Housing First: making real progress toward ending homelessness in Memphis

Hugh Barnes is a snappy dresser. On a recent Monday afternoon, his blue silk tie is crisply knotted, and his brown penny loafers are freshly polished. He's a friendly guy, tall and lean, with big, goofy ears and an easy smile. So you'd never guess that just two-and-a-half years ago Barnes was homeless, living near the overpass at Danny Thomas Boulevard and Madison Avenue.

"I used to sleep in the grass under the street light," remembers Barnes. "It was a little warmer under the overpass, but I didn't wanna go back there. Cause you never know what's gonna happen to you back there in the darkness."

Barnes, age 68, doesn't fit with most people's ideas about homelessness. After getting his degree in criminology from the University of Maryland, he returned to Mempis to pursue a career in music. But he says things started going downhill in the 1980s, when he discovered cocaine and became sexually promiscuous. He fell into homelessness after a stint in jail in the mid-1990s.

"It really kind of came up at me out of the blue," says Barnes. "When I got out of jail, I got rejected by people because of my HIV status, and I didn't have anywhere to go. I just didn't really have a support network."

Today, Barnes lives in a housing program run by Friends for Life, a nonprofit that works to improve the quality of life of Memphians with HIV/AIDS. It's a sunny one-bedroom apartment in Memphis' Medical District, piled high with paperbacks by Tom Clancy and Michael Connelly. During our conversation, Barnes pulls out his guitar and plays a few verses of "Brand New Key," a popular 1970s hit by folk singer Melanie.

"I rode my bicycle past your window last night," sings Barnes, in a gravelly baritone. "I roller skated to your door at daylight."

The money to sustain Barnes in his apartment comes from the nonprofit Community Alliance for the Homeless. Lately the organization has been getting a lot of press, and no wonder. In just two years, they've done more to end homeless in Memphis than agencies and nonprofits had been able to accomplish in the previous ten years.

Between 2011 and 2013, thanks in large part to the efforts of the Community Alliance, overall homelessness in Memphis is down 21 percent. Homelessness among families and veterans is down 30 percent. Most impressive, chronic homelessness is down 40 percent.

Katie Kitchin is the Community Alliance's Executive Director.

"What we're seeing," says Kitchin, "is that this is real. Over the next ten years, we really can house enough people to end chronic homelessness in our community."

Kim Daugherty is the executive director of Friends for Life, the nonprofit that administers Hugh Barnes' apartment.

"Without these programs," adds Daugherty, "many of the people we deal with--people who are chronically homeless--would die on the street. They would literally be dead without our help."

Created in 2010, the Community Alliance essentially acts as a clearinghouse. They receive funding from a variety of federal, state and local government sources, which they then disburse to landlords and care providers around the city.
    
But the job doesn't stop there. Just as important as the money, says Kitchin, is making sure that grantees like MIFA and Friends for Life are coordinating their efforts, and that they are developing the kinds of programs that will swiftly and permanently move Memphians out of homelessness.

"If we're going to make this work," says Kitchin, "then we all have to synchronize our efforts. We have to speak with one voice. And that is what the Community Alliance is doing. We are the hub of the wheel, and the care providers are the spokes."

So how has the Community Alliance accomplished so much in such a short time? The answer, says Kitchin, is simple and data-driven: it's a new approach called Housing First.

"We are moving pretty agressively," says Kitchin, "to implement a Housing First approach for all the populations we work with. We are helping our care providers learn about Housing First and get comfortable with it. And we are taking programs that are keeping people homeless longer than needed, and we are reprogramming those grants."

Pioneered in Los Angeles in the late 1990s, Housing First focuses on quickly transitioning people from the streets into permanent housing, rather than moving them through shelters or transitional homes. Once they have been placed in permanent homes, they are given the resources they need to stay there, often in the form of financial support and wraparound case management.

Controversially, that includes housing people who are still struggling with issues like drug addiction and domestic violence.

Previously, homeless people were moved through something called the Continuum of Care. Under this model, individuals and families had to meet certain requirements--for example, attending counseling or being drug- and alcohol-free--in order to graduate through different "levels" of housing: shelters, transitional homes, etc. The eventual goal was independent living, free of government and nonprofit assistance.

That might sound like a good idea, but it turns out that it's pretty tough to kick your drug habit when you don't have anywhere to sleep at night. And in many cases, organizations found that moving people from one level of housing to another actually destabilized them and made them likelier to return to homelessness.

"The data on this is pretty unequivocal," says Kitchin. "Once people are permanently housed, they're better at addressing these issues--things like substance abuse and mental illness--that oftentimes contributed to their homelessness in the first place. They participate in the relevant programs at higher rates, and they have higher rates of success."

A growing body of research demonstrates the effectiveness of Housing First in keeping people housed and healthy. Between 2005 and 2007, the number of chronically homeless people in the United States dropped by about 30%, from 175,000 to 123,000. That’s an unprecedented shift that many have credited to the adoption of a Housing First model by the U.S. Department of Housing and Urban Development (HUD).

Housing First also has the advantage of being significantly cheaper for taxpayers. That may sound dubious, but the explanation is actually pretty simple: when you give someone a place to live, they end up spending a lot less time in emergency rooms, psychiatric hospitals and prisons.

Denver is a good case in point. In 2003 the Colorado Coalition for the Homeless implemented a Housing First approach, providing permanent housing to 150 chronically homeless individuals in the Denver metro area.

Just two years later, the results were staggering. Among individuals in the program, emergency room visits were down 34 percent. Hospital costs were down 66 percent. Incarceration costs were down 76 percent. Most encouraging, 77 percent of those who had entered the program in 2003 continued to be housed in 2005, when the study ended.

During that time, the program saved Denver taxpayers a total of $4.7 million, or about $31,000 per homeless person housed.

As cities go, Memphis is ripe for those kinds of savings. A 2013 report found that a group of just 237 of the city's most vulnerable homeless people cost taxpayers over $7 million per year. Finding a way to curb those costs is particularly appealing in a city with $640 million in unfunded pension liabilities.

Although Memphis' Housing First study is not yet complete, Kitchin says she fully expects to get results like Denver's.

"Based on the preliminary data we're seeing," says Kitchin, "I think it's fair to say that Housing First is at least twice as effective at ending homelessness as traditional, treatment-based programs."

On a given night, about 1,600 people in Memphis sleep on the street or in shelters. Of those, 149 are chronically homeless, meaning they have been homeless at least four times in the last three years.

Through Housing First programs like 100,000 Homes and Strong Families, the Community Alliance is helping Memphis' chronically homeless find a permanent place to live. They are also responsible for implementing the Action Plan to End Homelessness, a ten-year plan developed in concert with Memphis Mayor A C Wharton Jr. and Shelby County Mayor Mark Luttrell Jr.

In 2013 the Community Alliance had a budget of $1.8 million. With that money, they were able to permanently house 811 homeless Memphians, including 340 homes created and administered through Housing First programs.

Going forward, Kitchin says she plans to continue expanding Housing First in Memphis, which means working with agencies and nonprofits to modify old programs and develop new ones. She also wants to grow her organization's ability to serve homeless seniors and people with fragile medical health.

But Kitchin says that once in a while, it's good to stop and appreciate what the Community Alliance has been able to accomplish so far.

"These days you can walk up North Main," says Kitchin, "and there is not a single person living on the street. And that is an amazing thing. I never stop being amazed by that."

Back at the apartment in the Medical District, Hugh Barnes has reached the last verse of "Brand New Key."

"Oh, I got a brand new pair of roller skates," he croons, strumming his guitar. "You got a brand new key. I think that we should get together and try them on, you see."

With the help of Friends for Life and the Community Alliance, Barnes is able to manage his HIV with a single pill, Stribild, that he takes in the morning. The two nonprofits also provide him with medical and dental care, financial assistance for food, drug and alcohol counseling, and case management in the form of a social worker who visits every Wednesday.

Barnes says he still occasionally struggles with his drug addiction, but he hasn't been to the emergency room--or jail, or any other kind of hospital--since he got his apartment two-and-a-half years ago. These days, instead of trying to score, he says he'd rather bike down to Beale Street, put out a hat and play his guitar.

"It doesn't really bring in much," he confesses. "Maybe twenty or thirty dollars a night. But I'm not doing it for the money. I just like to play my music, and hopefully that will bring people some happiness."

Which, when you think about it, is a lot better than sleeping in the grass near an overpass. At least Katie Kitchin thinks so.

"You think of all the problems we face," says Kitchin. "Things like domestic violence, infant mortality, unemployment and poverty. All these things that seem so impossible. And yet here is this one thing, this important social challenge, that we actually have the tools to solve. We just have to have the courage to do it."