Rapid Rehousing & Ending Homelessness

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Blog post authored by Brenton Hutson

Rapid Rehousing serves to prevent and end homelessness for the majority of individuals and, together with Permanent Supportive Housing and limited instances of Transitional Housing, can end homelessness as we know it today.

For all of society’s woes, we must acknowledge today more than ever before that we live and work in a world where great things are possible.  Steady advancements in the fields from science and technology to psychology and everything in between have presented opportunities never before experienced by humankind – we walked on the moon in 1969, Polio was eradicated in the United States in 1979, mental health has begun the long walk towards de-stigmatization, and today, we can end homelessness as we know it.  

Let us consider that for a moment – the end of homelessness.  An ailment which is intrinsically linked to sustained deterioration of mental and physical health (Oppenheimer, Nurius, & Green, 2016), costs communities roughly $30,000 per person experiencing chronic homelessness per year (Gibbs), and which tears away at familial ties, strips away freedoms so easily taken for granted, and undermines the principles of equality and opportunity upon which our nation was founded.  Imagine that world – the recovery of the human capacity for progress lost in the mire of homelessness, a world where there are not ‘homeless people’, but just people – most importantly, a world where we acknowledge the value of every human being, regardless of circumstance.  That is what we can accomplish, provided we have the will to see it through, and the grit to ask ourselves some tough questions.

How do we do it?  Recent years’ of evidence have made that answer abundantly clear – we do so as a community driven by evidence and efficacy.  Simply put – we do what the evidence shows to work, and we stop doing what doesn’t.  We titrate our interventions accordingly, opting for the most outcome and cost-effective method shown to work for each individual household.  Comparisons of these interventions with medical practice are not untoward when we consider the resources and services afforded each.  If Permanent Supportive Housing (PSH), offering permanent housing solutions with services attached, is the heart surgeon for those with the most emergent needs, then let us consider limited Transitional Housing (TH) for those with special needs to be the specialist provider, and Rapid Rehousing (RRH), which seeks to conduct generalist assessments and rapidly identify, prevent, and resolve homelessness with services and assistance suited to the majority of households, to be the primary care provider.  It is this last intervention (Rapid Rehousing) that I want to discuss in more detail, it being among the most recent (and debated) entries into homelessness solutions systems.

First, what is Rapid Rehousing?  It is a time-limited, housing-first based intervention (meaning that housing is the primary focus of the services provided, provided without precondition of other treatment or services) in acknowledgement of the reality that a lack of housing often undermines efforts to make progress in other areas requiring treatment.  Core components of Rapid Rehousing programs include housing identification, rent and move-in assistance, and supportive case management seeking to make connections to long-term service providers relevant to the household’s needs (U.S. Interagency Council on Homelessness, 2015).  With an average length-of-stay in the program of 116 days (U.S. Department of Veterans Affairs, 2015), it is meant to resolve the immediate housing crisis, to set up the participating household for success through connection to other supportive services, and then to move on to the next household so as to ensure parity between outcomes and available resources.

Next, who is it for?  It is for households that need only a relatively limited intervention, with service planning assistance and perhaps limited financial assistance.  Typically, these households are those that are experiencing short-term financial or social crisis, which represent 80-85% of the total population accessing shelters (Culhane, 2015).  Important to note that, while Rapid Rehousing has been demonstrated to effectively serve this particular population (which happens to be the largest segment of households experiencing homelessness), it is not the right fit for everyone.  Those experiencing chronic homelessness are often better served by Permanent Supportive Housing interventions (Culhane, 2015), and those who present with special needs or for whom rapid rehousing has not worked might be better suited for Transitional Housing.  Preliminary research has suggested that Rapid Rehousing may serve as an effective solution (but certainly not ideal) option for other populations, such as relatively low-vulnerability VI-SPDAT scorers in the 10-13 range (Richard & Kile, 2016), but this is not the primary population of focus, nor have the results been sufficiently examined over an extended period of time to know for certain.

Lastly, what are the results?  They’re good.  Rapid Rehousing is far and away the most cost-effective intervention, with a cost-per-exit of approximately $4,100 compared to $22,000 per-exit for Transitional Housing (National Alliance to End Homelessness, 2014), and an annual cost of approximately $8,000 to $18,000 per year for Permanent Supportive Housing (Kertesz, Baggett, O'Connell, Buck, & Kushel, 2016), Rapid Rehousing provides the capacity for the most services for the most people for the least amount of money. Perhaps the most comprehensive data set originates from the nationwide implementation of the Supportive Services for Veteran Families (SSVF) Rapid Rehousing program, funded and designed by the U.S. Department of Veterans Affairs.  Here are a few of the most relevant findings from FY2016 (U.S. Department of Veterans Affairs, 2015):

  • SSVF assisted a total of 69,419 literally homeless Veterans. Nationwide, an estimated 53 percent of all homeless sheltered Veterans received help from SSVF in exiting homelessness.
  • Of the literally homeless Veterans who received rapid re-housing services, 44 percent were living in unsheltered situations (including outdoor and vehicle locations) at entry.
  • Five out of every 7 Veterans (71 percent) exiting SSVF rapid re-housing programs successfully ended their homelessness and moved into permanent housing (35,660).
  • More than one-third (35 percent) of literally homeless Veterans who were assisted by SSVF to obtain permanent housing were able to do so in 14 days or less. The average time from program entry to permanent housing for homeless Veterans who exited the program was 118 days.
  • The average length of participation in SSVF rapid re-housing among the 49,880 Veterans who exited during FY 2015 was 116 days.

Of those who were placed into permanent housing, longitudinal studies have found that, “16% and 26% of single adult veterans experienced an episode of homelessness at 1 and 2 years post-SSVF exit; the comparable figures at those follow-up times for veterans in families were 9.4% and 15.5%, respectively. Relatively fewer single adult veterans and veterans in families receiving homelessness prevention services experienced an episode of homelessness at 1 and 2 years post-SSVF exit” (Cuhane, Kuhn, Treglia, & Kane, 2015).  A study of Homeless Prevention and Rapid Rehousing (HPRP) programs, inclusive of non-Veterans, had similarly impressive findings, “with an average follow-up of 4.5 years after HPRP exit, 9.5% of the permanently housed HPRP participants and 16.9% of those nonpermanently housed returned to homeless services. By assistance type, 5.4% of permanently housed and 15.8% of nonpermanently housed homelessness prevention recipients re-entered services, and 12.8% of permanently housed and 18.2% of nonpermanently housed rapid rehousing recipients re-entered during the follow-up period” (Brown, Vaclavik, Watson, & Wilka, 2017).  

One point of contention that periodically arises in public discourse is whether Rapid Rehousing participants are able to retain housing after they exit the program, and that there is no good way to evaluate this metric.  These studies make clear that, in fact, post-exit retention for Rapid Rehousing participants can be effectively assessed provided supportive systems (such as VA homeless data, and the Homeless Management Information System) are effectively implemented and managed.  Of course, that is not to say that we should be continually be looking for ways to accurately measure the true effectiveness of these programs – we should – but that these efforts must also align with larger strategies throughout the communicate to design, implement, and evaluate programs intelligently.

Rapid Rehousing serves to prevent and end homelessness for the majority of individuals and, together with Permanent Supportive Housing and limited instances of Transitional Housing, can end homelessness as we know it today.  How motivating to think that what was a pipe dream only years ago presents itself as our reality today – that together, if we work smartly and honestly, we can make an impact that will be felt for generations to come!

 

Works Cited:

Brown, Vaclavik, Watson, & Wilka. (2017). Predictors of homeless services re-entry within a sample of adults receiving Homelessness Prevention and Rapid Re-Housing Program (HPRP) assistance. Psychological Services , 14, 129-140.

Cuhane, Kuhn, Treglia, & Kane. (2015). Predictors of Homelessness Among Families and Single Adults After Exit From Homelessness Prevention and Rapid Re-Housing Programs: Evidence From the Department of Veterans Affairs Supportive Services for Veteran Families Program. Housing Policy Debate , 252-275.

Culhane, D. (2015). We Can End Homelessness. Philadelphia: Penn’s School of Social Policy & Practice.

Gibbs, A. Ending Homelessness Transforms Communities and Reduces Taxpayer Costs. Community Solutions. New York: Community Solutions.

Kertesz, Baggett, O'Connell, Buck, & Kushel. (2016). Permanent Supportive Housing for Homeless People — Reframing the Debate. New England Journal of Medicine , 2115-2117.

National Alliance to End Homelessness. (2014). Rapid Rehousing: A History and Core Components. Retrieved 2017, from http://endhomelessness.org/resource/rapid-re-housing-a-history-and-core-components/

Oppenheimer, Nurius, & Green. (2016). Homelessness History Impacts on Health Outcomes and Economic and Risk Behavior Intermediaries: New Insights From Population Data. Families in Society , 230-242.

Richard, & Kile. (2016). SSVF Outcomes for high-acuity non-VA Eligible, Chronically Homeless Veterans. Denver: Volunteers of America Colorado Branch.

U.S. Department of Housing and Urban Development. (2016). The 2016 Annual Homeless Assessment Report (AHAR) to Congress. Washington, D.C.: HUD.

U.S. Department of Veterans Affairs. (2015). Supportive Services for Veteran Families (SSVF) FY 2015 Annual Report. Washington, D.C.: U.S. Department of Veterans Affairs.

U.S. Interagency Council on Homelessness. (2015, December 10). Rapid Rehousing. Retrieved July 11, 2017, from U.S. Interagency Council on Homelessness: https://www.usich.gov/solutions/housing/rapid-re-housing

 


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