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An innovative strategy to house Santa Clara County’s sickest and most desperately struggling homeless residents is working, according to a new study, and the results could impact how agencies in the Bay Area and beyond address homelessness.
New research by UCSF looks at Project Welcome Home, which was launched by Santa Clara County in 2015 to target the most challenging of the area’s chronically homeless residents — those who are continually in and out of jail, hospital emergency rooms and emergency psychiatric wards. The first-of-its-kind study found 86% of participants received housing and then stayed housed throughout nearly the entire duration of the study.
But though the nearly $19 million program succeeded in getting and keeping people housed, it didn’t immediately solve their other problems. Participants continued ending up in jail and the ER — and many died before the two-and-a-half-year study period ended.
Even so, the researchers say these findings are groundbreaking because they show that permanent supportive housing — which provides subsidized housing paired with counseling, mental health, addiction and other services — is helping the county’s most difficult cases. The results fly in the face of opinions that some homeless people are beyond help, said Dr. Margot Kushel, professor of medicine and director of the UCSF Benioff Homelessness and Housing Initiative.
“It works. It improves people’s lives. It keeps people housed,” said Kushel, a co-author of the study. “It ends homelessness. Full stop.”
Between 2015 and 2019, Santa Clara County officials used a lottery system to move 199 chronically homeless people into housing via Project Welcome Home, where they received counseling, addiction treatment and other help from nonprofit Abode Services.
Another 244 people qualified but didn’t win the lottery, so they didn’t get housing through the program. UCSF researchers studied both groups and compared outcomes. About a third of participants in the control group eventually received housing through another program not affiliated with Project Welcom Home. Only three chronically homeless people approached by outreach workers declined to participate.
For those who have been involved in Project Welcome Home since it began, the UCSF findings are a major validation. The study marks one of the first times this type of housing program has been studied using a control group — which makes the results much more significant.
“We’re dismantling the belief that people can’t or don’t want to be housed,” said Jennifer Loving, CEO of Destination: Home, which has been involved in the program. “And we’re scientifically proving that permanent supportive housing is the solution to ending homelessness for people who need our help the most.”
At the same time, the study proves supportive housing is not a magic bullet. Seventy of the 443 participants died during the course of the study, including 19% of those who received housing. People in housing actually were more likely to die than those without housing.
“That is something that we definitely want to improve upon,” said Deputy County Executive Ky Le. To provide more preventative care, the county opened the Hope Clinic last year for people entering supportive housing.
Project Welcome Home’s high death rates are a testament to the trauma life on the street inflicts on a body, Kushel said. Homeless patients have health conditions associated on average with people 20 years older. So for many people in the study, when help finally came, it came too late.
“Thank God they didn’t die on the street,” Kushel said, “but how tragic that we couldn’t get to them earlier.”
Furthermore, participants who secured housing were no less likely to visit hospital emergency rooms than their unhoused counterparts. One of the selling points of Project Welcome Home was that it would save taxpayers money by reducing the strain chronically homeless residents put on emergency medical services. But many participants had become so sick during their time on the street that they continued to need frequent emergency care.
Another finding that surprised researchers: Participants who received housing were just as likely to end up in jail as their unhoused peers. In fact, some people ended up in jail immediately after moving into housing, Kushel said.
That was unexpected because people often are arrested for homelessness-related offenses — such as trespassing — and the researchers expected those arrests to decrease when people found housing. Kushel’s team isn’t sure exactly why that didn’t happen, but they have a theory. They think some program participants had outstanding warrants, and once they moved into a home with a searchable address, police found them and brought them in.
On the other hand, participants housed during the study did use emergency psychiatric services less often than their unhoused peers. Project Welcome Home offers counseling and mental health treatment.
But for Loving, the data that sticks out most is the high percentage of people who were housed — and stayed housed. She hopes this new research compels other jurisdictions to adopt similar Housing First models that combine housing and services, but don’t put up high barriers to entry — such as requiring participants be sober or employed.
“If communities are waiting to act because you’re not sure if this is a good investment,” she said, “here’s your proof.”