Preble Street’s Florence House: How Research and Advocacy made it Possible
Thomas Chalmers McLaughlin, PhD Jon Bradley, DSW Housing First Conference New Orleans Why Study the Cost of Homelessness?
The people…..
“My life being more stable for myself & my kids leaves me with a more positive outlook and able to use my everyday energy on other things besides if we
are going(Tenant quote to from eat Quality or of looking Life Survey) for a place to stay. Results
Housing projects:
Z Reduce burden public and emergency delivery systems
Z Help people use community supportive services more effectively
Z Increase a person’s quality of life Average Annual Cost of Care Savings
Average Annual Cost Per Person Before and After Permanent Supportive Housing Placement All Programs - Greater Portland $30,000 Total $27,101
$20,000 $13,092
$28,045
$10,000 $14,009
$0 1 Year Before 1 Year After
Service Cost Housing Cost Florence House: Lessons learned
Preble Street’s experience as an organization that has always included advocacy as part of its mission and this proved critical in planning meetings and developing written material for specific groups and individual Lessons learned-continued
The partnership of a university researcher with providers of services and experienced advocates proved invaluable in crafting a message that would be understood by all of the target groups. Lessons learned-continued
Z The research shows us that all types of housing work to provide better lives and better services to people
Z Provides an opportunity to Open dialogue with community, politicians, and funders about innovative working solutions to homelessness Home for Good continues
In April 2010, Florence House opened it’s doors providing 25 chronically homeless women with apartments and 15 others with safe haven units 1
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Preble Street’s Florence House: How Research and Advocacy Made it Possible By
Thomas Chalmers McLaughlin, PhD University of New England-School of Social Work Portland, Maine
And
Jon Bradley, DSW Preble Street Portland, Maine
Paper presented at the Housing First Partners Conference New Orleans, LA March 2012 Author contact information
Thomas Chalmers McLaughlin [email protected] 207-221-4511
Jon Bradley [email protected] 207-775-0026
The authors would like to acknowledge those who participated in the cost effectiveness studies and the Home for Good advocacy strategy as well as the staff who work tirelessly to provide support, encouragement and hope to people who are struggling with homelessness. 2
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Abstract This paper examines the importance of using research and evaluative findings to fashion an advocacy strategy to create additional housing first units. A review of the data collection methods and analysis protocol was used to develop a clear advocacy strategy for increasing housing for women who were homeless in Portland Maine. The culmination of this was the creation of Florence House. The process of developing the advocacy strategy, and then its implementation to secure funding from Federal, State and local sources is explored and discussed. Additional points are developed and refined regarding the importance of University/provider relationships which build on the strengths of all disciplines. Implications for further development and replication of this approach are also shared. 3
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Introduction/literature review Overview
Social service organizations advocating for increased funding during difficult financial times face a daunting task. Competing priorities and limited resources result in policy makers who are reticent to provide additional funding for new programming or services.
Beyond approval for funding, there are additional hurdles and challenges to social service organizations in program development, advocacy and sustainability. The use of credible data and clearly articulated analysis provides the initial framework from which social service organizations can develop advocacy strategies. Additionally, the translation of data and analysis into a language which is understandable is of equal importance. Moreover, the identification of a process that is workable for policy makers, legislators and the popular media are important facets of strategy implementation. This paper will explore how evaluation data is used to develop a clear, effective advocacy approach in what has been called the Home for Good strategy. The paper will also explore the importance of building strong relationships between providers and research collaborators in order to produce and then translate findings into important advocacy tools.
The Housing First Model
The housing first model suggests that placing people who are homeless is safe, supportive housing provides a solid base from which formally homeless clients can go about the business of rebuilding their lives. In recent years, a robust body of knowledge has developed around both the cost effectiveness and efficacy of housing first models 4
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Buchanan, Kee, Sadowski & Garcia, 2009, Culhane, & Metraux, 2008, Rosenheck,
Kasprow, Frisman, & Liu-Mares, 2003, Larimer, Malone, Garner, Atkins, Burlingham,
Lonczak, Tanzer, Ginzler, Clifasefi, Hobson, & Marlatt, 2009. All of the associated research suggests both increases in quality of life measures for people placed in housing first type units, as well as significant cost savings to the larger social service system. Buchanan, et. al., 2009, found that providing permanent supported housing through a housing first model reduced emergency nursing home costs by nearly
$500,000. Culhane and Metruax, 2008, found service provisions under a housing first type model actually moved people further along the continuum of self sufficiency and stabilization. Rosenheck, et. al., 2003, found that people who have a mental illness are typically at higher risks of homelessness than those without mental illness. However, their findings suggest with appropriate social supports, homeless people with mental illness have decreased symptoms of mental illness when in housing. Larimer, et.al., found that clients placed in housing first models have increased health outcomes as well as show significant decreases in health care costs while in housing. In the Larimer study, the average cost savings per client was $2449 per person per month of the 12 months of the study.
Other studies which focused on service delivery, also suggested increases in treatment and outcomes. Paget, Meaden and Amphlett, 2009, found that hospital usage was reduced significantly after client engagement in a case management type program.
Martell, Seitz, Harda, Kobayashi, Sasaki and Wong, 1992, found that hospitalization 5
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible rates of the homeless population dropped when direct housing with appropriate supports were introduced.
Cost effectiveness studies
Several cost effectiveness studies conducted in the past five years confirm significant savings associated with providing supportive housing for people who were formally homeless and shifting those costs away from the emergency services system. Perhaps the most cited work is that of Malcolm Gladwell in his 2006 New Yorker commentary
Million Dollar Murray. Gladwell’s article provided evidence that rudimentary studies of not providing formal services can be based on data available from local sources and with limited statistical analysis.
Building upon this, Culhane, Metraux, and Hadley, 2002, and Kupersanin, 2001 argue cost effectiveness studies can be used to provide evidence for housing programming and service delivery structures. Bennett and Burt, 1999 and Burt 2004, suggested that shifting homeless individuals away from the emergency service system can actually result in a significant system cost savings. Burts’ work focused on assumptions of the savings to the overall system but do not provide sufficient detail to identify actual levels or categories of cost savings. Nonetheless, her work has served as an important framework for developing evaluation protocols in examining costs associated with homelessness. Burt, 2004, established a clear protocol from which, detailed analysis of actual costs based on service usage within a broad range of social service categories can be developed. Using Burt’s framework Mondello, Gass, McLaughlin and Shore, 6
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
2007, found, that when individuals were housed, the in health and mental health care shifted from ambulance transports and emergency room visits to community supports for health and mental health. Importantly, within this cost shift, significant savings was observed. An additional study of rural homeless in housing first type models using
Burt’s, 2004, protocol confirmed cost savings to both the emergency and social service systems in rural Maine, Mondello, McLaughlin, Bradley, 2008. Similarly, a 2007 Kaiser
Family Foundation report also found similar cost reductions associated with housing of people with mental illness who happen to be homeless. Within this body of research a set of clear protocols and measurements has been developed and is currently being refined. Building on Burt’s, 2002, 2004, work on developing common categories for measuring cost effectiveness, and successful studies using real data from Mondello, et.al., 2004, and Mondello, et.al. 2008, Chalmers McLaughlin, 2011, proposed the creation of a common theme of categories for analysis. These categories include: health care, mental health care, substance abuse treatment, community support, prescribed drugs, ambulance calls, police contact, jail night stays, housing costs, shelter night stays, hospital emergency room visits and public transportation.
Using research in advocacy
There is a large body of literature on the importance of research in influencing public policy and on the challenges inherent in trying to impact policy decisions made by elected officials and bureaucrats’ policy in public service. Hanney, et. al. 2003, describe the challenges of linking researchers from university settings with practical social policy and they and others describe the types of research that can best be interpreted in a 7
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible useful manner by policy makers, Jenson, 2007; Stone, Maxwell and Keating ,2001. The importance of basing policy oriented research on theory and in providing detailed and valid evaluation research of practices in the field are cited as key means of linking universities to social policy, Sherraden, Slossar and Sherraden, 2002; Maton and
Bishop-Josef,2006. Gordon, Lewis and King, 1993 add ”Post Hoc review of policy impact may be used for feasibility analysis in future policy design..” (p.6) A goal should be to ensure that policy is empirically grounded, even as it moves through the political and often less than rational process of developing laws, budgets, and policy implementation, Hanney,2003; Greene,1997.
The relationship between advocacy regarding social policy and research has become more important with the increasing focus on evidence based practices. The challenge for researchers is often disseminating research in a manner that makes sense to public officials. Conversely, the challenge for advocates is often to base recommendations on more than stories and anecdotes. Stone, et. al. 2001 emphasize the importance of research as part of influencing social policy through participation in common strategies such as influencing the climate of opinion, community and policy maker education on issues, and working with collaborative and networks to promote evidence based policies. Gruendel and Aber, 2007, suggest that social scientists must build communications and advocacy plans based on set policy goals and partner with communities of interest to influence those in power.
The importance of advocacy at the state level regarding major social policy has increased as decisions regarding key issues related to health, housing, and other social 8
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible services have become less of a focus at the Federal level, Hoeffer,2005 . In fact, State plans to end homelessness and the focus on States and Continua of Care by HUD in tackling homelessness is evidence of this. Dear and Patti, 1981, introduced seven
“empirically based” tactics: introduce bills early; have more than one sponsor; have bipartisan support; obtain the support of the governor and relevant state agencies; seek influential legislative sponsors who will work to pass the bill; press for open hearings and make sure testimony at hearings is favorable; and use the amending process to promote passage. For advocates, increased State authority presents opportunities to more directly impact policy, but advocates must understand the unique social and political environment of their state. For instance, Butler and Seguino, 2000, indicated that national studies are less influential to Maine legislators than research about conditions for people in their state. As such, studies must be timely both in terms of funding and in the legislative cycles and “issue cycles” can change depending on specific local and national activities and incidents Media can be critical in influencing public opinion and the climate in which political figures review policy options, Holder and
Treno,2006. Research can be a critical component of this effort , particularly delivered simply and directly, and combined with a collaborative strategy and the participation of the people who are most affected by the policy, Stone, et. al.,2001. We will devote the rest of this paper on linking these two issues together.
Cost effectiveness study research methods/results
This study examined a total of 99 people with mental illness who where formerly homeless people in Portland, Maine. Participants were recruited for inclusion in the 9
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible study based on a random sampling of participants living within two housing first type providers. In order to be included in the study, participants needed to be housed for at least two years and had to have been chronically homeless prior to obtaining housing.
Participants were asked to complete multiple releases of information requests in order for the researchers to access service billing records, police and jail contacts and emergency room visits.
Participants in the study were currently living in permanent supported housing projects which were funded by State and Federal tax dollars as well as private donations. All of the participants were disabled and were receiving entitlements for their disability to include Medicaid or Medicare and in some cases other State entitlements. Service utilization data was gathered from providers for a four-year period; two years prior to and two-years after the tenants’ move-in dates. Analysis compared data across 11 different social service areas as established within the literature, Burt, 2002, 2004,
Chalmers McLaughlin 2011. These categories include: health care, mental health care, substance abuse treatment, prescribed drugs, ambulance calls, police contact, jail night stays, housing costs, shelter night stays and hospital emergency room visits. These areas were also selected because of their easy standardization and because they could be easily understood and accepted. As such, they provide a common language for policy makers and practitioners and opportunity to agree on the service area definitions and outcomes. Results were reported within these categories based on pre housing costs and post housing costs over a 12 month period.
Results 10
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Table 1: Pre/post cost of providing services
Category Cost of providing these Cost of providing these services while homeless services while being housed Health Care $645,999.60 $341,423.76
Mental Health Care $569,419.38 $338,336.96
Substance abuse treatment $74,563.93 $79,601.88
Prescribed drugs $148,590.43 $193,509.17
Ambulance calls $45,891.95 $15,370.99
Police contact $22,937.48 $7,828.81
Jail night stays $61,758.18 $23,497.91
Housing costs $389,379.37 $1,296,118
Shelter night stays $241,469.12 $9,108.44
Hospital emergency room $206,451.47 $78,178.91 visits
In the area of health costs, data show a reduction of 59% for a savings of $497,042, while emergency room costs decreased by 62% for a savings of $128,373, and general inpatient hospitalizations decreased by 77% for a savings of $255,421 suggesting that participants switched to using less expensive outpatient treatment. Prescription drug 11
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible costs increased by 31% to $46,049. Additionally, while the cost of substance abuse services increased slightly, the was also a 19 percent increase in the number of hours of services provided to clients which further demonstrating the expensive nature of emergency social services. In fact, the number of hours of mental health service actually increased by 35 percent while the cost of this service dropped overall.
Figure 1: Total costs for supporting people who are homeless on the streets versus supporting them in housing, including housing costs.
Average Annual Cost Per Person Before and After Permanent Supportive Housing Placement All Programs - Greater Portland $30,000 Total $27,101
$20,000 $13,092
$28,045
$10,000 $14,009
$0 1 Year Before 1 Year After
Service Cost Housing Cost
As figure 1 suggests, even with the overall cost of providing the housing to clients, a total cost savings between the emergency service system and the permanent supportive housing structure is observed.
Figure 2: More service, less cost 12
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Mental Health Care Services Increase
796 N = 99 900 590
600
300 Number of Contacts 0 Mental Health Care
1 Year Before Housing 1 Year After Housing
People in this study received 35% more mental health services at 41% less cost illustrating a shift away from expensive emergency and psychiatric inpatient care to less expensive outpatient community-based mental health services. The total cost of mental health service for participants when they were homeless was $569,416 as compared to
$338,317 when they were in housing. As such, a $231,082 savings was observed.
Figure 3: Reduction in health care costs
Health Care Costs Reduced Greater Portland Tenants
$837,012
$900,000
$600,000 $339,971
$206,451 $300,000 $78,079
$0 Health Care Emergency Room
1 Year Before Housing 1 Year After Housing N = 99 13
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
As figure 3 suggests, a significant cost savings in heath care was observed after participants were in housing. Additional cost savings were also observed in emergency room costs after participants were in housing.
Figure 4: Savings to the locally funded services.
Decrease in Use of Publicly Funded Emergency Services
$70,000 $61,758
$60,000
$45,872 $50,000
$40,000
$23,497 $30,000 $22,937
$15,371 $20,000 $7,829 $10,000
$0 Jail Ambulance Police
1 Year Before Housing 1 Year After Housing N=99
Figure 4 highlights a significant savings to those services in Portland which are funded primarily with local tax dollars.
Using evaluative data in advocacy
To be successful in social policy change, particularly in a time of limited resources and competing social agendas and philosophies, research evidence and collaboration between advocates and partners from academia can be an essential, if not required, part of strategy. Accountability has not always meant that change is data driven, but it does mean that practical programmatic policies such as housing first which can dramatically change the direction of social welfare institutions must be grounded in both theory and evidence before systems and resources can be redirected. 14
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
The cost studies by Mondello, et. al., 2008 targeted residents in supportive housing programs who had been previously homeless and had been housed for at least one year. This included individuals in the Shelter plus care Program, group homes, and the
Logan Place housing project. The studies were conducted under the auspices of the
State with funding from the Corporation for Supportive Housing and technical assistance from national experts such as Martha Burt. This support and the close monitoring of the evaluation study gave it essential credibility with state officials within the mental health and public housing bureaucracy. The effort was conducted by a team that included a university based social work researcher, a program coordinator with an understanding of and access to needed data and a local leader in homeless services and service networks. Success in recruiting participants for the study and in obtaining consents to gather detailed information about service usage and cost resulted from this partnership. It also was a key to the success of the advocacy effort, and demonstrates a critical role for academic researchers can play in effecting social policy. The data on outcomes at Logan Place, another housing first project in Portland, was taken directly from this cost study as was data regarding each participant’s second year of stable housing.
Home for Good Strategy
Logan Place, a 30 unit apartment complex with support staff and community programming included was the first housing first program in Northern New England and one of the first to target the most challenged homeless individuals in a small urban area.
As it quickly became clear that this model could work in Maine and as initial data 15
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible emerged supporting both the quality of life changes for tenants and the cost effectiveness of the project, Avesta Housing and Preble Street, the developers of the project, decided to develop an advocacy strategy which would result in the development of a second housing project and, at the same time, raise the visibility of the housing first approach as a means of ending chronic homelessness in our State. The efficacy of the model had been demonstrated in national studies as had the cost effectiveness of supportive housing for homeless individuals. However, in a time of budget concerns, it was essential to make a strong case for the value of any future development that would require substantial financial and policy support from the State leaders. The research results were a critical tool in obtaining essential resources to develop Florence House, the second major housing first project in the State.
Home For Good Campaign
To succeed in the effort to develop housing first projects in Maine necessitated an advocacy strategy that incorporated many different stakeholders. The goal of building
Florence House evolved into a broader effort to convince State and local decision makers that experts in the field of homelessness from the service provider and academic communities knew how to have a major impact on the number of homeless people and that it was efficient and accepted public policy to invest in this proposed solution. As evidenced by Local Emergency Shelter Assessment Committee reports and
HUD Annual Progress Report, 2010, when Logan Place opened in 2005, the census at
Portland Shelter went down for the first time in a decade and the number of chronically homeless individuals decreased by more than 50% the next year. This provided further 16
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible documentation that not only did the housing first model save money, it was also instrumental in reducing shelter bed nights for chronically homeless individuals.
However, the public advocacy effort needed to center on an innovative idea based in theory and empirical evidence rather than a program proposal which could be designed as part of the effort. With this in mind, Avesta and Preble Street developed the “Home for Good” campaign which centered on the belief that the solution to homelessness was housing and that with the success of Logan Place, the steps forward in this effort would begin with a housing first project targeting chronically homeless women.
The “ Home for Good” campaign and the specific planning around the development of
Florence House for Women involved advocacy efforts in several areas, all of which were essential to gaining support for the development and funding of a new project.
The primary targets of the effort to create a policy that would support the housing first effort were the Governor, the DHHS Commissioner, and the Maine Legislature at the state level and the City Council, Planning Board, and neighborhoods at the local level.
Influencing public opinion and educating individuals and groups that could influence the policy makers became a key part of the effort. The importance of the research on costs and changes in quality of life for tenants and the broader community were the most important tools in the campaign.
The choice of focusing the second “Home for Good” project on women resulted from an assessment of the community need, the potential outcomes that could be expected from the effort, and a recognition that homelessness among women often resulted from violent situations, including sexual assault, and led to further victimization on the street. 17
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
Additionally, the relatively small number of homeless women in Portland presented the possibility of ending chronic homelessness among women with a single project and public concern about domestic violence and sexual assault offered an opportunity to develop an effective public campaign to tackle homelessness among women through housing first.
The public campaign involved several strategies, primarily using the media to promote the nature of the problem, homelessness among women, and the solution to the problem as demonstrated by the success by quality of life outcomes and cost studies from Logan Place. Given the small population of the state, the limited news media, and the relative accessibility of public figures, it was possible to influence both public opinion and the willingness of the Governor and the legislature to consider the impact of housing first use of local newspapers and television.
Media coverage centered on the success of Logan Place in changing the lives of the tenants and in improving the quality of life in Portland through decreasing use of police and emergency services. Television and newspaper coverage of the results of evaluation and the national recognition of Logan Place as a model proved critical. For example, coverage of Logan place as a Maxwell Award finalist became an opportunity to emphasize the successful partnership that had created the housing project, the important data on cost and quality of life, and the importance of Florence House as the next housing first effort. In fact, it was decided from outset of the “Home For Good”
Campaign to create drawings and plans for Florence House as part of the strategy to give it reality long before there was funding and needed support. 18
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
A second major aspect of the public campaign was the creation of a public service announcement that would air on local television stations and in movie theaters. With support from Preble Street Board members and as a result of many years of public support for Preble Street and its mission, major state figures including both U.S.
Senators, our local congresswoman, the former first lady of Maine, key members of the
State legislature, leaders in major nonprofits, and advocacy groups such as the NAACP and Maine ACLU as well as several chronically homeless women, participated in the service announcement. It was opened and narrated by Glenn Close reminding the audience that homeless women were mothers and daughters and emphasized that we knew how to solve this problem. This powerful message referred viewers to Preble
Street’s website at which information about homeless women and about the success of housing first could be found. Creating a compelling and simple message supported by strong and detailed evaluation remained a focus of the Home for good Campaign.
Advocacy at the State Level
State level advocacy involved several concurrent strategies that have proven successful in influencing social policy. The first involved collaboration and building broad support among human service providers for additional housing first projects and for Florence
House. The success of Logan Place in providing stability to chronically homeless men who were known to many community providers as inebriates and/or psychotic street people made support for a second project easy to find. First, the Portland Continuum of
Care made a housing first project for women its greatest priority and advocated for resources to be made available. A second opportunity to gain support and resources 19
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible emerged when the Maine State Housing Authority released development funds to be dispersed to Regional Homeless Councils whose role was to identify priority needs and recommend new projects. Presenting data collected at from Logan Place and the national research on the rates of domestic violence and assault among homeless women, Avesta was awarded a substantial grant, the first funding directed toward the building of Florence House.
The second strategy involved advocacy through personal relationships and built on public awareness, collaborative support, organizational history of success, and especially the evaluation research (). The primary need for the project was staffing as funds for the building and operating a new site had been found through a combination of grants, tax credits, and site based subsidies. This presented a major challenge as the resources for staffing had to be committed annually for the project to move forward. To be successful in an era of tight budgets, the cost effectiveness of housing first, particularly Logan Place, would be a most compelling argument for investing in a second project, particularly for policy makers and implementers whose control of resources is a critical factor.
As has been noted in work on influencing social policy, factors related to timing and issues crises can play a critical role and there were several of these that had a an important impact on advocacy efforts. First, it was emphasized by advocates that the while State of Maine, particularly the Department of Health and Human Services regularly pointed to the success of Logan Place, quoting often from the cost study, it provided no funding for Logan Place, at the time lacking an understanding of the 20
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible requirements and efficacy of a housing first program. Second, to be successful, timing had to coincide with the development of the State’s biennial budget, meaning that both the Governor and the Legislature would need to support ongoing expenditures for the project with timing that would coincide with completion of the building.
A third, critical factor was the closing of the YWCA in Portland, a site which had provided 68 SRO units of which 20 were designated shelter beds, primarily for women.
This led to Preble Street assuming responsibility for sheltering homeless women in a temporary site and created additional momentum for the development of a safe place for homeless women to live. A qualitative study of the homeless women who were utilizing the shelter was conducted by Chalmers McLaughlin, 2009, and a subsequent report emphasizing homeless women’s histories and support needs became an additional tool in advocacy for Florence House.
Finally, in part due to the success of Logan Place and the strength of the data supporting this success, and in part resulting from the beginning of the Home for Good plan to develop new projects that would directly impact homelessness in Portland,
Preble Street received a $1,000,000 challenge match from the Kresge Foundation, a grant which was among Kresge’s first targeting capacity building. This grant supported improvements in technology and administration needed to succeed in the Homes for
Good goal and provided additional funding for research and evaluation of new and existing projects. 21
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
The first contacts with the commissioner of Health and Human Services resulted in an acknowledgement of the efficacy of the housing first model and an interest in the strong data presented by the cost study, but also a concern about finding grant funds at a time most State funds were being eliminated or used to cover the State portion of Medicaid.
Blankets on the Governor’s Couch
It became clear that the Governor would need to be the primary focus of advocacy efforts and that he might be inclined to address this important issue as he had made tackling homelessness a key priority of his administration. However, the convincing evaluation data demonstrating the results of the first effort at housing first would ultimately prove essential to obtaining his vocal support and putting the direct service costs in his state budget proposal, board members and other key supporters of Preble
Street who saw the success of Logan Place and became engaged in the “Home For
Good” campaign became key partners in getting the governor on board. Several meetings at the State House were initiated by a powerful supporter. These meetings started with a review of the Logan Place impact and brief reviews of the comparison of costs between homelessness and housing first. Evaluation data from the first and second years of stability as well as reports on the improved lives of the tenants, their families, and the community, all supported by the evaluation, were key in winning the
Governor’s support. The report on homeless women provided additional incentive for the Governor to decide to champion of the Florence House project. As part of the strategy, the Governor was presented with a blanket embroidered with “Florence
House, 2009” for the couch in his office. This was provided as both a gift and a 22
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible challenge with a date to complete project. In subsequent meetings, with the Governor, he frequently pointed to the blanket on the couch in his office.
Winning the support of the Legislature which was divided between political parties involved a complicated and interactive process. Many looked to the Commissioner of the Department of Health and Human Services to demonstrate how the funding would be found, a demand placed on her by the Governor. Some were skeptical about the value of the project, and others were looking at their own budget priorities. Factors weighing in favor of the support of the Legislature were the power of the Governor within his party and the support of the two U.S. Senators from the other party. Both had advocated for and found Congressional support for the building of Florence House.
Reviewing the evaluation results with an emphasis on cost effectiveness had won them over and both of Maine’s Republican Senators continue to be champions of housing first in the Senate.
After individual meetings with State Representatives and State Senators, all of which focused on the cost study as the reason housing first should be a primary policy in the effort to end homelessness, several champions with the legislature emerged. This included members from both parties, swayed as much by the possible savings and cost shifting as the changes in the lives of chronically homeless individuals. In addition to planned meetings, homeless advocates attended lobbying days and used flyers, tee shirts and blankets with the logo “Home For Good” and “Florence House” to engage legislators, legislative assistants, and others in conversations about the efficacy and cost effectiveness of housing first. Ultimately, the legislature left the funding for Florence 23
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
House in the budget even during a tension filled session in which many changes to the
Governor’s proposed budget were made.
Local Advocacy
Despite the support of the Governor and the allocation of State dollars, advocacy at the local level was needed to complete the project. In contrast to the success of Logan
Place, there were still potential neighbors opposing the proposed Florence House location. It was the use of data plus community partnerships, participation in the neighborhood, and the voice of homeless consumers that overcame hurdles placed at the Planning Board and the City Council.
The first year of Logan Place included initial neighborhood opposition, concerns about increased police activity, and a need for Preble Street to fine tune initial policies to address these concerns. In fact, the very vocal police chief at the time initially raised major concerns about the project, concerns that changed into support when he reviewed the statistics regarding police contacts with tenant at the new 30 unit project.
He became a strong supporter of the project after seeing the real impact the Logan
Place was having on nuisance crimes and emergency room transports. As additional data emerged regarding the decreased costs for emergency rooms and ambulance services, support in Portland grew. Publicity about Logan Place and its tenants sold housing first to skeptical politicians and service providers.
At Planning Board Hearings, opposition from potential neighbors was countered by neighbors of Logan Place as well as information about the impact on the neighborhood 24
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible provided by the Police Department who became active advocates for Florence House.
Testimony about family reunification, employment, social activities and improvement in health and mental health by formally homeless tenants and advocates supported the qualitative data about quality of life contained in the evaluation research. Despite the
“not in my backyard” sentiments of a few neighbors, the project received unanimous support from both the Planning Board and the City Council to go forward.
Home For Good Continues
In April 2010, Florence House opened it’s doors providing 25 chronically homeless women with apartments and 15 others with safe haven units. Collaboration with the coauthor started before the women moved from the shelter and continues today as we continue to prove the efficacy of housing first, its impact on costs, and utilize the evidence to make recommendations about ways to end homelessness in our community.
Lessons Learned
It is critical to have empirical evidence that is meaningful to different parts of
community and political environments. Social policy changes are driven by
numerous factors, but evidence that housing first works must demonstrate not
only its efficacy for the chronically homeless population, but its value to the key
drivers of policy: legislature and executive branches of government; provider
coalitions; private and foundation supports; bureaucrats who ultimately will be
asked to find the resources and implement policy; and most important, the 25
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
public. Mondello, et.al, 2008 and Chalmers McLaughlin, 2011, demonstrated to
various constituencies that not only did Housing First work for homeless tenants;
it shifted costs in the local community improving the quality of life for everyone
and saved the State resources that would be spent while individuals remained in
shelters or on the street.
It is essential to create a social policy effort based on sound theory and evidence
but also on values and mission so that the goal is related to meeting the needs
of populations. Therefore an effort should focus on housing first as a model that
works for everyone, especially the most disenfranchised vulnerable with
programs and funding as a secondary part of the message.
The partnership of a university researcher with providers of services and
experienced advocates proved invaluable in crafting a message that would be
understood by all of the target groups. For example, legislator’s interest in a
study is generally limited to short bullets and it is critical to decide on strategic
use of information and a goal before meeting with each elected official. Preble
Street’s experience as an organization that has always included advocacy as
part of its mission and this proved critical in planning meetings and developing
written material for specific groups and individuals.
Each state and locality is unique in its social and political environment. It was
clear that in Maine, Preble Street’s connections made over years and history of
advocacy on social justice issues proved a crucial asset in the Home for Good
campaign. Utilizing personal contacts is clearly a critical part of successful 26
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
advocacy and with data a critical component, it is critical to educate all who
become involved in the importance and meaning of the empirical evidence which
supports the goal.
Participation in coalitions that will support the goal is important in two ways.
First, the message becomes broader and stronger if other organizations add
their voices. The inclusion of the Continuum of Care, the Regional and Statewide
Homeless Councils, and the Maine Affordable Housing Coalition in supporting
the housing first model was an important part of the strategy. Second, in a time
of limited resources, State officials and social policy implementers need to make
difficult choices in funding. Competing interests can result in limited success. In
Maine, the Department of Health and Human Services hears from lobbyists
representing hospitals and mental health providers regularly. It was important to
demonstrate how Logan Place had impacted these service providers and gain
their support through coalitions in which they are members.
Timing is critical, both due to both funding cycle and issue cycles. One can
sometimes influence the degree to which an issue resonates with the public, but
this can be driven by specific incidents and agendas beyond control. A media
strategy is critical. Preble Street chose to talk about Home For Good,, housing
first, and Florence house at every opportunity, long before funding was available.
This aspect of the “Home For Good” campaign built needed momentum toward
making Florence House a reality. One can control the timing of public 27
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
statements about homelessness and its solutions participate in and create public
events that emphasize housing first as an evidence- based practice.
Most important to the advocacy effort is to make sure that the data is sound and
as current as possible even if that means waiting for outcomes. Advocacy on an
issue that changes policy direction and appears to be costly takes time and one
must be ready for a long, resource consuming effort.
Finally, while outcome data and cost data can be extremely convincing to many
with power, consumers speaking for themselves and telling their stories is still a
crucial part of all successful advocacy. 28
RUNNING HEAD: Preble Street’s Florence House: How Research and Advocacy Made it Possible
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