Permanent Housing for the Hardest Cases

Permanent Housing for the Hardest Cases

In Clark County, Nevada (shown), the LINK unit aims to target housing to the most vulnerable people in need of assistance while maximizing available housing resources.

On June 18, 2020, the Substance Abuse and Mental Health Services Administration’s Homeless and Housing Resource Network hosted a virtual symposium to examine ways to improve access to care for people experiencing homelessness and those living with serious mental illness and substance use disorders. During a half-dozen workshops, speakers discussed strategies for serving specific populations, approaches to transitioning people into housing, and ways to support people experiencing crises. One workshop, featuring speakers Michelle Fuller-Hallauer, manager for Clark County Social Service in Nevada, and Emmy Tiderington, assistant professor at Rutgers University, discussed general approaches and practical experiences for overcoming individual barriers, such as mental or substance use disorders, to accessing permanent housing.

Bringing Structural Awareness to Individual Cases

Individual-level barriers, such as inadequate income or drug use, can pose significant difficulties for accessing permanent housing. Additionally, Tiderington argues that examining the role of system-level barriers in the United States is crucial to understanding and adequately responding to the problem of housing the most vulnerable. Although systems-level awareness does not change the fact that the most difficult cases require intensive and individualized solutions, it does indicate areas where service providers may be able to tap resources strategically to create more individual successes. Tiderington reviewed numerous strategies, encouraging service providers to be creative, while Fuller-Hallauer demonstrated how these strategies can be effective in practice. Examples Tiderington cited include working as soon as possible toward long-term housing stability, such as improving credit or getting a criminal record expunged; helping a client construct a better self-image; building an extensive network in the community with those who know the pulse of a neighborhood; cultivating relationships with landlords who are allies in connecting vulnerable populations with housing; and encouraging clients to build their own support networks by helping them connect to faith-based communities, recreational activities, or volunteer opportunities.

Housing the Most Vulnerable in Southern Nevada

Fuller-Hallauer described one initiative her organization has taken that targets housing the most vulnerable people in need of assistance while maximizing available housing resources. Clark County Social Service noticed a bottleneck between referrals from the coordinated entry system and placement in permanent supportive housing. The bottleneck was not caused by having too few units available but rather by delays while assessing people in the housing queue and getting required documentation in order. In response, Clark County Social Service created the Linkages, Intervention, Navigation, and Knowledge (LINK) unit to quickly move their most vulnerable clients into housing and then create the needed documentation. This model, adapted from an existing program designed to rapidly house medically fragile individuals, employs whatever housing resources may be available, from scattered-site motel rooms to master-leased apartments. This strategy echoes a best practice Tiderington identified in which rapidly rehoused families have only a 10 percent chance of returning to homelessness.

Clients of LINK teams are referred from the community queue of people seeking permanent housing. Clients are placed in bridge units until a permanent supportive unit that meets their needs becomes available. Once housed, LINK clients are assigned “client navigators” who begin preparing the client for permanent supportive housing. This work includes ensuring that clients have all their documents in order, including an identification card, a Social Security card, and a birth certificate; connecting clients with needed medical, mental health, or substance abuse treatment providers; and working with the client to determine their housing needs, such as a first-floor unit, elevator access, a pet-friendly building, or proximity to certain bus lines.

When the client is ready to move into permanent housing, a LINK “housing navigator,” who functions as an intermediary between the client and landlords, helps find a unit that will meet the client’s needs, demonstrating an approach that Tiderington advocates for homeless service organizations: building a network with area landlords to demonstrate institutional support for individuals who are otherwise harder to house. After three years of successful operation, LINK has revealed other areas for systems improvement in Clark County, such as ensuring a spectrum of program exit options to meet all client needs and forming stronger connections to mental health and substance abuse service providers.

The Importance of Social Support

The close involvement of case workers in the LINK program reflects approaches Tiderington advocates that leverage the power of social support in promoting client success. For example, a program in the state of Washington to provide housing with wraparound services to vulnerable individuals exiting the justice system found particular success for individuals placed in housing with roommates. Both panelists reinforced the notion that intensive, client-focused approaches are needed in the hardest cases, and that success is more likely when robust systems of communication and support are put in place for both service providers and clients themselves.