'Housing First' model may find home in Vancouver

Stable shelter, even before sobriety, can leverage a cleaner life, experts say

By Scott Hewitt, Columbian social issues & neighborhoods reporter

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Elsewhere online

• “Housing First” research and references.

Report finds significant health care savings and improvement in quality of life for most Bud Clark Commons residents.

Who’s most at risk?

Share and the Council for the Homeless have adopted a Vulnerability Assessment Tool developed by Seattle’s Downtown Emergency Service Center. The VAT lets outreach workers determine who is having the hardest time surviving the streets by scoring each homeless person according to detailed criteria in 10 vital areas. For example:

• Survival skills: Does the person have street smarts or fail to recognize risky situations, opportunistic “friends,” dangerous predators? Has the person already been a crime victim?

• Basic needs: Can the person feed and maintain self, or is there little awareness of hygiene and human needs?

• Medical problems: Is the person healthy or suffering from wounds and injuries, chronic problems like diabetes or hepatitis, or a serious disease?

• Mental acuity and health: Can the person pay attention and understand? Is there mental decline or dementia? Is there treated or untreated serious mental illness?

• Addiction: How severe is it?

— Scott Hewitt

If Portland's experience with its Bud Clark Commons building is any indication, Lincoln Place is where some homeless people would go to die.

That's inevitable, Bud Clark managers say, and still better in every way — morally, economically, societally — than shrugging off deaths on the street or in the weeds.

Even better is the likelihood that many more residents of Lincoln Place would improve their lives than lose them.

The seven-story, 130-unit Bud Clark Commons, located near downtown Portland's Amtrak and Greyhound stations, is a larger and more complex example of what's proposed for downtown Vancouver: a 30-unit public housing building for chronically homeless people whose extreme vulnerability qualifies them for residence, and whose continued substance abuse doesn't disqualify them.

There would be no drug or alcohol testing at Lincoln Place, though drug dealing and other criminal activity would be banned. Sex offenders would not be allowed to move in. There would be no age limits, but planners believe the bulk of residents would be 45 and older.

Lincoln Place would be a three-story, 10,000-square-foot building at an anticipated price of $4.7 million. Residents would pay 30 percent of their income in rent — but many are expected to have little or no income at all, according to Vancouver Housing Authority executive director Roy Johnson. The rest of the rent would be subsidized by the government. The Washington Housing Finance Commission recently gave VHA its blessing to underwrite much of the project cost by selling low-income housing tax credits to private buyers; Johnson said VHA now will prepare formal plans for city approval and try to begin construction as soon as the fall.

"Housing First" is the philosophy behind Lincoln Place, and it's been gaining popularity across the nation in recent years. The idea is that the most troubled homeless people — the ones with hard-core problems such as serious mental illness, addiction, dementia — would be evaluated and invited to live there via grass-roots outreach efforts.

Nobody sugarcoats the fact that many, if not most, Lincoln Place residents would be addicts. "These are going to be substance abusers, and most likely they're not going to be accessing services" such as mental health and addiction counseling, said Johnson. "These will be the people who've tried traditional services and who stay away now. They're difficult to convince to take another shot."

"It's called 'low-barrier' housing," Council for the Homeless executive director Andy Silver has said, and it's aimed at "the small percentage of homeless who … are homeless for years and years. They are the hardest-to-reach people. Unfortunately, they're also the most visible. Historically, other programs and services haven't worked for them."

Coaxing them toward services remains the plan behind the plan. Silver points to research showing that people who live in Housing First facilities tend to do dramatically better than they would otherwise — and that Housing First saves society money by reducing the need for more-expensive services such as shelter space, emergency room visits, police calls and incarceration at the county jail. Numerous government and independent agencies "all consider Housing First to be the best practice for ending chronic homelessness," he said.

Formerly homeless alcoholics cut their drinking dramatically after being housed in a Seattle Housing First building, according to a 2012 study published in the American Journal of Public Health. An earlier study by University of Washington researchers found that program was saving taxpayers more than $4 million a year.

A new study of an Ontario (Canada) Housing First program found that "providing prompt, permanent shelter to the city's homeless is cheaper and more effective than trying to treat underlying conditions such as mental health or addictions first."

And a broad 2011 study by the University of New Mexico found that Housing First projects "save communities … hundreds of thousands to millions of dollars per year. … The quality of life for the newly housed … increases with the implementation of Housing First programs as well."

But a 2007 study by the U.S. Department of Housing and Urban Development, while generally positive about Housing First, noted how tough that road can be: "These clients have long-standing mental illnesses and, in most cases, co-occurring substance-related disorders. While the housing provided by the programs increased housing stability and afforded the opportunity to receive treatment, substantial progress toward recovery and self-sufficiency often takes years and is not a linear process."

The Hough Neighborhood Association remains "uneasy" about Lincoln Place, said co-chair Sacha Amundson — but the plan makes sense to her. "How are you supposed to do anything when your stomach is empty and there's no roof over your head? I can't fathom it." Lincoln Place "is not perfect but nothing is perfect. You can't change every single person, but you can make changes for a lot of them and I think that outweighs the ones who won't move forward."

Making sure the building is adequately staffed and managed will make all the difference, she said.

Services and size

Lincoln Place is perhaps "the most rewarding project I've ever worked on," Johnson said, because it'll provide a home, and perhaps some hope, for 30 people who have next to nothing at all. Crucially, proponents say, those folks will not even have to leave their new homes to avail themselves of basic and not-so-basic services.

They'll bathe and cook inside private studio apartments. Their apartments will be designed to outsmart the mishaps you might expect of this special-needs population — for example, stoves and faucets will be timed to turn themselves off, and separations between apartments will be extra fire-resistant. Or, Lincoln Place residents could go directly across to Share House for meals.

"Share will provide case management on-site," Share program manager Amy Reynolds said in an email, and "Community Services Northwest will provide mental health and substance abuse services on-site. A part-time recreation services coordinator will … provide additional on-site services for fun and life skills such as conflict resolution. There may be additional services on site."

Those services would be offered but not mandatory. For a population of chronically homeless people, Johnson said, making services optional instead of forced actually makes it more likely that tenants will use and appreciate them.

But no drop-in traffic will be accepted at Lincoln Place, which proponents say would be accurately considered permanent housing, not human services. It won't be a clinic or hangout. "It's not open to the public," said Reynolds. "It is only for the people who live there."

For that reason, proponents argue, Lincoln Place shouldn't trigger the restrictions of the city's Human Services Facility siting ordinance, which aims to spread the burden of services beyond the downtown core. "I don't see any way in which the ordinance comes anywhere close to covering this," Silver said.

The city seems to agree. While there's been no formal land-use application yet, informal talks have already prompted a preliminary finding — a memo to Johnson from assistant city attorney Linda Marousek — that Lincoln Place's land use would likely be classified as basic "household living," like any other apartment building.

Ceci Ryan Smith, a longtime Hough neighborhood resident and former VHA commissioner who is a persistent critic of this plan, calls that absurd. If the building includes special services for its special population, she figures, it's more than just housing — and it belongs outside downtown, which is too burdened already.

What Lincoln Place's highly vulnerable residents really need, she argues, is a medical facility.

VHA is adamant: Lincoln Place is not that. It's permanent housing that will spell a reduction, not an increase, in homelessness' impact on a neighborhood that's already highly impacted. Reynolds acknowledged negative publicity surrounding police calls to Bud Clark Commons, but said the big difference in size and scope should mean a big difference in problems.

Bud Clark Commons is 130 units in a big building that includes some walk-up services and a ground-floor day center. Lincoln Place would be 30 units in a small building with no open door to nonresidents.

"We don't have a homeless problem like Portland, and we don't have to build that big a building," Reynolds said.


Bud Clark Commons: Better health for those 'hard to house, hard to work with'

PORTLAND — Named for a beloved mayor, the high-rise Bud Clark Commons appears to be both a success story and a work in progress. A new study has found that Medicaid costs (taxpayer-supported health care for the poor) dropped steeply for people who moved into the building — from an average of $1,667 per month to $899 — even while the vast majority of residents report that long-untreated mental and physical health needs are being tended at last.

Spokeswoman Shelley Marchesi considers that a “major success” for a population that’s “really hard to house, hard to work with and generally hasn’t had any mental health services in a long time.” Most residents show up for at least one community-building event per month, too, she said.

But the building has gotten some seriously negative attention too; in January, the Portland Tribune reported that Bud Clark Commons is the subject of such frequent police calls that city leaders were considering a “chronic nuisance” complaint. That never happened, but the suggestion raised the controversy level.

Detractors say permissiveness toward alcohol and drugs has resulted in some serious trouble at Bud Clark Commons, including dealing of heroin and methamphetamine. Deaths in the building — including overdose deaths — are not all that rare, its managers admit. In all, 28 residents have died since the building opened in June 2011.

But tightened rules regarding the number of personal visitors who can come through the secure entryway — where they sign in and are observed by security personnel — means drug dealing is on the wane at Bud Clark Commons, they insist.

“We know people use, but we won’t tolerate dealing in the building,” said property manager Rachel Duke. There are monthly room inspections, and anything that seems out of order or unsafe — including great big messes — will trigger more frequent inspections and personal attention from staff. Eviction can follow.

The first three floors of the building belong to Transition Projects Inc., and include a men’s shelter and the day center, which provides services, restrooms, laundry, phones and storage to anyone. That section of the building is clean-and-sober. The other, “wet” floors are owned by Home Forward and hold 130 apartment units that serve as permanent housing for the chronically homeless.

One such resident is T. Anderson-Hewitt, who said she used to love the building — until the tighter rules made it feel more like prison.

In tears, Anderson-Hewitt said she’d been using intravenous drugs as long as she can remember. “Since Day One, I’ve had a needle in my arm,” she said. “I’m trying to change my ways.”

— Scott Hewitt

VHA Properties