UCLA Housing Voice

Ep 64: Ending Family Homelessness with Beth Shinn (Pathways Home pt. 4)

• UCLA Lewis Center for Regional Policy Studies • Season 3 • Episode 6

Share episode

“We have the resources, as a society, to prevent and end homelessness. And the knowledge.” Beth Shinn discusses the Family Options Study, which found that long-term housing subsidies, like housing vouchers, led to much better outcomes at similar cost compared to rapid rehousing, transitional housing, and “usual care.”

Show notes:

Shane Phillips  0:04  
Hello, this is the UCLA Housing Voice Podcast and I'm your host, Shane Phillips. This is the fourth installment in Pathways Home, our series on research into the causes of and solutions to homelessness. If you're up to date on the Housing Voice catalog, then this one is not new, but it is still a perfect fit for the series. It's a re-air from almost two years ago of episode 21 with Beth Shinn, though we've re-edited it to a slightly higher standard of quality than when it first came out. In this episode, we talk about Beth's book with coauthor Jill Kaddhuri, In the Midst of Plenty, and her research on the Family Options Study, which evaluated the effectiveness of different solutions to family homelessness. We talked a bit about solutions to vehicular homelessness with Maddie Brozen in part three, but this is the first episode where solutions are really front and center. As you'll hear, when it comes to families with children, long term housing subsidies like housing vouchers have proven amazingly effective. Even though this interview first came out almost two years ago, the topics of our next two episodes both came up in this conversation. In part five, we'll be talking about the impact of unconditional cash transfers for single adults who are experiencing homelessness and have relatively limited supportive service needs. In part six, we'll discuss the At Home/Chez Soi study, the largest randomized control trial in North America of the housing first model. That approach is generally reserved for adults who have been chronically homeless or have more service and support needs due to problems like, for example, mental health issues or substance abuse disorder. It's still in the works, but we have also got a special part seven planned to end the series, and I'm excited to share more about that once it's finalized. The Housing Voice Podcast is a production of the UCLA Lewis Center for Regional Policy Studies, with production support from Claudia Bustamante, Gavin Carlson, Jason Sutedja, and Divine Mutoni. As always, you can send comments and questions to shanephillips@ucla.edu. And with that, here's our conversation with Beth Shinn.

Our guest this week is Beth Shinn, professor in the Department of Human and Organizational Development at Vanderbilt University. She studies how to prevent and end homelessness and create opportunities for groups that face social exclusion. And she's also the co-author along with Jill Khadduri of a recent book titled 'In the Midst of Plenty: Homelessness and What To Do About It'. We'll spend most of our time today discussing a report that Beth co-authored. But we'll also be asking a few questions about the book. And we'll tell our listeners right now that they should go ahead and buy a copy of it. Beth, thank you for joining us today.

Beth Shinn  2:58  
Thanks so much for having me. And thanks for the plug for the book.

Shane Phillips  3:02  
And the co-host today. We got Mike Lens. Welcome back, Mike.

Michael Lens  3:05  
Thank you very much, Shane. I've enjoyed listening to a few great episodes. While I have been less active as a podcaster than I have been before. 

Shane Phillips  3:17  
Okay, so to start, Beth, how about you just tell us a little bit about Nashville where Vanderbilt is based? If you were taking us on a tour of the city, what would you want to show us, you know, either as regular ish people or urban planning and housing nerds?

Beth Shinn  3:33  
Well, Nashville is sometimes called "music city". And one of the fun things about Nashville is the number of places that you can go and hear live music, and it's a much more varied selection of music than it's given credit for. So that's a lot of fun. There's also great access to nature areas. So you know, one of my favorites is a path around Radnor Lake where you're sure to see you know, deer and turkey and egrets, and there's an eagle and some owls and just a lot of fun.

Shane Phillips  4:03  
That's great. So we'll start off with your book here. Once again, it's titled 'In the Midst of Plenty: Homelessness and What To Do About It'. As the title suggests, it's much more comprehensive in scope than the report we're going to be discussing most of the time today, but I think a summary might be really helpful to kind of prime our listeners for that more in-depth conversation. Could you tell us a bit about the book's main messages and kind of, you know, I think just some basics on what we know about who becomes homeless, and why would be great. And also, you know, what we know or don't know about strategies for ending and preventing homelessness generally.

Beth Shinn  4:43  
Um-hmm. So as the title of the book suggests, our central message is that we have the resources as a society to prevent and end homelessness. And we have the knowledge, there have been a number of studies in the last decade or two decades, that have really shown us the way to end homelessness for different groups. And we know something about prevention. So we're in a position to end homelessness, if we're ready to devote the resources to doing so. So who becomes homeless there, maybe half a million people are homeless on a given night, there many more people who are homeless over longer periods of time, there are three and a half million who use shelters just in the course of a year. And there are a lot of different kinds of people. So you know, your image of somebody who might be homeless is probably a single man. Perhaps a derelict. The age at which you're most likely to be in a shelter in the United States is infancy. 

Michael Lens  5:42  
Yeah, that's tragic. 

Beth Shinn  5:43  
And so about a third of the folks who experience homelessness are people in families. And we know quite a lot about how to end homelessness for families. We'll be talking about that later in a particular study. We know how to end homelessness for individuals with serious mental illnesses and co-occurring substance use disorders. There have been great randomized controlled trials of housing first programs, and we can talk about those if you want to for that group. We've been able to cut homelessness among military veterans in half because we've put the resources in. HUD and the Department of Veterans Affairs, put in the resources, mayors stood up to a Mayor's Challenge to end homelessness. The VA started asking everybody who came in for medical services, a couple of questions about their housing stability, and their projected housing stability, and referred folks to prevention. And we've shown that we can end homelessness, if we're willing to put in that kind of effort.

Shane Phillips  6:48  
That's yeah, that's a super helpful primer. I actually, sounds like Mike was aware, but I was not aware that the largest, and the most frequent user of shelters was infants. That is horrible.

Michael Lens  6:59  
I'm only aware because I've read the book. I mean just to just to kind of add on to to the praise there. I mean, I think I struggle a lot as somebody who who does housing research, and of course, lives and works in Los Angeles, where homelessness is, is more on people's minds that I think in past years and in in other places often, I really struggled to kind of understand and be informed of really about the interface between housing and homelessness and how housing policy interacts and affects homelessness, just because I don't strictly do I don't really do research on people experiencing homelessness and interventions there. And the book is really a fantastic introduction. Plus, you know, more, I think, for people who want to better understand like how we can use housing, and we can and we can do policy, so much better for people experiencing homelessness. So I think I would very much encourage people to look at it. 

Beth Shinn  8:09  
Thanks so much. And homelessness is really all about affordable housing. 

Michael Lens  8:13  
Right? 

Shane Phillips  8:14  
Yeah, I think we'll come back to this, perhaps. But I have a question for later about how homelessness policy and housing policy I think are often treated as separate disciplines. And I think that's still true in many ways. But there's a growing recognition of the intersection between these two things and kind of them being, homelessness in particular, maybe being downstream of housing policy in many cases, but not all. So we'll get there. But let's start with, so the report that we're talking about is known as the 'Family Options Study'. And its purpose was to evaluate the effectiveness of several common strategies for helping homeless families find their way back into housing, and ideally, to stay housed and to change other aspects of their lives for the better. Things like income, food security, substance abuse, intimate partner violence, child well-being and so on. I'm going to summarize the study as quickly as I can here, and then we'll dive into the details with Beth and Mike. So, more than 2000 families were recruited from emergency shelters to participate in the program. And each was assigned to one of four groups. One group got priority access to a long-term housing subsidy, usually a housing choice voucher. And that might also include some assistance to find housing but no other supportive services really. A second group got priority access to short-term rapid rehousing subsidies that offered families temporary rent assistance, potentially renewable for up to 18 months and paired with limited housing-focused services to help families find and rent conventional private market housing. Our listeners are probably familiar with vouchers, but maybe less so with rapid rehousing. So this intervention is basically as it sounds, programs are designed to quickly get people experiencing homelessness back into housing, this prioritizes getting people back into housing as quickly as possible rather than focusing on other services or circumstances in their lives that might be contributing to their homelessness. The third group was the "transitional housing intervention", offering families temporary housing for up to 24 months in agency controlled buildings or apartment units paired with intensive supportive services. Transitional housing also is probably not super familiar to everyone and contrasts with rapid rehousing in some important ways. It's typically paired with services, and it tends to prioritize these services, at least as highly as quickly putting a roof over people's heads. Before we go any further, Beth, have I correctly defined rapid rehousing and transitional housing and the contrast between them or is there anything you want to add there?  

Beth Shinn  10:54  
Well, I think that's right. In our study, people use Rapid Rehousing, temporary subsidies for about eight months on average. And they use transitional housing when they used it for about 13 months on average, you can stay in transitional housing up for two years. But basically, the the theoretical argument for transitional housing is a fix the family kind of argument that people experience homelessness, either came to homelessness because of difficulties in their lives or experienced trauma because they were homeless. And you can't transitional housing advocates would argue, rehouse people until you've tried to deal with those those issues that people may have, and you strengthen the families, the argument goes to the point where they can be self sufficient. We didn't find any evidence for that model.

Shane Phillips  11:45  
Interesting. Yeah. And it's it's sort of the inverse of the housing-first model, which I think we'll talk about a little bit as well here. So there's a fourth group and this group received what is called "usual care". Families in this group could use any housing or services in the community that a family could access in the absence of immediate referral to other interventions. And that typically included at least some additional stay in an emergency shelter, but they didn't get priority access to any type of homeless or housing assistance. So they're not getting priority access is the key. They're essentially the control group in this study, and the others are different treatments. I should also note that assignment to the first three interventions was not a guarantee of participation in it, but rather, it just meant that the family received priority access if they wanted to use it. And similarly, families assigned to the usual care group could still access housing vouchers and other programs, but they wouldn't receive priority access. So in many cases, they might wait months, or even years to actually receive a voucher or to move into assisted housing. So in other words, these families got the usual range of options that would have been available to them if the study had not taken place. Outcomes for the families were tracked at 20 months, and then 37 months, and the experiment was set up so that researchers could compare each group against the others. So for example, they could see how housing vouchers compared to usual care as an intervention or how rapid rehousing compared to housing vouchers, or transitional housing compared to rapid rehousing, and so on. Beth and her fellow researchers also evaluated the relative costs of these different approaches, which is important because we don't have unlimited funding to address people's housing needs. And it might not make sense to prioritize an intervention that's say twice as effective as the alternatives, if it costs three or four times as much, or if it's very effective for those who really need it, but unnecessary maybe for families who might need different or less intensive assistance. Closing out my summary here, just a tease a few of the findings. Unsurprisingly, families assigned to the usual care group did not have great outcomes, the control group, and compared to the usual care group, those who received priority access to housing vouchers or long-term housing subsidies were much less likely to end up in shelters again within the 37-month period. And they saw other benefits including reduced psychological distress and a halving of intimate partner violence compared to the usual care group. More surprising, at least to me, was that the impacts of the rapid rehousing intervention were essentially indistinguishable from the usual care group, especially at the 37-month check-in. The transitional housing intervention was somewhat better in that it improved housing stability, compared to the usual care, meaning that families were less likely to end up back in a shelter. But the impact was much smaller than the housing voucher intervention and had fewer co-benefits. I do want to note that these are all average outcomes for each intervention. So rapid rehousing, transitional housing and usual care probably worked perfectly well, for many households. But worse overall, for permanent housing subsidies, I don't think we want to imply that there's not a place for these other options, just that, you know, maybe one is generally more effective than the others. Beth, how is that for a summary? We're going to dig into the details here. But is there anything I got wrong or maybe misstated that you want to correct there?  

Beth Shinn  15:17  
No, I think that's that's basically right. We also tried to determine whether there was some families that would benefit more from one intervention than another. And we were we put our money on two kinds of characteristics of families. One was psychosocial challenges, things like substance abuse or domestic violence or psychological distress. And another was housing challenges, things like eviction records, or not having a rental history. And we couldn't find any evidence that any of the interventions worked better or worse, depending on what their families who are high or low in psychosocial challenges or in housing challenges.

Shane Phillips  16:00  
That's really interesting. One of the reasons we chose this study for our first episode on homelessness is because it makes use of a randomized control trial design, or RCT. Mike, maybe you can explain to the listeners what an RCT is for the uninitiated and say a little bit about why you wanted to have an RCT for our first conversation about homelessness.

Michael Lens  16:24  
Right. Yeah. So thanks, Shane. You know, I guess it is, at this point, cliche and policy evaluation and policy analysis to call randomized control trials or RCTs, like the gold standard. And the reason why we give it this this lofty title is, it's really the only studies arguably, or the best study, certainly for really isolating the effect of a policy intervention, on the outcomes that you want to study. The reason why we can be very confident or much more confident in an RCT, if the randomization is done, right, is because random chance is what splits you into the groups that determine what kind of program you participate in, right. So in this case, we had four groups, one of them as a control group, the usual care group, and then there's three other housing interventions that we're studying. And rather than the individual families choosing which program they thought was best for them, which introduces selection bias that, you know, is correlated with some attributes of the family are characteristics of the family that we can't necessarily control for. Or it's, you know, it wasn't also wasn't Beth's decision, or her fellow research colleagues decision, it wasn't the program administrators decision, you know, all these sorts of human decision making processes that would introduce selection bias in terms of, you know, that would determine where people are going to go, right. We get rid of all that. And we roll the dice, right. And we say, okay, family, a, you know, the dice said that you get Rapid Rehousing family be, you know, the day said, you get transitional housing. And so we have none of that selection bias. And we can assume that on average, all of these different groups are the exact same, and that whatever outcomes that they that we observe about them in terms of their housing outcomes, or their family outcomes, are actually due to whatever program they participated in.

Shane Phillips  18:38  
And, Beth, I think some listeners might wonder if it's ethical to assign some families to a usual care group to kind of roll the dice, as opposed to saying, you know, we think as professionals in this field that based on your circumstances, this is the right option for you, and and we're going to assign you to this treatment, or we're going to, you know, provide this service for you rather than a different one. What's, what's the response to like, why this approach is ethical and not setting people up for failure or what have you?

Beth Shinn  19:13  
Um-hmm. That's an important question. One reason we think it was ethical is that we brought resources to the communities that we were studying that they wouldn't ordinarily have had. So ordinarily, people who are in homeless shelters don't have access to housing choice vouchers, they can get on the list. And they can wait a couple of years. And even...many of our usual care families eventually got various forms of housing subsidy. But they aren't usually offered to folks who were in shelter. So we brought resources to the communities, and the usual care families had access to everything that they would have had access to anyway. So we didn't take anything away from anybody. And we, of course, got informed consent, we explain the study to people and asked whether they wanted to participate. We only had 13 turn-downs in nearly 2300 families, because we were bringing additional resources to the community. And the idea that somehow workers could do a better job of figuring out what's the right solution for a particular family is really arguable. And the fact that we couldn't find out afterwards, which families would flourish more, depending on their characteristics and different kinds of housing, suggests that could just be worker bias as well.  

Shane Phillips  20:39  
Yeah, can't even really figure it out, in retrospect, much less ahead of time. Yeah, I do want to reiterate that the usual care group, the families in the usual care group still had access to all of the interventions, they could still get vouchers, they could still get into rapid rehousing, it's just they would have to go through the same waiting process and all of that as anyone else. So let's get into some more specifics of the study, as you said, nearly 2300 families participated. And to be eligible, they had to be living in emergency shelter for at least seven days. What's the reasoning behind that seven day threshold, and were there any other important eligibility requirements, if you think it's appropriate, this might also be a good time to kind of sketch out some differences between short term homelessness and long term or chronic homelessness and why advocates and researchers might think they require different kinds of assistance.

Beth Shinn  21:36  
So the other requirement for families was that they had to have a child 15 or under, with them in in shelter, and 15 or under was, they'd still be around when we came back to do a follow up. The reason that we asked for families to be in shelter for seven days, is that there are a large number of people who are homeless quite briefly for a day or two. So if you have some kind of housing crisis, you might go to a shelter. But if you've got resources, you might be able to figure out something to do that would get you out of there. In a few days. There's another group that might have serious psychosocial needs serious mental illnesses, for example. And permanent supportive housing is a an intervention that's been shown to work for people with long histories of homelessness, serious mental illnesses, often co occurring substance use disorders. And if that's available in a community, we figured the shelters would be able to identify people within that first week, and set them up to get into permanent supportive housing. But if it wasn't available, then they were eligible for the study. So we weren't excluding people, because they might be high needs. But we wanted to give them the opportunity to get into something with heavier duty services. If that was available to them. Mostly it wasn't. 

Shane Phillips  23:03  
And this might be a good time actually to just review how permanent supportive housing differs from these treatments, because it was not one of the treatment options.

Beth Shinn  23:12  
Right. So permanent supportive housing has been tested mostly for individuals. There has been a big RCT for that in Canada...there is a small RCT that we did in New York years and years ago for the Pathways Housing First model...and then the At Home/Chez Soi study in Canada, a five-site study that showed that the Pathways Housing First model of permanent supportive housing really works. And in that model, people get housing with private landlords without any prerequisites for sobriety or participation in treatment, but with wraparound services: vocational, recreational, mental health, substance services, physical health services, but voluntary services only those that they choose because services work a lot better when people choose them than when they're foisted on folks. So in the supportive housing model, you've got wraparound services, but you also have permanent housing available. And that works very well for folks with serious mental illnesses and substance problems and long histories of homelessness.

Shane Phillips  24:14  
So in the report, you note that the typical family in the study was an adult woman with a median age of 29 years old, with one or two children living with her in the shelter, and that about 30% of families had two adults present mostly as couples, racial minority groups were over represented relative to the overall population, and even relative to the population of people experiencing or living in poverty. Some other things that stood out to me were that the participants had a median household income of just $7,400. That's annually. 26% had an eviction at some point in their history, and 35%. More than a third had never held a lease themselves. Are those numbers pretty reflective of homeless families in general? And is there anything else we should know about that families in this study in terms of demographics, family structure, those kinds of things?

Beth Shinn  25:09  
I think those are fairly representative figures for a cross section of people who experience homelessness. So most people who are homeless or homeless only once and fairly briefly, but those who have trouble extricating themselves or those who return are more likely to show up in a cross sectional survey. But yes, many people who experience homelessness have never had a place of their own. And most people who are found in the annual counts of people experiencing homelessness are not coming from places that they owned or rented. They're coming from doubled up situations, or in the case of single individuals, they may also be coming from institutions.

Shane Phillips  25:52  
So as I said, in the summary, you were looking at three interventions in addition to usual care. Those were long term housing subsidies, Rapid Rehousing, and transitional housing, I gave a quick definition of each intervention. But could you go into a little more detail for us about what each of those interventions look like from the perspective of the homeless family, and then help us understand we talked about this a little bit, the conceptual framework behind each approach, advocates and practitioners don't all agree on the origins of homelessness. And that does lead to different ideas about how it can be solved. So I'm curious how those concessions are reflected in each intervention. 

Beth Shinn  26:34  
So the theory behind behind using housing subsidies to end homelessness is that homelessness is essentially a housing affordability problem. And if it's a long term rental subsidy, the idea is that this is an affordability crisis, it's not likely to be quickly resolved. And we have a lot of evidence for that that was the intervention that worked by far the best, not only to resolve homelessness, but also to have radiating benefits for other aspects of family life. For an individual. This means finding a landlord who is willing to accept a housing choice voucher, yeah, and that can be difficult and leasing up. And we had much higher lease up rates than in other studies of use of housing choice vouchers, because our families were more desperate. So about 88% of families who were offered housing choice vouchers managed to lease up with them.

Shane Phillips  27:35  
How does that compare to the overall population of people receiving those vouchers?

Beth Shinn  27:40  
That's higher? And I don't have a specific figure. I can make one up. But yeah, around 60%. But yeah,

Michael Lens  27:50  
I would I would have said somewhere in the 60s. And and I think that probably hit the nail on the head, there's like, so many people who receive a voucher use the voucher in a place they already live in, right. And so this is a little bit of a different story where somebody doesn't have a place, right. And so they have to use the voucher in order to get a roof over their heads, if you already have the roof, which is the case for the vast majority of voucher holders. They they don't necessarily have to use the voucher. And if the landlord that they have currently says no, well, then they might just stay there and pay.

Shane Phillips  28:31  
Interesting. Yeah. And also maybe important to note that I'm sure that voucher utilization for the people who have them varies a lot from city to city, tighter rental markets, it's probably harder. There are also cities and states, California included that now ban source of income discrimination, at least in this way where you're not, at least on paper allowed to deny someone renting your place because they're using a voucher to pay.

Beth Shinn  28:59  
And there's an Urban Institute study that shows that in cities with source of income discrimination legislation, it's easier to use vouchers, it's still not easy, right?

Shane Phillips  29:09  
It's still only I don't know, 70 80% as opposed to be 60. Whatever. Yeah. It's better, though. So that's long term subsidy vouchers, how about the kind of ideological framework behind rapid rehousing and transitional housing.

Beth Shinn  29:24  
So Rapid Rehousing has a similar take to the long term housing subsidies. Again, it's thought that homelessness is a housing affordability problem. But the goal is to get folks back into the regular housing market as quickly as possible, and to give them only as much help as they need to stabilize. And what we found was that, to the extent that there were real effects of rapid rehousing, we missed them when we came back 20 months or 37 months later, folks used Rapid Rehousing subsidies on average About eight months in our study, and rapid rehousing was certainly no worse than usual care. And it was cheaper than usual care. So to be preferred on those grounds, but we didn't have a lot of effects of rapid rehousing, transitional housing, assumes that families have psychosocial needs that need to be addressed before they can be stable. And so those needs might arise from the trauma of homelessness, they might be needs that lead people to become homeless to begin with. But those needs need to be addressed in order for families to become stable. And we found no evidence for that approach. The transitional housing had no benefits for any of the psychosocial outcomes that transitional housing is supposed to address.

Shane Phillips  30:52  
I think we can talk a little bit more about the impacts here in some detail. So we've we've spelled out that long term housing subsidies are more effective. What does that actually look like? So at 37 months, in particular, how are people who have received priority access to long term housing subsidies doing better than the other groups.

Beth Shinn  31:14  
They're less likely to be homeless, they're less likely to be doubled up with other households because they can't find or afford a place of their own, they have moved less frequently in recent months. So they're much more stable on every measure of of housing. And then there are radiating benefits for other aspects of family life. So folks who got priority access to housing subsidies had lower levels of psychological distress, lower levels of substance abuse, lower levels of interpersonal violence than families who got simply usual care. That is the psychosocial problems that can sometimes lead to homelessness were improved. When families got access to affordable housing, affordable housing created a platform for them to solve whatever other problems they might have had on their own without any special assistance, they could use any kind of assistance that was available in the community, but no specialized assistance as part of an experiment. Kids moved less often between schools, and they had better school attendance, and they had fewer behavior problems. And in more pro social behavior, families were less likely to become separated. So parents were less likely become separated from their children, and 20 months, there were fewer families or fewer kids that were going into foster care,

Shane Phillips  32:36  
Which itself is a someone in foster care is so much more likely to end up homeless as an adult than the average person. Yeah.

Beth Shinn  32:45  
And families were more likely to be food secure, and experienced lower levels of economic stress. If they got the housing choice vouchers. The one clearly negative effect was that families were a little bit less likely to be employed, they didn't have lower incomes, but they're less likely to be employed at 20 months. And that was no longer significant at 37 months. But over the period of the study, it also seemed that they worked for fewer months. Now, these are families mostly with young children, fairly high levels of disability. And so they were able to maintain their their families and have better food security, with a little bit less work effort. 

Shane Phillips  33:31  
Yeah, it sounds like if they're working less, but earning the same amount, that's not such a bad outcome.

Beth Shinn  33:36  
That might not be a bad outcome. 

Shane Phillips  33:38  
Yeah, yeah

Michael Lens  33:39  
That's really a widespread set of positive outcomes there. And I guess it I can't help but to compare somewhat to the Moving to Opportunity study, which is, of course, both an RCT and involves housing vouchers as as a key or the key in that circumstance, and that study intervention, where, you know, there's certainly plenty of positive outcomes there, but a lot of no findings. Right. And it's, the findings from this study seem to be, you know, really much more pervasive and, and affect different aspects of people's lives in a different way. And

Shane Phillips  34:23  
do you think that's just because the Moving to Opportunity study was mainly people who already lived in public housing moving somewhere else, as opposed to people who are homeless, kind of, you know, desperation or just different circumstances or something else?

Beth Shinn  34:37  
Yeah, I think the the contrast is much bigger for us between homelessness. Moving to Opportunity was essentially offering people vouchers to move to better quality neighborhoods, or to maintain housing, with vouchers in poorer neighborhoods, and the long term effects of moving to Opportunity are pretty interesting. So upfront, there weren't a lot of effects. But for youth who got access to better neighborhoods early on before they were teenagers, there's some long term effects. And we're just now launching a 12 year follow up to family options. And we're very excited to look at what happens to the young children who are now adolescents in the middle school children who are now young adults. 

Michael Lens  35:28  
Oh, that's fantastic.

Shane Phillips  35:30  
Long term housing subsidies seem to be more effective. Do you have a sense for why?

Beth Shinn  35:35  
I think they really support the theory that homelessness for families is a housing affordability problem, you fix the housing affordability, you provide a stable platform for families to deal with whatever other problems they might have on their own. 

Shane Phillips  35:50  
It's a point in favor of that just give people money solution to many of our problems.

Beth Shinn  35:55  
I think that's also a very interesting solution. In this case, the money was essentially constrained to be used for housing. 

But I think the you know, 

Shane Phillips  36:08  
That's the next study.

Beth Shinn  36:10  
Yeah, we're actually trying to raise money now for a study to give on conditional cash transfers to keep babies out of shelter in New York City. 

Shane Phillips  36:20  
Oh, wow. 

Beth Shinn  36:21  
So I don't know whether we'll raise the money and be able to pull it off or not.

Shane Phillips  36:25  
We'll have you back on for that one. And yeah, six years or whatever, you're checking it on them?

Michael Lens  36:29  
Yeah. If if you know, Robert Wood Johnson or, or other funders are listening. Yes. Greet and greet Greenlight, this, please. This is a great idea. Well, I do think this does have lined up well, with with thinking about alternative, or different populations and families not to hammer this this point to obviously, but it's just there really is a lot of I think, controversy or differences of opinion, however you want to say it, where some people think this is, you know, homelessness is a housing problem. And some people think homelessness is like a mental health or substance abuse problem is, to me, it's absolutely not that simple. But like, there's so many people that feel very, very strongly on both sides or multiple sides there. And I can definitely see people listening to this conversation and saying, Yeah, okay, you know, maybe families have fewer substance use issues, for instance, and you know, the people that I encounter that are experiencing homelessness, are these individuals on the street that seem troubled then like, maybe they just can't hold down a house or something? You know, I'm not speaking for myself, which is like this, I think, pervasive idea that's out there. I guess, Beth, do you feel as confident about a housing first model? Do you feel as confident, it's always hard to extrapolate findings to another population? How much do you think this applies to people who are individuals experiencing homelessness, for instance?

Beth Shinn  38:06  
let me say three things about that first, families are less troubled on average, than individuals who become homeless, they have lower levels of mental illness and lower levels of substance abuse, they're more likely to be depressed, less likely to have psychotic disorders. Second, seeing somebody who's homeless is seeing somebody who's at the worst point in their lives. And one thing we found in this study is even we found that the experimental group, the housing subsidy group, had reductions in psychological distress and substance use over time. But we found that that was generally true as families stabilized even if they didn't get housing choice vouchers, their psychological stress, and their substance abuse went down. So families do better when they're not in the midst of an episode of homelessness. And if you see somebody in the midst of an episode of homelessness, you've seen somebody who's not at a good point in their lives. But there is evidence for a housing first approach for individuals with serious mental illnesses. It's not housing only Housing First for folks with serious mental illnesses includes wraparound services. It's not just putting people in housing and going away, but it's getting people in Housing First, rather than first trying to deal with their substance abuse or their psychological problems, which are very difficult to deal with when people don't know where they're going to sleep tonight. 

Shane Phillips  39:39  
So one thing that I think looms large and all of this is the cost of these different interventions, and you measure the cost of them in two ways. And the difference I think, illustrates something pretty important. One measure is the per family cost of a specific program per month or per use, whether that's a long term housing subsidy emergency shelter so on. That one's pretty straightforward. The second measure is the per family cost of all programs used by a family based on which intervention they were assigned which group they're assigned to. So if a family was assigned to community based Rapid Rehousing, you'd be looking at the cost of that program, as well as any other programs they ended up using during the 37 month period. It seems to be that that measure more accurately reflects the real cost of each intervention. It's acknowledging that just because a specific intervention may not work for someone, that doesn't mean they just disappear and are no longer, you know, making use of any public programs. We know for a fact that they usually are for both of these measures. What should we know about the monthly cost of each program and the costs for each intervention group? 

Beth Shinn  40:52  
Well, emergency shelters and transitional housing are expensive. emergency shelters are the most expensive option. But transitional housing is also quite expensive, because you're pairing services and supervision with the housing. And Rapid Rehousing is the cheapest intervention per month, because the subsidies tend to be a little lower than for housing choice vouchers. And housing choice vouchers are aren't intermediate there. But I think you're right, that it's the cost of all the programs that people use. That is the fair comparison. Right. So we're looking at the outcomes of the mix of things that people got into when they got priority offers for one or another intervention. And we should also look at the costs of those same things that people got into when they got those priority offers. And there, we were surprised at 20 months, it was almost a wash, that is Housing Choice, vouchers, or access to long term subsidies really didn't cost more than usual care at 20 months, by 37 months, the costs had diverge, because people continue to use the long term subsidies and the people in the usual care group, we're using fewer other kinds of programs. And so the long term subsidies cost about 9% more than usual care, I think it's worth it. 

Shane Phillips  42:21  
Presumably that would, that gap would continue to grow over time,

Beth Shinn  42:25  
We expect it to continue to grow or grow enormously. The last tracking interview we did with folks was in about six and a half years. And at that point, only about half of the long term subsidy group was still using their long term subsidies, and more of the usual care group had gotten into subsidies. So we do expect the groups to continue to diverge but not in a decelerating way.

Michael Lens  42:54  
Right, right. 

Shane Phillips  42:55  
That did stand out to me looking at you have some charts in the study that show what services people were using over time, you know, 1% of each group. And what you see is even in the Rapid Rehousing, and the transitional housing groups, that by 37 months, the plurality were well, the largest was probably using nothing. But then the next largest group was actually long term housing subsidies, housing vouchers, basically, as opposed to the thing they were initially assigned to. That's right. So the again, the long term housing subsidy option seems to be the superior in terms of the positive impacts for families experiencing homelessness. I know it's not, you know, it's more complex than this. And in some ways, it's because of the very long term open ended nature of the intervention, that this is the case, it's very likely that some of the families that received a voucher would have turned out perfectly fine, they would have been okay, with a temporary and less expensive intervention, or maybe even no real intervention at all. And if we could identify those families, then we could save that money and spend more of it on the people who really need more assistance, or on any other number of important public priorities. The challenge, of course, is we're not really good at identifying who needs more or less intensive assistance or what kinds of assistance from what I gather, I'm thinking actually have another study that I come back to very often and I think it was in San Mateo County, where they found that I think it was 5% of unhoused individuals were incurring a huge share of public costs, mostly in terms of healthcare, you know, emergency room and criminal justice, police in jail and that kind of stuff. The average expenditure was over $100,000 per person in terms of public services, and that's per year. But the problem was that it wasn't the same people every year, and we couldn't predict in advance who those people might be. So could you talk a little bit about that challenge and what role this plays in all of this maybe share some of the ways that practitioners try to identify the best interventions for different homeless families and individuals. Or maybe if, if the right answer is long term services for everyone, maybe that's not even necessary. 

Beth Shinn  45:14  
So the families who experienced usual care in our study used a lot of costly services, it was about $41,000, on average, over the three year period that we tracked it. So usual care is not nothing usual care is a variety of service programs that don't succeed in stabilizing very many families. But as you say, some families do fine without services, we weren't able to identify them. Now 2200 families isn't enough to really understand who benefits most from, from what, for the statistical nerds, you still don't have enough power to test statistical interactions. What that means is, you really need enormous samples to be able to tell what works for whom, when the signal is not very strong. And we weren't able to detect the signal, it wasn't strong enough to detect with the families that we had. We've seen in some other situations. So I've done some work with New York City in trying to predict who is going to need preventive services. So people come into a program in New York City called homebase, and ask for services. And initially, workers were deciding to whom to give services. And we helped the city develop an empirical model that worked better than what the workers were doing in predicting who is going to come into shelter. And the workers erred on the side of giving services to this is my term not there's the word the poor, they're more likely to give services to high school graduates. But people who weren't high school graduates are more likely to become homeless, they're more likely to give services to people who are employed, but people who weren't employed were more likely to become homeless. And so we were able to build a model that predicted who would become homeless and help the city give the services to the people that would benefit the most there. And in California, you've done some really interesting modeling using administrative services, to try to understand who's going to become homeless and who's going to become homeless for long periods. But it's that prediction is hard to do. And in the housing first model, basically, you let people choose, you offer a variety of services, and you'll let people choose what it is that they want to avail themselves of. And if you have the resources, that seems like a pretty good model, because as I said, services work a lot better when people choose them than when they're foisted on folks.

Shane Phillips  47:59  
I know this is a difficult question to ask because the or answer because there are so many moving parts. But do you have a sense for if we were to take this seriously, as you say and use the resources at hand? What would it cost to provide a housing subsidy to everyone who needs it? Like what would that look like in terms of who would receive them? Who would still have to wait that kind of thing? 

Beth Shinn  48:23  
Well, the Bipartisan Policy Commission a few years ago, calculated that it would be about 31 billion to provide housing subsidies to everyone who would use it whose income was below 30% of area median, we now give subsidies, we give subsidies to only about one in four households that are eligible, but we allow slightly wealthier households to get them. So you don't have to be below 30% of area median to get them you can be up to 50% of area median to get the housing vouchers. So if you restrict it a little bit more tightly to folks that are hurting the worst, then they calculated a few years ago, 31 billion, the National Low Income Housing Coalition is asking for more money than that. And there was money and build back better, that would have increased the availability of housing choice vouchers. 

Shane Phillips  49:24  
Yeah, and just for context, I don't have the figures off the top of my head, but the mortgage interest tax deduction that homeowners get cost the government maybe it used to be more like 80 billion, I think now after the 2017 tax bill, it's closer to 30 or 40. But almost all of the benefit goes to households earning at least $100,000 a year. There's a capital gains exemption on home sales that costs us a similar amount. So the money's there. We're just spending a lot of it on homeowners rather than renters and unhoused people,

Beth Shinn  49:55  
Right we spend a lot more money subsidizing housing for rich people than for poor people.

Michael Lens  50:00  
Right right.

Shane Phillips  50:01  
Yep, we've been focused here on what I said at the beginning might be called homelessness policy. But as we start to close this out, I'd like to hear your thoughts on the role of housing and land use policy. More generally, in all of this. I think, unfortunately, these are often treated as kind of separate disciplines. You're either a homeless person or you're a housing person. And you know, the solutions to homelessness are sometimes seen as essentially separate from efforts to build more homes and cities and improve the housing market affordability generally. I don't think it's a coincidence, though, that the cities and metro areas that build the least housing and have the most kind of restrictions often also have the highest rates of homelessness, even when those places spend a lot more money trying to address homelessness than less expensive cities. I do feel like there's a growing recognition that housing policy is often upstream of homelessness. And he kind of said yourself that a lot of this does just come down to affordability. And I think more groups are are aligning in their efforts to address both and not just be focused on one or the other. What are you observing in terms of the intersection between these two disciplines, whether it's in academia are kind of on the government and advocacy space?

Beth Shinn  51:16  
I think that our study shows that homelessness for families really is about housing affordability, and rates of homelessness are higher in cities where rents are highest. So there's a lot of evidence converging evidence, I think, that housing and homelessness are two sides of the same coin, you know, affordable housing, you have to ask affordable for whom. So affordable housing is often for folks who are below 80% of area median, folks who become homeless are going to be below 30%, or even 15% of area median, you pointed out that our families had a median income of $7,400, at the point that we recruited them. So it's pretty clear that they did not have incomes that would enable them to afford housing in the private market. And even three years later, a large number did not have incomes that would allow them to afford housing in the private market. So I think housing policy is homelessness policy. And if we want to prevent homelessness, we can do targeted social services to people who are at highest risk. But if we want to prevent homelessness, we have to stop keeping to generate homelessness, we have to stop generating more. Right, right. And because homelessness is essentially a housing affordability problem, we can increase incomes for people at the bottom of the income ladder where we can reduce their housing costs, or we can do both to make housing affordable. And there are lots of ways to do both. Housing Policy tends to be around the affordability of housing, reducing housing costs, they're also important ways to raise people's incomes. And to some extent those different policies trade off with one another. So if incomes are high enough, you don't need to subsidize housing to the same extent, for example.

Shane Phillips  53:14  
I really want to emphasize that point about the solutions requiring kind of constant action and how this is not there's not just like a stock of homeless people. People are becoming homeless all the time, people who have not been homeless in the past in many cases. And something I point to very often here in Los Angeles, we passed measure h h h, which is more than a billion dollars to fund mostly supportive housing, and also measure H at the county level, which is providing money for a lot of services. And we are helping more people experiencing homelessness than ever and helping more people become no longer homeless move into housing. And yet the number of people experiencing homelessness is rising even faster because of these sort of unaddressed bigger picture housing market and policy issues. And I think that's likely to continue if we don't address that upstream side of things. 

Beth Shinn  54:10  
Many more people experience homelessness over time and are homeless on any given night. So Bruce link did a social survey back in 1990, early in the current epidemic of homelessness, and he asked people whether they'd ever been homeless. Now these are people reachable in conventional dwellings, no prisons, no just mental hospitals, no homeless shelters, no barracks. 14% of people said yes, they had been homeless. And he asked follow up questions to say, well, was that what HUD would call literal homelessness? Was that on the streets, in shelters in places not meant for people to live? In 7% of people said yes to that. So vastly more people pass through homelessness, that are homeless on any given night, and thinking about homeless policy is separate from housing policies, essentially, thinking of homeless people as people who experience homelessness is kind of a separate species of individuals. And that's not the case. People who experience homelessness are among the poorest of our fellow citizens at the point that they experience homelessness. And over time, they will do better and other people will replace them in among the folks who are experiencing homelessness until we are able to attack income inequality and housing affordability. 

Shane Phillips  55:37  
Absolutely. All right. Beth Shinn, thank you so much for joining us today.

Beth Shinn  55:41  
Thanks so much for having me.

Shane Phillips  55:47  
You can read more about Beth's work on our website lewis.ucla.edu. Show Notes and a transcript of the interview are there to the Lewis Center is on Twitter, Facebook, LinkedIn, et cetera. And Mike and I are on Twitter. Thanks for listening. We'll see you in two weeks with the next installment of Pathways Home

Transcribed by https://otter.ai

People on this episode

Contributor

Michael Lens

Host
Contributor

Michael Manville

Host
Contributor

Paavo Monkkonen

Host
Contributor

Shane Phillips

Host