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TY @Gsainthelen & @kfrhoads I understand ppl’s skepticism & appreciate engagement. Will try explain what we are trying to do with the Initiative (which is, btw, not a study) (LONG Thread) (and please join us tomorrow 5/6 noon PDT #HomelessnessChat) 1/x
We know that cause of homelessness is the lack of affordable housing, particularly for those making <30% area median income (AMI). Also: historical/structural racism, income inequality/lack of living wage/lack of pensions, ableism. This is what causes homelessness 2/x
We know that permanent supportive housing (PSH)-deeply subsidized housing w supportive services offered VOLUNTARILY (Housing First) is the soln to chronic homelessness. (~85% of ppl w chronic homelessness & behavioral disabilities who enter PSH are housed successfully). 3/x
That Housing First PSH is preferred federal policy to address chronic homelessness & widespread throughout the country is due in large part to the incredible work of orgs like @CSHinfo, partnerships bw housing/healthcare sectors and research which demonstrated impact. 4/x
Fun fact: SF was one of the early adopters of PSH, led by the @sfdph. At time, idea of HF was radical—prior to that, ppl had to demonstrate sobriety etc to move up continuum of care. HF demonstrated need to flip the order. Offer ppl housing w/o preconditions. 5/x
Success of early projects (advocacy supported w research) convinced policymakers. Easy to forget how radical the idea of HF was when began & how hard change is, how many misconceptions exist (I still hear ppl say “we can’t take ppl w addiction & put them in housing"). 6/x
We can and we must. It is ableist/wrong to think that ppl who use drugs or ppl who live w mental illness can’t be housed (or worse -don’t “want” to be housed). What doesn't work is the reverse: it is hard to address one’s mental health or substance use while homeless. 7/x
Right now, as @NLIHC shows us, only 35 housing units available 4 every 100 extremely low-income (ELI) household in US. CA is worse: 22/100. reports.nlihc.org/gap (If you care about homelessness & are not yet following @NLIHC or @dianeyentel – pls do so now!) 8/x
Most ppl who are homeless, are homeless b/c of that fact ALONE. The ONLY way to get to a soln is by reinvesting in deeply affordable housing (the greatest need is for those making <30% AMI) (& living wage). There is no workaround. Yes-Some ppl will need supports to thrive.9/x
We need to focus on expanding PSH. But—there are ?s. What is the best array of services to meet the needs of specific pops? When can ppl be transitioned to subsidized housing w/o supports? Who will need more supports & what are they? 10/x
Who is not being served by PSH? (ppl w severe alcohol use disorder? cognitive impairment?) Who is not being engaged? How do we provide housing that maintains autonomy & avoids institutional care? (BC everyone has a right to live in the least restrictive environment)11/x
The aging of the homeless pop & the loss of residential care facilities has created more ?s. How do we avoid institutional care & homelessness & provide the right services to keep frail elders living in deep poverty out of nursing homes (when possible) & housed? 12/x
Do we provide for personal care needs w/in PSH? Can we adapt models such as PACE to partner w PSH? How do we align Medicaid LTSS w PSH? Align health services w housing services for pops living in deep poverty? How do we do this in an anti-racist way to create equity 13/x
Which families thrive w Rapid Rehousing? (Time limited financial assistance & services). Family Options Study shows voucher preferable—but right now, only ¼ households that meet criteria for housing choice vouchers get them & in high cost areas, vouchers hard to use. 14/x
What are tradeoffs bw displacing families to lower cost areas vs remaining in high cost areas? What services should follow? Which households can avoid homelessness w 1 time payments? (We know 1 time payments work for some, but don’t know how to predict who) 15/x
And so many more ?s. (Share yours!) We still can’t track in health systems who is homeless, despite it being one of the most important determinants of health. The VA does this, but most other health systems don’t. Why & how do we change that? 16/x
The scale of this crisis is enormous. As @jenloving23 points out, now 600K per door in Bay Area to create housing. We need $billions for housing & huge investment from Medicaid to provide appropriate supports for those who need. 17/x
The scale of the problem calls for large governmental support. Nothing else will solve it. The goal of the initiative is to provide unbiased answers to some of the vexing ?s And to change the conversation—to help the public understand the roots of the problem 18/x
(NOT mental health/substance use, but housing & racism/ableism) & to see what solns work. Philanthrophy is allowed to take risks-to pilot ideas that government isn't ready to try. To document & explain the problems to garner more government resources & trying novel solns 19/x
Our research will be community-engaged. Research that doesn’t involve the community (including those w lived experience) from the outset will come to wrong conclusions. We will respond to active ?s that community/decision-makers have re: aligning healthcare w housing. 20/x
We will work in partnership w others doing this work so we don’t replicate anything being done by others, but will amplify others' work. We will work w the orgs doing the work to answer their ?s. We will work w the community to answer your ?s 21/x
We will devote resources to changing the dialogue. Working w ppl w lived experience to do the research, to speak /write about their experiences. (Yes, we will pay for their labor). Train health care providers how to be effective advocates for change 22/x
We will make public what we find. We will make public & easily accessible what is known—so that all who need it can access it easily, separating myths from facts. Hope to be a resource for program developers, policymakers, the press, the general public. 22/x
Homelessness is solvable. But we will need a massive reinvestment to do so. The status quo is unsustainable. Those making decisions need to know what works and the public needs to back them. There is an important role for evidence—trusted, non-biased, in these discussions 23/x
There is no medicine as powerful as housing. We @ucsf look forward to doing our part to get to a solution. Join us in this work! /FIN
