In 2016, Denver launched a pilot supportive housing program for people experiencing homelessness. The program was created to explore a simple question: what happens if you give people experiencing chronic homelessness a permanent place to live, and intensive social services? Do they remain in stable housing? Do they have fewer interactions with the police? Do they use fewer emergency resources in general?
In short: are programs like this worthwhile?
That’s where the Urban Institute comes in. The city hired the nonprofit research group to evaluate the program, and that evaluation was recently completed.
Sarah Gillespie is an Urban Institute researcher who worked on the study. She spoke with Colorado Edition to discuss the results.
Interview Highlights:
These interview highlights have been lightly edited for length and clarity.
Erin O’Toole: What is supportive housing? And how did it get started in Denver?
Sarah Gillespie: Supportive housing is the combination of permanent affordable housing and supportive services to help people stay in housing. When we say permanent affordable housing, it means the person has a lease — just like anyone else would have a lease. It is their home and they pay no more than 30% of their income.
And then the supportive services often look like intensive case management, access to clinical care and health care and anything else that person might need to work on the goals they have and work on staying stable in housing.
That supportive housing is provided through a housing first approach. Housing first is not housing only. It just means that the housing comes without any preconditions. You don't have to agree to anything. You don't have to meet any requirements. The housing is provided first, understanding that that is such an important foundation and a necessary foundation to then be able to work on the other goals.
So you get people into housing. And then how do you measure the effectiveness of the program? I'm curious what metrics you're looking at and how do you even design an experiment like this?
This supportive housing evaluation looked at many, many outcomes. The very first one, though, is whether people are actually getting into housing and staying in housing. We found that to be the early sign of success in Denver. People were entering housing at higher rates and they were staying in housing at one year, at two years, at three years. We saw higher rates of people staying in housing.
It disrupts this false narrative that homelessness is unsolvable or that people choose to live on the street. What we saw was the opposite, that when you offer the right type of housing — through that housing first approach — and the right set of services, people will stay in housing.
The other outcomes that we saw is what that means for all of the other systems. We know when you're experiencing homelessness, you're more likely to interact with the police, you're more likely to spend time in jail, you're more likely to use the emergency department instead of preventative health care services. And what we wanted to know is when you have stable housing, does that cycle change? And what we found is that it does. It reduces people's interactions with police. It reduces the time they spend in jail and reduces the time they spend in the emergency department.
How did you set up the study? I'm just wondering if every participant got these kinds of services.
This is what we call a randomized controlled trial design, which is the most rigorous type of evaluation or what we sometimes call the gold standard in research. And we did that because Denver wanted to be sure that any changes we saw, any outcomes we saw, were directly because of the supportive housing and not because of anything else.
A group of people received the supportive housing program. But what is important to know is that so many more people in Denver need supportive housing than the program was ever going to be able to provide. So, we have this group of eligible people, some of whom we could serve through the program. But those who the program didn't have the resources to serve created what we call the control group. They met all of the same criteria as the people in the program. But because there weren't enough slots in the program, they were in the community receiving whatever usual care looks like, whatever services are available in the absence of this type of program. Oftentimes that looks like emergency shelter and other emergency care.
Then we could compare the outcomes of the people in the supportive housing program to the outcomes of the people in usual care in the community who didn't have access to the program. Any difference we saw in those outcomes, we can attribute to the supportive housing program.
Just to boil that down to a big takeaway, when you looked at all of the metrics, what was the effectiveness of the program?
Supportive housing ends homelessness. It ends the cycle of jail and emergency health care, and it reduces the public costs of that cycle.
And I wanted to dive into that a little bit, too. We all know the frequent use of emergency services is expensive. But housing and social services have a significant price tag, too. So, do programs like this ultimately save taxpayers money?
It absolutely reduces the cost of the outcomes in the absence of supportive housing. When people don't have supportive housing, the taxpayers have to pay for things like policing and jail and the emergency department. That all comes out of city and county budgets.
While supportive housing is an intensive intervention and it comes with a cost, it reduces the cost of those other budgets. The outcomes from supportive housing offset about half the cost of the program. But it's important to note that it's not just local government who pays for supportive housing. Federal government pays for a lot of the housing assistance that gets used in a program like this. The federal government funds Medicaid, which can fund a part of those supportive services we're talking about.
The full cost of supportive housing does not fall on a local government. It really is blending multiple funding sources. But the benefits of supportive housing are big for local government. When you think about who pays for jail, who pays for police, who pays for shelter. A lot of that cost falls on local government. when you think about the offset just for Denver, almost all of the cost — all of the resources they had to put into supportive housing — were offset by the benefits that accrued to their public budgets.
What about the future of Denver supportive housing program? Will this evaluation have any kind of impact on what the city decides to do next?
We certainly hope so. The evaluation is over, but the program is continuing. Denver continues to provide supportive housing to the people in the program. That part is not over.
We do hope that the evaluation and the evidence coming out of this evaluation helps Denver to continue to make decisions to invest in supportive housing and helps Denver advocate to other partners like the federal government to provide more housing assistance. That's part of what's needed to scale a program like this.
This conversation is part of KUNC’s Colorado Edition for July 26. You can find the full episode here.
