As homeless rates increase across the United States, it has become a policy focus across all levels of government. The most important place to start is the main cause of homelessness: the lack of affordable housing. In Missouri, for every 100 extremely low income renters, there are only 44 affordable units available. Missouri’s minimum wage has increased to $12.30 an hour but it would require working 50 hours a week to afford a modest 1-bedroom apartment here. We must acknowledge that a combination of a minimum wage which does not cover basic housing needs and a shortage of low priced units in our state will result in some of our neighbors being unhoused.  Even acknowledging this, we cannot ignore the individual factors that can contribute to, but do not cause homelessness, such as mental health issues, substance use, and unemployment. 

Exiting homelessness is a multi-step process involving engagement with houseless service providers for assessment, identifying level of need, and referral to appropriate interventions. Those interventions could consist of emergency shelters, transitional housing, rapid re-housing, or permanent supportive housing. Emergency shelters provide the lowest level of support while rapid re-housing and permanent supportive housing provides the highest level. 

Emergency shelters are often the first option for households experiencing homelessness. Shelters vary in who they serve and what services are offered, as well as length of stay permitted. Because emergency shelters are limited in Missouri, with only 21 counties out of 115 having emergency shelters, staff often has to assess who has the greatest need for a bed. Not all shelters serve everyone requesting a bed. Some shelters only serve families with children while others are single-gender. In addition, not all shelters are open all the time. Many are open only during extreme heat or cold, and may only be open overnight (8pm to 8am, for example).

Unsheltered homelessness has increased 24% in Missouri between 2022 and 2023. At the same time, the number of emergency shelter beds only rose 4%. Emergency shelter can be an effective resource to move households into housing, but only if they are low-barrier, have a strong focus on assessment and triage, and can help connect individuals to other services. With the shortage of emergency shelters and limited capacity of staff, emergency shelters are often used as crisis management, not as a tool to end homelessness. 

Rapid re-housing (RRH) focuses on getting households who have experienced a short stint in homelessness housed quickly. According to HUD, the majority of households entering homelessness for the first time do so as a result of a temporary financial crisis. Rapid Re-housing focuses on moving those households quickly into a more permanent housing solution, with the intention that they are quickly able to stabilize. This is done through identifying housing needs and barriers. A significant barrier to housing are the initial move in costs, such as deposits and rent. RRH provides financial assistance that can cover move-in costs and short-term rental assistance (6 months or less). RRH works to stabilize households so that they can work to move onto permanent housing options. 

Transitional housing is a short-term program that offers temporary housing for 6-24 months. A lease is signed for a minimum of one month, and can be renewed for a maximum of 24 months. Services are provided during this time, such as finding employment and completing applications for voucher programs, including Housing Choice Vouchers (HCV)/Section 8. Transitional housing is designed to be a bridge between homelessness and permanent housing. The benefits of transitional housing is that it offers low cost housing, a time for someone to stabilize, and services to increase success with permanent housing. 

Permanent Supportive Housing (PSH) is an evidenced based solution to address homelessness for those who are the most vulnerable and at risk of life-long homelessness without support. PSH integrates low-barrier housing with health care and supportive services to individuals who are homeless, have barriers to housing, and are unable to remain stably housed. In order to be eligible for PSH, individuals must fit Housing and Urban Development’s definition of chronically homeless, which is a pretty significant bar. For most individuals, they must have both a diagnosed physical or mental disability as well as 12 consecutive months living outdoors or somewhere else unsafe. Many, though not all, chronically homeless individuals suffer from substance use disorder, PTSD or have significant trauma histories.

PSH removes barriers to housing that many who are homeless have experienced. There are few to no programmatic prerequisites to permanent housing entry, such as requiring that a person is sober, and engagement in services is voluntary. PSH also has low barrier admission policies and screens in households versus screening them out. Households are not turned away due to lack of income, past evictions, or criminal history. 

To help with identifying households with the highest need for PSH, housing agencies are required to use a vulnerability assessment tool: Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT). Trained staff use this tool to gather information from those experiencing homelessness to assess their level of vulnerability. All information is self-reported, which helps to lower instances of bias. Once the assessment is completed, the person is given a vulnerability risk score, which is used to determine what level of support they need and then which program they qualify for. The VI-SPDAT also assists with tracking changes over time, such as with substance use, mental health, and income changes. 

It is extremely important to the long term success of our neighbors to be housed quickly.. Homelessness is not only a housing issue, but also a physical, mental, and safety issue. Individuals who are homeless experience a higher rate of violence than someone who is housed and face more bias and discrimination when seeking medical or mental health services. Due to this, PSH focuses on getting homeless individuals housed quickly by streamlining the application and approval process, and shortening wait times.

A common misconception about PSH is that it is “housing only” due to services being voluntary. Services are provided in a collaborative environment, using a Harm Reduction approach. Staff uses trauma informed communication strategies to broach the subject of sobriety and mental health care to identify what the individual needs and remove barriers to receiving this care. By removing barriers, stability is created, sometimes for the first time in a long time for these households. This approach has been shown to increase engagement in services, such as treatment for substance use disorder and reduce alcohol and drug usage

Services are provided not only to stabilize the individual, but to increase the success of remaining stably housed long-term. Core services provided are: case management, physical and behavioral health services, and peer support. The 2021 Missouri Homeless Study reported that of the 4,788 individuals who are housed in PSH, there was a 62.5% decrease in returns to homelessness, there was an average increase in income of 33.38%, and over 95% of individuals remained in stable housing or transferred to another program.

Because the goal of PSH is for formerly homeless individuals to maintain long-term housing stability, tenants are provided support to be successful, such as education on the provisions of their lease, legal resources if their rights as a tenant are violated, and encouragement to exercise their local, state, and federal tenant rights. Tenants in PSH programs are afforded the same rights and protections as any other tenant, as well as the same responsibilities. Tenants sign a lease, have annual inspections of their unit, and are provided information about their responsibilities as a tenant. 

Permanent Supportive Housing is critical to addressing homelessness and health care access barriers that individuals with disabilities and other complex health needs often experience. However, it can only be successful if the programs that provide affordable housing are funded. As homeless rates increase in Missouri, a 12% increase in 2023, we must address the shortage of affordable, permanent, and supportive housing for our most vulnerable residents. These programs are all funded by the federal government in a block grant. This grant has been underfunded for decades, and after deep cuts between 2011-2017, it has not returned even to the funding level of 2010. This results in as many as 3 out of 4 households experiencing homelessness who cannot receive assistance. We cannot continue to say PSH does not work if it hasn’t been given the chance Missouri deserves.

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