Focusing on housing first

Stylish and intelligent, Doc is a former TV producer and radio DJ, and a courtly gentleman who treats Lisa Kistler more like a princess than his case manager.

The two often sit together inside Doc's small apartment in the former Acacia Hotel building downtown. His favorite perch is in front of his piano, idle now because of a persistent shaking of his hand from a stroke three months ago.

The stroke is the legacy of a long, hard stretch of road. Doc, 58, lost his last broadcast job nearly 20 years ago, sank into a self-destructive depression and spent the intervening decades living on the streets of Colorado Springs in a vodka haze.

"Doc has been a fixture in this community for a long time, mostly as homeless," Kistler said. "I can't walk down the street with him without people saying ‘Hi, Doc.'"

But his life changed just over a year ago when he was accepted into the city's Housing First program and given his own apartment in exchange for allowing Kistler to visit him often. Although he still drinks vodka - only half as much as he used to - he's now clean and well-dressed, and he's getting medical care and physical therapy in the hopes that he'll someday play the piano again.

As Kistler and Doc chatted, he asked if she minded him firing up a cigarette.

"Doc, it's your house. You pretty much get to do what you want," she said.

That's the philosophy of Housing First, an approach that bucks conventional wisdom by giving the homeless a handout first, then slowly moves them toward treatment and productivity. Strange as it seems, it might be the most effective and cost-efficient way to deal with the homeless.

More than a dozen of Colorado Springs' hardest cases - chronically homeless people who also abuse substances and struggle with mental health - have been living in federally subsidized Housing First apartments scattered throughout the city for more than a year, and most of them have succeeded in the move from cardboard boxes to four walls.

The Housing First model started in New York several years ago, and has since spread from Anchorage to Atlanta as the evidence mounts for its success. About 80 percent of the hard-core homeless succeed in Housing First, and it saves public money at the same time, its advocates say. Several Colorado Springs agencies joined forces to gather grants and services for the local Housing First program.

Unlike most housing programs, the participants in Housing First don't have to swear off drinking or submit to formal counseling to get in. The only requirements are that participants abide by the lease agreement with the landlord and allow a case manager to stop by, as well as a volunteer "resource advocate" provided by a mental health collaborative.

"Nothing has been forced on me," Doc said. "Recommendations have been made, and I really feel I've had a say in what's happening with my life. These guys work entirely off of grace."

The idea is to start with basic needs and then climb the ladder to solving more complex problems, said Dee Drake, project director of the El Paso County Co-Occurring Collaborative. First, provide food and shelter to lend some stability. Teach life skills and treat medical problems. Then they'll decide for themselves that they're tired of being drunk or hearing voices in their heads, and Kistler will turn that motivation into action.

"They have so many people telling them they have to change, and they resist. It's about getting them to decide this is what they want to do for their life," Drake said. "About 90 percent have reduced their substance abuse, and about 75 percent stop abusing substances. It just takes a little longer."

But how does the program save money? Because it's cheaper to put someone in an apartment and assign them a case manager than to finance their emergency visits to the hospital and detox.

"People in Colorado Springs are conservative and we respect that," said Bob Holmes, executive director of Homeward Pikes Peak, an agency that coordinates the region's homeless services. "If we can find a way to save people money, that is a good selling point. We're hoping to bring people into the program who are mentally ill, who have substance abuse problems, who are very noticeable on the streets, and do right by them and also taxpayers."

Holmes estimated that Colorado Springs has about 2,000 homeless people, 400 of them chronically homeless. Each chronically homeless person costs area taxpayers $54,000 a year as they use the resources of police, fire, ambulances, emergency rooms and detox, he said. Through Housing First, agencies can house and treat these same people for about $15,000 a year, a savings of $39,000 per person.

Colorado Springs' Housing First program will have 33 slots by the end of this year, representing a potential savings of about $1.3 million to the community when they are filled.

"Do you want to pay $50,000 to keep someone on the streets, or do you want to pay $15,000 for us to house them and get them out of your face?" said Jeannine Holt, executive director of Harbor House Collaborative, which manages the lion's share of the clients in Housing First. "The Housing First philosophy is tough for a lot of people to swallow, but it works from an economic standpoint."

Since the program took its first client in February 2007, three people have dropped out - two were evicted and one died of a drug overdose. That's better than an 80 percent retention rate among a group that has universally failed to take advantage of other forms of aid, and it mirrors the rates of success in other cities.

"I've seen them take several individuals who have been out on the streets for years and years, and they've transitioned to living in mainstream society, and it's been a successful transition," said Greg Morris, director of homeless health for Peak Vista Community Health Centers, which provides medical care to some clients.

"They're not our cases," Kistler said. "They're our clients and our people. We are involved in every aspect of their recovery and their lives. And if they have a problem, we want to be the first person they call."

Most cities with Housing First programs put their clients in one location. In Denver, for example, the old YMCA building on 16th Street was converted into hundreds of apartments. Holt said the downside of Colorado Springs' scattered site approach to apartment rentals is it takes more time to check on clients, but the upside is avoiding the notin-my-backyard problem of building such a facility.
"In some ways scattered site housing is good because then you don't have a whole gaggle of mentally ill alcoholics congregating," Holt said.

Once in the Housing First program, a client can stay as long as needed. If the person gets a job or government assistance, 30 percent of his income goes toward the rent. The goal is to move the most successful clients into transitional housing so another person can take their Housing First slot, but that hasn't happened yet.

The federal Department of Housing and Urban Development funnels money to municipalities to pay for the housing and utilities, then requires the community to match that amount with services. Harbor House employs Kistler as a full-time caseworker dedicated to the Housing First program and partners with several community agencies to fulfill other needs. Among them: the El Paso County Co-Occurring Collaborative addresses mental health needs, Peak Vista addresses medical needs and the Springs Rescue Mission furnishes apartments.

HUD had given the city $146,480 through May to fund the program, matched dollar-for-dollar by local services, plus $27,000 worth of city staff time.

The payoff for the city is fewer homeless people on its streets and saving money long-term, said Valorie Jordan, head of the city's housing and community development division.

"Every city would like to not have panhandlers. But we're not just hiding them somewhere," she said. "We're getting them housing and the services they need to be more productive and successful."

She sees the program expanding significantly in coming years.

"I hope we can clear the streets in five to 10 years," she said. "You may laugh about that, but that's what we hope for."

CONTACT THE WRITER: 636-0226 or bill.reed@gazette.com