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Housing First: An Inside Look
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HRC’s Rachael Kenney chats with Larry Gottlieb of Eliot Community Human Services in Lexington, MA. Larry shares program highlights about Eliot’s Single Room Occupancy Housing First Program, including how the program was developed and funded.
image of Larry Gotlieb

Larry Gottlieb, MSW, MPA, is the Director of Homeless and Outreach Services at Eliot Community Human Services in Lexington, MA.

Q: Can you tell me how Eliot’s Single Room Occupancy Housing First Program developed?

A: At first, case management and support for the clients was sporadic, since the primary role of Outreach Clinicians was to do street outreach. In a Housing First Program, especially early on, clients often need more intensive case management services. They are generally not required to be sober or actively involved in mental health or substance abuse treatment upon entry. For example, the only requirement of our Housing First clients is that people pay 30% of their income towards rent, and that they are enrolled in the Massachusetts Behavioral Health Partnership (MBHP) Medicaid plan.

MBHP uses Medicaid funds to provide behavioral health services for over 300,000 Massachusetts residents. At one point, they created a funding mechanism to support community-based case management services. Once this policy was implemented, we expanded the program to ten beds. We continue to use this reimbursement to pay the salary of an on-site case manager.  This is a highly collaborative program and a good model to use since resources for supportive services are even more scarce than usual.

Q: How do you decide which clients to accept into the program?

A: The new philosophy of Housing First Programs is that there is no such thing as “housing ready.” Everyone is believed to be ready for housing. While I agree with this philosophy, I think that some level of screening is important to get to know new clients. For example, if someone has a personality disorder, an untreated mental illness, or an active substance abuse problem, you will need to ensure that the housing they receive is appropriate. It may not be wise to house them in a place where they may become over stimulated, or where others might be impacted by their behaviors. You have to know the clients and their levels of functioning to help them make these decisions.

Q: The Single Room Occupancy (SRO) Housing First Program evolved from a five-bed program with outreach staff who occasionally stopped in—to a ten-bed program with its own on-site case manager. Can you tell me more about this process?  

A: Our Housing First project started two years ago. At the time, we had Shelter Specialists who were funded by SAMHSA’s Projects for Assistance in Transition from Homelessness (PATH), and Street Outreach Clinicians funded by the US Department of Housing and Urban Development (HUD).

The Shelter Specialists and Outreach Clinicians initiated a collaboration with a non-profit provider of Single Room Occupancy (SRO) housing, Commonwealth Land Trust of Lawrence, MA. We used HUD funding to secure the housing units and the Outreach Clinicians provided the early case management services. PATH funds supported the Shelter Specialists who performed mental health assessments of potential residents.

Q: What tips or advice do you have for programs that are just beginning to develop a Housing First project?

A: In my opinion, time management is the greatest single challenge for new clients in Housing First programs. We are essentially housing people who are used to planning their daily activities around survival in shelters and on the streets. Once these folks are in housing, they have much more time on their hands and might not know what to do with it.  How do we help people who are facing loneliness and isolation? It helps if clients feel connected as members of a community. They also need some time and education to adjust to being housed.  Issues like how to be a good tenant and neighbor, keep your apartment clean, meet new people, maintain personal hygiene, and manage finances are all issues that challenge newly housed clients.  

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