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Ending Homelessness Through Housing First. Elizabeth McClam Lake Shore Behavioral Health Services Karen Carman Lt. Col. Matt Urban Human Services Center of WNY. DEFINITION – CHRONIC HOMELESSNESS.

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Ending Homelessness

Through Housing First

Elizabeth McClam

Lake Shore Behavioral Health Services

Karen CarmanLt. Col. Matt Urban Human Services Center of WNY



  • The federal government’s definition of chronic homelessness includes homeless individuals with a disabling condition like:
    • Serious mental illness
    • Substance use disorder
    • Developmental disability
    • Chronic physical illness or disability
    • HIV
  • and
    • Must be homeless12 months or longer or 4 homeless episodes in the past 3 years
    • Must be an unaccompanied individual up to 2011
    • Homeless families are now considered as chronic if they meet the same criteria above
low demand permanent housing
Low Demand Permanent Housing

These housing options utilize “low demand” approaches that addresses the risk-taking behavior without forcing clients to eliminate the behavior altogether.

Relapse should not result in termination from program.

Low Demand Permanent Housing focuses on permanent housing for persons with significant functional impairments that provides high degree of choice, integration, and community inclusion

All national research confirms that these housing options continue to be the most successful for individuals who are chronically homeless !!!

lake shore opened its doors december 2009
Lake Shore opened its doorsDecember 2009

A form of supportive housing that serves :

  • hard-to-reach homeless persons with severe mental illness
  • living on the streets , alleys, park bench, under bridges, etc
  • unable or unwilling to participate in supportive services
  • Provides safe housing …1st, without restrictions or requirements
safe h aven a n ew way of thinking
SafeHaven … a new way of thinking
  • Not a group home (highly structured)
  • Extremely independent
  • No curfew
  • No treatment requirements
  • No medication requirements
program differences
Program Differences

Safe Haven

Housing First

  • Transitional or permanent housing
  • Shared/common facility
  • No limit on length of stay
  • Disabling mental illness
  • Services in facility
  • Individuals only

(Training and Development Associates, Inc )

  • Permanent housing
  • Scattered site, rental housing
  • Long-term leases
  • Any disabling condition
  • Services in home
  • Individuals/families


lake shore s safe haven residence
Lake-Shore’s Safe Haven residence
  • 16 beds (co-ed)
  • No curfew for residents/visitors leave at midnight
  • Rent calculated using local fair market rent (FMR)
  • Eligibility is street homeless, severe mental illness, poor

linkage to treatment

  • Our rules…
    • No sex between tenants
    • No drugs or alcohol on the premises
    • No weapons
    • No criminal activity
    • No violence to other tenants or staff

Out of the 28 individuals served…

  • 7 recipients were hospitalized (that’s a good thing!)
  • 85% agreed to linked to treatment and/or care coordination services
  • 68% have length of stay6 months
  • 43% have length of staybeyond 12 months
  • 32% pursued education/employment goals
  • 14.3% obtained employment
  • 75% addressed medical needs
  • 75% accepted linkage to financial entitlements
what is engagement
What is Engagement
  • Engagement is the most effective tool in working with chronic homeless individuals !
      • Baby steps…”pump your brakes”
      • Build trust by consistency (same place, same time)
      • Be genuine and authentic
      • Listen to his or her story without judgment
      • Find that small need you can meet without “strings attached”
  • Respect the individual’s perspective
    • He or she feels safer in the streets
    • He or she has experienced many “closed doors”
    • He or she wants to be treated with RESPECT
what is engagement1
What is Engagement
  • While identifying a need, listen and quickly learn the priority
  • Exercise Activity

Take 60 seconds and Prioritize the following items for your client...

what order should these be
What order should these be
  • Shopping cart filled with belongings
  • Pet
  • Food
  • Clothing
  • Shelter

(Successful engagement is meeting an individual where they’re at)


What is housing first?

  • Housing first is a philosophy and program model that does not put conditions on housing.
  • It serves the “hard to serve”

Key elements of any housing first program:

  • Direct or near direct housing placement from streets or shelter
  • Supportive services offered, but participation is not required to stay in housing
  • Low demand methods of case management
  • Effort to hold housing when client leaves program (short periods)

Housing First


Least Structured

Permanent Housing

Transitional Housing



Ideal Housing Ready Trajectory

Moderately Structured

Highly Structured

No Structure

Chronic Homelessness





  • Identifying and eliminating behaviors that jeopardize housing
  • Assist with establishing an income or to maintain/increase an existing income
  • Social Reintegration
  • Property damage
  • Drug/Alcohol Abuse
  • Abusive to staff & neighbors
  • Arrests
  • Poor budgeting
  • Job Skills Development Program
  • Special Activities/Events
  • Advisory Group


Other Impairment Scales Include:

Mood – Behavior – Socialization – ADL’s – Chemical Dependency - Lethality


First Year

  • 46 Residents Housed
  • 3 Departed Program
  • 5 Had to be moved to a new unit
  • 1 Moved to Permanent Housing
  • 7 Job Skills Development Program

94% Are Still Housed

After One Year



Q & A

Karen Carman

Matt Urban Center

Elizabeth McClam

Lake Shore Behavioral Health



  • The Applicability of Housing First Models to Homeless Persons with Serious Mental IllnessPrepared for U.S. Department of Housing & Urban Development – 2007
    • Carol L. Pearson,, PhD., Walter R. McDonald & Associates, Inc. Gretchen Lock, Abt Associates Inc., Ann Elizabeth Montgomery, Walter R. McDonald & Associates,, Inc. Larry Buron, PhD, AbtAssociates
  • “Providing Housing First and Recovery Services for Homeless Adults with Severe Mental Illness”Psychiatric Services: – October 2005; Vol. 56, No. 10

The Soloist – DVD movie depicting Chronic Homelessness

Training and Development Associates

Projects For Assistance In Transition From Homeless (PATH)

National Alliance to End Homelessness (NAEH)

National Council for Community Behavioral Healthcare

Homeless Alliance of Western New York (HAWNY)

Housing and Urban Development (HUD)

Ward Family Foundation