The best way to break the harmful homelessness-jail cycle? Keep people housed, first; then quickly provide the supportive services they need to thrive.
Maria* is finally starting to feel at home. After living on the streets for eight years and a brief stint in a halfway house, she now has a permanent home in the Sanderson Apartments in south Denver. “I love my life, and I love myself, and I love my family,” she said, beaming. “And I found myself, found out who I am, where I belong.” The Denver Supportive Housing Social Impact Bond Initiative (Denver SIB) helped her find this stability.
There are many common myths about how to end homelessness. At RWJF’s Evidence for Action program, we wanted to test what truly works. We funded Sarah Gillespie and Dr. Devlin Hanson at the Urban Institute to conduct an evaluation of the Denver SIB program.What we learned is that supportive housing has several benefits. It can help end the homelessness-to-jail cycle, free up public resources for other priorities, and ultimately, it creates stability for people experiencing homelessness.Supportive housing seems to be especially beneficial for people with frequent interactions with the criminal justice system, and leads to better health outcomes for individuals and communities. In fact, the Robert Wood Johnson Foundation has included reducing incarceration among 35 illustrative measures to track progress toward building a Culture of Health in America.
In this Q&A, I spoke with the evaluators of the Denver SIB program about how to break the devastating homeless-jail cycle.
How do you explain Denver’s Social Impact Bond to address homelessness?
Denver—like many cities—recognized a broken system in which people experiencing homelessness were not getting the help they needed, while costing taxpayers considerably. In 2016, the city decided to implement a supportive housing program to end the harmful homelessness-jail cycle.
The Denver Supportive Housing Social Impact Bond Initiative used private investment, housing tax credits and vouchers, and Medicaid reimbursement to provide a supportive housing program that aimed to increase housing stability and decrease jail stays among people who were experiencing chronic homelessness and had frequent interactions with the criminal justice and emergency health systems.
This evaluation busted many myths! Despite the common public narrative, the evaluation showed that with the right housing and services, communities can end homelessness and people with complex needs can succeed in long-term, stable housing. We found that when offered housing first with supportive services, people quickly enter housing and stay there. They also experience many longer-term benefits, including reduced jail time.
The initiative used a Housing First approach, which aims to quickly get people out of homelessness and into housing, without requiring that participants meet typical preconditions (such as employment, income, absence of a criminal record, or sobriety).
Our research team designed an evaluation to see if supportive housing achieved the city’s goals.
More than five years in, results from Denver’s five-year supportive housing program show a better way to invest in people and communities. What surprised you most about the findings?
Our evaluation further showed that program participants had fewer interactions with the criminal justice system compared to those who received usual care services (for example, emergency shelter) in the community, including:
Eight fewer police contacts (34% reduction)
Four fewer arrests (40% reduction)
Two fewer jail stays (30% reduction)
38 fewer days in jail (27% reduction)
And people participating in the program stayed housed over the long term. Not only did they access more days of housing assistance, but 77 percent remained in stable housing after three years.
Ultimately, supportive housing is a better use of taxpayer dollars than the current business as usual: in addition to the benefits to those participating in the program, the costs of providing supportive housing are largely offset by savings in other services such as jail stays, court costs, police time, and local emergency services.
You also evaluated the program’s effects on people’s use of health care services. What did you find?
There were significant findings on the use of detoxification facilities, preventive healthcare, and emergency care that indicate that supportive housing increases access to and use of preventive healthcare while decreasing the use of costly emergency care. Compared to those who received usual care services in the community, people referred to the Denver supportive housing program had:
A 65 percent reduction in visits to short-term, city-funded detoxification facilities
A 40 percent decrease in emergency department visitsA 155 percent increase in office-based visits
A 29 percent increase in unique prescription medications to support their wellbeing.
The findings of the Denver SIB evaluation weren’t unique. Los Angeles County’s Housing for Health initiative provides permanent supportive housing programming (housing placement, financial subsidies, and supportive services) to people experiencing homelessness who frequently use county-provided health services. Similar to the Denver SIB findings, research from RWJF’s Systems for Action program showed the Housing for Health initiative was effective in addressing long-term housing needs, reducing jail time, and lowering the use of emergency room and inpatient visits.
What were the key components to Denver’s success with this SIB program?
Two qualities made Denver’s program stand out.
First, this was a well-targeted intervention. Participants became eligible for the program after frequent arrests and documentation of homelessness. Without this laser focus on the most vulnerable residents, it would have been harder for the Denver SIB to find such big impacts across multiple systems.
Second, the program had a very high quality of implementation. The Colorado Coalition for the Homeless and Mental Health Center of Denver were excellent service providers; both hit high benchmarks for success including engagement rates, take-up rates, and housing stability rates. Along with these providers, the Denver SIB had a high level of collaboration across many other partners in local government and national technical assistance and evaluation organizations. This collaboration helped solve implementation challenges quickly and effectively—and ultimately improved outcomes for individuals and communities.
How can this evaluation be put to use?
As chronic homelessness surges and pandemic-related eviction moratoriums end, evidence from the Denver SIB and other similar initiatives disrupts the story that homelessness is an unsolvable problem.
Housing First ends the homelessness-jail cycle. Cities need more development of and funding for subsidized housing along with services to help people access and stay in housing. We hope policymakers and practitioners use these data to advocate for supportive housing as a better solution.
Learn more about RWJF-supported initiatives and resources for communities working to ensure access to safe, stable, affordable housing for all.
* Program participants’ names have been changed to protect their anonymity.
About the Author
Erin Hagan is the deputy director of RWJF’s Evidence for Action program.