Project Welcome Home

The Problem

Individuals experiencing chronic homelessness disproportionately utilize significant government resources in the form of emergency room visits, mental health services, substance abuse detoxification and treatment, criminal justice resources, and other services. On any given night in Santa Clara County, more than 6,500 people experience homelessness, over 2,200 of whom can be classified as chronically homeless.

The Basics

Location: Santa Clara County, CA

Policy area: Homelessness

Population served: 150-200 individuals experiencing chronic homelessness defined as high-cost users of county services using a predictive screening tool that assesses historical utilization data.

Service providers: Abode Services

Size of investment: $6.9 million

Maximum success payments possible: $1.1 million

Investors: Reinvestment Fund ($500,000), Corporation for Supportive Housing ($500,000), Sobrato Family Foundation ($1.5 million), The California Endowment ($1 million), Health Trust ($1 million), The James Irvine Foundation ($300,000), Google.org ($500,000), Laura and John Arnold Foundation ($1 million for evaluation), Abode Services ($500,000 service fees)

Intermediaries: None

Other partners: Third Sector Capital Partners (transaction coordinator and government advisor), Laura and John Arnold Foundation (evaluation grantor), Palantir Technologies (technology partner)

Evaluator: University of California San Francisco School of Medicine

Evaluation methodology: “Intention to Treat” analysis, which will determine the duration of stable tenancy for all those receiving the intervention. A randomized control trial (RCT) is also being conducted, but will not determine outcome payments. Instead, the RCT will evaluate other intervention outcomes such as the utilization of other County services and mortality.

Outcome payor: Santa Clara County, CA

Outcomes that yield payments: Number of months of continuous stable tenancy achieved, meaning a tenant owns a valid lease or sublease and is allowed to enter the housing unit

Timeframe: 6 year service delivery term; 6.25 year repayment term; 6 year evaluation period

Project start: July 1, 2015

The Intervention

Intervention: This PFS project scales Housing First and a modified Assertive Community Treatment (ACT) model. Housing First provides permanent housing to individuals experiencing homelessness, simplifying the process of accessing housing by streamlining the application process and removing unnecessary barriers to accessing housing. In Housing First, treatment or services are not a requirement of tenancy. ACT is a multidisciplinary team-based approach with assertive outreach that delivers supportive services including case management, crisis intervention, substance use counseling, mental health treatment, peer support, skills building, and connection to primary care, among others. Services are designed to address barriers to housing stability, manage mental illness, reduce interaction with the criminal justice system, and improve health outcomes. A combination of housing and supportive services is referred to as Permanent Supportive Housing (PSH). 

Evidence base behind the intervention: A 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 benefit-cost 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. A meta-analysis of ACT shows a significant reduction in homelessness and improvement in psychiatric symptom severity compared with standard case management treatments. A second meta-analysis of ACT shows positive outcomes in psychiatric hospitalization and homelessness. A benefit-cost analysis shows ACT is not cost-beneficial.

The effectiveness of this intervention for the target population had been evaluated, and the service provider had provided this intervention previously.