) will notify states about the availability of the increased portion of allotments for hospitals.

To see a complete list of the revised DSH allotments that include additional funding provided through the Recovery Act, please visit the HHS site.

To track the progress of HHS activities funded through the Recovery Act, visit www.hhs.gov/recovery. To track all federal funds provided through the Recovery Act, visit www.recovery.gov.

HHS's Substance Abuse and Mental Health Services Administration is accepting applications for $5 million for FY 2009 for Grants for Primary and Behavioral Health Care Integration (PBHCI) to improve the physical health status of people with serious mental illnesses (SMI) by supporting communities to coordinate and integrate primary care services into publicly funded community mental health and other community-based behavioral health settings. Applications are due May 27.

Eligible applicants are publicly funded community mental health and other community-based behavioral health agencies. According to HHS, the population of focus for this grant program is individuals with serious mental illness served in the public mental health system. Physical health conditions among people with serious mental illnesses impact their quality of life and contribute to disproportionate premature death. In 2006, the National Association of State Mental Health Program Directors (NASMHPD) reported that people with serious mental illness on the average die 25 years earlier than people without serious mental illness.

Several contributors are identified as causes, including barriers to appropriate care, stigma and the lack of cross-discipline training, and empirical findings indicate that early mortality among people with serious mental illnesses is clearly linked to the lack of access to primary care services for this population.

People with serious mental illnesses have elevated rates of hypertension, diabetes, obesity and cardiovascular disease as compared to people without serious mental illnesses. Many of these health conditions are exacerbated by unhealthy practices like inadequate physical activity, poor nutrition, smoking, substance abuse, and by the side effects of psychotropic medication, including weight gain.

Many of these health conditions are preventable through routine health promotion activities, primary care screening, monitoring, treatment and care management /coordination strategies and/or other outreach programs at home or community sites. Because people with serious mental illnesses frequently seek and obtain services from community- based behavioral health providers, these organizations must be able to formulate partnerships to foster integration of primary care services and provide wellness education on site with the goal of improving health outcomes for clients.

SALEM, OREGON. Over $19 million for housing in Oregon is projected to result within two years from a new $15 increase to the state's document recording fee signed into law by Governor Ted Kulongoski, making the Oregon Housing Opportunity Bill the newest addition to the state's ongoing investment and partnership to end homelessness. With the increase from $11 to $26, new resources will flow into a dedicated housing fund whenever a real estate title changes hands.

The Oregon Department of Housing and Community Services will oversee the fund and make awards to non-profits, counties, or local housing authorities, including for housing to meet local 10 Year Plan goals in the state. Ten percent of the new funds will be targeted to prevent and end homelessness through the Emergency Housing Account (EHA), a flexible resource used at the local level to support efforts to decrease homelessness. The EHA funds are distributed by formula to agencies in every county to increase movement of homeless individuals and families into permanent housing; stabilize families and individuals in existing permanent housing through short term eviction prevention funds or foreclosure prevention funds; provide operating support for permanent supportive housing; and provide emergency shelter or transitional support to homeless individuals and families.

"Dedicated revenue streams invested in housing are a creative tool to fund Ten Year Plan objectives," indicated United States Interagency Council on Homelessness Executive Director Philip Mangano.

The majority of the new funds are going towards the development of rental housing for Oregon's low- income families, seniors, and people with disabilities. Fourteen percent will be directed towards homeownership and foreclosure prevention counseling.

According to U.S. Interagency Council on Homelessness Regional Coordinator Paul Carlson, Oregon has nine completed 10 Year Plans partnering cities and counties, and four in development. Completed plans include Portland/Multnomah County; Washington County/Beaverton; Clackamas County/ Oregon City; Lincoln County/Newport; Yamhill County/McMinnville; Marion-Polk Counties/ Salem; Lane County/Eugene; Linn County/Albany; Deschutes- Jefferson-Crook Counties/Bend. Plans in development include Jackson County/Medford; Coos County/ Coos Bay; Curry County; and Benton County/Corvallis.

Oregon has also strongly partnered in the Council- encouraged adoption of the innovation of Project Homeless Connect, with more than 20 one-day, one- stop events to date in Oregon: . Portland/Multnomah (6); Washington County (3); Lane County (3); Linn County (2); Lincoln County (2); Central Oregon (2); and Yamhill, Marion, and Klamath Counties.

SAINT PAUL, MINNESOTA. Heading Home Minnesota, the state's bi-partisan, public-private partnership that brings together local 10 year Plan initiatives around the state and the state's 2004 Business Plan to End Long-Term Homelessness, will receive a new investment of $5 million from the Frey Foundation, whose continuing commitment to the goals of the partnership was affirmed with the announcement. Heading Home Minnesota uses a three-prong approach to ending homelessness - prevention, outreach, and supportive housing.

"We see that the Heading Home approach solves the big problems and has the kind of effect that means our investment is aligned with an effort well positioned to succeed," says Jim Frey, President and CEO of the Frey Foundation. "Since our first contribution in 2006, we have been encouraged by the success this fiscally- responsible approach has had helping a particularly vulnerable population of Minnesotans move from homelessness to increased independence, long-term stability, employment, and self-sufficiency. These are the kind of changes that short, one-time fixes do not help."

The goal for the new Frey Foundation funding is to expand and enhance the availability of supportive housing services and increase the supply of affordable housing across the state. Since 2004, over 2,500 housing opportunities with supportive housing have been created around the state. Plans call for an additional 1,500 opportunities to be created over the next few years. Like the previous contribution, this Frey Foundation donation will be distributed over the course of five years and includes dedicated funding for partner organizations, including a set aside for communities outside the metro area and the involvement of the Greater Minnesota Housing Fund. The most recent research indicates that nearly a third of Minnesotans who are homeless live in Greater Minnesota.

PROVIDENCE, RHODE ISLAND. In January 2009, United Way of Rhode Island announced that its ongoing investments in safety net services and 211 services were "just not enough" and created a community-wide, three- month-long fundraising and education effort called the Fund to Prevent Homelessness in Rhode Island to raise money and build awareness about homelessness prevention and to draw attention to those at risk of becoming homeless.

According to United Way of Rhode Island's CEO and President, Anthony Maione, United Way's effort got a recent boost when CVS Caremark Corp. donated $50,000 to the initiative. The funds raised the total to more than $100,000, triggering a matching grant from the United Way's Providence affiliate. United Way then distributed more than $200,000 to 23 agencies around the state that assist people who are homeless.

The United Way now has started the second phase of its effort, during which it hopes to raise another $100,000 which the agency again will match. United Way has also invested in the state's 10 Year Plan partnered with the State of Rhode Island and with HousingWorks RI, a coalition of banks, builders, Chambers of Commerce, colleges, community and faith based agencies, realtors, municipal officials and unions, who initiated the successful and cost-effective Housing First RI pilot.

email: usich@usich.gov

web: http://www.usich.gov