Citation: Seelos, Ch. (2021) , a System Perspective. The Journey of Community Solutions. Stanford PACS working paper GIIL002/2021

Version: 23AUG21

Homelessness, A System Perspective

The Journey of Community Solutions

Christian Seelos1 Global Innovation for Impact Lab, Stanford University PACS

1 I am grateful to my colleagues Johanna Mair and Charlotte Traeger for joint interviews and reflection sessions throughout the work on this case study. Table of Contents Part 1 - The emergence of homelessness as a social problem The 1960s – Wars on poverty we can’t win… ______5 Contemporary frames of poverty ______6 Challenges of addressing complex social problems ______6 The 1970s – Setting the course for homelessness ______10 The undeserving poor: Framing the problem of homelessness ______10 A troubling situation but not a social problem ______12 The 1980s – Homelessness emerges as a social problem ______15 Homeless numbers-games and convenient explanations ______16 The awakening of homelessness activism ______17 Radical activism ______18 Research and documentation ______18 Litigation ______20 Dedicated organizations ______23 Innovations in supportive - New York ______24 Rosanne Haggerty finds her calling ______27

Part 2 - The emergence of system perspectives on homelessness The 1990s – Innovation and scaling of models ______29 Innovations for the mentally ill - Assertive Community Treatment and ______30 - redefining scale ______32 The 2000s – From housing the homeless to housing people ______39 Limitations of the supported housing model ______41 From to Community Solutions ______42 The Model ______42 A system perspective on solutions ______44 Street to - Rethinking taken for granted explanations of street homelessness ______45 The Rough Sleepers Unit (UK) ______46 Street to Home Initiative ______47 The Problem Space of Homelessness ______51 Methodological and Operational Competencies and Principles ______51 The Vulnerability Index ______52 Policy Influence ______53

2 Scaling Developments ______54 2010 – Scaling a robust template: the 100,000 initiative ______57 100khomes.org ______59 2015 – Innovating a new paradigm: Built for Zero ______65 Counting down, not counting up ______68 Functional Zero ______69 Built for Zero - Counting down is much harder than counting up ______71 By-name lists ______71 Success and resistance ______73 Organizational changes ______74 A new federal agenda - From Housing First to Housing Fourth ______77 Questions for the future ______77 Appendix 1. Main innovation programs between 2006 and 2010 ______79 Appendix 2. Bibliography (cited in this document) ______89

3 There is little joy to the imaginary mind in the enjoyment of abundance, while other people are in want. - Edward Amherst Ott, Drake University, 1917.

I don’t think you can have a thriving community when you have lots of people who experience homelessness. - Beth Sandor, Community Solutions, 2021.

4 The 1960s – Wars on poverty we can’t win… We constantly underestimate difficulties, overpromise results, and avoid any evidence of incompatibility and conflict, thus repeatedly creating the conditions of failure out of a desperate desire for success. More than a weakness, in the conditions of the present time it has the potential of a fatal flaw.2

In 1917, Edward Amherst Ott, a scholar at Drake University, offered a list of policy principles that he called “Hot Shots” in support of fighting a productive “War on Poverty”. Ott was optimistic that the world was sufficiently enlightened and capable, so that “Poverty […] can be eliminated. There is little joy to the imaginary mind in the enjoyment of abundance, while other people are in want.”3 Almost 50 years later, on 8 January 1964, President Lyndon B. Johnson announced his own war on poverty to build a “Great Society” in his State of the Union Address4. “Let this session of congress be known as the session which did more for civil rights than the last 100 sessions combined. […] As the session which declared all-out war on human poverty and unemployment in these United States.” And thus, the war on poverty should become “America’s longest war”5, a war it is still fighting on many fronts, new and old, today.

President Johnson set extremely high expectations from the beginning. He announced the “most federal support in history for education, for health, for retraining the unemployed, and for helping the economically and the physically handicapped.” Johnson saw it as a collective duty to fulfill the basic hopes of every citizen that in his own words included the following: “a fair chance to make good”, “fair play from the law”, “a full-time job on full-time pay”, “a decent home for his family in a decent community”, “a good school for his children with good teachers”, “security when faced with sickness or unemployment or old age”.6

Johnson explicitly integrated the problem of homelessness as part of his war on poverty: “We must, as a part of a revised housing and urban renewal program, give more help to those displaced by clearance, provide more housing for our poor and our elderly, and seek as our ultimate goal in our free enterprise system a decent home for every American family.”7 On August 10, 1965, President Johnson signed the Housing and Urban Development Act and established the US Department of Housing and Urban Development (HUD) that would become a central federal agency for addressing homelessness until today. Johnson correctly anticipated housing as a dominant challenge in the next decade: “In the next 35 years we will need to build a second America, putting in place as many and schools and

2 Moynihan, D.P. (1969) Maximum feasible misunderstanding. Community action in the war on poverty. The Free Press, New York. p. xii-xiii. 3 Ott, E.A. (1917) Hot shots in the war on poverty. Educational Extension Services, Byron, N.Y. 4 American Rhetoric. Speech Bank. Lyndon Baines Johnson. First State of the Union Address, delivered 8 January 1964, accessed on 19May20 at: https://www.americanrhetoric.com/speeches/lbj1964stateoftheunion.htm 5 Caldwell, L.A., Merica, D. (2014) America’s longest war. CNN, accessed on 21May20 at: https://edition.cnn.com/2014/01/08/politics/war-on-poverty-50-years/index.html 6 Ibid. 7 Ibid.

5 and parks and offices as we have built through all the time since the pilgrims have arrived on these shores. ”8

Contemporary frames of poverty Johnson framed poverty primarily as a problem of individual competence and opportunity: “Very often a lack of jobs and money is not the cause of poverty, but the symptom. The cause may lie deeper, in our failure to give our fellow citizens a fair chance to develop their own capacities, in a lack of education and training, in a lack of medical care and housing, in a lack of decent communities in which to live and bring up their children.” The principal economic calculus was that his war on poverty would pay for itself. If people could be equipped to take care of their lives as an integral part of a healthy social and economic system, this result would support his ambition “not only to relieve the symptom of poverty, but to cure it and, above all, to prevent it.” This framing of poverty as a problem of individual capability and competence rather than a result of systemic or structural factors, illustrates the “culture of poverty” perspective, a prominent perspective in social science and policy circles at that time. The culture of poverty perspective assumed that “personal defects” in the form of norms and values caused people to enter and to remain in poverty. The poor lacked motivation and skills and these deficiencies perpetuated a “cycle of poverty”9. Policy decisions rested on the “assumption that dependent people were mainly helpless and passive, unable, without the leadership of liberal intellectuals, to break the cycles of deprivation and degradation that characterized their lives.”10

Challenges of addressing complex social problems The war on poverty to build a “Great Society” is an important opportunity for reflecting on the many obstacles that can derail ambitious efforts of providing solutions to society’s problems. President Johnson’s war on poverty illustrates the limitations of even presidential power in the face of complex social problems. Discussing several of the challenges his initiative faced, helps to focus the attention of readers of this case study on core issues relevant for understanding potential “solutions” for homelessness. One obstacle that undermined President Johnson’s efforts was a rigid bureaucracy with an attitude of channeling efforts in a politically opportune and controlled manner. This structural obstacle stifled evidence- and performance-based resource allocation, creativity and innovation, and the necessary contextualization by decentralized efforts. Another obstacle was a decoupling of spending power and operational capacity. In August of 1965, Senator Abraham Ribicoff in a conversation with the President11 expressed grave concerns about the administration’s inability to implement the legislative package on poverty. He remarked: “But the greatest mess in the country, Mr. President, is the poverty program, believe me”. Ribicoff spoke about an “indigestion” in the system: “We’re pushing money out

8 LBJ Presidential Library. Signing of the housing and urban development act, accessed on 15MAY20 at: http://www.lbjlibrary.org/mediakits/hud/index.html 9 Zimmerman, D.H., Wieder, D.L., Zimmerman, S. (1976) Understanding social problems. Praeger Publishers, New York. 10 Katz, M.B. (1989) The undeserving poor. From the war on poverty to the war on welfare. Pantheon Books, New York, p.16-17. 11 “Lyndon B. Johnson and Abraham A. Ribicoff on 19 August 1965,” Conversation WH6508-07-8573-8574, Presidential Recordings Digital Edition [Lyndon B. Johnson: The War on Poverty, vol. 2, ed. Guian A. McKee, Kieran K. Matthews, and Marc J. Selverstone] (Charlottesville: University of Virginia Press, 2014–). URL: http://prde.upress.virginia.edu/conversations/4004988

6 too fast. I’m voting the money you’re asking for, all of it, but we’re pushing it faster than we got people who are ready to use it.” This episode illustrates a key concern of social policy: what are the potentials and limits to capacity and scale of collaborative action of public-sector and civil-society organizations implementing complex solutions? This case study on recent efforts around addressing the complex problem of homelessness is an opportunity to explore the fruitful but also fragile dynamics of collaborative action at various levels of scale, from communities to large cities, states, and nationally.

Another obstacle for effective policies towards creating a “Great Society” arises from the fact that social problems are neither a finite set nor are their dynamics predictable. Any political decision faces uncertainty over how the set of urgent challenges that compete over limited attention and resources evolves over time. During Johnson’s presidency, for example, the fiscal demands of the Vietnam war and the eruption of strong civil rights and antiwar protest movements started to dominate the political and media agendas. These developments created critical tensions for the president about whether to allocate funds to “guns or butter”. Johnson lamented toward the end of his life: “That bitch of a war killed the lady I really loved - the Great Society.”12 Of equal importance is the unpredictability of fundamental policy priorities and attitudes that arise from temporary political majorities. The history of homelessness is an important reminder of the vulnerability of solution providers to severe fluctuations in available resources and the legitimacy of approaches. The current presidency of Donald Trump and budgetary decisions and appointments of federal agencies responsible for is a powerful reminder of the importance of this dynamic.

Johnson’s war on poverty exposes an additional challenge for those who address complex social problems such as poverty and homelessness: What are appropriate and effective ways to communicate objectives and to manage expectations? Ginsberg and Solow reflecting on Johnson’s presidency concluded “that especially if the issues are complex, and especially if they have been ignored or minimized earlier, it is important that the leadership’s promises of results from intervention be realistic rather than extreme. A public which has been encouraged to expect great things will become impatient, critical, and alienated if the progress that is achieved falls far short of the rosy promises.”13 The political scientist Aaron Wildavsky in his essay in the New York Times in 1968 that he wrote amidst race riots and anti-war protests agreed with this view: "A recipe for violence: Promise a lot, deliver a little. Lead people to believe they will be much better off, but let there be no dramatic improvement. Try a variety of small programs, each interesting but marginal in impact and severely underfinanced. Avoid any attempted solution remotely comparable in size to the dimensions of the problem you are trying to solve. "14 In a more recent article on the ambitions of philanthropists to move beyond solving problems towards adopting bold “system change” and “big bet” strategies, Seelos and Mair also warn about the gap between ambitions and competencies. Growing a program’s or an organization’s ambitions is easy. But developing the competencies to achieve these ambitions is hard and takes time, focus, and effort. The authors conclude that this decoupling of ambitions and competencies is a predictable recipe for disaster and that “steering system change requires that we nurture and develop our levels of competence and

12 Zelizer, J.E. (2001) The Nation: Guns and Butter; Government Can Run More Than a War. The New York Times, 30DEC01. 13 Ginsberg, E., Solow, R.M. (1974) The Great Society: Lessons for the Future. Basic Books, Inc., New York, p.214. 14 Wildavsky, A. (1968) Recipe for Violence. New York, Vol. 1(7), New York Magazine Co., New York, NY, 20MAY68, p.28

7 ambitions in sync.”15

During Johnson’s war on poverty, the dominant “culture of poverty” aspect funded primarily ideas in line with traditional mainstream anti-poverty programs. Between 1965 and 1968, over a thousand of more traditional community action agencies coordinated locally customized antipoverty initiatives. “This direct funding mechanism allowed the federal government to work around de facto exclusion of the poor from designing programs to address their own poverty and de jure racial segregation that had restricted the political participation of African Americans. CAPs [Community Action Programs] aimed to empower the poor themselves to change their communities—to fight poverty while reforming local social institutions and undermining entrenched racial segregation.”16 Other observers shared his sentiment: “Many of us who shared in the formation and the running of local community action agencies have been both frustrated and dismayed. What was to have been a ‘grass roots’ war on poverty, sensitive and responsive to local need, emerged instead as a rigid program, directed all too frequently by inexperienced and arrogant bureaucrats who couldn't care less about local conditions and problems.”17

Only slowly, did a novel and controversial approach emerge in the form of “Community Action Programs” (CAPs). Near the end of the 1960s, it appeared that Johnson himself had become alienated from his war on poverty and in particular from this aspect of CAPs. This turn of events is vividly illustrated in a remarkable conversation in December of 1968, with Bertrand M. Harding, director of the Office of Economic Opportunity. Johnson was concerned about accusations of nepotism due to the involvement of Lady Bird Johnson’s niece in the community organization Urban League. The Ford Foundation announced a 1 million USD grant to Urban League to “build ‘ghetto power’ through new African American–controlled economic institutions.”18 In this conversation the president showed a remarkable level of frustration with the direction that his war on poverty took: “And this is not what I set up poverty. I set up poverty for people to just work like hell and get paid so they’d have something to eat. […] All this theoretical stuff, a bunch of goddamn social workers going out and shoveling money through a bunch of half-baked organizations. The biggest, crappiest thing that I ever saw. And I don’t think it’s worth a damn.” Johnson remarked that he would not give forty cents to the management of Urban League and that he revealed in a recent interview that his poverty program was the most disgraceful thing of his political agenda.

And so, the 1960s ended with little concrete inspiration for a fundamental shift in the troubling realities of poverty and homelessness. This introduction serves as a mental scaffolding for supporting a journey of inquiry into the remarkable story of civil sector organizations that addressed homelessness in the US in the last 50 years. This case study also strives to serve as an illustrative example in support of deeper reflections on several important questions on poverty and homelessness: Who defines a situation as a

15 Seelos, C., Mair, J. (2018) Mastering System Change. Stanford Social Innovation Review (Fall 2018), p36. 16 Bailey, M.J., Duquette, N.J. (2014) How Johnson Fought the War on Poverty: The Economics and Politics of Funding at the Office of Economic Opportunity. J Econ Hist. 74(2): 351–388. 17 Kruger, S.M. Foreword, in: Moynihan (1969). 18 “Lyndon B. Johnson and Bertrand M. Harding on 6 December 1968,” Conversation WH6812-01-13806, Presidential Recordings Digital Edition [Lyndon B. Johnson: The War on Poverty, vol. 2, ed. Guian A. McKee, Kieran K. Matthews, and Marc J. Selverstone] (Charlottesville: University of Virginia Press, 2014–). URL: http://prde.upress.virginia.edu/conversations/4005035

8 legitimate social problem and who defines appropriate action? How should we evaluate programs that address the complexities of poverty? What outcomes can we expect and what might be realistic time frames? Who defines success and how should success be defined in lieu of outright solutions of such complex social problems? How should federal and local approaches, public-, private-, and civic-sector approaches be balanced and coordinated? Can we expect public servants to have the motivation, ambition, passion, and empathy required to commit to sustained, difficult, and often unrewarding work? Are terms such as “poverty” and “homelessness” useful for aligning resources and actions or are they naïve simplifications of a complex and bewildering number of social forces at various levels individual, family, community, municipality, national and the characteristics of political and economic institutions such as laws or markets? Do these simplifications lure us to naively assume that such complex phenomena can be “solved”? And what might be relevant competencies that justify more recent discourses around “systems” and “systems change” as the panacea for addressing such complex social ailments?

9 The 1970s – Setting the course for homelessness At the time when President Johnson shared his frustration about the war on poverty and its community action aspect with Mr. Harding, a girl from the suburbs of Hartford, CT, Rosanne Haggerty, celebrated her 7th birthday. She would later fight her own war against poverty focusing on homelessness. According to information provided by Ashoka, young Rosanne was strongly influenced by her parents’ practice of Catholicism. Rosanne observed how her parents reached out to and befriended elderly people who lived in local “rooming houses”, single-room occupancy for disadvantaged citizens.19 Rosanne later shared with reporters that "I grew up in a constellation of extended family members in old hotels in Hartford. My parents were very devout Catholics, and they would take us to mass on Sunday, and then march us to one of the single-occupancy hotels where older or disabled people were living alone."20 But at that time, the homeless were not perceived as a social problem that demanded organized collective action. The visible aspects of street homelessness reduced the problem in the public’s eye to a hopeless group of single men with alcohol and mental problems who slept on the streets in so call skid rows, geographically bound places that people avoided.

Less visible was a disturbing trend of homelessness amongst families. By August of 1970, the numbers of homeless families in had risen by 300% within a year. About a thousand families were housed in 40 so called welfare hotels. Their average stay had increased from a few weeks to several months and often years. Observers called these welfare hotels a “modern horror”. Despite welfare programs paying between $600 and $1200 per month in rent to hotel owners, “Children are jammed five and six in a room, sleeping on mattresses dropped on the floor, on broken sofas, crowded beds. Dingy rooms and dark hotel corridors are their playgrounds, shared with roaches and mice. Ceilings are peeling, and walls have holes as large as two feet high and four feet wide.”21 The administration of New York City Mayor John Lindsay was able to move many families from welfare hotels to permanent housing. By 1972 only about 365 families were still living in hotels.22

The undeserving poor: Framing the problem of homelessness Homelessness was strongly associated with poverty and thus inherited earlier ideas of the “cycle of poverty” and the “culture of poverty”. These perspectives from the 1960s war on poverty also dominated the public discourse on poverty in the 1970s. Zimmerman and colleagues remarked that explanations of poverty and homelessness were grounded in viewing the poor as lacking skills, being lazy and unmotivated and suffering from defects of moral character. The authors were concerned that: “To restrict explanation of their poverty to citing individual defects can degenerate into passing of moral judgments. This is largely what happens when many Americans speculate on the causes of poverty. When individualism becomes a cultural fetish, each person becomes morally responsible for his or her circumstances. The result is that we seem compelled to find fault with the able-bodied poor, to blame them for the poverty they suffer. The concept of the immoral or ‘sturdy’ poor lives on in the United

19 Rosanne Haggerty - Ashoka Fellow. Ashoka, accessed on 20MAY20 at: https://www.ashoka.org/en/fellow/rosanne-haggerty 20 Moore, J. (2009) Taking the homeless beyond shelters. The Christian Science Monitor, 07SEP09. 21 Schumach, M. (1970) Welfare Cases in Hotels Called a Modern Horror. The New York Times, 23NOV70. 22 http://povertyhistory.org/#welfare-hotels

10 States even though the terminology may be forgotten.”23 Joel Blau argued that homelessness was an interesting test for the hypothesis that poor people are somehow responsible for their own poverty. The rapid growth of homelessness in the 1970s and 1980s “requires believers to argue that for some mysterious reason, a sizeable group of citizens suddenly became irresponsible at the very same time.”24

Robert Bendiner, a political commentator, writing in 1968 in the New York Times Magazine opined: “Today’s poor […] are viewed by most politicians with impersonal detachment. Congress evinces no qualms whatever about taking a stern, even self-righteous, attitude regarding welfare, showing a keener interest in controlling riots than in controlling rats”. Bendiner agreed with the concerns of Zimmerman and colleagues: “Altogether it is reasonable to suggest that the current drive against poverty is neither politically nor economically inspired, then, but essentially a ‘cause’, a moral crusade.”25 The dominant “culture of poverty” discourse in the 1960s and 1970s had important consequences for how the homeless and their situation were perceived. Perceptions at different ends of the political spectrum determined whether the poor and homeless were considered as “deserving” or as “undeserving”, how the causes of homelessness were articulated, and thus how priorities were set and decisions made for allocating resources towards changing their situation. Blau added another important psychological dimension to this discussion. He argued that poor people being constantly stigmatized and rejected learned to accept the views society held on them. As a result, homeless people lost self-confidence and started to doubt that they could be agents for changing their situation. This limiting self-image also lowered their political efficacy. “The message is a simple one: someone without a home is an inconsequential person, and the actions of an inconsequential person cannot have political consequences.”26

The term “homelessness” in the 1970s was ambiguous and not widely used. Writing in 1984, researchers Kim Hopper and Jill Hamberg remarked: “It is only in the past few years that this clumsy Victorian era word – ‘homelessness’ - has crept back into prominence, snatched from oblivion by a public made increasingly uneasy by the presence of large number of fellow citizens living on the streets. The term succeeds a host of others, generally terms of derogation - words like ‘vagrant,’ ‘derelict,’ and ‘bum’ - that, but a scant decade ago, were regularly used when describing this sector of the disenfranchised.”27

In the 1970s, it was mostly missionaries and church-based organizations that addressed the needs of these “unworthy poor”, that the media referred to as drifters, vagrants, bums, or transients28,29. Homelessness services lacked coordination and were mostly aimed at allaying the pain associated with the circumstances of homelessness. One consequence of these relief efforts was that homelessness was not a very visible problem. “For the most part, skid row men were housed - wretchedly to be sure - but

23 Zimmerman, D.H., Wieder, D.L., Zimmerman, S. (1976) Understanding social problems. Praeger Publishers, New York, p.64. 24 Blau, J. (1992) The visible poor. Homelessness in the United States. Oxford University Press, Oxford, p.ix. 25 Bendiner, R. (1968) Poverty is a tougher problem than ever. The New York Times Magazine, 04FEB68, p.22. 26 Blau, J. (1992), p.94. 27 Hopper, K., Hamberg, J. (1984) The making of America’s homeless. From skid row to new poor. 1945-1984. Community Service Society of New York, NY, p.1 28 Pascale, C.-M. (2005) There’s No Place Like Home: The Discursive Creation of Homelessness. Cultural Studies - Critical Methodologies, Vol.5(2), 250-268. 29 Blau, J. (1992)

11 quartered nonetheless, in the missions, , jails and municipal lodging houses that catered to their numbers. They were not, in significant numbers, a street-dwelling population.”30 These charitable activities may have slowed a proper public engagement with the characteristics and dynamics of the problem and reflections about the individual and structural factors that caused it. “Still, there remains the gnawing misgiving that despite the flurry of activity - indeed, in part because of it - the question of what really is going on hasn't received close enough scrutiny. The palpable, acutely felt nature of the distress, and the imperative to act accordingly, have impeded the recognition that something has gone grievously wrong with the fundamental needs-satisfying structures of our society. Urgent charity, not arduous justice, remains the watchword of the relief efforts that have been mounted. It is not mere cynicism to suggest that the deeper lesson they have to teach may well be their failure.” 31

A troubling situation but not a social problem Nan Roman, CEO and President of the National Alliance to End Homelessness speaking at their 2014 annual conference reflected on the situation: “When I began working in the 1970s, there was not wide- spread homelessness the way we know it today. That did not mean that people did not lose their housing. It did not mean that people did, at some times, have nights when they did not have a place to stay. It did not mean that everyone had enough money to live on or could afford and or had all the services that they needed. I can promise you that none of that was true. There was plenty of poverty and unemployment, untreated illnesses, all kinds of things. But the most significant difference between now and then, was that then there was enough affordable housing available. So that if you lost your housing, which people definitely did, you could get back into another apartment right away. You did not spend days or weeks or month or years homeless while you were trying to figure out how to get back into another place to live.”

Homelessness may not have been recognized as an important social problem in the 1970s. Nevertheless, this decade would dramatically change the face of homelessness. The 1970s ended a long cycle of growing prosperity since the end of World War II. Incomes had roughly doubled in inflation-adjusted terms without widening income inequality. These trends were abruptly reversed during the 1970s. Between the mid-1960s and the end of the 1970s the Dow Jones Industrial Average stock market index fell from a level of about 7800 points in 1965 to about 2800 points in 197932. Economic stagnation was coupled with a sharply widening income gap. Only the top incomes continued to grow strongly. This development resulted in a dramatic accumulation and concentration of wealth, a household’s property, and financial assets.33

Other factors that influenced the dynamics of homelessness in the 70s were a growing population and a dramatic process of urbanization. Perhaps to some extent, these effects were balanced by historically unprecedented levels of growth in housing units. Between 1970 and 1980, the US national housing stock

30 Ibid, p.20 31 Hopper, K., Hamberg, J. (1984), p.3. 32 Macrotrends, Dow Jones - DJIA - 100 Year Historical Chart, accessed on 25MAY20 at: https://www.macrotrends.net/1319/dow-jones-100-year-historical-chart 33 Center on Budget and Policy Priorities. A Guide to Statistics on Historical Trends in Income Inequality, accessed on 24MAY20 at: https://www.cbpp.org/research/poverty-and-inequality/a-guide-to-statistics-on-historical-trends- in-income-inequality

12 increased by 19.7 million units, a growth rate of almost 30%.34 However, prices in many places grew at an even faster rate. This development resulted in the emergence of what researchers termed “superstar cities”35. The term referred to cities that had persistently large housing price growth rates over the last 50 years. Data for real house price appreciations between 1950 and 2000 for 280 US metropolitan areas showed huge variance in the average annual increases that ranged between 0.2% to over 3.8% “with an especially thick right tail of growth rates above 2.6%”36. On the top of this list were superstar cities such as and Oakland, with annualized growth rates of 3.6% and 2.8% over 50 years, respectively. At the lower end were cities such as Buffalo and Syracuse with growth rates of 0.5% and 0.7%, respectively. These developments created a dramatic scarcity in affordable housing in many metropolitan areas and crowded out lower income residents. In New York City in the late 70s, single-room occupancy (SRO) units were amongst the only sources of housing in NYC that were available to low income adults.

According to the Coalition for the Homeless, one of the oldest US homelessness advocacy organizations, health policy decisions severely exacerbated the situation: “In the 1950s the State began to adopt a policy of ‘deinstitutionalization’ for thousands of patients of State facilities who were living with mental illness. The policy was adopted largely due to the development of psychotropic medications and new approaches to providing therapeutic treatment in the community instead of in institutional settings, but also because of the scandalous mistreatment of patients in some facilities. Deinstitutionalization led to the discharge of tens of thousands of mentally ill individuals from upstate facilities to New York City communities. Between 1965 and 1979 alone, the number of resident patients in State psychiatric centers fell from 85,000 to 27,000 patients” 37 In the early 1960s President John F. Kennedy had signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 196338 (Foley and Sharfstein, 1983, provide an account of the political, medical, and operational complexities of signing and implementing this Mental Health Act39). This policy dramatically accelerated the decline of hospitalized patients. In the 1970s, challenges of community-based mental care became apparent. According to Drake and Latimer (2012, p.47) these challenges included “integration and continuity of services for those with the most complex needs, appropriate housing, family burden, substance abuse and dependence, victimization, and violence […]unemployment, criminalization, and early mortality of people with mental illnesses […] these problems were exacerbated by poverty, reductions in housing subsidies, and shunting of people with mental illnesses into inner-city areas plagued by unemployment, crime, and drugs” 40. The Coalition for the Homeless also pointed out that the situation was further exacerbated by a dramatic loss of SROs. In cities like New York, SROs were the only affordable housing

34 US Census Bureau, Census History Staff. "Urban and Rural Areas - History - U.S. Census Bureau", accessed on 20MAY20 at: www.census.gov 35 Joseph Gyourko, Christopher Mayer, Todd Sinai (2013) Superstar cities. Am. Econ. J., 5 (4), pp. 167-199 36 Ibid. 37 Coalition for the Homeless. Why are so many people homeless? accessed on 28APR20, at: https://www.coalitionforthehomeless.org/why-are-so-many-people-homeless/ 38 US Congress Public Law 88-164-OCT. 31, 1963, at: https://www.govinfo.gov/content/pkg/STATUTE- 77/pdf/STATUTE-77-Pg282.pdf. 39 Foley, H.A. and Sharfstein, S.S. (1983) Madness and Government: Who Cares for the Mentally Ill? American Psychiatric Press, Washington, D. C. 40 Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World psychiatry : official journal of the World Psychiatric Association (WPA), 11(1), 47–51.

13 source for deinstitutionalized patients. Due to demolition and conversion, the stock of SROs in New York City fell from approximately 129,000 in 1960 to just 25,000 in 1978.

14 The 1980s – Homelessness emerges as a social problem As homelessness suddenly emerged on the scene in the 1980s, several characteristics of homelessness turned it into a complex problem that challenged efforts to understanding it, evaluating its importance, and finding effective solutions. Amongst these characteristics was the lack of a clear definition of homelessness from both theoretical and empirical perspectives. Joel Blau noticed a theoretical vacuum in the social sciences that resulted from disagreements about the social factors that contributed to homelessness. For example, research remained ambiguous about explaining why some people became homeless and others did not. Progress in homelessness research was limited by a lack of clear and shared definitions of fundamental terms such as “shelter”, “temporary”, or “mental illness”.41 Hopper and Hamberg writing in 1984, pointed out that some of the empirical challenges from understanding homelessness can be explained by the observation that “In the last fifteen years, homelessness has undergone a transformation of a scale and complexity not seen since the worst days of the Depression.” The authors provided a vivid account of the phenomenon: “Grizzled veterans of the rails and flophouses have had to make way for unfamiliar cohorts of new arrivals: men and women of all ages and colors, the hale and the disabled, the newly jobless and the never-employed. In some places, whole families on the road or in emergency accommodations outnumber the single homeless; many others are poised just short of homelessness, scraping by at a level few would grace with the term ‘decent.’ Still others slip periodically into homelessness as meager benefits meted out on a monthly or biweekly basis invariably give out before the next check's arrival. Indeed, the cautious imprecision of the word homelessness itself implies a reluctance to categorize, a prudent reminder that the only sure thing these people have in common is the one thing they all lack.42 Hopper and Hamberg provide the following list to illustrate the diversity of the homeless population that emerged in the 1980s:

 Single-parent households, many living on public relief at the time they became homeless, who have been burned out, removed on vacate orders, evicted for failing to meet rent, or ejected from residences in which they had been doubling up with friends or family (as in New York City, Detroit, Washington, D.C., Seattle);  Formerly working families, either intact or broken up in the interest of making use of what emergency shelter exists; they tend to be especially prevalent in areas where industries have suffered massive layoffs (Detroit, Youngstown, Pittsburgh), or in regions where the promise of new jobs still lures potential applicants in greater numbers than the dwindling demand for labor (Houston, San Diego);  Single men, either indigenous (Boston, Washington, D.C., New York) or on the road (Seattle, Sacramento, Phoenix), out of work, increasingly ethnic and racial minorities, and often with either nonexistent or outmoded skills;  Single women of all ages, who have lost husbands or long-term roommates, have been turned out by friends or family, have lost menial jobs, or simply could not keep up with rising rents;  Victims of domestic violence, which sometimes occurs in the wake of the hardship and strain attendant upon loss of work;  Psychiatrically disturbed individuals - some of whom were once hospitalized, others who have never been - who have lost whatever precarious accommodations they once had, and who lack

41 Blau, J. (1992) 42 Hopper and Hamberg, p.1-2

15 the resources or wherewithal to acquire substitute dwellings; to what extent their disability is a consequence rather than a cause of living on the streets is not always easy to determine;  Ex offenders released to fall back on their own meager or nonexistent resources, and who are unable to find work;  Youths, who are especially subject to the depredations of the street; today, they are less often runaways than they are "throw-aways" (ejected by families who are either unable or unwilling to support them), victims of abuse at home, or recent graduates of foster-care programs;  The elderly and near-elderly, housed until recently, but finally unable to make rent and feed themselves on what were once just subsistence-level incomes;  Legal and undocumented immigrants, as well as Native Americans fleeing "reservations" suffering from high unemployment and federal cutbacks, all of whom are finding that demand for unskilled labor has dried up (Miami, the Southwest).43

Homeless numbers-games and convenient explanations For Joel Blau, the lack of theoretical and empirical clarity and definitions reinforced a tendency for counting the homeless to provide objective and quantifiable data. This effort created another layer of complexity and uncertainty. Depending on who was counting, estimates of the size of the problem varied widely. Martha Burt called this variance the ”homeless numbers game” illustrated by the three most frequently cited estimates of homeless people in the US during the 1980s:44

 250,000-350,000 was the HUD estimate of 1984  500,000-600,000 was the Urban Institute’s estimate of 1987  2-3 million was the number used in a 1980 congressional testimony by homelessness activists Mitch Snyder and Mary Ellen Hombs that was later adjusted in their 1983 book Homelessness in America45.

An additional characteristic that challenged understanding and defining effective policy action towards homelessness was the complexity of potential causes for homelessness. While the traditional economic causes were still relevant, Joel Blau pointed out a disturbing puzzle: “Homelessness was always present in economic downturns – but this time it kept growing during an economic recovery”.46 This causal uncertainty and complexity resulted in a focus by researchers and policy makers on "proximate rather than ultimate causes [...] on the homeless individual rather than on the larger social structures and norms that sustain, tolerate, and justify homelessness and other severe kinds of deprivation."47 Unfortunately, this attitude sustained earlier tendencies of blaming the victims for their own misery, the “culture of poverty” argument of the 1960s and 1970s. This convenient and plausible narrative saw individuals make a series of bad life decisions, slip into alcohol and drug abuse, lose their jobs and become homeless. But what if the causality was reversed? What if becoming homeless led to alcohol

43 Hopper and Hamberg, 1984, p.9-11 44 Burt, M.R. (1999) Homelessness: Definitions and Counts. In: Baumohl, J. ed. Homelessness in America. Oryx Press, Phoenix, p.15-23. 45 Hombs, M.E., Snyder, M. (1983) Homelessness in America: A forced march to nowhere. Community for Creative Non-Violence, Washington. 46 Blau, J. (1992), p.10. 47 Blau, J. (1992), p.35.

16 and drug abuse and kickstarted a negative feedback process that was hard to escape? Research would eventually provide some plausible arguments for this reversed causality,48 and so did emerging practical experience in the 1980s and 90s. And thus, two competing logics the “Continuum of Care” (first treat, then house) and “Housing First” (first house, then support) eventually emerged in the 1990s. But during the 1980s, the attitude of blaming the victims and thus prioritizing “treatment” prevailed.

Some observers clearly saw this attitude reflected in the defining policy decisions of the 1980s: “The election of Ronald Reagan as president in 1979 marked a significant change not only in attitudes toward the homeless, but also in many governmental programs and missions. Reagan, in 1984, said: ‘One problem we've had, even in the best of times is the people who are sleeping on the grates, the homeless who are homeless, you might say, by choice’. The policies of the Reagan administration contributed to what was already becoming a growing national crisis. A common pattern of blaming the victim by attributing homelessness to poor choice or other personal characteristics such as drunkenness or mental illness characterized the comments made by members of his administration.”49

According to Dreier and Appelbaum, the federal budget decisions in the 80s reduced annual housing assistance from about $33 billion to less than $8 billion within a decade. In the 1970s, 200,000 federally subsidized apartments were built per year. In 1990 that number was reduced to about 15,000. “To put this in perspective, in 1981 the federal government was spending seven dollars for defense for every one dollar it spent on housing. By 1989, it spent over forty dollars on defense for every housing dollar.”50 The authors noted that “The single housing subsidy that did not fall to the Reagan (and now Bush) budget axe is the one that goes to the very rich. The federal tax code allows homeowners to deduct all property tax and mortgage interest from their income taxes. This cost the federal government $34 billion in 1990 alone - more than four times the HUD budget for low-income housing.” The authors also pointed out that rates of homeownership started to fall after a steady rise for three decades. This development was particularly troubling for young families leaving their parent’s homes. was also becoming problematic. As a result of these developments, two-thirds of poor people were paying at least half of their income just for housing. “The typical young single mother pays over 70 percent of her meager income just to keep a roof over her children's heads. Perhaps the most important statistic is this: Only one-quarter of poor households receive any kind of housing subsidy - the lowest level of any industrial nation in the world. The swelling waiting lists for even the most deteriorated projects are telling evidence of the desperation of the poor in the private housing market. Is it any wonder that the ranks of the homeless are growing?”51

The awakening of homelessness activism The constellation of all these factors created a new face of homelessness: “During the 1980s, a new ingredient was added to the landscape of America's cities - millions of people sleeping in alleyways and subways, in cars and on park benches. The spectacle of homeless Americans living literally in the shadow of luxury condos and yuppie boutiques symbolized the paradox of the decade: It was a period of both

48 Johnson, G., Chamberlain, C. (2008) Homelessness and Substance Abuse: Which Comes First? Australian Social Work 61(4), p.342–356. 49 Sweeney, R. (1996) Out of place. Homelessness in America. HarperCollins College Publishers, NY, p.88. 50 Dreier and Appelbaum, p.49 51 Ibid.

17 outrageous greed and outrageous suffering. The media gave us ‘lifestyles of the rich and famous,’ but they also offered cover stories about homeless families. And while the 1980s were often characterized as the ‘me decade’ - an orgy of selfishness and self-interest – more Americans were involved in social issues, as volunteers and activists, than at any time in recent memory.”52 The visible reality of homelessness was fueling grassroots activism. Local homelessness advocacy and activism had begun in the mid 1970s, “But the local advocates of those years – and I was one of them – had little sense of how to capitalize on provincial gains” said sociologist Jim Baumohl53. He remarked that “Homelessness remained a latent social problem, a growing but little-remarked phenomenon awaiting promotion to public view by more talented organizers, more strategically placed.” And there were many talented organizers emerging in the 1980s.

Four types of activities helped promote homelessness to public view and thus converted the troubling situation of “a few poor bums” into the recognized social problem of homelessness: i) radical activism by individuals and smaller groups; ii) research and documentation; iii) litigation; and iv) establishing dedicated organizations.

Radical activism In November 1978, the activist group Community for Creative Nonviolence (CCNV) occupied the Washington-based National Visitor’s Center. This occupation was identified by several observers as the key triggering event to homeless activism. CCNV demanded more housing and resources for the poor.54 “Throughout the 1980s, CCNV remained the nerve center of political theater, organized street vigils and punishing fasts, disruptive mischief, and determined evangelizing.”55 One CCNV activist, Mitch Snyder from , rose to national prominence. Just before the presidential election in 1984, he pulled off a 51 day fast demanding that President Reagan fund the renovation of a government-owned building in Washington D.C. for use as a . And “Mr. Snyder fasted twice more, when $6 million in promised money for renovations failed to materialize on time.”56 But while grassroots activism was able to address some issues it may not have put a dent into the larger problem of homelessness. Five years after his victory in Washington, Snyder, age 46, hanged himself in the very shelter that he had obtained from the federal government. The New York Times reported that Snyder who was troubled by personal problems “had expressed frustration with what he called waning public interest in the problems of the homeless.” 57

Research and documentation “A flood of reports, broadsides, newspaper articles, and scholarly publications ensued, all with the common intent of taking the measure and showing the face of the new homelessness. If there was an implicit premise to such work it was that houseless poverty was so alien to the American tradition of

52 Dreier, P. Appelbaum, R. (1991) American Nightmare: Homelessness. Challenge 34(2), p.46 53 Baumohl, J. (1996) Introduction, in: Baumohl, J. ed. Homelessness in America. The Oryx Press, Phoenix, p.xiv. 54 Anderson, G.L., Herr, K.G. (2007) Encyclopedia of activism and social justice. SAGE Publications, Inc., Thousand Oaks. 55 Hopper (2003), p178 56 Deparle, J. (1990) Mitch Snyder, 46, Advocate of Homeless. The New York Times, July 6, 1990, p.16. 57 Ibid.

18 poor relief that evidence of the betrayal of that legacy would suffice to prompt corrective action. Needless to say, it didn’t work out that way.”58

In New York, two PhD candidates at Columbia University, Ellen Baxter and Kim Hopper, finished up their field research of identifying, observing, interviewing, and closely engaging with New York’s homeless population. Their 129-page report “Private Lives/ Public Spaces: Homeless Adults on the Streets of New York City” was released in March 1981 and made the front-page of the New York Times. The Times had asked Robert Trobe, deputy administrator for family and adult services of New York City’s Human Resources Administration to comment. Trobe claimed limits to how much money the city could spend on the homeless problem. He was adamant that no one would be turned away from the city’s shelters but that some people chose not to come to the shelters.59

In retrospect, Hopper felt that the report did focus the public’s attention “on a scandal of major proportions”.60 But the disturbing reality that the report documented was largely dismissed by city officials:

“In the wake of the report’s appearance, Ellen [Baxter] and I made scores of appearances on television and radio news shows, often debating city officials. Predictably, they attempted to dismiss its findings as myopic and biased. In part, this was the reflexive response of bureaucrats to outside criticism. In part, it was a refusal to admit that the dimensions of homelessness had qualitatively changed and that city policy should be overhauled accordingly. And in part, it was a political choice to deny that the growing shortage of low-income housing had anything to do with the burgeoning ranks of the homeless, so as to forestall the day the city would have to confront a residential neighborhood (not one on the or on an island) with the news that a shelter was coming.”61

However, Hopper also felt that some of the report’s findings had practical utility and influenced subsequent intervention designs. One of these findings was a different interpretation of the widely assumed “service resistance” of many homeless people speaking to their pathological behavior and decision making. But Baxter and Hopper interpreted the resistance towards support as an understandable choice by the homeless. Making their own decisions on the street was deemed preferable when “support” meant receiving only inadequate and even dangerous “help” as was the case in shelters where people got robbed or physically harmed. Anyone helping the poor would thus also need to confront a deep distrust, a deeply ingrained suspicion of homeless people towards do-gooders.

In September of 1980, when Baxter and Hopper pursued their PhDs, Melvin Herman, professor at the school of social work at Columbia University, set up an interdisciplinary curriculum development and outreach program. The program was called Columbia University Community Services (CUCS) and Herman hired Tony Hannigan to supervise the effort. Herman intended to help “eliminate the ‘adversarial relationship’ that is said to exist between the university and the neighborhood. Too often in the past, Herman said, ‘the community has seen Columbia as a big goliath concerned with students and

58 Hopper (2003), p.178 59 Bird, D. (1981) Help is urged for the 36,000 homeless in city’s streets. The New York Times, 08MAR81. 60 Hopper (2003), p.115-116. 61 Ibid.

19 faculty and not with its neighbors’.”62 Hannigan remembered “the thinking at the time being: the elderly had a constituency, family and children had a constituency, but single poor people? What was that about? Why not just get a job and pull yourself up by your bootstraps?”63 Hannigan with a first-year budget of 450k USD mainly from state government and about 50 students from various schools developed both the outreach and research dimensions of CUCS. But where do you meet poor single people? Hannigan got started by setting up an office in a 110 unit privately owned SRO hotel on Central Park North in New York City. “These were the places where many people [with mental health problems] after deinstitutionalization went because the promise of the 1963 Community Mental Health Act never really materialized.”64 Hannigan describes these SROs as “pretty tough places”. But the owner was intrigued by the idea that CUCS would bring in a law student focusing on entitlement benefits. Maximizing people’s entitlement benefits was important for ensuring that rents got paid.

Research on homelessness was difficult because people were afraid to speak up. Jonathan Kozol in his influential book “Rachel and her children” described the grim reality of SRO hotels in New York with the following words: “Homeless people in this book are not identified by their real names. This decision is dictated in part by the wishes of the people interviewed. It is commonly believed by residents of homeless shelters, including hotels, that they render themselves subject to retaliation or eviction by authorities if they speak with candor to a writer or reporter. For this and other reasons, many have asked me to disguise sufficient details (time, date, place of interview, hotel room, floor number, physical features, exact ages of children in a family, and other identifying details) to assure their anonymity.”65

Litigation At the start of the new decade, New York city officials faced legal developments that would force an unprecedented response to the problem of homelessness. The ripple effects of homeless legislation from the 1980s can be felt even today. On 5 December 1979, a State Supreme Court justice in had ordered the city and the state to create 750 new beds for the “helpless and hopeless men of the Bowery.”66 In October 1979, the first class-action lawsuit on behalf of three homeless men from New York was filed by Robert Hayes, a 25-year-old lawyer with a habit to chat with people on the street. In an interview in 2015, Hayes remembered: “’Most people in New York either ignored homeless people or just figured they were out there by choice,’ Hayes said. ‘Free-thinkers, free-livers or down- and-out drunks.’ Instead, the men told Hayes that living on the streets was their only choice in the absence of city shelters. The ‘flophouses’ that catered to needy men were dirty, degrading and dangerous.’”67 The New York Times portrayed Mr. Hayes, whose law firm approved of his pro-bono efforts, as a man working in two worlds: “By day he would tread on soft beige carpeting in the hushed offices of his firm and work on antitrust and securities cases. At night he would walk the Bowery, talking to his newfound clients, the bedraggled men who check in at the Men's Shelter and are sent to cheap

62 Clark, P. (1981) Grad schools join in outreach program. Columbia Daily Spectator, Vol 114, 10JUN81. 63 Tony Hannigan interview, 27APR20. 64 Ibid. 65 Kozol, J. (1988) Rachel and her children. Homeless families in America. Fawcett Columbine, NY., p.ix. 66 Kaiser, Ch. (1979) A state justice orders creation of 750 beds for bowery homeless; Suit names Carey and Koch. The New York Times, 09DEC79. 67 King, N. (2015) Behind New York’s right to shelter policy. Marketplace, accessed on 29APR20, at: https://www.marketplace.org/2015/09/30/behind-new-yorks-right-shelter-policy/

20 hotels in the area or to the city's large shelter on Wards Island. His colleagues have chided him that his uneven red beard helped him look more ‘homeless.’ ‘Personally it's very troubling to go from large corporate offices to a ,’ he said. ‘It's schizoid. You see the affluent people and the utter poverty of others. It requires a lot of long walks at night to try to understand.’”68

New York City officials initially opposed the Dec 1979 ruling and this legislation in several rounds of negotiations that raised several objections. It is worth reproducing the introductory statement of the March 1980 complaint of the plaintiffs against the objections of the New York City officials. The document details the grim situation of homeless men in New York City in 1979/8069.

This class action seeks damages, as well as declaratory and injunctive relief to redress the deprivation of services and support due the named Plaintiffs, and the class they represent - homeless men without Income or property who live in New York City and who are unable to provide for themselves - under the United States Constitution, the New York Constitution, the New York Social Services Law, the New York City Charter, the New York City Administrative Code and Titles 14 and 18 of the New York Code of Rules and Regulations. There are approximately 10,000 homeless men living in New York City, the overwhelming majority of whom are incapacitated due to physical and mental disabilities, often exacerbated by alcohol and drug addictions. At the commencement of this action, the only public facility in New York City providing regular services to homeless men was the Shelter Care Center for Men (the "Men's Shelter"), located on Manhattan 's Iower eastside. On December 17, 1979, Defendant BREZENOFF opened an emergency shelter in the Keener BuiIding on Ward's Island, located in the East River. This building, which has a capacity to shelter 180 men, presently is scheduled to be closed on March 31, 1980. In addition, Defendants provide shelter to approximately 800 homeless men at Camp La Guardia which is located in Chester, New York, a two hour bus ride from New York City. The only service which the Men's Shelter makes available to all homeless men on a consistent basis is three meals a day. In addition, the Men's Shelter dispenses anywhere from 750 to 925 Iodging vouchers, redeemable in one of several dangerous and unhealthy Bowery Iodging houses. During winter, 1,200 to 2,000 men seek lodging from the Men's Shelter each night. When the Men's Shelter exhausts its supply of lodging vouchers, the remaining homeless men are permitted to sleep with several hundred other men on a concrete floor in the "big room" at the Men's Shelter or, during the winter of 1979—1980, are bussed to Ward's Island. Once the "big room" is filled to capacity, the remaining men are turned back into the street. During the winter of 1979—80, any man who declines to go to Ward Island after the supply of vouchers for lodging houses has been exhausted is turned into the street, regardless of the weather. The "big zoom" is opened only after midnight. Up to 100 men then spend the night on the floor and in plastic chairs in the "big room." Most of the homeless men living in New York are physically and/or mentally disabled. As a result, they are particularly vulnerable to, and fearful of, violence. The violence and brutality associated with the Men's Shelter and the Bowery lodging houses used by Defendants to shelter some homeless men is well-known to New York's homeless men, many of whom have experienced such violence.

68 Herman, R. (1981) Attorney for homeless worked in two worlds. The New York Times, 30AUG81. 69 Supreme Court of the State of New York. County of New York. Amended Complaint. Index No.: 72581/79, dated 30APR80.

21 Because of this long-standing and well-known pattern of violence, many homeless men are afraid to seek assistance at the Men's Shelter. A large number of New York's homeless men, fearful of conditions at the Men's Shelter, live in the streets, in subways, in doorways, on ventilation grates and in steam tunnels. Although the Men's Shelter is the only public social service facility for homeless men in New York City, it is understaffed and unable to provide the hygienic, rehabilitative and other social services which Defendants are required by law to provide Plaintiffs. Further, due to severe understaffing at the Men's Shelter, Defendants fail to provide sufficient security in and around the Men's Shelter to make it a reasonably safe environment for members of Plaintiffs' class who do seek assistance at the Men's Shelter. No security is provided by Defendants in Bower lodging houses. No services are provided to men in the Keener Building on Ward 's Island where the men live virtually under house arrest. No man is allowed to leave the Keener Building for any reason except to leave Ward's Island. Then a uniformed guard places a man on a bus leaving Ward's Island. Further, some men are denied the fifty cents needed to leave Ward's Island thereby coercively detained in the Keener Building.

The legal process seemed to have been an important learning opportunity for both plaintiffs and defendants. Robert Hayes recalls an interesting anecdote: “After the first court order came down, the municipality got the state government to cede the Keener Building, an abandoned psychiatric hospital under the Triborough Bridge on Wards Island. We, young idealists, thought this was abhorrent: to create a shelter on the grounds of a psychiatric institution, on an island in the middle of the East River, shoving humanity out of sight. And we were ready to try to block that, arguing that the operation was basically a sham: the building was inaccessible, and nobody would go there. But talking to some homeless individuals then living at the Bowery, I learned that those sheltered at the Keener Building were relieved to get away from the pressure and the stress of the hard-living conditions of the . They were welcoming the Keener Building as a refuge, from which they could walk across the bridge from Wards Island right onto Third Street in Manhattan. So sometimes our idealism did not converge with the actual demands of our clients.”70

In August 1981, the case was finally settled as a consent decree. “By entering into the decree, the City and State agreed to provide shelter and board to all homeless men who met the need standard for welfare or who were homeless ‘by reason of physical, mental, or social dysfunction.’ Thus the decree established a right to shelter for all homeless men in New York City, and also detailed the minimum standards which the City and State must maintain in shelters, including basic health and safety standards.”71

70 Blanco, L.A.C. (2019) A Cut Above the Streets: Robert M. Hayes, Co-Founder of Coalition for the Homeless, in Conversation with Lluís Alexandre Casanovas Blanco. Archinect, accessed on 31MAY20, at: https://archinect.com/features/article/150133042/a-cut-above-the-streets-robert-m-hayes-co-founder-of- coalition-for-the-homeless-in-conversation-with-llu-s-alexandre-casanovas-blanco 71 Coalition for the Homeless. The Callahan Legacy: Callahan v. Carey and the Legal Right to Shelter. Accessed on 27APR20, at: https://www.coalitionforthehomeless.org/our-programs/advocacy/legal-victories/the-callahan- legacy-callahan-v-carey-and-the-legal-right-to-shelter/

22 Dedicated organizations In March of 1981, several activists including Ellen Baxter and Kim Hopper incorporated the Coalition for the Homeless as a 501(c)(3) organization. The coalition and its partners, in particular the Legal Aid Society, continued legal activism on behalf of the homeless. The coalition filed several lawsuits that extended the right to shelter to women (Eldredge v. Koch, 1982) and to families (McCain v. Koch, 1983). Several similar organizations emerged in other parts of the US. Robert Hayes quit his job and became director of the newly established National Coalition for the Homeless. In subsequent years, several other national advocacy organizations were formed: The National Low-Income Housing Coalition, the National Housing Law Project, the Legal Services Homelessness Task Force, the National Alliance to End Homelessness, Students to End Homelessness, and self-organizing efforts by homeless people such as the National Union of the Homeless.72 The net effect of these lawsuits was substantial: “[…] a combination of mutually reinforcing incremental changes produced a nonincremental change: an operational right to shelter for both singles and families, with detailed quality specifications, that would empower the advocates of the homeless to drive policy for years to come.”73 Eventually, New York City Mayor Koch adapted his strategy to these new legal realities. In his 1985 state of the city address, Mayor Koch announced an ambitious plan for supporting affordable housing. And two years later, Koch officially announced that $4.2 billion in public financing would be used to build or rehabilitate 250,000 apartments for low- and middle-income people over the next 10 years. Half of these apartments were intended to be allocated to families with annual incomes below $15,000.74

Hopper outlined how several organizations started to collaborate around more ambitious legislative efforts at the national level: “In 1986, CCNV and the National Coalition for the Homeless joined forces with nine other groups to draft a comprehensive relief bill, the ‘Homeless Persons’ Survival Act,’ to guide and give substance to a federal role in ending homelessness. The following spring, Congress approved a version of Title I of that act—essentially, the emergency relief provisions—and that summer it was signed into law by a reluctant President Reagan as the ‘Stewart B. McKinney Homeless Assistance Act’ (McKinney Act). It was the first significant piece of federal legislation to address homelessness in fifty years. Appropriated funding for programs sponsored under the McKinney Act increased steadily, from $189 million in fiscal year (FY) 1988 to nearly $1.8 billion in FY 1994, and then dropped to just over $1 billion in FY 2001.”75 The McKinney act also established the Interagency Council on the Homeless (ICH). The ICH at that time described its mission to act “as an ‘independent establishment’ within the executive branch to review the effectiveness of federal activities and programs to assist people experiencing homelessness, promote better coordination among agency programs, and inform state and local governments and public and private sector organizations about the availability of federal homeless assistance.”76

72 Hopper (2003) 73 Main, T.J. (2016) Homelessness in New York City: Policymaking from Koch to de Blasio. New York University Press, NY, p.51 74 Purnick, J. (1987) Koch to announce plan for 250,000 apartments. The New York Times, 30APR87. 75 Hopper (2003), p.181. 76 U.S. Interagency Council on Homelessness: Historical Overview.

23 Innovations in - New York In 1983, Ellen Baxter, co-author of the influential ‘Private Lives’ report, established the organization Committee for the Heights Inwood Homeless which was later renamed to Broadway Housing Communities. Baxter wanted to demonstrate that alternative forms of housing coupled with services could provide the homeless with much more desirable, effective, and much less costly alternatives to the shelter system. Ellen traced her inspiration for this idea to a 1975 fellowship that she had spent in the small Belgian village of Geel. Geel had become famous for refining a successful system of community care for the mentally ill in the last 700 years77. “The town has for centuries integrated mentally ill people into the families of townspeople. ‘In Geel, stigma do not exist because a tolerance had evolved over the years,’ Ellen explains, ‘and it was there I learned that, if given the chance, the mentally ill and destitute can co-exist in community with others.’”78

One local inspiration in New York City that influenced Ellen’s ideas was the St. Francis Residence, an experimental SRO building conceived by two Franciscan priests, Father John Felice and Father John McVean, who were fondly referred to as the “Johns’”. The duo had successfully tested a prototype supportive housing model at the Aberdeen Hotel to address the problem of the many thousand mentally ill patients that were discharged from psychiatric institutions with nowhere to go. “There was no community to receive them. A few had families who took them in, but most ended up living on the streets. Some who could afford it found refuge in the SRO hotels,” remembers Father John McVean79. But in 1979, with increasing real estate prices, the hotel owners sold The Aberdeen to developers. This episode encouraged the Johns to convince the Holy Name Province, the largest community of Franciscan friars in the US, to fund the purchase of the Beechwood Hotel, that had about 100 simple SRO rooms. Says Father McVean, “When you own a building, you have greater control over everything. You eliminate the profit motive, so right there, you can do more. You can make sure the bathrooms are kept clean. If a wall needs to be painted you can get it painted. It’s all very basic, but it makes an enormous difference in the environment of a place.”80 In 1981, after spending roughly 550k USD for the purchase of the hotel and another 100k USD for renovating the rooms, the hotel was renamed to St. Francis Residence. The residence became the first nonprofit-owned and -operated permanent supportive housing residence for mentally ill homeless people that also provided social, medical, and psychological support. “The support program ‘strongly urged tenants to be medication compliant,’ but if a tenant refused services or medication, he or she was allowed to remain housed. With the help of formal linkages to specialists in outside medical and psychiatric programs, the residence staff would reengage the person on their own terms until he or she could once again be stabilized. Often, noncompliant tenants would need to be hospitalized until stable, but almost always returned to the residence once they were capable of maintaining themselves in the housing. One activities specialist at the St. Francis Residence summarized the program’s service philosophy best when she said simply, ‘We are a family here’.”81

77 Goldstein, J.L, Godemont, M.M.L. (2003) The legend and lessons of Geel, Belgium: A 1500-year-old legend, a 21st-century model. Community Mental Health Journal, 39(5), p. 441-458 78 Petra Foundation. Ellen Baxter. Access 27APR20, at: http://petrafoundation.org/fellows/ellen-baxter/index.html 79 St. Francis Friends of the Poor, accessed on 21JUN20, at: https://stfrancisfriends.org/who-we-are/our-story/ 80 Houghton, T. (2001) A Description and History of the New York/New York Agreement to House Homeless Mentally Ill Individuals. Corporation for Supportive Housing, NY, p.28. 81 Ibid.

24 The Residence became a model for Ellen’s first experimental supportive housing project, “The Heights”, located in New York City’s Washington Heights area that opened with 55 units in 1986. Tony Hannigan remembered: “Around 1981, 82, we were really starting to feel the force of the Callahan decree, which established the right to shelter in New York. There was a lot of pressure on the city to get people out of shelters because there was such a demand for shelter. Up until that point, if you had a mental illness and you were reliant on the public sector for housing. Your only option was - what was most commonly known as - a group home, where there were only other mentally ill people. It was licensed by the state. But at that time - and this figure might be a little rough - at the time when homelessness was really starting to be all over the place, you could see it, the community residences were running a very high vacancy rates, something like 15%. Homeless people felt like: ‘I'm not going to go there with all those rules’, while the community residences felt like: ‘Well these are not compliant people’. And so, there was a disconnect.”82 Importantly, at the St. Francis Residence people had a legal right to tenancy. “In a community residence or a group home, if they didn’t like you, you were out. And also [in the St. Francis Residence] you were not expected to move on. Community residences were time limited. You were supposed to leave in three years and get placed and you were done.”83

However, instead of having only people with mental illness, The Heights was designed to integrate people with and without mental illness. And the team working on it also wanted permanent housing like the St. Francis Residence had instead of the limitations of the state licensed community residences or group homes. Modeled after privately-run SROs, The Heights had shared kitchens and bathrooms and access to quality services to overcome the problem of personal isolation. Services were voluntary, people did not have to use them. This design decision meant that services needed to be made attractive to motivate their use. Hannigan called it a “Hippy model, if we didn’t have to have a rule, we didn’t want to have a rule.” To identify tenants, on Friday nights Hannigan and Baxter would invite homeless people from a nearby bus station for dinner into a rented apartment to see how they were doing. And so, they ended up with a mixture of homeless people. Fifteen units were reserved for people with severe mental illness. But they also wound up with eight drug dealers and thus had to adapt their “hippy model”.

While Hannigan was signing the service contract for The Heights, Ellen Baxter managed to orchestrate an elaborate financing scheme that became an inspiration for later efforts. An article from 1986 in the New York Newsday provides a fascinating perspective of the complexities and logics behind this financing effort:

The old five-story tenement in the final stages of rehabilitation, which is to shelter 55 homeless men and women, was financed in large part as a tax shelter for a group of affluent investors. It should be quickly added that the financiers of the project, which include six partners of the Wall Street banking house Goldman, Sachs & Co., and a lawyer at Sullivan & Cromwell, will receive relatively modest tax savings, based mostly on operating losses, mortgage interest and depreciation. […] And its developers hope that The Heights, as the building is called, will become a model for developers and politicians, including Mayor Edward I. Koch, who say they are searching for ways to house the poor. John Nolan, a Tarrytown lawyer and housing specialist who developed

82 Tony Hannigan interview, 27APR20. 83 Ibid.

25 the financing plan, explained: ‘This project shows what is possible. And the possibility exists that investors in housing for the poor and the homeless can get rates of return consistent with other kinds of real-estate investment.’ The purchase and rehabilitation of The Heights, an abandoned building owned by the city, is expected to cost about $1.2 million. In addition to foundation grants for operating the building and tending to the needs of its residents, the state has granted the developers, the Committee for the Heights-Inwood Homeless, $283,000, and the city has furnished a $366,000 loan at 1 percent interest. Another loan, at 14.5 percent interest, came from the Community Preservation Corp., a consortium of banks. Many of these grants and loans were extended because the committee for the homeless, through a limited partnership it was required to set up, got $300,000 in ‘equity capital’ from a group of investors.84

Baxter believed that The Heights may have been the first project to use tax-shelters to shelter homeless people. She also noted that “it has taken more than four years just to house 55 people. In that time thousands have become homeless. Private efforts can do so much. Only the government can do what really needs to be done. But the city and state with their regulations, made it very difficult at times. It was like pulling teeth,” she said. “And sometimes there were spurts of malevolence.”85

The St Francis Residences and The Heights helped to mobilize resources from a variety of sources, public and private. But the supported housing innovations also helped rethink – what many commentators perceived as – a flawed economic calculus of the public shelter system. According to the New York Times, the Koch administration under pressure of earlier court orders that had established a right to shelter felt a need to limit the public’s efforts. “Making the shelter too comfortable in a city starved for housing, the Mayor worried, could stimulate so much demand as to break the bank.” 86 But the Times argued that projects such as The Heights were proof that superior services could be provided at less than half the costs of public shelters. “With tenants organized to help with daily management, the operating cost, including salaries for a general manager and social workers, comes to only $15 per day per resident. All the tenants have some income: with The Heights for an address, they are able to apply for Social Security, veterans' and other public benefits. Some now hold jobs. The residents pay rent, buy their own food and cook for themselves. Such a setting makes it easy to provide medication for the mentally ill.”87

Other projects were developed by Baxter and Hannigan. One was the 28 unit “Stella”, named after Stella Levine, who according to Hannigan was “the oldest heroin addict Ellen and I had ever met and she was charming.” Some of the original tenants ended up living at the Stella until today.88 Another project was the “Rio” that was intended to include families for the first time. Ellen Baxter as CEO of Broadway Housing Communities would continue to develop the supportive housing model over subsequent decades with several buildings in Washington Heights and projects such as the Dorothy Day Apartments in West Harlem or The Sugar Hill Project in Upper Manhattan’s Sugar Hill historic district.

84 Friedman, S. (1986) Tax Shelter: Investing in the Homeless. Partners’ Investing Covers Homeless. New York Newsday, January 5, 1986. 85 Ibid. 86 Opinion. Housing street people better, cheaper. The New York Times, 13JAN89. 87 Ibid. 88 https://www.broadwayhousing.org/affordable_housing/stella/

26 The late 1980s also saw the emergence of supported housing models in other parts of the US. For example, Tanya Tull in 1989 in Los Angeles, started a program focusing on getting homeless families into permanent housing. “We help families overcome the barriers to housing: negotiating leases, overcoming bad credit histories. We offer landlords a case agent for each family that will help them solve problems that might interfere with paying their rent.”89 By 1994 she had moved 600 families into permanent homes and was convinced that the principle of Housing First rather than treatment first was effective for all kinds of homelessness. By 2010, Beyond Shelter had helped close to 5,000 primarily single-parent families to move into affordable permanent housing in residential neighborhoods throughout L.A. County.90

Rosanne Haggerty finds her calling Meanwhile, Rosanne Haggerty had graduated from Amherst College in 1982 and volunteered at Covenant House. Covenant House “served a population that had previously fallen between the cracks: homeless teen-agers who either had run away from home or been kicked out. Many turned to drugs and prostitution and met grisly fates.”91 Covenant House had been founded and run by Father Bruce Ritter, a Franciscan priest. The charity offered young people shelter, food, clothes, community, training, and education to steer their lives in a better direction. It operated in several US states, Canada, and Central America. Covenant House was located in Times Square and for a year Rosanne and about sixty other volunteers lived next door to the faded Times Square Hotel that had earned the nickname “homeless hell”. The volunteer quarters reminded Rosanne of the rooming houses she had seen in her childhood. Though she lived in such accommodations by choice rather than necessity it reinforced to her how little space a person needed in order to feel secure.”92 Overnight, once a week, Rosanne also volunteered at a church basement shelter for homeless women. And she remembers thinking naively: “We’ll be enough volunteers and shelters–we can nail this!”93

Moving on from Covenant House, Rosanne started working in the housing development office at Brooklyn Catholic Charities. Catholic Charities, established at the turn of the 20th century, enacted Catholic teachings with a strong focus on the personal dignity of the most vulnerable members of society, social justice, and human development. The Catholic Charities became one of the largest faith- based providers of affordable housing. During that time, Rosanne developed skills in applying a new legislation that was put in place in 1986, the Low-Income Housing Tax Credit.

Rosanne was also interested in The Heights and the ongoing planning of the Rio and she met with Hannigan and Baxter. Hannigan remembers: “About four or five months after this meeting, Rosanne called and she said: ‘I know this might sound kind of crazy. But there is a hotel in Times Square called the

89 Tull, T. (1994) The Next Step Toward Home: Tanya Tull helps homeless go beyond temporary shelter and into residential neighborhoods. Los Angeles Times, 18SEP94. 90 Dvorak, H. (2910) Tanya Tull: First, a Home. LA Weekly, 20MAY10. 91 Kelley, T. (1999) In Quiet Fields, Father Ritter Found His Exile; After Scandal, Covenant House Founder Had a Simple, Solitary Life Upstate. The New York Times, 22OCT99. 92 https://www.ashoka.org/en/fellow/rosanne-haggerty 93 https://denver-frederick.com/2016/09/06/roseanne-haggerty-president-ceo-of-community-solutions-joins- denver-frederick/

27 Times Square Hotel. It's seven hundred and something units. Would you be interested in working on that, to do the services?’ So I’m like ‘Seven hundred units, really?’ Because [at that time] Ellen and I were thinking about the Rio. The Rio had 82 units and it would be the largest supportive housing residence then. So, she was talking about 700 units. And I said: ‘Well, let me think about that.’ I was intrigued by it and figured it was either going to be the largest crack house in the world or it would become the beacon for supportive housing, which it did.”94

94 Tony Hannigan interview, 27APR20.

28 The 1990s – Innovation and scaling of affordable housing models The 1990s did not start on an overly optimistic note if a New York Times article from June 1990 is any indication. The article highlighted several issues that severely challenged the optimism that was generated by the new supportive housing templates that were created in the 1980s. One issue was a simplistic but somewhat convenient framing of homelessness that may have collapsed the problem with the solution: “housing, housing, housing”.95 But at least two factors challenged this framing. First, although cities such as New York spent unprecedented amounts of money on building new affordable housing, the supply of housing did not seem to make a dent in the numbers of homeless people. It dawned on decision makers that current efforts were unable to close the huge gap between supply and demand. There seemed to be a significant divergence in the rhetoric of the optimists and the pessimists: “Anna Kondratas, H.U.D.'s assistant secretary for community planning and development, asserts that although ’the problem is shocking and getting worse,’ she's convinced that it will be turned around in this decade. ‘After all,’ she said, ‘this is the land of the rich as well as the free, by world standards, and we should be able to do it.’”96 But Gary Blasi, president of the National Coalition of the Homeless, had a much more pessimistic view of the future: “’The future? The pessimist in me sees homelessness becoming a permanent part of American society, with millions of kids growing up in an essentially third- world country with all those sadly familiar extremes of wealth and poverty.’”97 A second issue that the article highlighted was the concern that neither the prevailing problem frames nor the solution templates adequately captured and addressed the reality of homelessness. “Homelessness, as James D. Wright, a Tulane University sociologist and author of ‘Address Unknown,’ has written, is ‘simultaneously a housing problem, an employment problem, a demographic problem, a problem of social disaffiliation, a mental health problem, a family violence problem, a problem created by the cutbacks in social welfare spending, a problem resulting from the decay of the traditional nuclear family, and a problem intimately connected to the recent increase in the number of persons living below the poverty level.’ Even that partial list of targets makes the 1960's War on Poverty seem like a simple commando raid.”98

There were many questions about the adequacy of contemporary “solutions” to the problem. A developer of in New York state was concerned that half of the homeless mothers and older children in his facilities had a drug problem. Seventy-five percent of them were located in the Bronx. “We have just moved the Martinique Hotel there and built a time bomb. Unless these women become self-supporting, society should be prepared to take care of them and their kids for the rest of their lives. Is that the kind of country we want?” Challenges to the appropriateness of solutions were also grounded in what seemed to be enduring ideologies around the previously discussed “cycle of poverty” and the “culture of poverty” perspectives. An illustrative example of this enduring ideology can be found on page iii of the 1994 HUD report “Priority: Home! The Federal Plan to Break the Cycle of Homelessness”. The report cites the following statement by President Clinton: “I do not believe we can repair the basic fabric of society until people who are willing to work have work. Work organizes life. It gives structure and discipline to life. It gives a role model to children. We cannot repair the American community and restore the American family until we provide the structure, the value, the discipline and

95 Levitas, M. (1990) Homeless in America. The New York Times, 10JUN90. 96 Ibid. 97 Ibid. 98 Ibid.

29 reward that work gives.” 99 This statement is put into context in the executive summary of the report: “We must remember that government's role is to help people help themselves; that government is most effective when it does not rely solely either on the invisible hand of the marketplace or on the heavy hand of policies that reward inertia and punish initiative; that government is at its best when it offers instead a helping hand to those willing to climb onto the first rungs of the ladder of economic opportunity; and that, ultimately, government action cannot substitute for the individual's will or responsibility.” The HUD report was prompted by executive order 12848 of May 19, 1993 by President Clinton with the intent to streamline and strengthen the Nation's efforts to break the cycle of homelessness.

Clearly, homelessness as a public social problem had evolved. The 1990s did not suffer from a lack of awareness or attention to the problem. Rather, there seemed be a frantic search for solutions. Throughout the 1990s, unmet demand for emergency shelters remained at 20%-25%.100 Could the supported housing templates that Ellen Baxter, Tony Hannigan and others had pioneered be that solution? In 1990, Baxter and Hannigan had just opened two new housing projects in New York’s Washington Heights, the Delta and the Edgecombe. It seemed that their tenants, formerly homeless, had indeed found a new home that changed the tenants’ lives for the better. And this type of supported housing was able to operate at a steep discount compared to the costly public shelter system. An article from 1990 vividly described this new reality: “When one sees the treasured two rooms plus kitchenette of a man who lived for years on the street, it's clear that for him it's heaven. His medicines (he has AIDS) are lined up like soldiers. Posters and plates hang on the walls; magazines are in precise little piles; dust has been banished. The place shines.”101 But at the same time, the article warns that any lapse in proper management of such initiatives can easily turn them into the old SRO models and their reputation as being “homeless hells”.

Tony Hannigan’s involvement in so many supported housing initiatives eventually increased tensions with his “Alma Mater”. Hannigan’s focus was not compatible with Columbia University’s intentions for CUCS as a research and curriculum development initiative. For that reason, in 1993, Hannigan spun off CUCS as the Center for Urban Community Services, an independent non-profit organization developing affordable housing and providing integrated programs that link housing, health and social services for New York’s homeless and most vulnerable people.102 Hannigan led the development of the new CUCS until his retirement in 2020.

Innovations for the mentally ill - Assertive Community Treatment and Housing First The supported housing template also received support and legitimacy from parallel developments that focused on mentally ill homeless people. In 1992, a community psychology clinician, Sam Tsemberis, founded the organization “Pathways to Housing”, a nonprofit agency in New York City, to develop a supported housing program. Tsemberis focused on the needs of homeless individuals with severe

99 U.S. Department of Housing and Urban Development (1994) Priority: Home! The Federal Plan to Break the Cycle of Homelessness, p.3. 100 The United States Conference of Mayors (2004) Hunger and Homelessness Survey, accessed on 17AUG20, at: http://www.ncdsv.org/images/USCM_Hunger-homelessness-Survey-in-America%27s-Cities_12%202004.pdf 101 Cantwell, M. (1990) The Editorial Notebook; A Tub of Their Own. The New York Times, 23NOV90. 102 https://www.cucs.org/our-story/

30 psychiatric disabilities and concurrent addiction disorders: “The program is designed for individuals who are unable or unwilling to obtain housing through linear residential treatment programs. Founded on the belief that housing is a basic human right for all individuals, regardless of disability, the program provides clients with housing first—before other services are offered. All clients are offered immediate access to permanent independent apartments of their own.”103 A significant number of patients discharged from mental institutions could not stand on their own feet and were unable to access proper services. They ended up coming back to the mental hospitals, being jailed, finding a bed in a shelter, or living on the streets. “Pathways to Housing” focused on those patients that were screened out of programs such as city-supported permanent supportive housing. Instead of providing purpose-built supportive housing, Tsemberis rented apartments in “normal” communities. In his 2000 research paper, Tsemberis demonstrated that 88% of participants in his “Pathways” approach remained housed after five years.104 The comparison group that followed the federal linear Continuum of Care model only achieved half of Pathways’ housing rates. For his approach to supportive housing Tsemberis’ created the term “Housing First”. The term proved sticky and the program was eventually sufficiently well developed to become widely adopted in policy circles as a fundamental approach to homeless services in the coming decades. A central element to the Housing First approach was the service component, known as assertive community treatment (ACT).

ACT had been developed by researchers at a state mental hospital in Wisconsin during the 1970s, at a time when large numbers of patients with mental disorders were being discharged from state-operated psychiatric hospitals.105 Len Stein, one of the researchers involved, remembered how the mental hospital had operated from a genuine conviction of offering thoughtful and effective treatments and discharge plans for its inpatients. “We made sure patients had and that their SSI [supplemental social security] check was coming to the right address. We had an appointment for them at the mental health center to get their medications when they ran out. […] But they kept coming back, over and over again.”106 Stein and others noticed this phenomenon in hospitals everywhere in the United States and the term “revolving door patients” was coined. When the Wisconsin researchers tasked social workers to investigate this phenomenon, the reports identified rather banal issues. Discharged patients made consumption decisions without considering the consequences. For example, patients often did not have money left in the middle of the month “to fill the refrigerator”. Other issues related to personal setbacks or arguments with friends and families that the patients could not deal with. It dawned on Stein that “if we wanted to help people make it out there, that is - to be able to live stable lives of decent quality out in the community where everyone else is living - we couldn't do it in the hospital. It can't be done because the kinds of problems that were getting him [a patient] into trouble could not be addressed in the hospital.” The researchers set up an experiment. Patients were randomly selected into two groups. One group continued to come into the hospital for services as usual. A second group instead received access to a dedicated hospital ward, a “hospital without walls” as Stein

103 Tsemberis, S. and Eisenberg, R.F. (2000) Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals With Psychiatric Disabilities. Psychiatric Services Vol. 51(4), p.488. 104 Ibid. 105 Stein LI, Test MA. (1980) An alternative to mental health treatment. I: Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry (37), p.392–397. 106 Sam Tsemberis Interviews Len Stein about Assertive Community Treatment, 17JUN14, accessed on 10OCT20 at: https://www.youtube.com/watch?reload=9&v=683yoITWZxc#action=share

31 called it. This ward was staffed with psychiatrists, psychologists and social workers. The measures used by the teams to compare the two groups included emergency room use, police use, how many people ended up in jail, family illnesses or anxiety levels in the community. The study found that patients accessing the hospital wards had a 95% lower hospitalization rate and that this approach reduced the revolving door syndrome from 60% to 5%. Stein commented: “This [new approach] was not costing any more than traditional treatment with much, much better clinical results and we found there was no increase in community or family burden because we were giving a tremendous amount of support to families and the community as part of our program.”107 While the researchers thought the results were so convincing that everybody would now adopt this approach, Stein shared his subsequent frustration that “for 15 years we banged our heads against the walls”. At conferences, people found their results remarkably interesting but put forward all kinds of reasons why something like this could work in Wisconsin but not in another context. Eventually, someone from Michigan replicated the Wisconsin study with similar results and this got the bandwagon rolling. Stein remembered: “Then someone else saw it and said, ‘Well now we got two studies, maybe we better try it’. Soon there was enough people doing it. The attitude - it was like overnight - changed from ‘Well you can do it but we can’t’, to ‘Everybody is doing it, we better start doing it’.”108 ACT was being slowly accepted and adopted as a new paradigm in the 1990s. Meanwhile, the philosophy of Pathways to Housing that built on ACT and offered a direct pathway from “streets to homes”109 was met by the same resistance that had slowed the adoption of ACT. Adopting the principles of Pathways to Housing required a paradigm shift for which the mainstream homelessness system was not yet prepared.

But the parallel developments in the homelessness sector around supported housing and Housing First principles were slowly influencing attitudes and approaches at the policy level. In August 1990, New York City Mayor Dinkins and New York State Governor Cuomo signed an agreement to build new housing for more than 5000 mentally ill people by the middle of 1992. Observers interpreted this agreement as an admission that services catering to the special needs of homeless people with mental illnesses had been grossly inadequate.110 Seemingly inspired by the recent innovations in supported housing, the city and state decided to build on the emerging expertise of the nonprofit sector. And this may have been an important enabling element for initiatives such as the Times Square Hotel, the largest SRO proposal at that time.

Times Square Hotel - redefining scale The Times Square Hotel building was originally constructed in 1922. By the 1980s, the 15 story, 735 room building had become the city’s, if not the nation’s, largest SRO hotel. The charity Covenant House bought the Times Square Hotel in 1984. The SRO’s tenants who were frequently physically and mentally handicapped and were living in their 200$-a-month rooms were described as “a mix of failed actors, aging prostitutes, and unlucky immigrants.”111 According to the same source, expensive financing and lacking a strategy for adequately dealing with the existing tenants, resulted in the deal costing Covenant

107 Ibid. 108 Ibid. 109 Tsemberis, S. (1999). From streets to homes: An innovative approach to supported housing for homeless adults with psychiatric disabilities. Journal of Community Psychology (27), 225—241. 110 Houghton, T. (2001) 111 Fahs, J., Stern, E. (1988) The slumlord is my shepherd. Spy, The New York Monthly, April 1988, p50-57.

32 House six million dollars, being entangled in three racial-discrimination suits, rent strikes, hundreds of building-code violations, and “a long slog through bankruptcy court”. Some of the difficulties resulted from a policy decision by Mayor Koch that extended an earlier moratorium banning the destruction of SRO housing. The ban prevented a profitable sale of the hotel. “I’m trapped. When the city passed the S.R.O. law it killed us,” Father Ritter, Covenant House’s founder, remarked in 1987 lamenting the $3 million in annual losses that his organization had to shoulder.112 Ritter contracted Ronald Mitchell, cofounder of the American Association of International Hostels, to run several floors of the hotel as a hostel that “catered to students from around the world - sometimes to the dismay of the approximately 340 permanent residents”.113 But in 1987, when Covenant House put the building up for sale, Mitchell was forced to bid or lose his hostel business. On the last day of 1987, Covenant House sold the Times Square Hotel to New York International Hostel. Six months later, Mitchell, filed for bankruptcy and in December of 1988, a landlord of several flophouses with a very questionable reputation, Mr. Truong Dinh Tran, was appointed by the Bankruptcy Court to oversee the Times Square Hotel. According to the New York Times, Mr. Tran “collected rents as high as $2,640 per month from the city to house homeless families, even as the number of health and safety and building code violations climbed past 1,500. City inspectors said they saw drug dealers and heard gunshots in the halls”114. Under Tran’s management, by January 1990, the hotel had deteriorated to such an intolerable state that the city decided to take possession of the hotel. On January 12, 1990, the city had won court approval to take over the management of the bankrupt hotel.

In the same year, Rosanne Haggerty with an unshaken belief that she could develop the Times Square Hotel had founded a non-profit organization, Common Ground Community, as a vehicle to organize this effort. On her board were both Tony Hannigan and Ellen Baxter. Rosanne reached out to Lola Finkelstein who was a member, and after 1996 the chairwoman, of Community Board 5, an agency that dealt with neighborhood issues from 14th Street to 59th Street, from Lexington to Eighth Avenues. Ms. Finkelstein remembered how the city’s plan was to bifurcate the Times Square Hotel building in support of economic and commercial development of the Times Square area. She also vividly remembered meeting Rosanne Haggerty. “We met this inspirational, aspirational, and yet practical young woman who absolutely blew us away, and we thought: ‘Oh my god, what an opportunity’. And here is the perfect proposal because she described how they would use the building, what the programs would be, who their partners for social services would be. It was totally comprehensive as well as very exciting.”115 Nicholas Fish who chaired Community Board 5, shared with reporters how important this level of preparedness was. “She won over Board 5 by disclosing not only her general plans but also detailed financial data, including the formal prospectus for bank lenders. By contrast, when Steve Coe, executive director of Community Access, wanted to build a similar residence for psychiatric patients in Gramercy Park in 1994, he was ‘unprepared, evasive and had no firm numbers,'’ Mr. Fish said. The community board opposed the project. Mr. Coe denies he was evasive, but acknowledges that he has lost Board 5's trust. '’We're damned forever now,’' Mr. Coe said.”116

112 Williams, W. (1987) Investment sours for a Times Sq. shelter. The New York Times, 17MAR87. 113 Hevesi, D. (1988) Covenant House Sells a Times Square Hotel. The New York Times, 03JAN88. 114 Leland, J. (2014) Mr. Tran’s Messy Life and Legacy. The New York Times, 24JUL14. 115 Interview with Lola Finkelstein, 17APR20 116 Ramirez, A. (1996) The Four Rules of Politics, By Nick Fish. The New York Times, 03NOV96.

33 Several observers from that time described Rosanne as fiercely determined, entrepreneurial, wicked smart, with a strong sense of mission, not afraid to hire talented people, a person with a great deal of humility while also being greatly confident in herself. The unprecedented size and scale of the Times Square initiative did not seem to trouble Rosanne. She told a reporter "Covenant House had almost 700 permanent tenants and it wasn't troublesome until transient homeless families started coming in [lacking adequate support]. We said, 'Let's improve the physical plant and the social services."'117 It appears that one way Rosanne compensated for – what observers perceived as - her lack of experience in the housing sector was by aligning herself with influential and respected people. Lola Finkelstein remembered how she reached out to influential contacts in the Broadway theater scene to gain their support and to introduce Rosanne. “And I can't remember all of the outreach that we did but we kind of circled the Mayor. We didn't go directly yet to the Mayor. We circled around creating support. And then we contacted Barbara Fife [then New York City’s Deputy Mayor for Planning and Development]. And we proposed this as an alternative to the bifurcated plan that the city had originally decided on. We knocked on every elected officials’ door. So finally, through Barbara Fife, I believe, the project went to the Mayor. And the city reversed their position, which was a major, major accomplishment. I think that every time Roseanne went to see anybody or spoke to anybody they were convinced, and she built up this army of supporters, with the city council members and other elected officials.”118 But Rosanne’s ambitions and creativity were for some observers also a liability for the people working with her. One commentator confided to us how staff were always concerned “when Rosanne went to another conference and came back with all these ideas, like, ‘What’s next Rosanne, world peace?’”.

Rosanne added the following context119:

In particular, my eagerness to create jobs for tenants and work on improving the surrounding neighborhood simultaneously with the redevelopment of the hotel seemed to some to be taking on too much. My ideas included recruiting socially minded retailers to the commercial spaces at The Times Square along Eighth Avenue and I became a Board member of the Times Square Business Improvement District, which was to play a catalytic role in the turn-around of the then notoriously troubled Times Square area itself. At that time, the blocks surrounding The Times Square were blighted and crowded with x-rated businesses. I was successful in bringing a Ben & Jerry’s Ice Cream store and one of the first New York City Starbucks locations to the building’s Eighth Avenue retail spaces. The Times Square Jobs Training Program for many years provided employment for residents of The Times Square and other supportive housing buildings and received the prestigious Peter Drucker Award for Non Profit Innovation in 1998.120

The period between first discussions with city officials in summer of 1990 and the first tenants moving into the Times Square Hotel in February of 1993 was a constant uphill race of maneuvering a complex set of political, financial, and social hurdles. This case study cannot do justice to the complexity of coordinating public, private, and civil-society interests and structuring complicated financing and tax

117 Oser, A.S. (1991) Perspectives: Housing the Dependent; Times Square Hotel as the Biggest S.R.O. The New York Times, 01DEC91. 118 Interview with Lola Finkelstein, 17APR20 119 Rosanne Haggerty, personal communication, May 2021. 120 Peter Drucker Award, at: https://ccdl.claremont.edu/digital/collection/dac/id/7652

34 schemes that integrated Federal subsidies, state grants, loans sponsored by city departments, philanthropic funds, and private investments. Fortunately, the effort is documented in existing comprehensive case studies.121,122 An abstract from Common Ground Community’s application for the Rudi Bruner award for excellence in the urban environment from December 1996 provides a brief glimpse into this complexity:

Between 1991 and 1994, Common Ground Community HDFC, Inc. transformed The Times Square from one of the most dilapidated and infamous commercial SRO's in New York City into a model of successful large-scale supportive housing. The project entailed a complete renovation of the building's interior and the creation of 652 new efficiency apartments, each with a private bath. More than 80% of the units were also equipped with kitchenette facilities. The design for the building included the creation of community space on each floor, the construction of an institutional kitchen and dining area on the 15th Floor, and an extensive renovation of the Renaissance Revival-inspired lobby and mezzanine. As part of the rehabilitation, Common Ground voluntarily sought National Register listing for the property and undertook a full historic restoration of the building, which was the first of the large midtown residential hotels built in conjunction with the early twentieth century emergence of the Times Square theater district. The project provides permanent housing for Iow-income and previously homeless single adults, AIDS patients, the mentally ill and the elderly, including approximately 200 tenants who lived in the building prior to Common Ground's arrival. Our programs take a holistic approach to overcoming homelessness and joblessness, integrating high-quality housing with a range of services designed to foster self-sufficiency and independence among tenants. Working in partnership with the Center for Urban Community Services (CUCS), which maintains an extensive on-site staff at The Times Square, Common Ground has created an environment where tenants have access to extensive social and psychiatric services, a medical clinic, community facilities, job training programs and ongoing employment assistance. On-site businesses, including a restaurant and catering facility, a Ben & Jerry's franchise, and a Starbucks Coffee Store, provide training and employment opportunities to tenants of The Times Square as well as to supportive housing tenants across New York City.123

Commentators called the Times Square Hotel a “watershed event for homeless services in both the magnitude of the effort and in its creative acquisition of public and private funds”.124 It became the largest supported housing project in the country and according to Tony Hannigan changed how people perceived the scale of such projects. Hannigan thinks that the Times Square Hotel gave organizations the confidence that large scale was feasible. While few people would take on 600 unit buildings, a size of about 125 units became the typical scale of supported housing projects until today.

121 Farbstein, J., Wener, R., Axelrod, E. (1998) The Times Square in New York, New York. Rehabilitation of a historic high-rise hotel into supportive low-income housing. In: Visions of urban excellence: 1997 Rudy Bruner Award for Urban Excellence. Bruner Foundation, Cambridge, MA. 122 Blake, J. The Times Square: A Case Study in Successful Supportive Housing. The Development Training Institute. 123 Common Ground Community (1996) Application to the Rudy Bruner award for excellence in the urban environment, 13DEC96. 124 Padgett, D.M., Henwood, B., Tsemberis, S. (2016) Housing First: Ending Homelessness, Transforming Systems, and Changing Lives. Oxford University Press, Oxford, p.38.

35 Spurred by the accomplishment of the Times Square Hotel was a series of subsequent development efforts by Common Ground Community. Following is a list of supported housing projects that were developed under Rosanne Haggerty’s leadership at Common Ground Community (*…in construction at time of spin-off of Community Solutions, the organization that Rosanne founded in 2011 after her departure from Common Ground Community)125

 The Times Square (Manhattan) 652 efficiency units for formerly homeless and workforce, including 200 tenants in residence when building acquired  The Dorothy Ross Friedman Residence (Manhattan) 178 units (27 1 bedroom, the remainder shared apartments) for individuals living with HIV/AIDS, low income elderly and low income workers in theatre professions. Owned by Actors’ Fund and operated by Common Ground.  The Prince George (Manhattan) 416 efficiency units for formerly homeless and workforce  The Christopher (Manhattan) 207 units (40 “foyer” shared units for homeless young people 18- 24 or those aging out of foster care, 167 efficiency units for formerly homeless and workforce  The Prince (Manhattan) 60 units (operated from 2002-2007, approximately) Transitional housing for homeless men moving directly from the street en route to permanent housing  The Andrews (Manhattan) 146 “Safe Haven” transitional housing for homeless men moving directly from the street en route to permanent housing  The Schermerhorn () 217 studio units for formerly homeless and workforce  Montrose Veterans Residence (Montrose, NY, on grounds of Veterans Hospital) 90 units of transitional housing for homeless veterans en route to permanent housing  The Brook () 190 studio units for formerly homeless and workforce  The Lee (Manhattan) 262 studio units (54 units for homeless young people or those aging out of foster care, 208 units for formerly homeless and workforce)  The Domenech (Brownsville, Brooklyn) 72 units for formerly homeless or low income elderly*  The Hegeman (Brownsville, Brooklyn) 161 studio units for formerly homeless and workforce*  The Hollander (Hartford, CT) 54 1 bedroom and 16 two-bedroom units for formerly homeless or very low income (70% of units) and market rate (30% of units) households  Cedarwoods (Willimantic, CT) 60 one-bedroom and studio units for formerly homeless and workforce*  Eastman Commons (Rochester, NY) 80 one-bedroom and studio units for formerly homeless and workforce*  Scatter Site Program (Manhattan, Brooklyn, the Bronx) 120 leased apartments for formerly homeless under our management

In retrospect, it is remarkable that The Times Square Hotel was not just a “one-hit-wonder”. Rosanne would later reflect on these pioneering times: “The origins of Common Ground were not ‘I want to create an organization that solves homelessness’. It was more like ‘Somebody should save that building.’ I had to create an organization to make an idea happen. I didn’t begin with the ambition to create an organization, to lead an organization.”126 But early advisors of Common Ground including Lola Finkelstein and Paul Crotty pushed her to keep going. Rosanne also felt she needed to silence voices that

125 Information provided by Rosanne Haggerty in May 2020. 126 Rosanne Haggerty interview, 18MAY20.

36 called the Times Square Hotel a “fluke”, the result of an artificial and highly idiosyncratic constellation of factors. “And I said ‘No, no. It’s actually a model.’ So let us demonstrate it again.”127 Rosanne was also aware of the symbolic nature of taking on buildings such as the Prince George hotel, that together with The Martinique and The Holland represented the degrading, humiliating, and inefficient processes of the city’s welfare system dealing with the problems and needs of homeless people.128 After restoring the Prince George’s 5,000 square-foot ballroom and the adjacent former Hunt Room, its Beaux Arts lobby and two outdoor patio-gardens, the first tenants moved into the Prince George in October of 1999. Common Ground Community’s achievements did not go unnoticed. The organization and Rosanne gathered national attention and were portrayed in the popular CBS 60 Minutes TV show. CBS ran a 14- minutes feature in August 1997 with the title “Miracle on 43rd Street”, and a follow up 13-minute feature during Christmas season in December 1999. CBS prominently identified Rosanne for creating this “miracle”.

Inspired by the collaboration with Common Ground Community, CUCS also added a development component to its social services focus. One observer from that time remembered that politicians and journalists who were covering the emerging supportive housing scene would emphasize the “sexy” real estate deals and leave out sufficient attention to the service provider dimension. But the innovative service component developed by CUCS was of crucial importance to the effectiveness of the supportive housing model, as Tony Hannigan explained:

It wasn’t simply a matter of “do” the services. Targeting housing to homeless individuals, particularly those with mental illness, is a defining feature of supportive housing, and the services are what distinguishes it as “supportive” and differentiates it in community mental health services and the marketplace. CUCS introduced a concept of services at the Heights and then expanded it at the Times Square Hotel. For instance, support services were not a requirement of tenancy and were to be offered as voluntary options, no matter the level of an individual tenant’s disability. Support services required a very different perspective and methods than most practitioners were accustomed. It also influenced the emphasis on non-clinical amenities recommended for the Times Square Hotel, such as a physical fitness gym, sewing room, photography dark-room, allowing pets, all of which happened. It was figuring out how to design supportive services of this nature at this scale so as to be attractive to tenants. Details as seemingly simple as how/where to place a staff of 30+ to accomplish a non-institutional setting needed to be considered in the building design and planning. I also worked extensively with Rosanne Haggerty presenting the integrity of the design and model to city government and meeting with the existing residents. Both were initially very reluctant to buy in. That we had the fundamentals of a “model” that could be described, had some track record, and was clearly progressive and meant to be inclusive and person-centered was significant. It was a completely new approach which influenced and shaped supportive housing for funders and the field going forward.129

The difference to Rosanne’s model was that CUCS also extended supportive housing to families, particularly single parent households where the parent might have suffered from a mental illness.

127 Ibid. 128 Kozol, J. (1988) 129 Tony Hannigan, text note to the author, 15DEC20.

37 Another distinction was the separation between services and real-estate management as – according to Hannigan - an effort to “normalize” homelessness “to make it follow the contours of how everybody else lived. Typically, your landlord is not your social worker.”

38 The 2000s – From housing the homeless to housing people The new decade started with a flurry of new initiatives towards ending homelessness. In 2000, the National Alliance to End Homelessness (NAEH) released their blueprint for progress: “A Plan Not A Dream: How to End Homelessness in Ten Years”130. NAEH argued that ending homelessness in 10 years’ time will require efforts around four main pillars:

 Plan for Outcomes - NAEH proposes a shift from merely managing homelessness to setting and achieving the objective of ending homelessness. Localities are expected to collect data as a basis for identifying effective strategies for different segments of a heterogenous population of homeless.  Close the Front Door – NAEH proposes to create incentives for systems upstream of homelessness to cater to the needs of troubled people rather than shifting the costs and burden to the homeless assistance system. These upstream systems include the mental health system, the public health system, the welfare system, the veterans system, as well as the criminal justice and the child protective service systems. The focus is on effective action that prevents homelessness.  Open the Back Door – NAEH proposes to radically shorten the time that people spend in homeless systems such as shelters or transitional housing. Achieving this will require a Housing First approach for the majority of homeless people and a permanent supportive housing approach for the chronic homeless.  Build the Infrastructure – NAEH proposes long-term efforts towards changing systemic problems that lead to and exacerbate homelessness. These efforts would include a focus on increasing the supply of affordable housing; considering the dilemma of incomes that are insufficient to satisfy people’s basic needs; and provision of effective and accessible services for the poorest.

One year later, in the fall of 2001, the U.S Department of Housing and Urban Development (HUD) announced the following news: “President Bush and Housing and Urban Development Secretary Mel Martinez today announced more than $1 billion in grants to provide housing and supportive services to hundreds of thousands of homeless families and individuals across America. The announcement represents the largest amount of homeless assistance in history.”131 HUD also announced that “More than 2,500 individual projects, over 90 percent of which are administered by non-profit organizations, will receive Continuum of Care funding and will assist more than 200,000 families and individuals to find housing and supportive services they need to move toward the goal of self-sufficiency. More than 1,300 projects will serve homeless veterans. In addition, more than 400 projects, awarded a total of $133 million, will be operated by faith-based organizations.” This new scheme provided two types of funding. Most of the funds were for Continuum of Care grants and supportive services and the remaining funds helped convert buildings into homeless shelters. The spirit of of the NAEH’s 10-year plan ambition was also adopted at the federal level: In 2002, as part of his fiscal year 2003 budget, President George W. Bush officially endorsed ending chronic homelessness in 10 years’ time as a goal of his Administration.

130 A Plan Not A Dream: How to End Homelessness in Ten Years. National Alliance to End Homelessness (2000). 131 HUD Archives: News Releases, 20NOV01, accessed on 10OCT20 at: https://archives.hud.gov/news/2001/pr01- 998.cfm.

39 However, there seemed to be disagreements about the appropriateness and effectiveness of this strategy. Some accused the administration’s focus on chronic homelessness as an effort to appeal to conservatives by emphasizing the aspect of cost savings and the political goals of getting the most visible instances of homelessness out of sight of the public. A CNN article from January 2003 illustrates both arguments. The article claims that the issue of cost savings derives from a 1998 research study that was popularized by its implied finding that only 10% of the homeless population were chronic homeless but that this segment consumed 50% of available homeless services resources.132 The CNN article cites Susan Baker, the wife of former chief of staff to Ronald Reagan and Secretary of State to President Bush senior, and the co-chairwoman of the National Alliance to End Homelessness who was also inspired by the 1998 study: “Three weeks after Bush named Mel Martinez his HUD Secretary, Baker landed a meeting with him. She sold him Culhane's research, arguing that with just 200,000 apartments, the Administration could end chronic homelessness in 10 years. The meeting went so well that the plan became Bush's official stance on homelessness: the 2003 budget has four paragraphs promising to end chronic homelessness in a decade.”133. But others disagreed with this focus: "’The largest-growing sector is actually women and children,’ says Donald Whitehead, the executive director of the National Coalition for the Homeless, the oldest and largest advocacy group on this issue. ‘A true strategy needs to include the entire population’. Andrew Cuomo, founder of HELP USA, a national, nonprofit shelter provider, says the Administration is merely redefining the issue so as to appear to be doing something. ‘What makes you say that a guy who has been on the street for five years and is a heroin addict is any more needy than a woman who is being beaten nightly in front of her children?’ he asks.”134

Bush’s endorsement of the goal of ending homelessness within a decade also revitalized the starved Interagency Council on the Homeless (ICH) that had not received any direct funding since 1994 under President Clinton. Under Clinton, ICH’s name was changed to United States Interagency Council on Homelessness (USICH) with the mandate to coordinate the federal departments’ and agencies’ responses to homelessness.135 Philip Mangano became the new head of USICH. Mangano had previously indicated that he favored the Housing First approach over the linear Continuum of Care programs: "’There's no absolute promise that if you move through [the programs' requirements], you'll get housing,’ says Philip Mangano, executive director of the Interagency Homeless Council on the White House Domestic Policy Council. ‘You can do all the right things, make the right promises, perform well in the program. The promise of that is housing, and the difficulty is, there's a shortage. The housing-first strategy’, he continues, ‘puts the emphasis on the appropriate antidote to homelessness - housing. And that housing becomes the nexus point for the delivery of social services.’"136

132 Kuhn R, Culhane DP. Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. Am J Community Psychol. 1998;26(2):207–232. 133 Stein, J. (2003) The real face of homelessness. The New York Times, 13JAN03. 134 Ibid 135 USICH. United States Interagency Council on Homelessness Historical Overview, accessed at: https://www.usich.gov/resources/uploads/asset_library/USICH_History_final.pdf 136 McCarroll, C. (2002) Pathways to housing the homeless. The Christian Science Monitor, 01MAY02.

40 Limitations of the supported housing model Meanwhile, Rosanne Haggerty’s experiences and reflections during the late 1990s, had evolved into a critical evaluation of important limitations of Common Ground’s model. A critical trigger for this reflective process was an encounter by Rosanne with a woman who had been homeless on the streets at Times Square for a long time.

She wanted to move into The Times Square, and I discovered in this exchange that there was absolutely no way for a person who was living on the street to move into our buildings. It was the beginning of a self – examination around, ‘What do I even understand about this issue anyway? I understand how to build housing. Do I understand the dynamics of this issue and why all these parts are so disconnected?’ I started looking at our intake policy and how it had come about, and realized it was very much designed for the ease of operations of our buildings, not to reach those who needed our help the most. That our practices were the same as those of other not for profit housing groups was equally troubling. I started wrestling with ‘What do I do about all this?’ - this awakening to the fact that we were part of the problem and that I knew so much less than I thought I knew.137

Significant funds for Common Ground’s model were provided by the New York City’s Department of Housing Preservation and Development. These funds required that residents had to be officially approved by the City. Eligibility criteria for city-sponsored permanent supportive housing such as sobriety, stability, certified medical compliance effectively “screened out many of the most vulnerable people experiencing homelessness”138. Rosanne sent out teams to speak to every single homeless in Times Square and to find out why they were not housed but instead continued living on the street. “And it just reinforced this sense that it was actually those of us in the sector not having a clue about what it took, how people's lives had gotten trapped there. I kept accumulating more information that was more and more damning.”139 Rosanne admits that it took a few years before she realized a fundamental problem: The Times Square and other city-sponsored permanent-supportive housing buildings counterintuitively contributed to the persistence of street homelessness. Starting with “The Andrews” hotel, Common Ground eventually removed these stifling eligibility criteria for all its buildings and became philosophically ‘Housing First’. “This adoption of ‘Housing First’ as an operating philosophy represented a complete inversion of our prior thinking: We went out looking for those who in the past our criteria would have judged ‘least likely to succeed’ as tenants. And we prioritized those individuals for our vacancies and new buildings.”140 And this principle defined Rosanne’s work in subsequent decades.

Rosanne reasoned that perhaps part of the problem of street homelessness lay also in the narrow housing choices and building designs they had offered until then. She searched for inspiration and real innovations in housing within and outside the US. Particularly Japan, with its history of interesting designs around limited space and modular constructions got Rosanne interested. A Japan Society Local Government and Public Policy fellowship in 2000 allowed her to spend time in Japan and to witness the emerging homeless problem there. Rosanne shared that seeing this issue in a different cultural and

137 Rosanne Haggerty interview, 18MAY20. 138 Ibid. 139 Ibid. 140 Ibid.

41 political context with fresh eyes was transformational to her own journey. “By the time I left there, I was in tears a lot. I had been taken to shelters there, gone on overnight outreach with some Jesuit seminarians that somehow I got connected with. And I saw the crazy ways communities responded to homelessness as if for the first time. I was constantly asking, ‘Why is that policy in place? Why do you not just do that? Why is that not possible?’ All of the things that were so plain for me to ask in this other cultural context were exactly the questions that I needed to come back and ask in New York.”141

Rosanne returned from Japan and brought these questions to Common Ground, which by then was a sizable organization with about 150 staff. She questioned whether Common Ground’s mission needed to evolve from addressing homelessness to ending homelessness, a question that Rosanne remembers as “terrifying” but fundamental. In 2001, Rosanne received a very prestigious MacArthur Foundation fellowship: “Awarding unrestricted fellowships to talented individuals who have shown extraordinary originality and dedication in their creative pursuits and a marked capacity for self-direction.”142 The fellowship provided Rosanne with annual funds of 100k USD over five years. Over the next 18 months, Rosanne reached out to other organizations working on homelessness in to explore her new sense of mission of ending homelessness. She also wanted to develop a more collaborative working model. But her ideas were mostly met with resistance and a lack of motivation to thinking and acting differently. Rosanne felt she would need to lead the exploration of this new vision and new way of working herself. To move the organization in a new direction, Rosanne set up an innovation unit. “I do not know if I was totally honest with myself at the time, but from the beginning of getting that new innovations unit started, that was really where my energy was coming from. Not from another tax credit deal.” 143

From Common Ground to Community Solutions In 1998, Common Ground’s mission statement was: “Common Ground addresses homelessness and joblessness through the creation of innovative programs designed to promote stability and independence for the individuals it serves while strengthening local communities”144. In 2000, the mission statement had changed to: “Common Ground works to end homelessness through the creation of innovative programs designed to promote stability and independence for the individuals it serves.” A more radical change of its mission statement was announced in 2003: “We are solving homelessness through innovative programs that transform people, buildings and communities.” And in 2008, the mission statement read: “Our mission is to end homelessness.”

The Foyer Model In the early 2000s, the topic of prevention became an important element for Rosanne. “After we found the Foyer model in and visited programs in and around London and Northern , we realized that groups like Common Ground have to look at prevention issues. There’s a high correspondence

141 Ibid. 142 https://www.macfound.org/programs/fellows/strategy/ 143 Ibid. 144 These mission statements were copied from Common Ground’s website at different timepoints accessed on the Waybackmachine Internet Archive.

42 between single adult homeless people [and] those who had been in foster care.”145 However, there were no dedicated funds available for this segment of homeless people which limited effective action. In 2004, Common Ground started its own Foyer program the “Chelsea Foyer” at its Christopher Residence in collaboration with the Good Shepherd Services (GSS), an NGO addressing the needs of New York City’s youth and families. The problem that Common Ground intended to address resulted from the annual discharge of 1,200 young people ages 18 and older from the New York City foster care system. Only 20% of them were discharged to the care of a family member or other adult. The other 80% were required to take care of themselves and manage their housing, education, employment, and health needs. More than 25% of the homeless in New York City shelters were graduates of foster care.146 In 2000, Rosanne, together with the CEO of GSS, representatives of the Administration for Children’s Services, Department of Homeless Services, Housing Preservation and Development, Corporation for Supportive Housing, and the Mayor’s Office of Management and Budget visited Ireland and to study the British Foyer model.147 The authors of the 2009 report described the program philosophy:

Chelsea Foyer was launched with the belief that no young person is ready to be fully independent at 18, and young people with no adult support have vastly diminished chances for sustaining stable housing and financial independence. […] At the Chelsea Foyer, these young people have the opportunity to practice living on their own – learning to take care of themselves and developing the skills to become fully self- sufficient. They live in a community of peers. They see each other go to school and to work. They share successes, suffer setbacks and learn to stay on track. Community living is a hallmarks of the U.K. Foyer model, which emphasizes a mixture of low-, medium- and high- needs residents in community. Program requirements are rigorous: Chelsea Foyer residents must be employed at least 20 hours a week, be in school or vocational training, meet with case mangers twice a month, participate in community life-skills development workshops and pay a monthly ‘program fee’ roughly equivalent to 30 percent of their income. Upon leaving the Foyer, they are expected to have secured stable housing and be employed to meet their financial needs and avoid reliance on public assistance.148

The report pointed out how Common Ground’s Christopher Residence had pioneered the first supportive housing project in New York City for young adults and helped draw attention to the link between foster care and homelessness. On its website, the organization reported a growing level of national interest in its Foyer model as well as interest by several organizations within and outside of New York City. Common Ground decided to expand the program’s capacity by developing a 54-unit Foyer program in its Lee Residence. “The Foyer units at the Lee will help the City meet its goal of creating an additional 200 supportive housing units for young adults by 2015.”149

145 Shelterforce Staff (2002) Common Ground: an interview with Rosanne Haggerty of Common Ground Community. 01SEP02, accessed on 01JUL20 at: https://shelterforce.org/2002/09/01/common-ground-an- interview-with-rosanne-haggerty-of-common-ground-commnity/; Note: the original quote was slightly changed as requested by Rosanne Haggerty to correct a misleading statement. 146 Information provided by Common Ground’s website on the Waybackmachine Internet Archive. 147 The Chelsea Foyer at Five Years: Lessons in Developing Stable Housing and Self-Sufficiency For Homeless Youth and Youth Exiting Foster Care. Community Ground and Good Shepherd Services, Oct 2009. 148 Ibid., p.2-3. 149 Information provided by Common Ground’s website on the Waybackmachine Internet Archive.

43 A system perspective on solutions Managing and trying to influence the mainstream part of her organization became more and more of a burden to Rosanne. Her ideas about a new direction were still taking shape: “You have probably gotten the picture that we tend to begin working on a problem and then figure out what the work is that we are supposed to be doing.”150 Sometime in 2003, around the time when she started the innovation unit, her questions about ways to build collaborative solutions to homelessness led a mutual funder to introduce her to Dr. Donald Berwick, President and CEO of the Institute of Healthcare Improvement. Berwick is credited (together with at least two other systems thinkers) with a fundamental insight about systems: “Every system is perfectly designed to get the results it gets. If we want better outcomes, we must change something in the system. To do this we need to understand our systems”151. This perspective emphasized the design and configuration of various parts of a health system as the determinant of overall performance. Increasing the performance of a system therefore required the redesign of the whole system. Performance may not improve by maximizing the performance of parts in the system for example by pushing people to work harder or merely attracting more funds. Overall performance requires an understanding and finetuning of how all the parts work together rather than optimizing any single part. Systems thinkers in Berwick’s words do not “ask people to be superhuman; they accept people for their humanness and help them avoid error.”152 But he made it also clear that existing systems put up powerful barriers to change. Berwick saw in the Institute of Healthcare Improvement’s change model a real opportunity for improving a systems’ performance. This opportunity relied on a successful coupling of the change model with strong and committed leadership. Berwick’s approach to improving healthcare systems became a defining inspiration for Rosanne’s work. “It was very exciting to discover that there was a whole language and practice around how you improve systems.” […] We started thinking and mapping, ‘What is the system driving homelessness here in New York City?’ And also looking and meeting with people experiencing homelessness. A couple of times I just went and stood in line outside of the family shelter admissions up in the Bronx to ask families why they were there, what had happened.”153 The information that Rosanne gathered expanded her understanding of homelessness as a social problem. “I found that , and by extension individual homelessness, in New York is very much a product of certain neighborhoods; they are racially segregated; they are the lowest opportunity neighborhoods in the city. Homelessness is not a random event. So, I started, probably well before we were ready, thinking: ‘How do you start on the other side of this?’ And to start thinking about prevention; even as the team Becky [Becky Kanis, Director of the “Street to Home” initiative, see below] was leading was thinking and experimenting around ‘How do you get people out of homelessness more systematically once they experience it?’”154

This deep engagement with systemic aspects of homelessness started a process of emotional separation from Common Ground. Rosanne felt that the core permanent supportive housing development activities of the organization could well continue without her. Around 2007, Rosanne asked her board to look for

150 Rosanne Haggerty interview, 18MAY20. 151 What is systems thinking? West of England Academic Health Science Network, accessed on 01JUL20 at: https://www.weahsn.net/toolkits-and-resources/quality-improvement-tools-2/more-quality-improvement- tools/what-is-systems-thinking/. 152 Donahue, C. (2015) Learning from Healthcare’s Use of Improvement Science. Carnegie Foundation, 17APR15, accessed at: https://www.carnegiefoundation.org/blog/learning-from-healthcares-use-of-improvement-science/. 153 Rosanne Haggerty interview, 18MAY20. 154 Ibid.

44 a replacement and to allow her to focus exclusively on the innovations unit. Many factors, not least the economic meltdown in 2008, finally led to a separation of the two organizations into independent bodies. Common Ground continued its legacy work as “”, an organization that was still actively developing projects at the time of writing this case (2020). Rosanne remained at Common Ground, focused on the innovations group and its growing national presence, until 2011 when the group became a separate not for profit, Community Solutions. Due to internal sensitivities and issues around board confidentiality, this account of developments fails to capture the tensions, angst, and emotional trauma involved which Rosanne succinctly characterized as: “It was a divorce.”155 And it was probably a very lonely divorce, as Rosanne – according to observers from that time - went out of her way to shield her team form that process. This episode may also demonstrate some of Rosanne’s traits as a leader. One observer remarked: “Rosanne is, sort of, inherently disruptive and rebellious and anti-structure. She wants structure if it will execute what she wants to be done in the world, but she doesn’t want structure if it will clip her wings.” And far from being a weakness this trait may have been a fundamental strength as one of her team members from that time remarked: “I think the question is: ‘How do you set up a structure where the lights are on, the bills get paid, the people are happy but what you are doing is revolutionary and disruptive collectively.’ It takes a certain temperament to be able to make that work but that is who Roseanne is in her DNA and that is what the world needs from her.”

Street to Home - Rethinking taken for granted explanations of street homelessness Despite all the efforts around scaling up permanent supportive housing models during the 1990s and early 2000s, Rosanne felt frustrated walking past homeless people on the streets on route to her office at Times Square. Her anecdotal observations were unfortunately supported by devastating numbers of the dynamics of the homeless situation in the early 2000s. According to the State of the Homeless, 2003 report by the Coalition for the Homeless: “From January 2002 to January 2003, the number of homeless adults and children sleeping in New York City shelters rose by 7,399 persons, a 24 percent increase, from 31,064 to 38,463 people per night. This represents the largest one-year increase in homelessness since the Great Depression, and surpasses last year’s one-year increase of 5,534 people. The number of homeless New Yorkers sleeping in shelters is at all-time record levels, and is expected to continue rising.”156 The report also indicated one crucial driver of homelessness: Between 1990 and 2000, the numbers of affordable apartments in New York City with monthly gross rents below USD 500.- had fallen by more than 50%, amounting to 517,000 fewer apartments available within one decade. Socio- economic and political changes in the larger social and market systems kept recreating and reinforcing the very same problems that homelessness activists were trying to solve.

Homelessness remained a puzzling and stubbornly robust social problem. Already in 2003, Common Ground had started filling a knowledge vacuum around the question: Why do people become homeless and then remain living on the streets outside of the public homeless services system? The taken for granted assumption in policy and service circles was that some homeless people were “service resistant” and that there was little one can do. After all, as long as people do not directly create harm for others, they cannot be forced to accept help. Rosanne decided to get closer to the problem and to design an aggressive and novel approach: “We’re going to count and document who’s homeless. We’re going to

155 Ibid. 156 State of the Homeless 2003 (2004) Coalition for the Homeless, accessed on 05JUL20 at: https://www.coalitionforthehomeless.org/wp-content/uploads/2014/06/SOTH2003.pdf.

45 establish a target for reducing that number. We’re going to organize all of the existing service providers to work together in a more focused way without overlapping resources. And we’re going to start with a case-management philosophy: What’s it going to take to get each one of these people who’s now homeless into some type of stable accommodation?”157

The Rough Sleepers Unit (UK) Rosanne was inspired by UK’s Prime Minister Tony Blair’s announcement in 1999 to reduce the number of “rough sleepers”, people sleeping on the streets, by two-thirds in three years. Blair said: “On the eve of the 21st century it's a scandal that there are still people sleeping rough on our streets. This is not a situation we can continue to tolerate in a modern and civilised society.”158 In 1999, Blair had established and tasked a Rough Sleepers Unit (RSU) to achieve this goal and Louise Casey was appointed to lead the effort. Casey who had previously been the deputy director of Shelter, a UK charity and a large campaigning organization working on homelessness, later remarked that the problem of homelessness for many working in the sector “had epitomized all that was wrong; it represented selfishness, and it represented an uncaring, uncivilized society.”159 RSU focused on street homelessness and was built on the learnings of an earlier initiative, the Rough Sleepers Initiative that ran from 1990 to 1997. That earlier initiative had operated as a series of multi-stakeholder programs in London exploring various aspects of homelessness. Central to the initiative were outreach teams who identified rough sleepers and linked them to emergency housing, hospitals, and clinics160. In 1997, a Social Exclusion Unit was set up situated within Blair’s Cabinet Office and homelessness was one of its four key themes. In 1999, the government published the learnings from the seven-year Rough Sleepers Initiative in a report, “Coming in from the Cold”. That report’s recommendations were adopted by the RSU. Casey reflected on some of the problems with earlier efforts: “The government had left it to the charities to define the whole problem, to define it, to dissolve it, and then to decide whether it had worked.”161 Casey pointed out that most of the focus of the significant monetary investment had been directed at process issues: “How many people you had met; how many people you had fed; how many people have been assessed?”162 Casey argued that this process focus failed to engage individuals as human beings and to understand what would get them off the street safely and permanently. In her keynote, Casey also shared an important lesson from her time at Shelter. Because people were passionate about ending homelessness, they exaggerated the number of homeless people by including anyone who could even remotely be counted within that category. As a result, the organization’s claims were dismissed because nobody believed their numbers. Casey pointed out another weakness of Shelter’s strategy of emphasizing that “Anybody could become homeless! Anyone! It can happen to you! And everybody therefore needed help.”163 Shelter was accused that “we were not judgmental enough who we were actually trying to help”. The RSU thus operated from the principle of owning both the problem and the solution. An important challenge for the effort was to break the prevailing culture of framing homelessness as a fact

157 Sittenfeld, C. (2002) What would it take to end homelessness? Fast Company, 31DEC 02. 158 Blair pledge to reduce rough sleeping, BBC News, 14DEC99, accessed on 05JUL20 at: http://news.bbc.co.uk/2/hi/uk_news/politics/565001.stm 159 Casey, L. (2013) Canadian Alliance to end Homelessness, National conference, 27NOV13. 160 Randall, G. and Brown, S. (2002) Helping Rough Sleepers Off the Streets. London, UK: Office of the Deputy Prime Minister. 161 Casey, L. (2013) 162 Ibid. 163 Ibid.

46 of life and that homelessness could never be solved. “We were never ever going to take ‘No’ for an answer. This was a first and a brave decision. We looked quickly at data and information about who was actually on the streets; real information, real people.”164 By counting those who they found on the streets between midnight and 5am and by getting names and engaging with homeless people directly, they established a concrete target population and a deeper understanding of individual needs that helped focus the various efforts. Casey felt that the street counts of names, places, faces, and individual stories were a powerful tool that provided legitimacy in engaging with other charities. “We wanted to get the bosses out on the streets. We wanted to get the people at the top of these organizations to reconnect with what it was that they were all about.”165 Casey also shared that they were targeting “the most difficult, the most vulnerable, and the people everybody said wouldn’t come in. We did not go for the easy. We went for the difficult. […] Psychiatrists had to leave their hospitals, their consulting rooms, and their couches and they had to go on to the street. Not to shop, but to perhaps do an assessment of a homeless person, if you are not too busy. You can see how popular I was.” Casey felt that orchestrating a system of efforts around the homeless individuals wherever they were was perceived as liberating by many charities who had wanted to do something like this before. Charities now felt empowered to structure efforts around priorities rather than helping everyone and thus no one. In this new mode of operation, a system of supporters was able to work towards a concrete target. Casey and her team also sent a strong public message: They were prepared to do whatever it takes and to go out of their way to help a vulnerable homeless person, once identified! These principles underlying the RSU’s work radically changed the culture of homelessness service provision and reestablished the idea that a collective could solve homelessness. The RSU successfully enacted Blair’s ambition of reducing rough sleeping by two-thirds even earlier than intended. Rough sleeping remained at a relatively stable low level for the rest of the decade until numbers started rising dramatically around 2010.166

Street to Home Initiative Rosanne visited the UK initiatives and kept in regular contact with Louise Casey. The RSU inspired the principles and ambitions of her new Street to Home initiative. In 2001, Rosanne began convening organizations working in Times Square to introduce them to the RSU approach and to seed the idea of working collaboratively to reduce street homelessness in Times Square. Within 18 months it was clear that the effort needed a full- time director, who could bring a similar determination and resourcefulness to the work that Rosanne had found in Louise Casey’s team. In early 2003, Rosanne hired Becky Kanis, a West Point graduate and former army officer and tasked her to reduce homelessness in West-Midtown by two-thirds in three years time. “She, for whatever reason, thought that someone with a military background would be a good fit for the job. No idea why she thought that. […] I knew nothing about street homelessness. My preconceived notions were like, ‘We are going to help them get jobs, that’s what we need to do to resolve their homelessness’. I was that clueless.”167 With the very lean support of a 75k USD grant from JP Morgan Chase, Becky built a team of three to get started in New York City. Rosanne sent Becky to London for a week’s immersion with the RSU team and the charge to adapt their principles to Times Square. Becky remembered a conversation during a late-night work session with

164 Ibid. 165 Ibid. 166 Sasse, T. (2018) Extra money alone will not tackle rough sleeping, Institute for Government, 09OCT18. 167 Becky Margiotta (Kanis) (2017) 100k Homes case study mapped to the model for unleashing. The Billions Institute (Video recording)

47 Nicky, an advisor to Common Ground. “About two or three months into the job, I said to Nicky: ‘You know, I think two more conversations with Rosanne and I am going to know what I need to do to solve street homelessness.’ My mental model was that Rosanne knows what I need to do, she just has not got around to telling me all of it, yet. And Nicky said: ‘Oh honey, that is why she hired you, to figure it out’. I was like ‘What?’ But what Rosanne did know how to do was how to wind someone up and set them loose.”168

Mid-Town Manhattan turned out to be a complex and challenging space with around 400 street homeless people on any given night. Becky recalled around 30 other non-profits working with a homeless mandate and little motivation to collaborate. “Rosanne just threw us into that, it was like throwing us to the wolves. Her theory of change was that we could just knit together these disparate efforts. And if people could coordinate their efforts that would somehow result in housing and lower street homelessness by two-thirds in three years, just like in England.”169 Becky also shared that “six months later no one was interested in being knitted together and certainly not by me.” Becky felt that no one was excited about her military background. Only the police, the business improvement district, and the had an interest to engage. Two interns in Becky’s team interviewed street homeless people about their needs and what they most desired. Housing came up most frequently. For Becky who was desperate for answers this insight created a dilemma. Common Ground had plenty of housing but the selection process would exclude the very people that she was expected to get off the streets. She was inspired about Sam Tsemberis’ approach to “Housing First” and pitched this idea to Rosanne, who got the property management staff and social services team from CUCS on board. Becky was permitted to move 10 people in Common Ground apartments as an experiment. “And it worked. We now knew that you can move someone straight off the streets into housing - which is what they wanted and we knew that from asking them - without having to go through the shelter system. They didn’t want the shelter system.” A new initiative was born, and the team named it the Street to Home initiative (S2Hi).

During summer and fall of 2003, Becky’s team went out for several weeks at 5am every day to map street homeless people in West-Midtown (see Figure 1).

168 Interview with Becky Kanis, now Becky Margiotta, May 2020. 169 Becky Margiotta (Kanis) (2017)

48 Figure 1. Location of street homeless people identified by the S2Hi team in Sep 2003.170

The team concluded that Mid-Town as an area was too large and thus decided to focus on the 55th street homeless people in Times Square (Figure 2).

Figure 2. Location of target street homeless people identified by the S2Hi team in 2003 and 2008171.

By now, S2Hi had successfully developed a reputation of being able to house people and thus received more cooperation from other NGOs and partners in this effort (see Figure 3).

170 accessed on 05SEP20 at: http://www.commonground.org/s2hi/map.pdf on the Waybackmachine Internet Archive. 171 Screenshots from a recording of a presentation by Becky Margiotta (Kanis) in 2017.

49 Figure 3. Street to Home Initiative Collaborating Partners as of November 18, 2003.172

By 2008, only one homeless person was left in Times Square. A New York Times article published a whole story on him: “His name is Heavy, and he has lived on the streets of Times Square for decades. Day after day, he has politely declined offers of housing, explaining that he is a protector of the neighborhood and cannot possibly leave, the workers who visit him every day said.”173 The intention of the daily visits were not to pressure him to accept housing. Heavy’s cognitive impairment made rational conversations futile. But the workers were patiently waiting for a moment when Heavy would threaten direct harm on himself or others. In such an event, the teams could bring him into a hospital for treatment of his mental condition. Eventually, Heavy was hospitalized and – according to Becky’s recollections – with the help of psychiatric medicines he recovered after several days saying: “Hey what took you so long?” He was completely lucid and unwilling to go back to the streets. “So, I knew in my bones that there was nobody that could not be housed”, Becky said.

Over the years, the S2Hi team accumulated important knowledge and nurtured sources of influence in three areas:

172 accessed on 10SEP20 at: http://www.commonground.org/s2hi/buy-in matrix.asp on the Waybackmachine Internet Archive. 173 Bosman, J. (2010) Times Square’s Homeless Holdout, Not Budging. The New York Times, 29MAR10.

50 1. A sophisticated understanding of the problem space of homelessness and how street homeless people problematized the situation they found themselves in. 2. Development of methodological and operational competencies and principles as a basis for effective interventions and scaling efforts. 3. Reputational and relational assets that enabled influencing the policy process by shifting mindsets and attitudes of decision makers.

The Problem Space of Homelessness Far from being simply service resistant – with rare exceptions such as “Heavy” – street homeless people rationalized their decisions to refuse accessing and collaborating with the official homeless service and support system. On the one hand, homeless people encountered numerable obstacles to engaging with the system. These included174:

 bureaucratic requirements and the rationing of limited resources by human service workers  lack of knowledge about where to go for help  previous denial of services  encounters with unsympathetic staff  the waiting, confusion, and aggravation associated with applying for services and entitlements

On the other hand, screening processes under the official Continuum of Care or staircase models required tough measures to eventually arrive at a state of “housing readiness”. These included mental health or substance abuse treatments made available after homeless individuals had been placed in transitional facilities. Housing readiness required a certification of demonstrated sobriety and psychiatric stability. For many homeless, these requirements constituted hurdles that were seemingly impossible to overcome.

Methodological and Operational Competencies and Principles Research on S2Hi summarized the key components of the program as follows: 175

 To establish a registry of street homeless in a targeted geographic area  To use a caseload approach in which individual outreach workers are responsible for consistently approaching particular individuals on the registry  To bypass shelters or drop-in centers and place people directly into transitional or permanent housing  To not require clients to demonstrate sobriety and/or psychiatric stability or adherence to psychiatric treatment prior to being placed into housing.

The latter component strongly deviated from the prevailing federal principle of the Continuum of Care (CoC) approach. But during the final years of Mayor Giuliani, the CoC principles displayed important cracks. Thomas Main in his history of homelessness policymaking called the CoC principle a paternalistic

174 Jost, J.J., Levitt. A.J., Porcu, L. (2010) Street to Home. The Experiences of Long-term Unsheltered Homeless Individuals in an Outreach and Housing Placement Program. Qual Soc Work 10(2), 244-263. 175 Ibid.

51 quid-pro quo of housing in return for compliance: “It was then that DHS [Department of Homeless Services] executives began to notice that substantial numbers of shelter clients refused to take up the paternalistic deal offered by the then newly developed program shelters: admission to a better-quality shelter in return for participation in a rehabilitative regime. That deal was also being offered to street dwellers, to whom outreach teams would offer access to permanent, supported housing, but only if they demonstrated themselves to be housing ready by abstaining from substance abuse, participating in psychiatric treatment, and in general behaving themselves. A frustratingly high number of street dwellers declined this deal, making inroads against public homelessness hard to achieve.”176

The decision by S2Hi to hire people who had not been socialized by prior work in the homeless services system may have helped to approach the situation with fresh eyes. In contrast to the federal paternalistic attitude, the S2Hi team treated the homeless as individuals who had a name, a face, a history, and a future. The team tried hard to register and approach every homeless person by full name and taking a picture of the person so that others could also identify her. One creative use of this procedure was to take pictures, with their permission, of homeless people before- and after housing. The transformation of formerly street homeless individuals after even a few months of housing and having received social support services was strikingly visible in these contrasting pictures. These vivid demonstrations of success became important communication tools for S2Hi.

The Vulnerability Index An important innovation was the focus on those homeless individuals who had been on the street the longest. These individuals often were amongst the most vulnerable and had the highest mortality risk due to untreated diseases or mental instability. Prioritizing them was important for several reasons. One reason was economic. Housing was always a scarce resource. The prioritization criteria enabled tough decisions about who would receive access to scarce resources. Having transparent and legitimate criteria was better than merely basing decisions on empathy. Prior research had already established that a small percentage of the most vulnerable homeless people consumed an unproportionally high percentage of service system resources. Transforming them into less vulnerable constituents through a Housing First approach was expected to be economically efficient. But emotional reasons may also have played a role. It was deeply disturbing and frustrating to see so many homeless people die before someone had a chance to help them. “You can comfortably walk past a nameless guy in Harlem, but once you know it’s Ed, a Vietnam vet with cancer, you can’t be comfortable anymore,” said Rosanne.177 And there may have been a strategic reason as well. Proving that even the hardest “cases” could be treated effectively, would have important symbolic value for eliciting the support of policy makers and implementors.

To structure this focus, the S2Hi team developed a Vulnerability Index for engaging with people who had been homeless for more than six months. The index was grounded in research into the specific health conditions that increased the mortality risk of homeless individuals by Dr. Jim O’Connell and Boston’s

176 Main, T.J. (2016) Homelessness in New York City. Policymaking from Koch to de Blasio. New York University Press, NY, p. 206. 177 Yu, H. and Kanis, B. (2015) Case 10: Finding Community Solutions from Common Ground: A New Model to End Homelessness. In: Hitt, M., Ireland, D., Hoskisson, R.E. eds. Strategic Management, South Western Cengage Learning, Mason, OH.

52 Healthcare for the Homeless organization. The Vulnerability Index ranked homeless individuals by mortality risk according to whether one or more of the following markers applied to them178:

1) more than three hospitalizations or emergency room visits in a year 2) more than three emergency room visits in the previous three months 3) aged 60 or older 4) cirrhosis of the liver 5) end-stage renal disease 6) history of frostbite, immersion foot, or hypothermia 7) HIV+/AIDS 8) tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical condition

S2Hi now registered specific, self-reported health information in addition to the names and pictures of homeless individuals. This registry coordinated the efforts of many service providers around a shared set of criteria for prioritizing efforts and tracking progress.

Policy Influence Robert Hess became commissioner of New York’s Department of Homeless Services in 2006 and was deeply interested in chronic street homelessness. Becky Kanis shared with us an episode that she felt was defining in shifting homelessness policy. Becky remembered sitting in a meeting with Hess. “He said, let us do a 100-day challenge and let us see how many people we can house in 100 days.” He wanted to know what a small team with a different approach could achieve in a short period. The S2Hi team housed about 30-40 homeless individuals according to Becky: “And we were not even getting any City money as compared to the other service providers that they were paying money to house - like - one person! The initiative was not necessarily framed as a competition from the outset. But it made it abundantly clear that our solution was better than the others’.” Hess reacted to this success by inviting all organizations that had city contracts to a joint workshop. No managers of these organizations, only front-line workers could attend. The consensus from the meeting was that most front-line workers deemed the S2Hi approach superior, and they were willing to adopt it. “Rob [Hess] then let all the executive directors in, who were sweating bullets about what was happening in that room. He said: ‘Effective immediately, I am cancelling all your contracts. Effective immediately, you can re-apply but you have to do what Street to Home is doing’.” A 2005 article in the Columbia Daily Spectator provides additional context to this account:

S2Hi's street survey methodology combined with Common Ground's supportive housing program inspired HOPE [Homeless Outreach Population Estimate], as well as the city's ‘Uniting for Solutions Beyond Shelter,’ a five-year plan to end chronic homelessness by moving away from the shelter system into rental assistance programs. ‘The city is replicating Street to Home Initiative's method, which is gratifying,’ said S2Hi Director James McCloskey. He added that the city's ability to network many service providers and conduct a citywide count was necessary to see how many individuals are out there. Although the count is only a first step, it is a significant one. DHS [Department of

178 Vulnerability Index: Prioritizing the Street Homeless Population by Mortality Risk. Common Ground, accessed on 10SEP20 at: http://www.commonground.org/wp-content/uploads/2008/04/Vulnerability Index 101.pdf on the Waybackmachine Internet Archive.

53 Homeless Services] spokesperson Jim Anderson said the count is ‘an incredibly safe, well planned opportunity to advance the city's effort to understand what is [happening] on the street and then to do something about it’.179

In 2006, Mayor Bloomberg announced his ambition to reduce street homelessness by two-thirds in three years’ time thus replicating the same mantra that had guided the UK’s RSU and the S2Hi initiatives. In a remarkable change of tone compared to prior initiatives, the Mayor emphasized preventing and ending homelessness instead of merely managing an annoying social problem. In a New York Times article Bloomberg spoke about how commissioner Hess “and his team, working with community organizations and faith-based groups, will begin visiting these sites to ‘humanely, respectfully, and firmly’ talk to the homeless seeking shelter […]”180. He reaffirmed the principle that “Our motive is the simple belief that every human being deserves better than to sleep on the streets”. Bloomberg explained the rationale behind the initiative: “Our view is that any level of street homeless, no matter how reduced in scope and visibility, is an inexcusable civic failure that consigns our fellow human beings to lives tragically shortened by exposure to the elements, to the ravages of disease, and to their own self-destructive behavior.’’ Referring to the devastating state of the shelter system he said that “more of the same simply was no answer.” Mayor Bloomberg was also outspoken about his preference for a Housing First approach. The policy change had important implications for service providers, as the CEO of Bronx Works, Scott Auwater, explained: “We used to go up to a guy that had a serious crack-cocaine problem that was chronically homeless on the street. Our pitch to him was, ‘Look, you’ve got to clean up. We have got to get you drug free. Once you’re drug free [and] in a program, then we can move you into housing.’ And that didn’t go over very well with our guys. ...They’d tell you, ‘Yeah, I’m going to think about that. Why don’t you come back next week?’ And we’d come back next week for a year and get nowhere. And that’s what’s changed. Our pitch to them now is … ‘Let’s get you into an apartment. Let’s get your housing application done.’…And then, we move him into our stabilization beds. ... [A] stabilization bed is...a no-frills place. ... There’s no staff on-site. There’s no security on-site. It is, however, heated, with bathrooms. There’s a place they can heat up a meal. ... It’s the least restrictive environment for a street homeless [person]… I guess ... [the] difference between the Housing First model and [what we did] previously is that ... all we [now] care about is getting housed. ... We just think you need to be housed. And we work on mental illness and substance abuse issues when appropriate in the appropriate way. [But] that’s not a requirement. ... So the pitch is pretty simple, it’s not judgmental. ‘You need a house. We’ll get you a house.’” 181

Scaling Developments The success and learnings of S2Hi’s focus on the Times Square enabled the team to eventually refocus on the larger West-Midtown area. By then, S2Hi had shed its ”i” and became known as the Street to Home (S2H) program. S2H had the support of many organizations and a city government that was clearly behind this effort. In 2007, the city provided S2H with a 3.2 million USD contract to roll out its program to Midtown, Brooklyn, and and to reduce street homelessness in these boroughs by

179 Sherman, G (2005) HOPE 2005 Counts Homeless. The Columbia Daily Spectator, 25FEB05. 180 Newman, M. (2006) Bloomberg Unveils Plan to Reduce Homelessness. The New York Times, 17JUL06. 181 Main (2016) p. 164-165.

54 two-thirds. Additional funding of 6 million USD was provided by the U.S. Department of Housing and Urban Development putting the program on solid financial feet.182

In 2006 Becky was appointed Director of Innovations, a new unit that established and operated several initiatives in parallel with the continuing work of S2H that now was under the leadership of fellow teammate, James McCloskey who had worked on S2H from its start. The innovations unit operated a wide range of programs. Appendix 1 provides descriptions of main innovation programs between 2006 and 2010.

National and International Expansion In 2003, Common Ground had established a replication unit that expanded its scope to the following main workstreams:

 Create housing  Share knowledge  Test and improve innovative solutions  Champion creative and effective practices

Over the next decade, replication work took place in several national and international partner cities that included , ; London, England; Los Angeles, California; New Orleans, Louisiana; New York State; Santa Monica, California; Toronto, Canada; Washington, DC; Portland, Oregon; Nashville, Tennessee.

Community Solutions’ ongoing work with organizations throughout Australia began in 2005. The Premier of South Australia (2002 - 2010), , had been influenced by meetings with Blair and Casey who had shared the UK’s experience and successes of RSU. Rann was also influenced by , who Rann described as a friend and mentor and as being “at the centre of social reform and policy innovation in South Australia and nationally and in 1976, it was he who said: ‘What we are out to do is to see that every citizen in society has the social, economic, educational, cultural and recreational wherewithal to enjoy life and draw the most personal satisfaction from it’.”183 During 2005 and 2006, Rann invited Rosanne to work for several weeks in South Australia as an Adelaide Thinker in Residence, a program operated by the Don Dunstan Foundation, with the objective to “bring world-leading experts to South Australia to address urgent challenges or to explore areas of opportunity through new policy development and systems reform.”184 The key objectives of Rosanne's visit according to the program were:

 to provide Rosanne Haggerty with opportunities to influence key decision-makers and leaders in South Australia  to engage stakeholders (government and community organisations) in thinking and acting creatively about the prevention of homelessness and new housing options for homeless people

182 Yu and Kanis (2015) 183 Government of South Australia (2009) People and Community at the Heart of Systems and Bureaucracy. South Australia’s Social Inclusion Initiative, p.2. 184 Archived website, https://dunstan.org.au/thinkers-in-residence/

55  to raise the debate with the community about innovative approaches to housing for homeless people

Working with Monsignor David Cappo, South Australia’s Chair of the Social Inclusion Board, Rosanne helped lay the groundwork for the first supportive housing developments in Australia and to set up a program modeled after the UK’s RSU and her own experience with S2H. On 20 December 2006, Common Ground Adelaide Ltd was established as a public company. “Common Ground Adelaide Ltd is a key strategy in achieving the target of South Australia’s Strategic Plan to halve the number of rough sleepers by 2010.” 185 In 2007, the Department for Families and Communities provided a $5 million grant to Common Ground Adelaide and a one-off payment of $2 million from the Department of Treasury and Finance to improve facilities and services. Two downtown residences were opened during the next five years, and the model spread to other Australian states and territories. From the South Australia Department for Families and Communities’ annual report 2007: “The concept of support services is based on the principle of ‘housing first’ as a means to stabilise people’s lives and reconnect them with the community. Collaborated with the Department of Health regarding the extension of the Street to Home service in the broader metropolitan area and linked to points of identification such as the South Australia Police, local councils and nongovernment agencies. In partnership with the Department of Health, Street to Home was established as a key strategy in achieving the target of South Australia’s Strategic Plan to halve the number of rough sleepers in South Australia by 2010.”186

Other scaling initiatives that Common Ground launched during that period included a national technical assistance program, the Common Ground Institute. Initiated in July 2007, the Institute aimed to help communities increase the effectiveness of their efforts to end chronic homelessness.187 The largest effort to scaling the S2H model became known as the 100,000 Homes initiative.

185 Department for Families and Communities, Annual Report 2006 – 2007, Government of South Australia, September 2007. 186 Ibid. 187 Common Ground, Annual Report 2007.

56 2010 – Scaling a robust template: the 100,000 Homes initiative In 2010, USICH released Opening Doors: The Federal Strategic Plan to Prevent and End Homelessness. Opening Doors is the first-ever comprehensive federal commitment to end homelessness. The plan is especially notable because, when the federal government challenged communities to create plans to end homelessness in 2003, there was little in the way of federal assistance for these plans. Opening Doors aims to support local plan implementation and promote effective strategies across the country with a concrete timeframe and clear, measurable national goals. The four national goals set in Opening Doors are: ending chronic homelessness in five years; ending veteran homelessness in five years; ending family, youth, and child homelessness in 10 years; and, setting the nation on a course to end all homelessness in 10 years. The plan is built around five themes:

 Increase leadership, collaboration, and civic engagement.  Increase access to stable and affordable housing.  Increase economic security.  Improve health and stability.  Retool the homeless crisis response system.188

Several observers that we interviewed emphasized the opportunities provided by the 2010 federal plan and the ambitions of President Obama’s administration: To create legitimacy and momentum around the problem of homelessness, to provide resources, and to align and orchestrate disparate efforts. However, the shortcomings of these plans were also visible to those involved in this work. One observer stated: “There were evident limitations. A committee would come together, they would pass a report, and nobody owned it. It was almost always: ‘Let us do more of the same.’ Some good things happened in some communities with leaders who got turned on to this from the business sector and a few Mayors. […] But I think in the 100,000 Homes campaign [see below] - there was this idea of dynamic problem solving. It highlighted how a static plan is not the instrument that is going to solve a dynamic problem. Also, it highlighted the fragility of relying on a Mayor or a country executive. As soon as they were out of office, the first thing, that got cancelled was that guy's plan.”189

For Rosanne and her team, the transition time from Common Ground to Community Solutions was a critical period for setting strategic direction. The team was faced with tough choices between collaborating with programs aligned with the top-down federal strategy or pursuing a more bottom-up approach. During 2004 and 2010, one strategic thread emerged that became the nucleus for Community Solution’s next big step. In 2004, Rosanne had a meeting with Darren Walker, who then was Community Ground’s program officer at the Rockefeller Foundation. She remembered him asking: “’What are you seeing in New York or nationally that really makes sense, that is working to put a dent in homelessness?’ And he specifically asked me about the ten-year plans. And I said, ‘Well, I don’t know about that. But here is what we are thinking about [a systems perspective]’ - having been introduced to the Institute for Healthcare Improvement about what this kind of systems thinking could bring. Darren got excited about

188 Ten-Year Plans to End Homelessness. By Steve Berg, Director of Capacity Building, National Alliance to End Homelessness. 2015 Advocate’s Guide. p 26-27 189 Personal communication

57 that and said, ‘Who else is thinking like this?’ I said, ‘Well, I don’t know for sure’, but at that point, even a year into the Street to Home initiative, we had started hearing from some innovators in other cities who asked, ‘What is this you are doing around targeting and using a team-based approach and using data?’ So, Darren invited a proposal and they funded us for three years around the puzzle: How do we begin to bring other willing early-adopter communities into this notion of using a data and a team-based approach and a systems-level strategy to work on ending street homelessness. “190

Rosanne approached Phil Mangano who was heading USICH and asked him: “I don’t know the Mayors of these cities I am getting calls from, but you do. Is there some way to reinforce the work you are doing by getting teams from these cities together and to have, even at the mayoral level, some buy-in into a new way of working?”191 With Mangano’s support, Common Ground formed the Innovators Network: “I think we had nine meetings over three years, of different city teams involving someone from city hall, the homelessness lead agencies, sometimes foundations and that group became the nucleus of the 100,000 Homes campaign [see below]. We had, I think, about a dozen cities who had participated in the network to one degree or another by 2010.”192

Work was exhausting and calls would arrive from communities that “only” had 35 homeless people to which Becky would say: “You don’t need me, just house them!” But Becky got inspired by the 100,000 lives campaign initiated by the Institute for Healthcare Improvement (IHI). In 2004, Don Berwick, IHI’s director, ended a keynote in which he proposed the 100,000 lives campaign by quoting a poem inscribed in a sundial at the campus of Wellesley College in Massachusetts:

The shadow by my finger cast, Divides the future from the past. Behind its unreturning line, The vanished hour, no longer thine. Before it lies the unknown hour In darkness and beyond thine power. One hour alone is in thine hands, The now on which the shadow stands. One hour alone is in thine hands . . . the now.

Let’s get started. ‘Some’ is not a number; ‘Soon’ is not a time. One hundred thousand lives. Now.193

Berwick announced his campaign by providing a specific number, “saving 100,000 lives”, and a specific date, “June 14, 2006, at 9am ET”. This motto “some is not a number, soon is not a time” became defining for Community Solutions’ 100,000 Homes campaign. Rosanne and Becky learned about this initiative at one of the Innovators Network meetings in Washington, DC. They had invited Joe McCannon

190 Rosanne Haggerty interview, 18MAY20 191 Ibid. 192 Ibid. 193 Institute for Healthcare Improvement (IHI) Senior Fellow and President Emeritus Dr. Donald Berwick's 2004 IHI National Forum keynote address cited in: Berwick, D.M. (2014) Promising Care: How We Can Rescue Health Care by Improving It. Jossey-Bass, San Francisco, p.44.

58 and Tom Nolan from IHI to deepen the group’s awareness of how IHI was going about systems change work. Becky reflecting on this IHI initiative thought “What if we could house a 100,000 people?” Rosanne knew Berwick and they set up a meeting to understand the 100,000 lives campaign. Eventually, Joe McCannon who had been the campaign manager for 100,000 lives came on board and integrated his experience about driving large-scale change. 100khomes.org This is how Rosanne’s team portrayed the campaign on the dedicated 100khomes.org website:

The 100,000 Homes Campaign brings together change agents from across the country to find and house 100,000 of the country’s most vulnerable and long-term homeless individuals and families over the next three years. Launched by Common Ground [later changed to ‘Powered by Community Solutions’] and a host of national and local partners, the Campaign is designed to fundamentally alter our response to homelessness by giving communities concrete tools and connecting them to each other so no one has to innovate alone.” 194

The campaign aimed to become a national movement of communities working together to “find homes for 100,000 of the most vulnerable homeless by July 2013;”195 and to “fundamentally alter forever the way that this country responds to street homelessness.”196

We want your list! was broadcasted by the 100khomes team on its web site and social media. The ambition was to get a list of all the cities that had more than 1000 unsheltered homeless people. But it would take years to get to some of these cities. Jessica Marcus, who had joined the 100khomes team around 2010 recalled that coordinated community work on homelessness was limited by several factors197: fragmentation of many smaller NGOs “operating in silos and doing piecemeal work”; the only data that were used were Point-in-Time counts for subsegments of a community without having a collective picture of the problem; a lack of a clear goal towards which work was directed and thus no clear accountability or responsibility for specific results; NGOs were competing for the same sources of funds; a lack of ambition to go beyond deliverables defined in individual grants.

The organization also laid out four defining principles of its campaign in the form of a manifesto:

Our movement stands for: Housing First - Permanent housing that happens first and fast, so that no one must battle disease, disability, mental illness or substance abuse without the safety and stability of a home. Know Who's Out There - Communities where every homeless person is known by name because someone has deliberately gone out on the streets to find them, assess their needs and meet them where they are at. Track Your Progress - Local, multi-sector teams that use regularly collected, person-specific data to accurately track their progress toward ending homelessness for their most vulnerable neighbors.

194 Data from the 100khomes.org website (historical snapshot of 09NOV10) 195 Ibid. 196 Becky Kanis (2010) 100,000 Homes campaign video. 197 Jessica Marcus interview, 29APR20.

59 Improve Local Systems - Housing and service systems that are simple and easy to navigate, while targeting resources quickly and efficiently to the people and families who need them most.

These principles reflect the danger and urgency of homelessness and chart a clear, viable path to overcoming it for the thousands of Americans at risk of dying on our streets. For those Americans and for all of us, the time for temporary, go-it-alone strategies is over. Instead, let our communities come together in meaningful collaboration to end homelessness, once and for all.198

Going from S2H to a national campaign required a dramatic shift in the attitudes and operational procedures of communities. But this shift also required that the 100khomes team invested in building new competencies and skill sets adequate for their bold ambitions. Becky attended one of Dan Heath’s Switch bootcamps and Dan proposed to highlight the emotionally arousing before and after pictures of unsheltered people three months after they moved into their own home. The pictures told a convincing story of possibilities and progress and helped the movement get the attention required to achieve its goals. The team made creative use of social media, symbolic acts, and celebrating successes to keep people engaged. Becky, after housing the first 10,000 people got a tattoo on her left forearm that said “100,00 Homes” with the last zero missing to demonstrate her commitment (the tattoo was completed in 2014 by adding this last zero). Becky in an interview from 2011 also shared her team’s attitudes and approaches for trying to change the very systems that made it so hard for homeless people to engage and seek support:

But I can tell you about a recent innovations call. We had charted out all the steps the VA says you need to take in order to house a vulnerable veteran using their VASH vouchers199. And, it was a LOT of steps! Then we asked everyone on the phone to volunteer if they’ve done a step faster or – gasp! – eliminated it. People started chiming in with “we don’t do step #4 anymore!” and then Nancy Campbell, who is the national director of HUD VASH, spoke up and said, “That’s correct, step #4 is not necessary.” Then someone else said, “I know step 10 says it takes six to eight weeks, but if you put a cover sheet on the fax that says, “This is a vulnerable veteran in need of housing,” the VA will fax it back to you within 48 hours. BAM. DONE. Collectively, the call participants shaved about five steps and seven months off the process to move a vulnerable veteran into housing. All with the head of HUD VASH nodding her head in approval. And the beauty of it is that the webinar was recorded and Nancy Campbell then forwarded it to all her VASH coordinators to say that this is the new standard. These kinds of things – nerdy though they may be – are really a big deal. The key is that people need to listen in and be thinking, “Is there anything from this call that I can start doing right away TODAY?” We can’t wait for other people to do it. Each person in this network is so powerful. We can do this.200

198 Retrieved from historical records of the 100khomes.org website. 199 HUD-VASH is a collaborative program between the Department of Housing and Urban Development and the Department of Veterans Affairs that combines HUD housing vouchers with VA supportive services to help Veterans who are homeless and their families find and sustain permanent housing. https://www.va.gov/homeless/hud- vash.asp 200 Kraybill, K. (2011) Q.A. with Becky Kanis: The 100K Homes Campaign. Homeless hub, accessed on 20OCT20 at: www.homelesshub.ca/resource/qa-becky-kanis-100k-homes-campaign.

60 The model seemed to work and by January 2012, more than 100 communities participated. Collectively they had housed more than 11,000 homeless people201. Becky hired an analyst who looked at the rate of progress, and – according to Becky – said: “We are on track to be the 30,000 homes campaign”. This projection was a wakeup call. If the campaign wanted to succeed, it had to adapt some of its design parameters. The team extended the campaign timeline by one year from July 2013 to July 2014. Calculations showed that achieving their goal required enlisting three new communities each month. Furthermore, every participating community needed to double the people they housed each month. Basically, every community needed to house 2.5% of its homeless population every month. Prior investments in building strong relations helped get the communities’ buy-in to the new goals. A 2.5% Club was established that gave national recognition to those communities who achieved this housing rate. Successful communities were recognized in the presence of all their peers at an annual homelessness conference.

The 100khomes team also adapted the use of the Vulnerability Index as the central arbiter of who gets housed. Community Solutions decided that it might be smart to align its activities a bit more with the priorities of the federal USICH program priorities. The team chose to integrate a more explicit focus on veterans and chronic homelessness. With the support of a consultancy, the Rapids Results Institute, the teams started mapping local homeless services systems to illustrate and to understand the many bottlenecks that homeless people faced. This mapping helped redesign the service system. This system change effort made a strong contribution to increasing housing rates. Communities also adopted a comprehensive framework for measuring progress:202

 Know All Homeless By Name: Communities that have completed a Registry Week or have employed some other method of knowing all of their homeless neighbors by name with enough information to triage each one into an appropriate housing option.  Housing 2.5% of Homeless Neighbors Each Month: Communities housing at least 2.5% of their chronic and vulnerable homeless neighbors each month. This figure, calculated on a three- month rolling average, puts a community ahead of the growth curve in homelessness and places it on a sustainable path to end homelessness locally within four years. It also puts the entire movement on track to reach 100,000 by July of 2014. (Note: 2.5% is not the end of a community's improvement effort. Once a community reaches 2.5%, the Campaign continues to work aggressively with that community toward reaching its goals under Opening Doors, the federal plan to end homelessness.)  Fully Committed Communities: Communities that have consistently reported their housing placement numbers to the Campaign for each of the last three months, even if those numbers have not changed.  Total People Housed: The total number of vulnerable and chronically homeless individuals and families housed by all participating communities since each joined the Campaign. Communities report their new housing placements monthly, and new national totals are made available on a rolling basis.

201 Data from the 100khomes.org website (historical snapshot of 06Jan12) 202 Retrieved from historical records of the 100khomes.org website.

61 Below is an example of actual Vulnerability Index data from 2013. “More than 8,200 volunteers have surveyed their homeless neighbors with our Vulnerability Index survey to identify those facing the greatest health risks. Each of the eight health conditions below corresponds to an elevated risk of death on the streets.”203

Frostbite 3,203 (6.74%) HIV/AIDS 1,554 (3.27%) Kidney Disease 2,010 (4.23%) Liver Disease 3,782 (7.96%) ER 3x + in 3 Months 6,534 (13.75%) Hosp/ER 3x + in 1 Year 10,316 (21.71%) Tri-Morbid 12,098 (25.46%) Age 60+ 6,125 (12.89%) Total Vulnerable 23,493 (49.44%) Total survey universe 47,518

Linda Kaufman who had joined the core team of the campaign in 2010, remembered an important collaboration with Iain De Jong, the CEO of OrgCode, a consultancy with an ambition to enact lasting social change for adults, families, and youth. “Iain De Jong was doing a lot of work with data and information and he had what was called the service prioritization decision assistance tool [SPDAT]. And it really helped people understand what services somebody needed. And we had the Vulnerability Index. So Iain and I were at a meeting in West Virginia and I said: ‘Let's have dinner together.’ So, we had dinner and we put together the idea of combining the Vulnerability Index with this SPDAT. You'd have a much better tool for helping people know what they needed and he just ran with it. And probably most communities in the US now use the VI-SPDAT. So, he's another partner that I think was a really important part of the 100,000 Homes campaign.”204 Rosanne remarked that OrgCode took on full responsibility for the support and evolution of this tool.

Many stumbling blocks and setbacks had to be overcome. Prominent researchers pointed out that the Vulnerability Index had not been validated or that the allocation of scarce housing resources was unethical. One partner organization started “selling” the free training brochures. CBS ran a local news segment in Los Angeles205 that created an impression that it was Becky’s team who had housed all the homeless people rather than acknowledging that these achievements primarily resulted from the efforts of a local community. Rosanne remembered: “When you work at a systems level, the question of how you credit everyone’s contribution never gets simpler. For instance, with the Anderson Cooper 60 Minutes piece, Nashville was the community that they focused on. I spoke with the local team, and they felt that they and their work were absolutely celebrated. But I also know that there are folks out there who feel we take the credit. We have clear values and protocols around who we highlight, how we focus credit, but it’s always sensitive.”206

203 100,000 Homes Report 2013. 204 Linda Kaufman interview, 30APR20 205 100,000 Homes. CBS, 60 Minutes, 09FEB14 206Rosanne Haggerty interview, 18MAY20.

62 Becky also commented on how the “60 minutes” segment exposed some enduring mental models towards homeless people. “What he [Anderson Cooper, the host of CBS 60 Minutes] really wanted to know, because I think it’s what he thought his listeners would want to know is: ‘But how can you do that? Do they really deserve that?’ And he asked it again, and again, and again.”207 Cooper wondered whether it was fair to spend scarce resources on non-deserving homeless people. The argument that legitimized the approach was that it was still cheaper to the public to keep such a “non-deserving” person off the streets. This framing may have avoided confronting contested arguments inherent in the culture of poverty perspective of the last century. This legacy framed the poor and homeless as non- deserving because they were largely responsible for their own misery. But, as Becky revealed in her 2017 presentation, this framing may have contributed to sustaining the system that kept recreating the same problem by “treating a symptom as if it was a root cause”.

Meeting the ambitious 2014 deadline of the 100,000 Homes campaign must have felt like an uphill race that even exhausted a former army officer like Becky. “This is the work. It’s deeply personal, it deeply requires all of us, it requires as much as possible creating almost a forcefield where people aren’t scared to try things and fail. Because that’s what we’re really up against, that people are afraid to fail.”208 Figure 4 summarizes the progress of the campaign until it officially ended in July 2014.

Figure 4. Numbers of homeless people housed by 100khomes community participants209.

On 10 June, 2014, the 100khomes team announced success:

For Immediate Release

Calling the fight to end homelessness “America’s next moonshot,” 100,000 Homes Campaign Director and former Army Captain Becky Kanis announced today that communities participating in the 100,000 Homes Campaign have permanently housed 101,628 homeless Americans, including

207 Becky Margiotta (Kanis) (2017) 208 Becky Margiotta (Kanis) (2017) 209 Data retrieved from historical records of the 100khomes.org website.

63 31,171 homeless Veterans, one month ahead of their four-year July deadline. That number represents an estimated annual taxpayer savings of $1.3 billion and reflects the collective work of 238 U.S. communities who have joined the Campaign since July 2010. The 100,000 Homes Campaign is a national movement coordinated by New York-based non-profit, Community Solutions, which launched the effort in July of 2010.210

In August, 2014, after giving an inspiring presentation at the National Alliance to End Homelessness annual conference that was followed by a keynote address by First Lady Michelle Obama, Becky left Community Solutions to start her own consultancy and to continue to help communities drive effective change.

210 Ibid.

64 2015 – Innovating a new paradigm: Built for Zero How can we evaluate the 100,000 Homes campaign? What might be legitimate metrics and dimensions of outcomes and areas of impact? The conclusion of a formal evaluation by the Urban Institute illustrates the complexity inherent in these question:

The 100,000 Homes Campaign has had a major impact on national efforts to end homelessness, particularly chronic homelessness and homelessness among veterans, despite its modest staffing and budget. Qualitative data suggests that the Campaign helped bring new energy and partnerships to the work of ending homelessness. One of the defining themes that emerged from stakeholder interviews with local and national groups was the uncommon joy that Community Solutions brought to the work of addressing homelessness. Another defining theme was the Campaign’s ability to bring diverse community stakeholders together around ambitious, data-driven goals. The Campaign has also helped to establish the credibility of the Housing First approach by demonstrating both the severity of the public health needs of people experiencing homelessness and the positive impact permanent housing can have on peoples’ lives.211

But a focus on the hard numbers particularly in larger communities did not always prove a statistically significant relation between campaign and quantifiable outcomes. Community Solutions was concerned whether despite the success of 100,000 Homes they somehow may have failed collectively to have a significant impact on the overall problem. Jessica Marcus reflected on her feelings at that time: “And when we got to that goal in 2014, when the campaign ended, we realized that a lot of the communities have actually not really made a significant dent in their homeless populations. Although they had housed all these people they hadn't actually done much to fully end veteran homelessness and chronic homelessness. And that was a difficult thing to swallow and a huge kind of lightning bolt moment: that what we had been doing for four years was perhaps only scratching the surface of what actually needed to be done.”212 Beth Sandor, who had been with Community Solutions the longest apart from Rosanne, said: “While we did accomplish a lot, the fact that it did not translate to our underlying theory of change, I remember, emotionally – despite all the accolades and going to the White House – feeling that we had failed.”213 Beth shared that she was sitting at her desk in tears but unwilling to give up: “We did not figure this out, we need to build something else now.” She felt that framing the experience in terms of failure was demotivating to the team. Instead, asking the question “what did we learn” restored the team’s motivation: ““It is emotionally exhausting to go through the ups and downs of success and failure as we learn more about the problem. And you constantly reset your expectations as you learn more.” Beth thinks that this resetting of expectations is a good indicator that you are learning: “If we are not thinking differently in 6months or a year that might be a sign that we are not learning enough.”

Linda Kaufman, another member of the campaign team remembered her own concerns at that time: “Why did we not move the needle on how many people are homeless if we housed a 100,000 people? Why did that not start a trend downward? If there were five hundred thousand homeless people and we housed a hundred thousand of them, what are we not doing right that we didn’t see it trending

211 Leopold, J, and Ho, H. (2015) Evaluation of the 100,000 Homes Campaign. Urban Institute, p.46. 212 Jessica Marcus interview, 29APR20. 213 Beth Sandor interview, 19JAN21.

65 downward? The obvious answer is: ‘More people became homeless, more people flowed into homelessness,’ but I think that's been one of the absolutely hardest things to deal with. How do you stop the kind of hemorrhaging inflow into homelessness, as you work your ass off to get people housed?”214 Despite many successful innovations, the growth of the homelessness problem seemed to outpace its solutions. New segments of the population seemed to be affected at unprecedented levels: “The US Department of Education estimates that 1.3 million public school students nationally were homeless during the 2015–16 school year (National Center for Education Statistics, 2017). A twofold increase in the number of homeless students over the past decade has caused alarm among educators and policy makers, as homelessness is thought to be a form of extreme hardship that contributes to other social inequalities,” said Michael Evangelist and Luke Shafer from the University of Michigan.215 The authors were concerned that HUD in 2017216 had estimated “that on a single night in January there were 551,000 sheltered and unsheltered homeless individuals and that 1.4 million people passed through US shelters that year. Yet these estimates understate the severity of homelessness, as they exclude people who are doubled up and often miss the so-called hidden homeless living in cars, abandoned buildings, and other less visible places (Hopper et al., 2008217; Auerswald and Adams, 2018218).

In 2017, Brian Lehrer in his radio show invited former NYC Mayor (1990-1994) and his Deputy Mayor Barbara Fife to reflect on the following topic: “What unbalanced power relationships contribute to making housing so unaffordable in greater New York decade after decade?” Lehrer posed the following question to Dinkins and Fife: “It seems like Mayor after Mayor takes office with big affordable housing programs. We just talked about Koch’s [affordable housing program]. You continued it in the Dinkins’ administration. We had a Bloomberg deputy Mayor on yesterday saying they had the biggest affordable housing program. Now we have de Blasio saying that he has the biggest affordable housing program. It’s not that it’s a competition with history. It’s that Mayor after Mayor takes office with big historical affordable housing programs that are real and yet, affordability never really improves in a major way. It feels like it’s getting worse. Mr Mayor, why do you think that is?”219 David Dinkins identified increasing housing costs as a major factor. He framed homelessness primarily as a housing problem: “Homelessness is exactly that: lack of a home,” he said. Dinkins also believed that subsidies for housing would cost the government less than taking care of homeless people in shelters and on the streets, an argument that illustrates the persistence of economic frames of homelessness. Barbara Fife was concerned that the gap between housing costs and salaries was growing wider and wider over time. As a result, many of the people who are homeless have full time jobs. But their salaries remain in the

214 Linda Kaufman interview, 30APR20. 215 Michael Evangelist and H. Luke Shaefer (2020) No Place Called Home: Student Homelessness and Structural Correlates, Social Service Review 94, no. 1 (March 2020): 4-35. 216 US Department of Housing and Urban Development (2018) The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Part 2: Estimates of Homelessness in the United States. Washington, DC. 217 Hopper, Kim, Marybeth Shinn, Eugene Laska, Morris Meisner, and Joseph Wanderling (2008) Estimating Numbers of Unsheltered Homeless People through Plant-Capture and Postcount Survey Methods. American Journal of Public Health 98 (8): 1438–42. 218 Auerswald, Colette L., and Sherilyn Adams (2018) Counting All Homeless Youth Today So We May No Longer Need to Tomorrow. Journal of Adolescent Health 62 (1): 1–2. 219 WNYC (2017) Mayor Dinkins on Affordable Housing, 12OCT17, accessed on 01OCT20 at: https://www.wnyc.org/story/mayor-dinkins-affordable-housing/

66 lower 20 to 25 thousand USD. “No matter how low you set your price of housing there is no way that you can create housing at that cost. […] We don’t have federal money anymore for provision of housing. That was killed with Reagan.” Fife also mentioned the additional problem of losing older affordable housing stock when 30-year mortgages aged out and stabilized rent restrictions were lifted. She said: “So you are losing some of your older low-income stock at the same time as you are trying to replenish it.” Another policy arena that would define progress into the 2000s that Fife pointed out were challenges to balancing gentrification without dividing communities and neighborhoods. “All of a sudden you improve a little bit and then somebody comes in and says ‘Oh, this neighborhood is looking great, I’m going to quickly buy up some land,’” Fife said, “Well, government has to put a hold on that land. Because you have the capacity to see ahead a little bit because you are doing the planning.”

The framing of homelessness in terms of a widening housing cost/salaries gap, is also a prominent theme in other large cities. For example, Gary Painter’s research at USC Price revolves around understanding intractable problems and the precarity of people with median or lower incomes in the context of Los Angeles220. The fact that people might have few savings makes them vulnerable to economic disruption for example by losing their jobs. The resulting inability to pay the rent triggers a whole cascade of events that may put whole families on the streets or in shelters. Painter’s research thus also explores the more systemic factors that explain why society is not building enough affordable housing especially in the large cities and what prevents incomes from keeping up with rents for housing.

In a similar line of argument, Tony Hannigan also reflected on the challenges of economic reality for the effectiveness of the supportive housing model in contemporary New York City: “The reality is that people are in shelters and it remains much more expensive than supportive housing. But it begs the question: ‘Are we going to build our way out of this problem?’ It does take a lot of capital upfront to develop supportive housing.”221 Hannigan cited upfront development cost of 80 million USD for a current affordable housing project to build 116 apartments in New York City. If homelessness was primarily an issue of affordable housing, then the prospects for solutions did not look bright. In 2019, the state of New York, according to numbers by HUD, had about 92,000 homeless people. But 83,000 of these were housed in emergency shelters222. This state of affairs could also be interpreted as a legacy of the “right to shelter” legislation, a hard-won legal victory of homelessness activists in the 1980s. Under the pressure of this legislation, the state or city pays expensive leases to niche developers who buy cheap property for cash and convert them to shelters that seem to continue the tradition of the SROs of the 1990s in terms of inadequate housing quality. The Daily News reported that “The practice of housing people in cluster, or scatter-site apartments has come under fire because the units cost the city a fortune to rent, and are often in a terrible state of disrepair.”223

According to Kat Johnson, a senior project manager at Community Solutions, the question thus remains, whether the principles of the 100,000 Homes campaign would be applicable to larger cities? “I do think

220 Gary Painter interview, 11MAY20 221 Tony Hannigan interview, 27APR20 222 HUD (2019) HUD 2019 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations. New York, 28JAN19. 223 Gioino, C. and Boyer, T. (2019) NYC to spend as much as $41 million to buy more run-down buildings to house homeless. New York Daily News, 17DEC19.

67 there are a couple of contexts that will require something dramatically different. So, one of the things we're grappling with in our next strategic plan is getting a large city down to zero homelessness on chronic homelessness, which has not happened. “ […] there have been communities of populations of a million or so, that have done it. But we think the things that have worked for those cities just genuinely may not be the things that are going to work for San Francisco or New York. And so there's actually a separate team that's just working on large cities.“224

Counting down, not counting up Roughly one month after ending the 100,000 Homes campaign, on July 29, 2014, Community Solutions already announced their new initiative: “Zero: 2016”. From the announcement:

The success of the 100,000 Homes Campaign has generated huge momentum in the fight to end homelessness. Still, while greatly decreased, chronic and Veteran homelessness continue to plague our nation’s streets, and the health effects of these solvable problems remain as lethal as ever. We know what works to end homelessness, and, as a nation, we have a moral imperative to bring the solutions to scale. The time to finish the job is now. Community Solutions is excited to announce the application process for Zero: 2016, a rigorous follow-on to the 100,000 Homes Campaign designed to help an elite group of communities do whatever it takes to end chronic and Veteran homelessness in the next two and a half years.225

Zero: 2016 was described as “a national movement of 75 communities working to end chronic and veteran homelessness by December 2016.”226 Setting this ambitious target may have been partly politically motivated to match the federal effort of Obama’s ambitious homelessness strategy that was announced in the same year:

Today, as part of the Joining Forces initiative, First Lady Michelle Obama announced the commitment of 77 mayors, 4 governors, and 4 county officials to meet that goal, and called on additional mayors and local leaders to commit to ending veteran homelessness in their communities by the end of 2015. Through the Mayors Challenge to End Veteran Homelessness, mayors and other state and local leaders across the country will marshal federal, local, and non-profit efforts to end veteran homelessness in their communities. Ending veteran homelessness means reaching the point where there are no veterans sleeping on our streets and every veteran has access to permanent housing. Should veterans become homeless or be at-risk of becoming homeless, communities will have the capacity to quickly connect them to the help they need to achieve housing stability. When those things are accomplished, our nation will achieve its goal.227

The press release indicated a much closer alignment with the program and operational principles of Community Solutions than prior federal initiatives. This created more opportunities to collaborate and

224 Kat Johnson interview, 09APR20. 225 100k homes, archived website. 226 Community Solutions, annual report 2015. 227 Fact Sheet: Mayors Challenge to End Veteran Homelessness. The White House, 04JUN14, accessed at: https://obamawhitehouse.archives.gov/the-press-office/2014/06/04/fact-sheet-mayors-challenge-end-veteran- homelessness.

68 to align the momentum of federal and civil society efforts. Another reason for setting such an ambitious goal by Community Solutions may have simply been the experiences and successes of the 100khomes campaign that instilled a strong belief in the efficacy of Community Solutions’ approach. This argument is illustrated in a statement in the organization’s 2015 annual report: “Homelessness is a solvable problem that has lost its sense of urgency. Most communities already have what they need to provide homes and support to their most vulnerable homeless neighbors. The challenge is in organizing those resources effectively and offering assistance in a data-driven way.”

Functional Zero Addressing the dynamics of homelessness required a mental shift for Community Solutions and its collaborating partners. “At the time we were realizing that we were only looking at half the equation. But we did not realize that while we were doing it [the 100khomes campaign]. As the campaign transitioned to ‘Zero 2016’ and then to ‘Built for Zero’ a few years later we knew we needed to basically flip the script on how to count. Previously we had just focused on counting up, just aggregating all the housing placements and adding them up. And if you were to turn it on its head, that is what we needed to be doing. We actually needed to help communities count down toward zero. There was no framework for how to do that, we kind of had to invent it and it was way more difficult than counting up.”228 It seems that counting up did not enable implementation partners to own the problem but only the solution. This approach decoupled implementation performance from problem dynamics. The role of implementers was limited to chasing a problem that changed dynamically with no criteria for success in place. Russell Ackoff, an influential systems thinker and scholar, famously described the dangers of thinking in terms of problem solving: “In reactive problem solving we walk into the future facing the past — we move away from, rather than toward, something. This often results in unforeseen consequences that are more distasteful than the deficiencies removed.”229 Perhaps counting down to zero would be a more effective way to own the problem, to define a concrete future state that inspires and coordinates action, and to get real-time and meaningful feedback on performance? Owning the problem would also imply that the term success could not just be reduced to a political statement or a subjective interpretation. Success would be coupled to measures whose validity and relevance could be objectively established.

An important aspect of Community Solutions new approach was to define counting down to zero as a new criterium for success. An important element in redefining their approach was finding an answer to the question: How do you succeed solving a problem whose supply dynamics you cannot control? A breakthrough for this challenge was the development of a metric called “Functional Zero“. Community Solutions defined functional zero as “a dynamic milestone that indicates a community has solved homelessness for a population. Reaching and sustaining this milestone is in service of building a future where homelessness is rare overall, and brief when it occurs.” 230 In its operational definition of functional zero Community Solutions differentiated between veteran homelessness and chronic homelessness: “A community has ended veteran homelessness when the number of veterans experiencing homelessness is less than the number of veterans a community has proven it can house in a month. A community has ended chronic homelessness when the number of people experiencing

228 Jessica Marcus interview, 29APR20. 229 Ackoff, R.L. (1978) The art of problem solving. John Wiley & Sons, NY, p26. 230 https://community.solutions/functional-zero/, accessed 20OCT20.

69 chronic homelessness is zero, or if not zero, than either 3 or .1% of the total number of individuals reported in the most recent point-in-time count, whichever is greater.”231

To illustrate this definition, Community Solutions provided the following example: “City A has a Veterans PIT [Point-in-Time] Count of 17 and has averaged 22 permanent housing placements of homeless Veterans per month for the past year (14 placements dedicated exclusively for Veterans and 8 placements of veterans in non-dedicated units). City A would have met the definition for ending Veteran homelessness. City B has a Veteran PIT Count of 75 and has averaged 50 permanent housing placements of homeless Veterans per month for the past year (38 placements in units exclusively for Veterans and 12 in non-dedicated units). City B would not yet have met the definition of ending Veteran homelessness.” In addition to introducing the concept of functional zero, Community Solutions also replaced PIT count data with real-time by-name data as a fundamental principle of its new effort.

Jessica Marcus remembered that a few months after Community Solutions had released the definition of functional zero for veteran homeless, the Department of Veterans Affairs (VA) released their own definition. “They did not appreciate our definitions. They actually came up with their own several months after we had released ours. So, I like to think that at least we pushed them to come up with something. But their definition was not quantifiable, confusing, and hard to follow.”232 This episode illustrates a key challenge for collaborative efforts towards complex social problems: “Our disagreement [with the VA] put us in a bind. We couldn’t (and still cannot) do our work effectively without strong coordination with our federal partners. Their role in furthering research, spreading innovation, and securing federal housing resources has been essential to the progress the country has made on homelessness over the last 20 years. We have great faith in their skill, expertise and commitment to ending homelessness. That said, we felt strongly that communities could meet the Criteria and Benchmarks [set by VA] without actually ending veteran homelessness. This dissonance risked leaving an unconscionable number of veterans behind, and we feared it would weaken the public’s belief that real solutions were possible.”233 Despite some differences between sectors, these pioneering efforts of defining a novel perspective on ending homelessness also illustrate the power of trusted collaboration across sectors. According to Marcus: “About a year later HUD came up with their own definition of chronic homelessness and involved us in the process and said: ‘You know, we've actually learned from what the VA did. We don't want to repeat their mistakes, we realize it needs to be more stringent and more quantifiable.’ We saw that as a huge victory and our willingness to stick by our principals actually helped to push HUD in a better direction than maybe they would not have otherwise.” HUD eventually produced a definition of functional zero for chronic homelessness that was more stringent than Community Solutions’ and thus the organization adopted HUD’s definition.

The year 2016 passed and on 5 January 2017, the Associated Press reported that “As Obama era closes, goal to end veteran homelessness unmet.” 234 And Zero: 2016 continued as the core program of Community Solutions under the name “Built for Zero” ever since.

231 Ibid. 232 Jessica Marcus interview, 29APR20. 233 Getting to proof points. Community Solutions, March 2018. 234 McDermott, J. (2017) As Obama era closes, goal to end veteran homelessness unmet. Associated Press, 05JAN17.

70 Built for Zero - Counting down is much harder than counting up According to Community Solutions, the shift from 100,000 Homes to Built for Zero, like most of its earlier innovations, was not a subtle shift but a radical departure from taken for granted assumptions and actions.

We’ve discovered that working back from the goal of measurably ending homelessness will require (at least) five shifts in our communities:  a shift of belief, from seeing homelessness as inevitable to being solvable;  a shift of organization, from thinking in terms of individual programs to a shared, whole of community commitment;  a shift in information, from generalized or estimated data on homelessness to by-name, real-time knowledge on who is experiencing homelessness and each individual and family’s situation;  a shift in culture, from complying with program rules to relentless problem solving; and  a shift in investments, from automatically maintaining traditional services to making, targeted, data-informed, constantly monitored and ever improving investments in the things that prevent and end homelessness. 235

To provide communities with a more operational set of expectations, Community Solutions formulated the following theory of change for its Built for Zero initiative:

First, they [communities] must define the desired end state clearly and adopt an actionable and objective framework for measuring it. Next, they must develop the reliable ability to track homelessness across their entire geography, at least monthly and on a person-specific basis. Third, communities must apply a quality improvement framework for systems improvement, testing and refining the most promising ideas in order to achieve month-over-month reductions in chronic and veteran homelessness. And once communities reach functional zero, they must work to sustain that outcome, even as they expand to other populations. This critical challenge— not just can we reach zero, but can we hold it and prove that we are holding it— is perhaps the most important one of all.236

By-name lists Over the course of 2015 and 2016, Community Solutions and its partners explored novel data management tools and processes that enabled the real-time capture of every person experiencing homelessness at any given time in the form of a “by-name list”. Real-time by-name lists required that communities track at least five data points to capture the dynamics of a “stocks and flows” model of at least 90% of homeless single adults, including:

235 Haggerty, R. (2019) Moving from Charity to Justice in Our Work to End Homelessness. Journal of Vincentian Social Action 4(1), p.15. 236 Getting to proof points. Community Solutions, March 2018.

71  Unsheltered individuals living in a place not meant for human habitation (e.g. street, cars, campsites, beaches, deserts or riverbeds)  Individuals in shelters, safe havens, season overflow beds, hotels paid for by homeless providers or Health Care for Homeless Veterans (HCHV) beds  Individuals in transitional housing, including VA-funded Transitional Housing  Individuals on your list who are entering an institution (e.g. jail or hospital) where they are expected to remain for 90 days or fewer  Individuals fleeing domestic violence237

Communities also needed to have written policies that specified how these lists were kept up to date and to assess whether they had made informed decisions about coordination and outreach coverage in their whole geography, and documented those decisions including setting up a regular feedback loop to respond to new information. Communities were required to establish a written policy that specified the number of days of inactivity (i.e. the person could not be located) after which a person’s status will be changed to “inactive,” and which included protocols to attempt to locate an individual before they were moved to inactive status. Communities had to track actively homeless individuals who have not consented to services and/or assessment and to find ways of continued engagement with them.238 What legitimized this effort was the insight that a dynamically changing problem such as homelessness required real-time adaptative action and thus real-time feedback on the dynamics of change. It is fascinating to reflect on the similarities of this perspective and the ideas explored by scholars working on cybernetics, an influential systems perspective that was developed in the last century. For example, Ross Ashby’s law of requisite variety comes to mind. The “law” specified the conditions under which an object succeeded in maintaining a system in a particular state or a narrowly defined set of states239. The applicability of this perspective for the program assumptions underlying Functional Zero are apparent. Ashby’s law roughly stated that the regulating object must be able to attain as many different states than the system to be regulated. Applied to Built for Zero, Ashby’s law says that whatever the quantitative and qualitative state into which the problem of homelessness evolves, the community intended to maintain the state of Functional Zero needed to be able to adapt its interventions in real time. The objective of such an effort would be to absorb and thus counter the variance of possible outcomes that would be incompatible with the definition of Functional Zero. Ashby’s perspective on regulation has been developed into specific prescriptions for managing organizations.240 It would be tempting to explore whether and how the insights from management cybernetics inform the design of viable systems to counter homelessness.

Initially, the requirements for producing comprehensive and real-time by-name lists seemed like an impossible challenge as Beth Sandor explained: “It is difficult to appreciate just how radical the change was when we made the shift from using static point in time data to convincing people to shift to real time data.”241 But early successes demonstrated the feasibility of this approach. For example, Riverside County, with a population of 2 million, succeeded to reach functional zero in 2016 as announced by

237 Built for Zero (2020) All Single Adults By-Name List Scorecard Explainer. Community Solutions. 238 Ibid. 239 Ashby, W. R. (1957) An introduction to Cybernetics. Chapman & Hall Ltd, London. 240 Beer, S. (1985) Diagnosing the System for Organizations. John Wiley & Sons, New York. 241 Beth Sandor interview, 19JAN21.

72 Community Solutions: “Riverside County, CA is the tenth most populous county in the United States. A year ago, more than 200 of its veterans were experiencing homelessness. Today, that number has dropped to functional zero, meaning the County has fewer veterans experiencing homelessness than it has proven it can house in a single, routine month.”242 But the challenge for communities was not only to maintain real-time by-name lists but to build the capacity for translating information into decisions and actions that enabled effective adaptation to changing problem dynamics. As a legacy of the many years that Community Solutions had been experimenting with and finetuning its approach, Built for Zero operated from a well-developed problem-solving framework that revolved around six key dimensions:

 Focus on the outliers - People and neighborhoods most likely to fall through the cracks of existing social welfare programs hold the key to better solutions for everyone.  Convene broad multi-sector partnerships - Pull all actors together around the same problem solving table.  Set measurable, public, timebound goals - Build a sense of urgency and spur key players to innovate by putting your reputation on the line.  Engage the user - Those trapped in poverty, along with frontline health and human services workers, are essential to designing effective solutions.  Optimize existing resources - Use real-time, by-name data to inform decisions about spending and strategy  Learn by doing - Test and evaluate new ideas in short cycles to learn what works quickly and build on successful strategies243.

Success and resistance In March 2018, Community Solutions published an optimistic three-year retrospective of Built to Zero: “The communities participating in Built for Zero have housed collectively more than 85,000 of their neighbors experiencing homelessness in under three years, and those communities that have reached functional zero are the first in America ever to do so. Even communities that have yet to reach functional zero have made concrete progress toward this goal, and for the first time, we can measure this.”244 But for Beth Sandor it is also frustrating to acknowledge that this idea of real time data and by- name lists still has not scaled. She compares this to the current efforts around COVID-19: “We would never try to address COVID by taking a snapshot of what was happening nationally or globally during one week at the end of March. And yet in the homeless response system, this [real time data] is still not a mainstream idea.”245 One observer mentioned that there is a whole homelessness services “industry” at work. “This industry operates from robust vested interests in continuing to work the way that it works. People don’t really see ‘what’s in it for me’ if we get real-time data or we get to zero. There is a lot of fear in driving reductions [in service delivery]”. This problem of misaligned incentives is a hurdle for scaling Built for Zero. Sandor believes that some communities may not want to announce reaching functional zero because this announcement could result in reduced budgets. Decision makers could interpret the message of having reached functional zero as a reduced requirement for future funds. Sandor thinks that this interpretation by decision makers signals a misunderstanding of the behavior and

242 Community Solutions, annual report 2016. 243 Community Solutions, Annual Report 2015 244 Getting to proof points. Community Solutions, March 2018. 245 Beth Sandor interview, 19JAN21.

73 characteristics of the dynamics of homelessness. “We [the homelessness service system] boxed ourselves in a corner by setting up this system where we built teams with program and technical expertise to treat homelessness like a static problem. And now we have to untangle that. I think this is scary for people and sometimes not in their self-interest.” Beth Sandor thinks it is difficult to mainstream the use of by-name, real-time data. On the other hand, she considers this aspect as the foundational part of their work: “Right now it’s a coalition of willing communities.” Sandor argues that the evidence is clear and that no community has ended homelessness without real-time data. “Our hypothesis for the next year is that we will have to change the incentive structure.” Community Solutions is now targeting both state and federal policy processes to adopt a perspective of standardized real-time data.

Another important issue revolves around the question: Can communities sustain a state of functional zero once achieved? Will it be possible to maintain levels of motivation and ambition for updating real- time by-name lists? After all, the excitement and motivation for a race towards achieving a state of functional zero for the first time may be quite different from a situation of merely maintaining the new “normal”. Sandor reflecting on communities who had sustained functional zero for almost 5 years: “They don’t get anything for that. They don’t get more money. They don’t get any praise because nobody knows they are doing that. But the impact is phenomenal. If you are a homeless veteran, you are housed within days.” And while these communities scale their efforts to include other homeless segments such as chronic homelessness or all single adults the question remains what will happen then? “Once they have covered all the populations [of homeless people] how will they maintain that [functional zero level] without any incentive structure set up?” Perhaps, this question defines an important learning curve for Community Solutions in the next years. How to move from changing a system to maintaining a system so that the problem of homelessness does not occur. Maintaining this commitment may be challenging from the input- and solution-driven attitudes that persist in almost all relevant sectors. “When Mayors, electives, federal agencies start talking about how a population has improved rather than how much money they have spent on a problem -that’s how we will know that we have been successful,” Sandor said.

Organizational changes In 2016, Community Solutions also adapted its mission statement: “We help communities adopt the best problem-solving tools from multiple sectors to end homelessness and the conditions that create it.”246 To improve its reach and to facilitate local knowledge sharing, the organization established a dedicated consulting unit. The unit provided a training program called “agile problem solving” to support organizations and communities tackling complex problems. International efforts included a collaboration with a pioneering leadership program with the Institute of Global Homelessness. However, the consulting unit was dissolved a few years later to focus fully on Built for Zero.

Community Solutions also revived its legacy as a real estate developer to assist Built for Zero communities in reaching functional zero veteran and chronic homelessness. David Foster who is currently directing the real estate program reflected on the bottleneck of housing units during the 100khomes campaign: “Many communities had the housing resources they needed but many also did

246 Community Solutions, Annual Report, 2016.

74 not. And so that’s where the next iteration came from. We said: ‘Now we need to have some focus on innovating there as well.”247 Rosanne remarked the following: “While most of the team’s work is focused on helping Built for Zero communities acquire housing units using social impact capital, they also play a role in the organization’s work to reduce inflow into homelessness. In Hartford, CT, a Built for Zero-led team is working to eliminate ‘inflow’ into homelessness altogether within two years in the two adjacent zip codes with the highest rates of homelessness in the region. At the center of these neighborhoods, Community Solutions has revitalized the former Swift Factory, a historic gold leafing complex, as an anchor to the job creation and housing stabilization efforts”.248 “The revitalization of the Swift Factory harkens back to the very, very beginnings of the organization as Common Ground. An idea of a very massive challenge that matters to a community and Rosanne being inspired to solve that impossible challenge. That’s at the root of what Swift is. ”249 The factory was gifted to Community Solutions but did not come with any collateral assets. “The organization set out to raise money initially around stabilizing the building without having to have a specific plan on what it was going to be. And so what the team did was to develop the business plan around what it could be. That plan was rooted in two different things. One is the voice of the community. At a very early stage we heard from the community - and continued to hear from the community - about what they did and did not want. They did not want affordable housing which would be probably the easiest thing to do on a site like that. They did want jobs. So, the voice of the community was influential. And then the second consideration was the reality of the market. What could be financed? What businesses can function here? What kind of places need this space? And then molding that to best meet our mission.”250 Because Community Solutions had been working on measuring health outcomes in that community for a decade, the project team also wanted to integrate an explicit health aspect potentially by focusing on jobs in the food industry. But realizing this vision and bringing so many disparate elements together was no easy feat: “We iterated on that [thesis] and worked to address the complexity of a plan that would anchor tenants to it. The financing for a project like that is among the most complicated that you would see anywhere in the country. As a result, the deal costs were very, very expensive, the construction is very hard. Everything that changes needs to be approved by 25 different people. It’s complicated but there wasn’t another choice. And so, business plan, community voice, another business plan, the kinds of financing that might be available and then pulling them all together. And where there were gaps, it was back to Rosanne and the organization to raise private dollars to help fill in those cracks that came along the way. Having faith that we can do that is to take a tremendous amount of risk. No private entity would ever want that kind of risk for a project like this.” 251

The challenge for real estate was to develop what David called “lighter and faster” development models. These models would be more in line with the traditional Housing First model combined with services that matched the needs of individuals. The fact that Community Solutions may not want to or be able to provide services creates an opportunity to develop housing models that facilitate the integration of various service components by community partners. Another challenge for David’s team are high cost markets such as San Francisco where even an experienced, committed, risk tolerant organization may be

247 Dave Foster interview, 20MAY20. 248 Rosanne Haggerty, personal communication, May 2021. 249 Dave Foster interview, 20MAY20. 250 Ibid. 251 Ibid.

75 unable to overcome economic barriers. David also outlined his vision for developing and scaling new models for delivering housing: “I would like to see it go in three phases. In the first phase, we do it by ourselves, like the Abrigo Apartments [outside Denver, where the organization prototyped their social impact finance model], and we prove the concept. In the second phase, we do it with a joint venture partner. We are pursuing this right now in Santa Fe [and other locations] with a partner on the ground. Projects where we bring a partner in, we open our books, they see everything that is happening. They learn and then ultimately, they own it and benefit from it. And then the third phase is that we would move out of the development role and move into the financing role. So, we would transition from project-based financing to a funds structure. […] We would really just be the financing partner and so developers would come to us and say we want to do this. We would be a lender but maybe like a lender plus - a lender plus technical advisory but not the owner and developer of the property. So that’s how we would see that evolution.”252 But the question is whether or not Community Solutions could actually align its levels of ambition with the attitudes of its partners from other sectors: “Rosanne has a very, very high standard of work; her work and also organizationally, how far we try to push progress and outcomes on anything that we do. You know, we will always try to go for one more thing and if we don’t I think we would all feel like we’re failing. We may not get it, but we try to have the most impact we possibly can and go down trying. That approach is not always consistent with a for-profit approach. And so, a non-profit for-profit partnership I think is very difficult.”253

Community Solutions also started to invest in building and strengthening its organizational and governance structures. Heads of departments became principals and joined an expanded executive team that would jointly make important strategic decisions. The organization also developed a new strategy that revolved around the idea of a “tipping point”. A tipping point, according to Rosanne, would be a moment around 2026. Kat Johnson understands a tipping point as a moment where a critical number of people and communities shared Community Solutions’ belief that homelessness could be solved, that the resources and operating templates existed, and where “some of the barriers around data and around funding are cleared out of the way of leaders who are doing the work. ”254 As a result, Community Solutions orchestrated its various operative, knowledge sharing, capacity building, and public relations work streams towards achieving this tipping point to radically shift the public perspective on homelessness: “There is this idea of normalizing that homelessness is solvable. It is a shift from possibility to normalization.”255 But how to measure a tipping point? Even for relatively simple natural systems, science is only slowly making progress on this question.256

Community Solutions is also deeply reflective about the boundaries of its work as it rejuvenated earlier efforts towards prevention of homelessness. Kat Johnson remembered: “On this question of prevention, we got a really good piece of advice: ‘On the prevention of homelessness - you have to be careful because the root causes are so structural. If you put a team on this and didn't give them some bumpers, you could go all the way back into trying to fix the criminal justice system, you could go all the way back into trying to fix income inequality.’ You have to stop yourself at some point and think about: How far

252 Ibid. 253 Ibid. 254 Kat Johnson interview, 17APR20. 255 Ibid. 256 Scheffer, M. et al. (2009) Early-warning signals for critical transitions. Nature 461, 53-59.

76 back are you willing to go? How far back do you have the resources and staff time and capacity to go? And create some bumpers for yourself.”257

A new federal agenda - From Housing First to Housing Fourth But not everyone was willing to adopt a nuanced and systemic perspective on homelessness. When President Trump proposed his first budget in October 2017, entitled “America First: A Budget Blueprint to Make America Great Again”, a frosty wind was blowing in the faces of federal homelessness agencies and the larger services sector. Severe cuts to HUD and a proposal to sunset ICH in 2018 signaled a shift in the administration’s core ideology towards homelessness. A 2019 report by the Council of Economic Advisers to the President’s office started with this statement: “Due to decades of misguided and faulty policies, homelessness is a serious problem”258. The Council suggested to abandon the Housing First approach and to focus on the deregulation of housing markets, making sleeping on the streets less ‘comfortable’, rethinking right-to-shelter policies, and emphasizing individual-level factors such as drug abuse, mental health, incarceration, low-income, and weak social connections. In December 2019, the Trump administration appointed Robert Marbut, a community college professor and homelessness consultant, as the new director of USICH. In his first statement, Marbut strongly supported the administrations intent for radical policy change on the topic of homelessness and the inadequacy of the agency’s prior work: “Playing games with data, changing definitions and hiding from realities only mask the challenges we face. This in turn impedes implementing real solutions that address the true causes of homelessness. We need to be honest with ourselves; much of what we have been doing is not working.”259 Marbut rejected the principle of Housing First, whose efficacy he had openly questioned prior to his appointment. His principle of ‘Housing Fourth’ is illustrated by a shelter complex that he had co-founded, named the “Haven for Hope”. At this shelter, homeless people were forced to sleep in an open air courtyard until they passed a drug test. Only then were they allowed into the roof-protected part of the shelter. Observers feared that Marbut might push his model as a nationwide template for shelters. Seventy-five members of congress registered their dismay about Marbut’s appointment in a letter to President Trump. According to Bloomberg City Lab, the letter said: “We are very concerned that the Trump administration would pick someone whose professional work is based on practices that are cruel, punitive, ineffectual, and expensive to run the only federal agency tasked with ending homelessness.”260

Questions for the future Given this policy shift, Community Solutions future will be defined by facing some fundamental questions. Will the challenges to the legitimacy of basic building blocks of Community Solutions’ approach (such as the Housing First principle) lower the capacity of the implementing communities to absorb fluctuations in homelessness rates? If fewer resources are made available, will communities be able to effectively absorb variance if change exceeds certain thresholds? If resources are stretched, adaptation gets difficult. Having resources at levels that exceed short-term demands may be a

257 Kat Johnson interview, 17APR20. 258 The Council of Economic Advisers (2019) The State of Homelessness in America. Executive Office of the President of the United States. Sep 2019. 259 Marbut, R. (2019) A statement from the new executive director of USICH. USICH 13DEC19. 260 Capps, C. (2019) The Consultant Leading the White House Push Against Homelessness. Bloomberg City Lab, 12DEC19.

77 prerequisite for adaptive work but may be tough to justify politically. Resource constraints may be particularly painful when trying to recover from short-term shocks such as those provided by the Covid- 19 pandemic or a major economic down-turn such as the one in 2008. Restoring functional zero may utilize many more resources than sustaining it. Another key question for the future may be whether the community of implementers will be forced to widen its system boundary from owning the problem of homelessness towards integrating the upstream societal mechanisms that generate the problem in the first place. Until recently, Community Solutions shied away from explicitly taking responsibility for this inflow into the problem space of homelessness and to go beyond advocacy:

One of the things that makes the task of inflow reduction so challenging is that it asks the homeless services system to manage outcomes it does not fundamentally control. We must be clear-eyed about the fact that inflow into homelessness is always a negative outcome measure for another failing system, often more than one. Traditionally, the sector has called for structural change in mainstream systems (e.g. healthcare, criminal justice) and additional investments in affordable housing in order to address the challenges of inflow. Collectively, we should continue to advocate urgently for these things. Still, resources are not a panacea, and structural change often plays out over decades. How might we make ongoing progress, even as we continue our advocacy?261

What if we replaced our fascination for solutions and innovations with a genuine ambition to create fewer problems that needed such interventions? Imagine a future in which society does not generate the problem of homelessness in the first place. Imagine we find consensus about the desirability of this future as a beacon of a healthy society. What would it take?

261 Getting to proof points. Community Solutions, March 2018.

78 Appendix 1. Main innovation programs between 2006 and 2010.262 Recovered from historical website repositories of the www.commonground.org domain. Information was copied and pasted “as is” with few minor formatting adjustments.

1. Chronic Homeless Someone sleeping on the street is the most visible and troubling manifestation of homelessness. In a March 2006 survey, an estimated 3,843 people were found to be sleeping on New York City streets, a 13% decrease from 2005. Of these individuals, 37% (or at least 1,600) are believed to be chronically homeless, meaning they have slept outside continuously for more than a year. Common Ground’s goal is to change that, and demonstrate how chronic street homelessness can be ended.

Andrews House The Andrews House, opening in spring 2007, will offer private, safe, clean and affordable short-term accommodations to individuals who are transitioning to housing, facing homelessness, or who have rejected or failed in other programs. Currently home to 58 long-term residents, the Andrews House is undergoing renovations to both expand and enhance the structure. Once renovations are complete, the site will offer 146 short term living units, including 88 “first step” units for only $7 per night First Step housing was designed following extensive interviews with homeless individuals on the street who do not use shelters. Issues such privacy, security, affordability and space for personal belongings were highlighted as reasons chronically homeless individuals would be motivated to take their first steps into housing from homelessness. Services for residents will include medical care, and help in locating permanent housing. At the Andrews is our Home, Health and Wellness Clinic (HHW), operated in partnership with St. Vincent’s Medical Center and the Henry St. Settlement House. The HHW Clinic provides comprehensive mental and medical health services for medically frail Andrews House residents, as well as other homeless or marginally housed individuals in the Bowery neighborhood. Design Competition: In 2003, Common Ground and The Architectural League of New York held an open design competition for this new form of accommodation. Competitors were asked to design a prototypical individualized dwelling unit and show how 19 such units could be organized on a typical floor of The Andrews. Chronic homelessness – including the Foyer program

Street to Home Street to Home (S2H) focuses on the 250 blocks of West Midtown, Manhattan, which has a significant street homeless population, to help chronically homeless individuals secure housing. Through S2H, one- hundred and thirty-six men and women who were on the streets an average of nearly 10 years moved directly into housing during the past three years. S2H combines intensive outreach to long-term street homeless adults who we get to know by name, and individually tailored help in creating a housing plan. A peer support component, the weekly “ShopTalk” session, brings together those working on securing housing to encourage and educate each other through the process. Progress is monitored through regular “street counts,” and the charitable efforts and resources of a network of local organizations including churches, business groups and government agencies, are coordinated through monthly meetings and the use of a shared database. A new

262 Recovered from historical website repositories of the www.commonground.org domain.

79 component of the program focuses specifically on chronic alcoholics who have lived on the street for a year or more. The three primary features of S2H are: i. it is a neighborhood-based approach to solving street homelessness, involving a range of community members; ii. it uses peer advocacy and support; iii. it has a consistent and exclusive focus on assisting the chronic street homeless to secure permanent housing, and this focus is the primary tool for engaging homeless clients.

There are many ways you can help us solve this tragic and unacceptable situation. You can:  Participate in one of our Street Counts  If you live or work in our catchment area and you know someone who’s been homeless for more than a year, you can refer them to us by calling 1-800-871-8910 Previous counts have established a baseline of 416 chronic homeless. To meet our goals, we must find homes for 277 individuals.

Vulnerability Index The Vulnerability Index is a tool for identifying and prioritizing the street homeless population for housing according to the fragility of their health. It is a practical application of research into the causes of death of homeless individuals living on the street conducted by Boston's Healthcare for the Homeless organization, led by Dr. Jim O'Connell. The Boston research identified the specific health conditions that cause homeless individuals to be most at risk for dying on the street.

To learn more about the Vulnerability Index, click here.

The Innovations Team has worked with Los Angeles County, the City of Santa Monica, New Orleans, and Washington, DC to implement the Vulnerability Index in their communities.

To learn more about bringing the Vulnerability Index to your community, fill out our Vulnerability Index survey.

Chronic Inebriates The Chronic Inebriates Initiative provides rental assistance for permanent housing and visiting care workers for chronic alcoholics who have been living on the streets for more than a year. The program is supported by a grant from the Federal Department of Housing and Urban Development (HUD).

Hospital to Home The Hospital to Home (H2H) Team - The H2H Team is comprised of 8 communities improving the health of people experiencing homelessness and decreasing unnecessary health care costs. Health care providers are working alongside homeless outreach and housing providers to link individuals with an integrated medical home and a “bricks and mortar” home. The H2H Team gains faculty support and access to an international learning community by participating in the Institute for Healthcare Improvement’s Triple Aim initiative.

80 Early Outcomes September 2009 - January 2010  135 people housed  631 people connected to primary care

Teams also track:  Self-reported health status  Hospital and outpatient utilization  Individuals’ experience of care systems

Current Member Communities  New York, NY: Common Ground Community and Bellevue, Woodhull and Elmhurst Hospitals  Bronx, NY: BronxWorks and Montefiore Medical Center  Camden, NJ: Camden Coalition of Healthcare Partners  Philadelphia, PA: Jefferson Medical Center, Pathways to Housing and Project HOME  St Petersburg, FL: St. Anthony’s Health Care  Santa Monica, CA: Venice Family Clinic, St. John’s Health Center, Ocean Park Community Center, City of Santa Monica Department of Homeless Services  Los Angeles, CA: United Homeless Healthcare Partners, Access to Housing for Health, St. Joseph Center  Portland, OR: Central City Concern and CareOregon

Hospitals and outpatient care providers work to:  Develop Care Management Teams  Pay for respite beds  Link individuals to primary care & homeless outreach  Provide patient navigation

Housing Providers work to:  Partner with hospital staff to inform discharge plans  Secure housing  Link individuals to primary care and social services  Provide patient navigation

Sample Interventions:  Connect individuals with primary and mental health care  Help individuals back into permanent housing  Coordinate outreach efforts to improve in-reach to people who frequently use emergency and inpatient care  Leverage resources across various community-based health and social service providers and local government  Coordinate care plans with individuals to address individuals’ stated health and concrete needs  Host collaborative workgroups and ongoing case presentation meetings to bridge complex systems of care

81 The map below shows cities across the country participating in Hospital to Home (Data from 6 Jul 2010).

2. Long-Term Shelter Stayers New research has demonstrated that a small percentage of the adult homeless population consumes the majority of resources spent on assisting the homeless. This group of chronically homeless individuals living in shelters, “ Long Term Shelter Stayers” (LTSS), is comprised of individuals or families who have lived two of the past four years in a shelter, or one of the last two years in a shelter yet have a disability. Common Ground prioritizes LTSS to live in our supportive housing, where the combination of stable housing linked to help getting on their feet helps people to rebuild their lives and move toward self- sufficiency.

Rental Assistance Program Launched in fall 2005, Common Ground’s Rental Assistance Program (RAP) provides a three year rental subsidy, assistance with finding an apartment, and case management services for Long Term Shelter Stayers. In its first five months, RAP secured homes for 15 individuals.

The Prince Transitional Residence Common Ground leases two floors of the Prince Hotel a former Bowery lodging house to operate the 60-unit Prince Transitional Residence for long term homeless men. The Prince helps residents to secure

82 permanent housing within six months, and to establish stable, self sufficient lives. Since the program opened in January 2004, we have helped over 150 men to secure their own homes.

3. Preventing Homelessness For many, homelessness follows a failed transition from institutions such as the military, foster care or prisons and jails. By helping those without families or homes to go to during these transitions, we seek to stop homelessness before it occurs

Foyer In New York City alone, between 1,200 and 1,300 young people age 18-21 transition from (or “age out” of) the foster care system each year. As they leave, nearly 20% indicate that they have no home to go to. Others, who hope to return to their biological families or former neighborhoods, find themselves alone and homeless instead. Indeed, New York City estimates that more than one in four young adults who experienced foster care will become homeless as adults. Sadly, New York’s experience is repeated in every community.

Modeled after a successful type of residence for young people found in Europe, Common Ground’s Foyer Program is a housing-based career development program for young adults ages 18-24 who are “aging out” of foster or residential care, are homeless, or likely to become homeless. The foyer provides two-years of supported housing and help in securing a steady job, pursuing training and education, establishing a savings account, and ultimately finding an affordable apartment. In partnership with Good Shepherd Services, which provides foyer residents the educational and counseling services and help with finding and keeping jobs, our first 40-unit Foyer program opened in July 2004 at The Christopher. Two additional foyers are planned at new Common Ground projects in development at Pitt Street on the Lower East Side, and Brook Avenue in the South Bronx.

Homelink Common Ground’s HomeLink program is reducing family homelessness in Brownsville, Brooklyn—one of ten New York City neighborhoods producing the highest number of homeless families each year— by two-thirds over the next four years. By identifying families struggling to maintain their housing, and working with them to find the help they need, HomeLink contributes to solving homelessness by preventing vulnerable families from becoming homeless in the first place.

HomeLink services include: Housing Support Services – Working with Brownsville community organizations, City agencies, local churches and other institutions, Homelink identifies and offers help to families struggling to maintain their housing. HomeLink works with families to stabilize their living situations, and provides links to what families need to maintain their housing such as employment assistance, child care, counseling, psychiatric evaluations, continuing education, and drug and alcohol treatment. In addition, family service coordinators and case managers help families to manage family tensions (including those resulting from overcrowded conditions, substance abuse, and domestic violence) that can lead to homelessness. In certain cases, HomeLink is able to provide small grants or loans to help families avoid an eviction or help maintain their current housing. Since HomeLink began operations in March 2005, 40 families on the verge of becoming homeless were helped to remain housed, and another 244 families and individuals received help with less acute housing-related problems.

83 Single Stop Services – HomeLink offers a Robin Hood Foundation-funded Single Stop program, which helps families and individuals to become more financially stable and better able to pay for their housing. A “benefits calculator” service connects families with food stamps and other income supports; tax preparation services help families to secure Earned Income Tax Credits, and legal assistance helps families individuals to resolve immigration issues, credit problems, and other matters that jeopardize their financial and housing stability.

Re-Entry Housing Initiative Frequent User Service Enhancement (FUSE) Individuals who have served their time in prisons and jail often face homelessness upon their return to the community. Studies show that without a stable home or job, these individuals are more likely than others to end up in jail again. For many a pattern of cycling back and forth between jail and shelter develops - at a great cost to individuals and society alike.

A new initiative, growing out of a three year collaboration between service providers and New York City’s Departments of Corrections and Homeless Services, will target these high-need, chronically institutionalized individuals known as “frequent users,” and provide them with housing assistance and the help and structure they need to build a new life. As part of a larger City initiative, Common Ground is working with 25 frequent users, helping them to find affordable apartments, jobs and medical and mental health care and to become part of the community.

HOPE for New Veterans Common Ground created HOPE for New Veterans (HOPE) to prevent homelessness among veterans returning from Afghanistan and . Almost one out of four (23%) of the homeless population are military veterans. By learning from the past and helping new combat vets to secure housing and other help in adjusting to civilian life at the earliest sign of crisis, we can solve homelessness among new veterans before it occurs.

HOPE has organized a network of private and public agencies to provide new veterans facing homelessness with the help they need to secure affordable housing. Once in a stable home, the team works with each veteran to help him or her secure employment, education, and/or access the appropriate VA benefits needed to achieve self-sufficiency. 1. Identification and Outreach to At-Risk Veterans: New veterans come to HOPE through referrals made by organizations such as the Department of Veteran Affairs (VA). Common Ground staff assesses each individual’s housing options and helps those facing homelessness to secure stable, affordable housing. 2. Housing assistance: For veterans who would otherwise be living on the streets or in shelters, HOPE provides a three to six month rental subsidy 3. Mental health evaluation: Common Ground’s psychiatric nurse practitioner conducts a thorough mental health evaluation and assessment of each veteran. Along with establishing a veteran’s treatment needs, this assessment provides documentation needed to secure VA benefits. A high percentage of veterans struggling with housing issues suffer from PTSD and require both treatment and assistance accessing their VA benefits.

84 4. Access to jobs and benefits: We help veterans in crisis to secure benefits, which may include food stamps and VA disability compensation, and when they are able, to find steady jobs, to support themselves and their families.

Veterans Transitional Residence In collaboration with the U.S. Department of Veterans Affairs, Common Ground will open a transitional residence for 100 homeless veterans on the VA’s Montrose Campus in Westchester County in 2007. The Veterans Transitional Housing Program will offer housing placement assistance to homeless veterans recovering from trauma and other mental health problems, medical conditions or substance dependency. The program will allow homeless veterans up to two years to use VA health and mental health services, employment programs, and other therapeutic activities on the Montrose Campus while living on Campus in a supported residence. During that time, Common Ground will connect individuals to permanent housing and steady jobs.

4. Evaluation Common Ground monitors its programs to measure progress against stated goals and to make necessary refinements. Program outcomes and data such as the number of clients who secure and remain in housing, cost per client, and other measures indicating success and effectiveness are rigorously tracked and analyzed to inform the design of new programs and provide an evidence base to Common Ground’s policy views.

5. Real Estate Services Common Ground’s Real Estate Services unit assists clients of all Common Ground programs to find affordable, privately owned housing. Common Ground also makes sure that families and individuals are connected with the help they’ll need to be successful tenants once settled into their new homes. The unit has a special focus on Brownsville, Brooklyn, where it works with local landlords to avert evictions, secure apartments for families facing homelessness and put vacant apartments back in use. In addition to helping families, Real Estate Services provides local landlords with help in improving and maintaining their properties, including financing, assistance with renovations and repairs and property management.

In return, these landlords commit to providing affordable rents to families and individuals in our HomeLink, FUSE, Street to Home and RAP programs. In 2006, Real Estate Services will begin training tenants and landlords in knowing their respective rights and responsibilities, and on building good working relationships between landlords and tenants.

6. Brownsville Partnership Common Ground focuses on both ends of the homelessness spectrum: eliminating chronic homelessness and preventing homelessness among known vulnerable groups. Our homelessness prevention programs provide targeted assistance to at-risk families and individuals so that they can maintain their housing while they work to improve their financial situations, or make the transition from institutions into stable housing.

85 Since March 2005, Common Ground has operated a homelessness prevention services program for families in the Brownsville neighborhood in East Brooklyn. Brownsville ranks sixth among New York City neighborhoods that produce family homelessness: on average, 350 families become homeless there each year.

To date, we have worked with over 500 families and stabilized the living situation of nearly 200 families at immediate risk of becoming homeless. Using intensive case management, legal services, and cash assistance to defray rent arrears, these families were able to remain housed. As a result of our work in the community, Common Ground amassed considerable knowledge regarding the causes of family homelessness in Brownsville and how to address them. We know, for example, that a consistent 26% of our clients come from and, of this group, the majority struggles with crises in maintaining housing.

Based on this knowledge, Common Ground created the Brownsville Partnership, a unique collaboration with the New York City Housing Authority (NYCHA) and top social service organizations. The Partnership will serve four large public housing developments – the Brownsville, Van Dyke I and II, and Tilden Houses.

The following comprise the three main components of the Brownsville Partnership:

 A public housing conservancy: The Brownsville Partnership will introduce the concept of a public housing conservancy – the first of its kind – to support and revitalize the community. Modeled on public-private collaborations that characterize business improvement districts, park conservancies, and charter schools, this is a proven strategy for effectively transforming troubled environments. By partnering with organizations whose expertise has made them leaders in their respective fields, we will bring best practices to Brownsville in six areas of focus: public safety, employment, housing, early childhood, health, and leadership development. We have received statements of interest from a number of potential partners, all of which have exceptional track records; we are in discussions regarding scope of work, space to be allocated, and how we will coordinate programming.

 New affordable housing: Common Ground will create at least 350 and as many as 1,350 new units of sustainable affordable housing in and around Brownsville. We will begin construction in 2008 on the first two residences, on Hegeman Avenue and St. Mark’s Place. Support services will be integrated with housing management activities to assist vulnerable people in maintaining their housing, returning to the workforce, and improving their physical and mental health.

 The community hub: Common Ground will renovate an abandoned bank building located just outside the public housing complex, creating a neighborhood “hub” that offers early childhood development services, e.g., educational workshops for parents, business development services, a credit union and financial literacy service, a technology center, and a restaurant. We will acquire the property by the end of the year, and we anticipate that renovations will be complete by 2010.

86 Ultimately, the Brownsville Partnership – with its combination of affordable housing, a community hub, and linkages to resources outside the community – will provide a vital stabilizing institution and offer a new means of addressing the urgent and interrelated issues that arise from concentrated poverty.

7. The Institute In communities around the country and across the globe, in cities as diverse as New Orleans, Los Angeles, and London, the Common Ground Institute is creating local strategies to end homelessness. We partner with government, not-for-profit, and private sector leaders to accomplish four main objectives:

 Create housing  Share knowledge  Test and model innovative solutions  Champion creative and effective practices

A Force for Innovation As New York’s largest developer of supportive housing, an award-winning property manager, and an acknowledged leader in helping homeless men and women move from the street to stable housing, Common Ground is a potent force for innovation and results.

Create a Plan to End Homelessness We offer 17 years of experience and comprehensive expertise in housing development, property management systems, and social service delivery. We guide you in bringing together service providers, government agencies, landlords, businesses, and community leaders to support homelessness prevention and housing solutions.

End Street Homelessness Through Targeted Outreach and Housing Placement We help you adapt our innovative outreach and housing placement program that reduced street homelessness in New York City’s Times Square neighborhood by 87%. We move individuals living on the street directly into housing, and provide them with the individualized assistance they need to get back on their feet and lead a stable life. The City of New York adopted our approach as its citywide strategy to end homelessness, and we have assisted other cities — Denver, Toronto, Atlanta, Adelaide — in introducing similar efforts to their communities.

Develop State-of-the-Art Supportive Housing Working with public agencies, nonprofit and for-profit developers, we create housing based on our model of integrating mixed-income workers with the formerly homeless. We assess project feasibility, including organizational readiness; we help select development team members, evaluate financial options, advise on site acquisition and quality design, and help to secure political and community support.

Integrate the Formerly Homeless into Mixed-Income Housing Mixed-income communities can successfully integrate formerly homeless individuals and families at risk of losing their homes. Common Ground’s experience in working with national leaders in mixed-income

87 housing will help you incorporate supportive housing components in large-scale redevelopments and a range of projects.

Provide Quality Housing Management Common Ground currently operates more than 1,600 units of housing. We have established a strong track record of providing housing for the formerly homeless in properties reflecting the highest management standards. Our innovative Management Index monitors and evaluates tenant well-being and the quality of building operations. We guide you through establishing facility management systems, tenant selection, rent collection, and security planning for special needs populations. We demonstrate the feasibility of renting to a wide range of households, while enhancing neighborhoods and contributing to communities’ economic development.

Prevent Homelessness We help communities prevent homelessness by assisting individuals and families who are particularly at risk, e.g., veterans, young people aging out of foster care, and families in areas where high rates of unemployment, incarceration, and child welfare involvement are predictors for homelessness. We help you use data to design targeted local strategies to combat homelessness before it happens.

Do you need our assistance in your community? For information on our services and fees, please contact: [email protected]

For general information, or to request a tour of Common Ground’s housing complete a tour request or email [email protected]

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