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"Ask the Expert" Welcomes Carol Wilkins, M.P.P.
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“Ask the Expert” features an interview with a leading expert on homelessness or co-occurring mental and substance use disorders. The following is an interview with Carol Wilkins, M.P.P., consultant and national leader in the supportive housing movement.

We are pleased to welcome Carol Wilkins, who has more than 25 years of experience in public finance, human services, and policy work at the State and local levels. Ms. Wilkins provides consulting support for the U.S. Interagency Council on Homelessness. She also provides consulting support for organizations that include the Council of State Governments Justice Center, Abt Associates, PolicyLink, Building Changes, and others. At the Corporation for Supportive Housing (CSH), she worked for more than 15 years to develop and support the implementation of evidence-based policy solutions to end long-term homelessness for people with complex health needs and reduce the avoidable use of emergency, inpatient, and institutional care. Ms. Wilkins' previous work includes working with the California Legislature’s office of the Legislative Analyst and the Assembly Ways and Means Committee, as deputy mayor of finance in San Francisco, and as finance director for the San Francisco Housing Authority. She managed CSH’s national public policy and research activities, and worked to increase the capacity of State and local governments and non-profit agencies to create integrated systems to provide housing opportunities linked to effective health care and supportive services for people who are homeless or at risk of homelessness.

Question:

During the past few years, what are a few of the major changes you have observed in the supportive housing industry and its stakeholders?

Answer:

First, there is a growing recognition that even people who have been homeless for a very long time, including those who experience frequent crises because of mental health and addiction problems, do want housing and can be successfully housed with the right combination of housing, supportive services, and partnerships. I see a real paradigm shift in progress, away from the idea that people must go through a series of steps to be “ready for housing” and toward the idea that those with the largest obstacles to housing can still succeed.

Communities are finding that without investment in housing, their investment in treatment cannot deliver the hoped-for returns of recovery, stability, and a successful life in community. I also see increased understanding that supportive housing projects may need to rely on multiple sources of funding from different agencies and levels. Recognizing this, leaders at the State and local levels are beginning to work together to create the infrastructure needed to combine funding from multiple agencies.

Question:

What are researchers and practitioners learning about supportive housing that can help States and communities fund and develop effective programs?

Answer:

We see nonprofit sponsors successfully pulling together multiple sources of funding for supportive housing projects, deal by deal. This can be a slow process. In a growing number of communities, people are crafting interagency partnerships to coordinate funding more systematically. Those communities are achieving results. At CSH, we are describing systems change efforts through our “Taking Health Care Home” initiative. Martha Burt, our lead evaluator, is examining the evolution of effective practices at the State and local levels and how these translate into coordinated investments in supportive housing, as well as agreements that target new housing opportunities to those who need it most. We look for replicable practices that can benefit everyone and help reduce costly cycling between systems. The third in a series of reports on this topic was published in 2008 and is available on the CSH Web site.

Many studies have shown that supportive housing often results in dramatic savings in the overall cost of community services. This growing body of research should help generate the political will for communities and States to invest in supportive housing so that they can make the best use of scarce resources in a difficult environment. The CSH Web site provides resources to show how supportive housing can save resources and benefit communities.  Also, CSH has published a do-it-yourself guide to help States and local communities conduct their own cost studies.

Researchers have also learned a good deal about the many pathways into homelessness. For example, we know that when families experience homelessness, there is increasing risk that their children will end up in foster care; and we know that when youth age out of the foster care system, they themselves are at increased risk of becoming homeless. Research focuses attention on those pathways and highlights the urgency of finding targeted prevention strategies and interventions that work.

Question:

How has the current economic downturn created challenges and opportunities for supportive housing?

Answer:

The picture is complicated. Much media attention has focused on the plight of people who have never experienced homelessness before who have lost their jobs or lost homes to foreclosure. Although this focus has increased the awareness of homelessness as a national problem, it has also shifted attention away from the problems faced by people who are chronically homeless. In addition, little coverage has been given to renters who are displaced from affordable housing because of foreclosures—a common problem in communities with a high poverty level. We know the crisis is also weakening the safety net of support that relatives and friends can give to people in crisis—the “social capital” that most families and individuals use up before they are forced to turn to shelters.

The breakdown in capital financing is also having a negative impact on efforts to create supportive housing. Some cities and States face difficulty selling bonds that have been approved by their voters. Some of these jurisdictions also have affordable housing trust funds that are supported by property taxes or fees associated with real estate transactions, the value of which has been reduced. Other revenue streams for States and local governments are also shrinking during the current economic downturn. We hope that the efforts to stabilize U.S. financial markets will help remedy this situation.

Question:

Do you see progress in reducing the fragmentation of the public systems that finance and create supportive housing? What windows for engagement might be opening?

Answer:

One window is the increased attention to people with co-occurring disorders who are involved in the criminal justice system. State policymakers are seeing dramatic increases in the funding they spend on incarceration. Some have noticed that many people who return to prison after being released on parole have done so because of relatively minor failures in compliance. People with co-occurring disorders are especially prone to relapse and missed appointments, especially if they don’t have a place to live. Sending people back to prison for months for minor infractions may not be the best use of scarce public dollars. Instead, States are looking at ways to increase the likelihood of successful integration in the community for these former prisoners, especially by ensuring their connection to housing and treatment and other community supports.

Another opening window is attention to the pressing needs of veterans, not only those from current wars but also those who served earlier and who are now chronically homeless and overrepresented among those without shelter. Congress has already provided 20,000 new vouchers for housing through the Housing and Urban Development and Veterans Affairs Supportive Housing program (HUD-VASH). Another 10,000 vouchers are in the budget for the current fiscal year and will be distributed in 2009. We are hopeful that service providers, government agencies, public housing authorities, and veterans’ groups will come together in a coordinated effort to reduce homelessness among veterans. 

Healthcare reform, a major focus of the current administration, offers a third window. Many influential experts recommend expanding coverage and access to care, producing better health outcomes for populations that have been underserved, as well as those who have received costly and avoidable care in hospitals. Supportive housing is a strategy that lines up well with the principles and goals of healthcare reform. Now is the time to make the case that supportive housing should be a part of any comprehensive strategy for healthcare reform.

Question:

Looking ahead, what trends do you see in funding for supportive housing?

Answer:

We see a growing interest in developing and using a full range of models for supportive housing, including models in which consumers live in integrated settings with other tenants who simply need an affordable place to live. Many consumers prefer integrated housing, but this model creates some challenges in the use of categorical funding that will need to be worked out.

Question:

What’s new at CSH? Do you have resources available or coming soon you’d like grantees to know about?

Answer:

CSH has just released a set of materials designed to help communities achieve and maintain quality supportive housing. Based on a 2-year process of engagement with consumers, tenants, funders, providers, and others, we identified seven key dimensions of quality. We have developed definitions and indicators, quality assessment tools, and additional materials and resources to help communities and practitioners meet applicable standards for high quality, effective supportive housing.

CSH has also created a toolkit to help supportive housing tenants find employment.  We are learning that even tenants with disabling health problems often can find and keep meaningful jobs in their communities.

Q & A
2009
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