Los Angeles County Just in Reach Project

The Problem

On any given night in Los Angeles County, 60,000 individuals are experiencing homelessness. About 18 percent of Los Angeles County’s homeless population have substance abuse disorders and 30 percent have serious mental illnesses. People who experience homelessness and mental illness often cycle through the criminal justice and emergency health care systems, which is both costly to society and detrimental to their health. In fact, the total cost of social services to the county each year amounts to $35,000 for each person experiencing homelessness.

The Basics

Location: Los Angeles County, CA

Policy area: Homelessness, Criminal Justice

Service provider: Los Angeles County Department of Health Services Intensive Case Management Providers, Brilliant Corners (Flexible Housing Subsidy Pool Operator)

Size of investment: $10 million

Maximum success payments possible: $11.5 million

Investors: The Conrad N. Hilton Foundation, United Healthcare

Other partners: Third Sector Capital Partners (Technical Assistance Provider), Gibson, Dunn & Crutcher (Legal Counsel), CSH (Transaction Coordinator), National Council on Crime & Delinquency; the Los Angeles County Sheriff’s Department, the Los Angeles County CEO’s Office

Evaluator: RAND Corporation

Evaluation methodology: Success metric calculation; broader impact analysis

Outcome payor: Los Angeles County, US Department of Housing & Urban Development, California Board of State and Community Corrections

Outcomes that yield payments: Housing retention at six months and twelve months; reduction in number of arrests in two-year period following placement into permanent supportive housing

Timeframe: Four years

Date announced: Pilot began in July 2016, PFS project announced October 2017

The Intervention

Intervention: Just in Reach (JIR) will place 300 individuals experiencing homelessness who are currently in custody in a county jail, and who have a mental health or substance-use disorder, into permanent supportive housing (PSH). In addition to receiving PSH, individuals will be connected to mental health, substance misuse, and physical health services, as well as intensive case management to help them remain housed and reduce their likelihood of committing another crime.

Evidence base behind the intervention: 2014 review of individual studies from 1995 through 2012 found substantial literature, including seven RCTs, demonstrating that components of PSH reduced homelessness, increased housing tenure, and decreased emergency room visits and hospitalization.  A 2014 longitudinal study shows PSH is also associated with reductions in the rate of chronic homelessness on a community level. Although at least three studies show that the net public cost of providing PSH to homeless people with mental illness and/or addictions is about the same or less than the cost of allowing them to remain homeless, this analysis suggests the intervention may not be cost beneficial. A meta-analysis of PSH shows positive outcomes for hospitalization, psychiatric hospitalization, homelessness, emergency department visits, and primary care visits. The Administration on Children, Youth and Families at the US Department of Health and Human Services has funded a multisite demonstration to test the efficacy of the supportive housing model, providing $5 million five-year grants to each of five sites across the country. The Urban Institute is evaluating the demonstration. Additionally, to date, several pay for success projects have provided permanent supportive housing, each of which are evaluating the outcomes of their population.