Housing First in Action

Housing First in Action

Highlights

• Boston’s Housing First approach includes a front-door triage assessment process conducted at shelters and through street outreach to help route people to appropriate services and permanent housing.
• Rapid rehousing is a vital component of Chattanooga’s Housing First strategy, which relies on housing navigators who match people with housing and services tailored to their specific needs.
• Financial incentive programs for local landlords who are willing to lease units to people exiting homelessness who may have criminal records or a poor rental history are a vital component of Housing First approaches in Boston and Chattanooga.

Many U.S. cities have adopted a Housing First approach to reduce the prevalence of homelessness, meaning that they move people experiencing homelessness into housing without preconditions for sobriety, treatment, or participation in supportive services.¹ In 2015, the city of Boston released Boston’s Way Home, an action plan with the ambitious goal of ending veteran and chronic homelessness in the city through a Housing First approach. Since implementing this plan, Boston has helped more than 6,800 households experiencing homelessness access permanent housing.² In 2018, the city of Chattanooga, Tennessee, enacted its Homelessness Action Plan, which embraces the Housing First approach primarily through rapid rehousing (RRH) interventions. These local Housing First models have successfully reduced long-term, chronic, and veteran homelessness by developing streamlined data systems, targeted action plans, and low-barrier housing. Both cities are using federal funding and partnering with local service providers to develop additional housing units for people who require a higher level of care. Boston and Chattanooga have also signed onto House America: An All-Hands-on-Deck Effort to Address the Nation’s Homelessness Crisis, an initiative launched in 2021 by HUD and the U.S. Interagency Council on Homelessness (USICH) to assist communities with implementing Housing First plans.

The Mayor’s Office of Housing deems front door triage a vital component of Boston’s Housing First approach to assess people’s needs and route them to housing and appropriate services. Photo courtesy of City of Boston, Mayor’s Office of Housing

Addressing Homelessness in Boston

The city of Boston has been following a Housing First approach for several years.³ Some of the city’s earliest Housing First efforts began in December 2014, when Mayor Martin Walsh established the Mayor’s Task Force on Individual Homelessness, which worked to reduce long-term homelessness among sheltered and unsheltered adult individuals. The group also focused on improving discharge planning for people leaving institutions of care and channeling more financial resources into addressing homelessness. These steps laid the groundwork for Boston’s Way Home: An Action Plan to End Veteran and Chronic Homelessness, which emerged in 2015 from the goals and shared vision of the task force.⁴

The Housing First approach that Boston’s Way Home follows routes anyone entering the shelter system onto a path to permanent, stable housing.⁵ According to Laila Bernstein, deputy director of the Supportive Housing Division at the Mayor’s Office of Housing (MOH), Boston has a large influx of people entering and reentering homelessness.⁶ Boston’s Way Home recommended creating a front door triage system within shelters along with street outreach to connect people experiencing homelessness to services tailored to their specific needs. Front door triage provides an immediate response for people who enter an emergency shelter or are living on the street. Much like an emergency room triage system, front door triage staff assess the vulnerability and individual needs of those they encounter, engage in collaborative problem solving with them, and route them to the supports that best address their particular situations.⁷

In August 2016, Boston established a coordinated access system — a centralized data system that matches people who are experiencing long-term homelessness with permanent supportive housing (PSH) opportunities.⁸ Housing providers with a vacancy notify MOH, which then matches that information with Homeless Management Information Systems (HMIS) data to identify a person in need. As a tool of coordinated entry, the coordinated access system tracks people as they transition from homelessness to permanent housing. One unique feature of Boston’s coordinated access system software is that its code is open source, meaning that anyone can use the code free of charge, and communities can invest in new features and improvements that benefit everyone using the platform. Boston modeled its coordinated access system after the city of Houston’s system, and it has been a major success for targeting PSH, Bernstein noted. Boston also developed an open-source data warehouse that merges different front-end systems, including HMIS, and offers systemwide reporting as well as unified records for clients who access multiple programs. According to Bernstein, "[T]he open-source component is unique, and something we want to see spread. We’re really excited when we also can learn from other communities or benefit from the iterations or the tools that they’ve created within these platforms. The more communities that join in using these tools, the more we all benefit."⁹

Pathways to Housing

Housing First principles are embedded in all of Boston’s housing programs, and the approach’s low barrier to entry is a critical component. MOH has ensured that all city-funded housing maintains low barriers to entry by applying fewer screening measures, which addresses the concerns of prospective tenants who have past criminal histories or active substance abuse disorders.¹⁰ A critical component of Boston’s Way Home is the development of additional low-barrier, subsidized rental PSH units that include wraparound supports. MOH ensures that PSH units offer enough services to address tenants’ potential safety concerns. Long-term, wraparound supports for tenants include medical care, mental health care, substance use counseling, and employment services, which help tenants improve their well-being and develop life skills to further their stability.¹¹

Boston Mayor Michelle Wu participated in the annual Point-in-Time count, which showed 270 fewer veterans experiencing homelessness in 2022 compared with 2014. Photo courtesy of City of Boston, Mayor’s Office of Housing

Several new PSH projects are under development in the city. In November 2019, the Boston Planning and Development Agency approved a proposal for Pine Street Inn, a nonprofit service provider for people experiencing homelessness, and The Community Builders to create 202 units of supportive and income-restricted housing in the city’s Jamaica Plain neighborhood. Once completed in early 2024, this project will be the city’s largest supportive housing development. A total of 140 units will be designated as PSH and reserved for people who are transitioning out of homelessness.¹² Another project, 140 Clarendon Street, will create 210 units of affordable housing in a former Young Women’s Christian Association building located in Boston’s Back Bay neighborhood. Of the 210 units, 111 will be PSH for people who are transitioning out of homelessness. This project is slated for completion in 2024, and Pine Street Inn is also supporting this project by offering its services to residents in need of additional care.¹³

The city is also reducing reliance on shelters and preventing new people from experiencing chronic homelessness through RRH, which provides assistance to quickly rehouse and stabilize households. In Boston, RRH focuses on preventing long-term homelessness by supporting the rapid transition of households from homelessness to being housed.¹⁴ Several nonprofit service providers, including Pine Street Inn, receive city funding to house people via RRH and provide case management and other supportive services to people exiting homelessness.¹⁵

In addition, the Boston Housing Authority (BHA) prioritizes applicants in need of subsidized housing who are experiencing homelessness.¹⁶ To qualify for housing through BHA, these applicants must complete a certificate of homelessness form and meet BHA’s definition of homelessness. A shelter, police department, or a social services agency can also complete the form on the applicant’s behalf to certify that they meet the criteria for priority service.¹⁷ HUD awarded a limited number of Emergency Housing Vouchers to BHA for high-priority populations, including households that are experiencing or are at risk of homelessness, domestic violence, dating violence, sexual assault, or human trafficking. These households must be currently living in a shelter in or outside of Boston or already enrolled in a city-funded RRH program but are at risk of returning to an emergency shelter or unsheltered living situation.¹⁸ Although the percentage of unsheltered people in the city is low, BHA’s priority service for households experiencing homelessness has been helpful in quickly providing housing to people directly off the street, said Bernstein.¹⁹ The city also maintains a set-aside policy that requires all affordable housing projects with 10 or more units that receive city funding to reserve 10 percent of the units for people transitioning out of homelessness.²⁰

Engaging with landlords is also a critical component of Boston’s Housing First approach. The city launched a landlord incentive program in 2022 to encourage landlords to lease units to households exiting homelessness. The program aims to allay concerns among landlords about renting to people transitioning out of homelessness who may have a poor rental history or limited income to afford rental payments. The program supports landlords through signing bonuses of up to $4,000, broker fees, unit retention bonuses, and a dedicated customer service provider. The city also pays the tenant’s security deposit. The financial support to landlords encourages their participation and, in turn, provides residents with a stable place to call home. The landlord incentive program received approximately $1 million in HUD Emergency Solutions Grants — CARES Act (ESG-CV) funds under the coronavirus pandemic stimulus relief package as well as city funding. As of February 2023, more than 160 people moved into rental units supported by the program. The program empowers landlords to be part of the housing solution for residents who can sign a 12-month lease. Residents typically qualify for housing vouchers or RRH to cover their monthly rent payments.²¹ Bernstein noted that, although the landlord incentive program is gaining momentum, the ESG-CV funding for it will end in September 2023. Conversations are ongoing on how to continue the program through alternative funding streams.²² The program offers an avenue to tap into private and existing housing stock to fulfill housing needs for people exiting homelessness.²³

Boston’s coordinated access system tracks people as they transition from homelessness to stable housing, and the open source feature has facilitated resource sharing of Housing First strategies among communities. Photo courtesy of City of Boston, Mayor’s Office of Housing

Building on Successes

In 2016, Boston ended chronic veteran homelessness under USICH criteria, but it has not yet ended all veteran homelessness.²⁴ Since the 2014 launch of "Boston Homes for the Brave," an initiative to end veteran homelessness by 2015, the city has reduced veteran homelessness by 60 percent.²⁵ The 2022 Point-in-Time (PIT) count identified 180 veterans who were experiencing homelessness, a considerable reduction from the 450 veterans experiencing homelessness identified in the 2014 PIT count.²⁶ The city’s Supportive Housing Division has a veterans working group that maintains a list of veterans in need of housing and coordinates supportive services. The working group also collaborates with federal, local, and nonprofit agencies to address housing barriers facing Boston’s veterans.²⁷ The New England Center and Home for Veterans (NECHV) is a local nonprofit service provider that offers several permanent and supportive housing services for veterans who are experiencing homelessness and their families. NECHV manages a 97-unit building at 17 Court Street for veterans who previously experienced homelessness and also provides case management, housing and financial counseling, and resources for accessing benefits.²⁸ In addition, a partnership among BHA, Brighton Marine (a local nonprofit service provider that supports veterans and active-duty members), and other service organizations led to the development of Veterans Housing at Brighton Marine, which opened in fall 2020. Funded through the HUD-Veterans Affairs Supportive Housing program, Veterans Housing at Brighton Marine provides 25 fully furnished PSH units to veterans in need. On the same campus, Brighton Marine also operates The Residences at Brighton Marine, a 102-unit, mixed-income housing community for veterans earning between 30 percent and 120 percent of the area median income. These developments offer onsite medical and mental health care as well as substance abuse counseling, financial literacy coaching, and other wraparound supports to maintain housing stability.²⁹

Boston has accessed several federal funding sources to implement its Housing First agenda. In 2020, the city received Community Development Block Grant CARES Act funding of $10.6 million and $9.8 million during the first and third rounds, respectively. A portion of this funding helped finance PSH projects.³⁰ The city also received American Rescue Plan Act of 2021 (ARPA) Coronavirus State and Local Fiscal Recovery Funds (SLFRF), of which approximately $19 million was allocated for PSH for people with substance use and behavioral health disorders. In addition, approximately $19 million more in SLFRF funding was directed toward low-barrier transitional housing and supportive services. This transitional housing helped address crowded living conditions at a large encampment in the city known as Mass and Cass.³¹ In 2022, the Mayor’s Office, public health officials, outreach staff, and mental health providers mitigated the encampment crisis through a humane, dignified response that included low-threshold, noncongregate shelter. The city created 6 low-threshold shelters, which included 131 noncongregate shelter beds plus 79 low-threshold beds in smaller congregate spaces for a total of 210 beds across the sites, to serve this unsheltered population. According to Bernstein, the "low-threshold sites, designed specifically for people with active substance use disorders who are having difficulty accessing our shelters, have transformed shelter options in Boston. There was a lot of thought about how to make shelter accessible to people who are actively using drugs, including harm reduction specialists, amnesty lockers, ability to leave at any point to use, and other best practices to meet people where they are and prevent overdose."³²

Developments such as the Residences at Brighton Marine provide affordable units and onsite wraparound services to help veterans remain stably housed. Photo courtesy of WinnCompanies

"There are a lot of different funding sources that are coming into the city — and a lot of them are related to COVID — that are spurring more investments that we wouldn’t be able to make otherwise," Bernstein stated. The Supportive Housing Division is the lead agency for Boston’s Continuum of Care (CoC), and in March 2023, HUD granted the city a CoC award of more than $42 million to be allocated to 14 nonprofit organizations that support residents experiencing homelessness and help fulfill the goals of Boston’s Way Home. According to Bernstein, approximately 92 percent of this CoC funding supports 2,150 PSH and RRH units.³³ In April 2021, the city also received $21.6 million in HOME Investment Partnerships Program – American Rescue Plan (HOME-ARP) funds from HUD.³⁴ These funds are earmarked for affordable rental units, rental assistance, supportive services, and the development of noncongregate shelters. A small portion of the funding can be used for administrative and operating costs.³⁵ In September 2021, Boston joined the House America initiative. The city committed to rehousing 1,100 households that had experienced or would experience homelessness from September 2021 through December 2022. The city aimed to fund and develop 650 housing units combined with supportive services to ensure the long-term stability of tenants.³⁶ According to Bernstein, House America helped the city document its production status and track the number of households that had been rehoused. The initiative supported work that was already underway, and, as Bernstein indicated, the city exceeded its goals.³⁷

As of February 2023, Boston had 3,230 PSH units and 1,964 RRH units in scattered sites. Through the work of Boston’s Way Home, from July 2015 to February 2023, the city provided stable housing for 6,821 single adults, 11,295 families with children, and 1,107 veterans. Bernstein attributes these positive outcomes to the city’s success in pairing affordable or subsidized housing with services. Although most households remain stably housed once they have been allocated a unit, the city monitors the rates of return to homelessness on the street, emergency shelters, transitional housing, and safe havens. In 2022, the city determined that approximately 10 percent of households had returned to homelessness within 2 years of receiving stable housing, and approximately 4 percent of households had returned to homelessness within 6 months of receiving stable housing.³⁸

The state of Massachusetts is also a right to shelter state. Although local CoCs have traditionally focused on single adult homelessness, several state regulations and funding sources focus on emergency shelter for families with children. Bernstein noted that the Supportive Housing Division is now shifting its focus to families experiencing homelessness to better align with state initiatives. In 2020, the Boston City Council passed an ordinance establishing a Special Commission to End Family Homelessness, which Mayor Michelle Wu launched in March 2022. The commission is composed of nonprofit representatives and city and state officials. Although the Boston’s Way Home action plan is still Boston’s guiding document for Housing First initiatives, the city is embarking on a new phase of work as the commission develops a new strategic plan to end family homelessness.³⁹

Overcoming Challenges

Boston’s large shelter system often means that limited staff is available to triage everyone in need. People may enter shelters in the middle of the night, when triage teams are unavailable, and people may have other impairments that hinder them from being fully triaged. In addition, community pushback and not in my back yard (better known as NIMBY) sentiments can make developing additional PSH units difficult. Overcoming stereotypes that existing residents may hold about people experiencing homelessness will be critical to increasing PSH production. Bernstein indicated that some existing residents perceive these developments as shelters and predict that people transitioning out of homelessness and moving into the neighborhood may contribute to neighborhood crowding or alter its character. Furthermore, Boston is a dense city, and its geography also limits the amount of space available for new developments in an already tight housing market. State and city funding streams for vouchers, PSH, and services are not always coordinated, and the Boston CoC connects these three components into a unified system to ensure that housing and services continue to be offered uninterrupted and with few barriers. Predicting the number of PSH units that will satisfy demand is also difficult because the number of people experiencing long-term homelessness constantly fluctuates.⁴⁰

To ensure people can transition quickly to stable housing, Chattanooga’s rapid rehousing program relies on housing navigators who assess the specific needs of households and maintain strong partnerships with local landlords.

Lessons Learned

Bernstein explained that, although Boston has several low-barrier shelters, the influx of people from outside of the city and state is higher than that of most metropolitan areas. According to Boston HMIS data from 2016 to 2018 and a 2019 community of origin custom assessment, more than 50 percent of the people in Boston’s shelters come from ZIP Codes outside of the city limits. "If there were more low-barrier shelters across the country, people wouldn’t need to come to Boston to be sheltered," Bernstein noted. In addition, it is critical for jurisdictions to perform higher-level "housing problem solving within every system of care and in every community and have the resources for it," she said. For example, all hospital staff should be trained in routing people to housing resources "so that shelter doesn’t just become the default and we all accept that homelessness is inevitable for someone," Bernstein emphasized. "The work of training hospitals in housing problem solving and holding them accountable [for] not discharging to homelessness has started in Massachusetts thanks to leadership at MassHealth [Massachusetts’ state Medicaid agency], but more needs to be done in all systems of care to prevent [these] discharges," said Bernstein.⁴¹

Partnering with the state to coordinate services is one strategy for using existing state-funded programs in innovative ways. Bernstein noted that pairing Medicaid services with public housing units can create a PSH package for people in need.⁴² The Massachusetts Housing and Shelter Alliance and the Massachusetts Behavioral Health Partnership partnered to create the Community Support Program for People Experiencing Chronic Homelessness (CSPECH), which funds services for people experiencing chronic homelessness. CSPECH allows people to use their MassHealth state Medicaid plan to access supportive services within permanent housing rather than having to rely on more expensive care accessed within emergency rooms. CSPECH was the nation’s first program of its kind and represents a model for providing PSH services through Medicaid.⁴³ For seniors experiencing homelessness who also need nursing home care, the Supportive Housing Division has partnered with the federal Program of All-inclusive Care for the Elderly (PACE), locally administered by MassHealth. In addition to the PACE enrollment, Boston’s CoC partnered with BHA to prioritize seniors experiencing chronic homelessness for public housing. Pairing the wraparound supports of PACE with public housing has created PSH for seniors exiting shelters or entering directly from the street. PACE helps seniors exiting homelessness effectively age in place with health services brought to their homes and a van to take them to appointments. People who enroll in PACE and public housing tend to stay housed, Bernstein noted, further underscoring the potential for state and local partnerships to help communities lower barriers to housing and carry out a Housing First approach. These programs have been expanded under a 1115 MassHealth Demonstration ("Waiver") issued in 2022 by the Centers for Medicare and Medicaid Services (CMS), which created a new framework called health-related social needs (HRSN). CMS granted $8 million to Massachusetts to support HRSN work, including case management, data systems and management, trauma informed training, cultural competency training, operational support, and creation of community outreach materials.⁴⁴

Housing First in Chattanooga

In spring 2018, the Chattanooga Interagency Council on Homelessness conducted a needs assessment to understand the state of homelessness in the city and identify resource gaps.⁴⁵ The needs assessment led to the development of the 2018 Homelessness Action Plan and the Office of Homelessness and Supportive Housing (OHSH), one of the city’s lead agencies for implementing Housing First principles, primarily through its RRH program.⁴⁶ Sam Wolfe, former director of OHSH, explained that a strategic planning process revealed the need for more RRH. Wolfe indicated that many OHSH clients are experiencing homelessness for the first time, and RRH can help them quickly return to stable housing.⁴⁷ Housing navigators working for the city’s RRH program identify housing vacancies and services that meet the specific needs of households and foster strong relationships with landlords, offer landlords financial incentives to encourage their participation, and assist households with move-in costs and other expenses.⁴⁸ OHSH prioritizes housing navigation and partners with the Chattanooga Housing Authority (CHA), which operates a Housing First program that provides preference on some waiting lists — such as CHA-managed housing and the Housing Choice Voucher program — for individuals experiencing homelessness or domestic violence to be quickly housed. Although OHSH does not offer addiction management or mental health treatment itself, it offers case management services to its clients in need.⁴⁹

Navigating Households to Rapid Rehousing

Housing navigators are the backbone of Chattanooga’s Housing First model. Housing navigators offer direct outreach to clients and assess the specific needs of households experiencing homelessness. They help streamline the administrative process to allow families to move quickly into housing. The lead housing navigator for OHSH, Johnetta Langston, indicated that navigators follow up with tenants each week to determine whether they are remaining stably housed or need additional connections to services in the community. The navigators also regularly engage with landlords to maintain good working relationships. OHSH primarily works with mom-and-pop landlords, who often are more willing to negotiate with OHSH and accept clients who may have criminal records or a history of eviction. These small landlords form the "lifeblood for our program," Wolfe stated, and have helped increase the number of people that OHSH has been able to move into stable housing. In December 2021, OHSH housed 7 people, and by December 2022, OHSH housed 98 people through RRH offered through participating landlords. Langston and her team check in with landlords weekly and work closely with the CHA to ensure that landlords and tenants complete required paperwork.⁵⁰

Landlord Incentives

Offering landlords incentives to participate in RRH has been critical to the program’s success. In 2019, OHSH created a city-funded Landlord Risk Mitigation Fund managed by its partner organization, the Chattanooga Regional Homeless Coalition (CRHC).⁵¹ The Landlord Risk Mitigation Fund provides additional protection to landlords who lease units to people with low incomes, past evictions, or criminal records. The fund helps landlords defray costs associated with damage to the unit, unpaid rent, or other fees that a security deposit does not cover.⁵² Landlords can receive up to $1,000 per reimbursement claim to pay for repairs. Motel units converted to studio apartments with a 1-year lease can also qualify.⁵³ As of February 2023, OHSH had more than 150 landlord partners, including mom-and-pop landlords, the CHA, and apartment complexes. Local property management companies also provide OHSH with vacant units for RRH.⁵⁴ As outlined in the 2018 Homelessness Action Plan, the city also created the Flexible Housing Fund (FHF), which CRHC operates, to further reduce barriers to housing for people experiencing homelessness. FHF assistance can be used to help tenants cover pastdue rent, move-in costs, utility payments, security deposits, pet surcharges, and short-term rental assistance. Applicants must access the FHF assistance through their housing navigator, who submits a request to CRHC.⁵⁵ Both the Landlord Risk Mitigation Fund and FHF require participating landlords to accept tenants with criminal records, previous evictions, substance abuse challenges, and limited employment histories. Together, these funds will help improve landlord participation in RRH.⁵⁶

Financing Permanent Supportive Housing

Although OHSH focuses primarily on RRH, it also recognizes the demand for PSH for those who need a higher level of care.⁵⁷ Federal funding sources have been vital for financing PSH in Chattanooga. Mayor Kelly allocated most of the city’s $38.6 million in ARPA SLFRF to community development initiatives such as homelessness prevention, affordable housing development, and supportive services.⁵⁸ In response to the need for more supportive housing units in Chattanooga, the city has initiated plans to renovate the former Airport Inn (a dilapidated hotel). In October 2021, the city council unanimously voted to purchase the Airport Inn for $2.79 million using ARPA SLFRF. This project will add approximately 70 new PSH units.⁵⁹ The city plans to assign each Airport Inn resident to a dedicated case manager who can provide wraparound support. Discussions are underway to identify local service providers who can offer residents case management services to keep them housed and maintain daily operations. Onsite staff will also be available to connect residents to the Chattanooga Area Regional Transportation Authority shared ride service to allow residents to access grocery stores, offsite appointments, and other community amenities. City officials are also examining the feasibility of adding two commuter vans so that onsite staff can coordinate outings for residents.⁶⁰ In April 2021, HUD awarded Chattanooga nearly $3 million in HOME-ARP funds.⁶¹ One third of this funding has been allocated to tenant-based rental assistance, and it is helping to finance several housing placements. "It is a tremendous resource and has really led to our ability to get more folks housed," Wolfe stated. Although discussions are underway to explore the feasibility of using HOME-ARP funds to finance services and renovations at the Airport Inn, OHSH is also working to leverage private investment for the renovation.⁶²

Staff members of Chattanooga’s Office of Homelessness and Supportive Housing work to reduce barriers for people transitioning out of homelessness by using resources such as the Flexible Housing Fund, which helps tenants cover move-in costs and other housing fees. Photo courtesy of the Chattanooga Office of Homelessness and Supportive Housing

Reaching Positive Outcomes

In 2019, as a result of collaboration among the city, the U.S. Department of Veterans Affairs, and CRHC, the Chattanooga/Southeast Tennessee CoC, which serves an area of Southeast Tennessee with a population of nearly 700,000, reached functional zero on all veteran homelessness. Achieving functional zero means that a community has established a coordinated system of care that connects people experiencing homelessness to housing and services. Once an individual has been identified, their experience of homelessness becomes rare and brief.⁶³ Since that time, however, veteran homelessness in Chattanooga has risen, largely because of the COVID-19 pandemic. As of February 2023, 56 veterans in Chattanooga were experiencing homelessness, still a dramatic improvement from the 300 veterans who experienced homelessness before the city implemented the housing action plan. CRHC will be launching a 100-day challenge to reduce the number of veterans experiencing homelessness. "We’re really confident that we’ll be able to get back to that functional zero benchmark with some intentional work," said Wolfe.⁶⁴

From 2021 to 2023, Chattanooga had rehoused more than 2,000 people experiencing homelessness.⁶⁵ From January 2022 to January 2023, the total number of people experiencing homelessness in Chattanooga declined by 28 percent, and the unsheltered population declined by 40 percent. Wolfe indicated that the rate of chronic homelessness in the city is also declining, adding, "We feel really confident that we’re within striking distance on a lot of subpopulations to reach functional zero."⁶⁶ The number of agencies that refer households to OHSH for services, including local schools, domestic violence shelters, and area hospitals, has also increased.⁶⁷ These referrals have helped households in need learn how to access stable housing.

OHSH has also begun a data cleaning process in partnership with CRHC. Streamlining the paperwork and data entry processes will improve tracking of service delivery and allow more providers to participate and receive funding for housing placements. CRHC maintains a database to identify households that have received housing but returned to homelessness after 6 months to a year. In these situations, CRHC communicates with the housing navigator that was assigned to that individual to determine whether the city could have offered additional training or support to keep the individual housed. CRHC also communicates with the landlord to determine whether any challenges existed that may have caused the person to return to homelessness. In the future, CRHC will create a landlord satisfaction survey to collect feedback on landlords’ experiences and identify areas for improvement. Taking these steps can improve housing outcomes for people exiting homelessness and encourage more landlords to participate in RRH.⁶⁸

In December 2021, Chattanooga joined House America with the goal of rehousing 240 households and adding 100 PSH units for people transitioning out of homelessness.⁶⁹ According to Wolfe, House America encouraged the city and its partners to rally behind a common goal. The city exceeded its goals by rehousing 620 households and adding 115 PSH units. In 2022, approximately 428 people received housing through OHSH’s RRH program using HOME-ARP funding. In addition, roughly 250 people were housed using FHF. Once residents move into their units, 90 percent of households remain stably housed, Wolfe noted. The OHSH team closely monitors the retention rate throughout the year to determine whether the interventions continue to be effective. As of January 2023, Chattanooga had 160 occupied PSH units and more than 70 under development through the Airport Inn redevelopment project.⁷⁰

Best Practices for Implementation

Communication with existing residents, partners, developers, and stakeholders is critical for successfully implementing Housing First. Wolfe explained that staff and partners must communicate frequently with residents, even on topics that may seem obvious. He learned that a lack of information can sometimes lead to "people assuming the absolute worst." Approximately 90 percent of Chattanooga’s PSH is located across scattered sites, which is helpful for integrating people into the broader community. Some people exiting homelessness, however, require higher levels of care in which their supportive services are collocated with their housing. Once completed, the redevelopment of the Airport Inn will stand as a visible PSH example and lay the groundwork for future PSH developments in the city. According to Wolfe, "We’ve had to face a lot of hurdles in terms of resistance from local residents and their concerns about the [Airport Inn] and what supportive housing would entail. It’s been a really great learning process for us for community engagement." OHSH has worked to dispel myths and ease negative perceptions that existing residents might have about people experiencing homelessness. "If we had just acted a little bit quicker" to communicate with community residents, Wolfe said, "it would’ve helped out tremendously."⁷¹

Over the past decade, the city’s housing supply has not kept up with the demand among those experiencing chronic homelessness, who may need PSH units. Although some landlords are offering scattered-site units, some households "do not do well in those types of environments.... We want to try to have something that’s owned and operated by a nonprofit that could be a little bit more lenient" and responsive to the individual service needs of people transitioning from chronic homelessness, Wolfe indicated. Key to OHSH’s success has been the innovative strategies it has pursued to increase housing capacity. The Airport Inn project is a hotel conversion that also leveraged city funding. "We’re also hoping to leverage private resources, and we’re going to quickly scale 70 units as opposed to traditional construction, [which] could take years to build," Wolfe stated.⁷²

OHSH has been successful in aligning its objectives with those of its service providers and other partners. OHSH staff recognize that everyone in the Housing First community is working toward the same goal. Information sharing is critical for partners to progress in their shared goal of ending homelessness. If another local housing provider is applying for grant funding, OHSH will not compete for it. "We try to help out as much as we can," said Wolfe, who often will first check with other executive directors to determine whether they are applying for a grant before OHSH applies for it. "We complement the work that’s being done, and I think that intentionality has been able to point everyone in the same direction and allow us to go a lot further," Wolfe stated.⁷³

Strengthening relationships with landlords is critical to the success of any housing program, Langston emphasized. This is especially important when working to overcome the existing stigma toward voucher holders. Many landlords refuse to accept housing vouchers, so Langston is taking measures to improve their perceptions. In addition, some funding resources limit the amounts that OHSH can allocate for landlord incentives. In the past, OHSH could use Emergency Solutions Grants to double landlords’ security deposits, incentivizing their participation in RRH.⁷⁴ Although this measure is no longer an option, participating landlords have stated that the process for receiving payments from the Landlord Risk Mitigation Fund is simple and quick. CRHC typically processes checks within a week of receiving a payment invoice.⁷⁵

Conclusion

The Housing First approaches in Boston and Chattanooga have reduced barriers for people who may not be able to access housing otherwise and provide vulnerable households with the stability they need to succeed. As Wolfe stated, "Housing is the only thing that solves homelessness, in our view. Every single thing we do around homelessness in terms of providing emergency shelter or food or other things, while they are critically important from a life-saving standpoint, at the end of the day, the housing unit is the thing that ultimately ends someone’s homelessness and gives them the stability to build their life."⁷⁶ Both cities recognize that landlords are a fundamental component of their Housing First models and have adopted landlord incentive programs to increase the supply of housing available to people transitioning out of homelessness. Collaboration with service providers and housing navigators has streamlined the process of rapidly rehousing households and ensured that agencies tailor their resources to the specific needs of households. In addition, both cities are actively engaging and educating community residents to overcome misconceptions about supportive housing. Using financial resources in innovative ways and developing staff capacity to continue to meet housing demand will be critical to sustaining progress.

1. United States Interagency Council on Homelessness. 2022. "All In: The Federal Strategic Plan to Prevent and End Homelessness," 92.
2. Interview with Laila Bernstein, 27 February 2023.
3. Ibid.
4. City of Boston. 2015. "An Action Plan to End Veteran and Chronic Homelessness in Boston 2015-2018," 7.
5. City of Boston. "Boston's Way Home Fund Surpasses $10 Million Two Years Ahead of Goal" (www.boston.gov/news/bostons-way-home-fund-surpasses-10-million-two-years-ahead-goal-0). Accessed 10 January 2023.
6. Interview with Laila Bernstein.
7. City of Boston 2015, 13; 16–20.
8. City of Boston. 2016. "Boston's Way Home: One Year Report."
9. Interview with Laila Bernstein.
10. Ibid.
11. City of Boston 2015, 13; Interview with Laila Bernstein; City of Boston. "More Than $38 Million Awarded to Nonprofits Providing Services to Homeless Individuals" (www.boston.gov/news/more-38-million-awarded-nonprofits-providing-services-homeless-individuals). Accessed 12 January 2023.
12. Lauren Bennett. 2022. "Construction Begins on City's Largest Supportive Housing Development," Jamaica Plain Gazette, 28 January; Pine Street Inn. "Financials" (www.pinestreetinn.org/about-us/financials). Accessed 6 April 2023.
13. City of Boston. "Groundbreaking for 140 Clarendon Street Celebrated" (www.boston.gov/news/groundbreaking-140-clarendon-street-celebrated). Accessed 1 March 2023.
14. City of Boston 2015, 13;19; Email correspondence with Laila Bernstein, 3 April 2023; City of Boston 2016.
15. Boston Housing Authority. "Emergency Housing Voucher Program" (bostonhousing.org/en/For-Section-8-Leased-Housing/Voucher-Programs/Emergency-Housing-Voucher.aspx). Accessed 1 March 2023.
16. City of Boston. 2022. "Members of Special Commission to End Family Homelessness Announced."
17. Boston Housing Authority. n.d. "Certificate of Homelessness."
18. "Emergency Housing Voucher Program."
19. Interview with Laila Bernstein.
20. City of Boston. 2014. "Action Plan Program Year 2014 July 1, 2014 – June 30, 2015," 5; Interview with Laila Bernstein.
21. City of Boston. "Landlord Incentive Program" (www.boston.gov/departments/housing/landlord-incentive-program). Accessed 12 January 2023; Andrew Brinker. 2023. "Boston is paying landlords to house formerly homeless people. Will it help?" Boston Globe, 10 February; Interview with Laila Bernstein.
22. Interview with Laila Bernstein.
23. Brinker.
24. City of Boston 2016; Interview with Laila Bernstein; United States Interagency Council on Homelessness. 2016. "Criteria and Benchmark for Achieving the Goal of Ending Chronic Homelessness"; Criteria include: identifying and offering outreach to individuals experiencing or at risk of homelessness; providing immediate access to shelter or other temporary housing; administering a Housing First approach throughout the community that also accounts for the preferences of the individual; helping individuals move quickly into permanent housing with supportive services; and developing resources, plans, and capacity to recurrence.
25. Interview with Laila Bernstein; City of Boston 2016.
26. U.S. Department of Housing and Urban Development. 2014. "HUD 2014 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations"; U.S. Department of Housing and Urban Development. 2022. "HUD 2022 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations."
27. Interview with Laila Bernstein; Email correspondence with Laila Bernstein, 23 March 2023.
28. New England Center and Home for Veterans. "Tax and Financial Information" (nechv.org/about-us/tax-and-financial-information/). Accessed 3 April 2023; New England Center and Home for Veterans. "Mission" (nechv.org/about-us/mission/). Accessed 3 April 2023; City of Boston. "17 Court – The New England Center for Homeless Veterans" (www.boston.gov/buildinghousing/17-court-new-england-center-homeless-veterans). Accessed 3 April 2023; New England Center and Home for Veterans. "Permanent and Supportive Housing" (nechv.org/get-help/permanent-housing/). Accessed 3 April 2023.
29. Brighton Marine. "Housing Support for Veterans" (www.brightonmarineinc.org/housing#veterans). Accessed 13 March 2023; City of Boston. "New Supportive Housing for Veterans Opens in Brighton" (www.boston.gov/news/new-supportive-housing-veterans-opens-brighton). Accessed 13 March 2023; Tim Logan. 2020. "Home at last: Formerly homeless vets are moving into Brighton Marine's new 25-unit building," Boston Globe, 22 September.
30. U.S. Department of Housing and Urban Development. n.d. "CPD FY2020 CARES Act Formula Grants"; Interview with Laila Bernstein.
31. City of Boston. "American Rescue Plan Projects" (www.boston.gov/news). Posted 1 November 2022. Accessed 27 March 2023.
32. Interview with Laila Bernstein; Email correspondence with Laila Bernstein, 3 April 2023.
33. Ibid.
34. U.S. Department of Housing and Urban Development. "HOME - American Rescue Plan Program" (www.hud.gov/program_offices/comm_planning/home-arp). Accessed 1 March 2023; U.S. Department of Housing and Urban Development. "American Rescue Plan Act HOME Supplemental Allocations" (www.hud.gov/sites/dfiles/CPD/documents/HOME-ARP.pdf). Accessed 1 March 2023.
35. City of Boston. 2022. "Summary of the HOME – ARP Allocation Plan."
36. City of Boston. "Boston to Participate in 'House America' Initiative to End Homelessness" (www.boston.gov/news/boston-participate-house-america-initiative-end-homelessness). Accessed 26 January 2023.
37. Interview with Laila Bernstein.
38. Ibid; Email correspondence with Laila Bernstein, 23 March 2023.
39. Ibid.; City of Boston. 2020. "An Ordinance to Create the Special Commission on Ending Family Homelessness"; City of Boston. 2022. "Members of Special Commission to End Family Homelessness Announced"; Interview with Laila Bernstein.
40. Ibid.
41. Ibid; Data provided by Laila Bernstein, 3 April 2023.
42. Ibid.
43. Massachusetts Housing and Shelter Alliance. "CSPECH" (mhsa.net/partnerships/cspech/). Accessed 1 March 2023; The Commonwealth of Massachusetts. "MassHealth" (www.mass.gov/topics/masshealth). Accessed 1 March 2023.
44. Interview with Laila Bernstein; Centers for Medicare & Medicaid Services. "Program of All-Inclusive Care for the Elderly (PACE)" (www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/PACE/PACE). Accessed 10 March 2023; The Commonwealth of Massachusetts. "Program of All-inclusive Care for the Elderly (PACE)" (www.mass.gov/program-of-all-inclusive-care-for-the-elderly-pace). Accessed 10 March 2023; Department of Health and Human Services. 2022. "Approval Letter MassHealth Medicaid and CHIP Section 1115 Demonstration," 129; Manatt. 2023. "New Medicaid Opportunities to Invest in and Sustain Health Related Social Needs: A Conversation with States," 4; 11.
45. City of Chattanooga. 2018. "2018 Homelessness Action Plan for the Chattanooga Community," 4.
46. Ibid, 1; Joint interview with Sam Wolfe and Johnetta Langston, 6 March 2023.
47. Joint interview with Sam Wolfe and Johnetta Langston.
48. City of Chattanooga 2018, 7; 77; National Alliance to End Homelessness. "Core Components of Rapid Re-Housing" (endhomelessness.org/resource/core-components-of-rrh/). Accessed 10 March 2023.
49. Joint interview with Sam Wolfe and Johnetta Langston; Chattanooga Housing Authority. n.d. "Housing First Program Basic Information"; Chattanooga Housing Authority. "CHA-Managed Housing" (www.chahousing.org/low-income-public-housing). Accessed 6 June 2023.
50. City of Chattanooga 2018, 64–5; Joint interview with Sam Wolfe and Johnetta Langston.
51. Dave Flessner. 2022. "Chattanooga to help landlords cover damages, rehab costs to boost housing for homeless," Chattanooga Times Free Press, 2 March; Chattanooga Regional Homeless Coalition. 2022. "TN-500 CoC Plan for Serving Individuals and Families Experiencing Homelessness with Severe Service Needs," 3; City of Chattanooga. "Accomplishments" (chattanooga.gov/ohsh/accomplishments). Accessed 17 February 2023.
52. Flessner; United States Interagency Council on Homelessness. "Engaging Landlords: Risk Mitigation Funds Community Profiles" (www.usich.gov/tools-for-action/engaging-landlords-risk-mitigation-funds-community-profiles/). Accessed 15 February 2023; Email correspondence with Sam Wolfe, 28 March 2023.
53. Chattanooga Regional Homeless Coalition. 2023. "Landlord Risk Mitigation Fund Manual."
54. Joint interview with Sam Wolfe and Johnetta Langston.
55. Chattanooga Regional Homeless Coalition. "Flexible Housing Fund Guidelines" (view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.homelesscoalition.org%2Fwp-content%2Fuploads%2F2021%2F12%2FFlexible-Housing-Fund-Guidelines-Update-12.3.21-Pg.-1-3-1.docx&wdOrigin=BROWSELINK). Accessed 21 February 2023.
56. Chattanooga Regional Homeless Coalition 2022, 3; Chattanooga Regional Homeless Coalition 2023; Joint interview with Sam Wolfe and Johnetta Langston.
57. City of Chattanooga. "The Need" (chattanooga.gov/mayors-office/airport-inn/need). Accessed 21 February 2023; Joint interview with Sam Wolfe and Johnetta Langston.
58. City of Chattanooga. "One Chattanooga Relief and Recovery Plan" (https://recovery.chattanooga.gov/). Accessed 7 March 2023.
59. David Floyd. 2022. "Chattanooga mayor addresses concerns about converting hotel into low-income housing," Chattanooga Times Free Press, 11 October.
60. Chattamatters. 2023. "How to End Chronic Homelessness," YouTube video, 18 January. Accessed 17 February 2023; Floyd; City of Chattanooga. "Frequently asked questions about the Airport Inn conversion" (chattanooga.gov/mayors-office/airport-inn/faqs). Accessed 21 February 2023.
61. U.S. Department of Housing and Urban Development. "Home-American Rescue Plan Program" (www.hud.gov/program_offices/comm_planning/home-arp). Accessed 18 January 2023; U.S. Department of Housing and Urban Development. "American Rescue Plan Act HOME Supplemental Allocations" (www.hud.gov/sites/dfiles/CPD/documents/HOME-ARP.pdf). Accessed 18 January 2023.
62. Joint interview with Sam Wolfe and Johnetta Langston.
63. Community Solutions. 2020. "Press Release: Chattanooga Reaches Functional Zero for Veteran Homelessness"; Joint interview with Sam Wolfe and Johnetta Langston.
64. Joint interview with Sam Wolfe and Johnetta Langston.
65. City of Chattanooga. "Accomplishments" (chattanooga.gov/ohsh/accomplishments). Accessed 17 February 2023.
66. Joint interview with Sam Wolfe and Johnetta Langston.
67. City of Chattanooga. "Accomplishments."
68. Joint interview with Sam Wolfe and Johnetta Langston; Chattanooga Regional Homeless Coalition 2022, 3; 7; City of Chattanooga. "Accomplishments."
69. Chattanoogan. "Mayor Kelly Says New Federal Funds Will Help Provide Shelter For Homeless" (www.chattanoogan.com/2021/12/17/440251/Mayor-Kelly-Says-New-Federal-Funds-Will.aspx). Accessed 17 January 2023; U.S. Department of Housing and Urban Development. "House America" (storymaps.arcgis.com/stories/c1809ec8854a4f62853d19f41ba1f89a). Accessed 17 January 2023.
70. Joint interview with Sam Wolfe and Johnetta Langston; Chattamatters.
71. Joint interview with Sam Wolfe and Johnetta Langston.
72. Ibid.
73. Ibid.
74. Ibid.
75. Chattanooga Regional Homeless Coalition 2022, 3.
76. Joint interview with Sam Wolfe and Johnetta Langston.