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Kimberly Beck, the St. Louis County Continuum of Care (CoC) board chair, has worked with both the city and county’s CoCs for 20 years and remembers a time when homelessness service providers imposed requirements for unsheltered individuals to access shelter. In accordance with a Treatment First model, individuals had to be sober to access the region's care, she says.
A CoC is a local or regional planning body that coordinates funding for homelessness services. Even 10 or 15 years ago, Beck pushed back on that model and tried to incorporate Housing First into plans when the county asked the Salvation Army to help create an overflow shelter. Alongside her work with the county CoC, Beck has worked for the Salvation Army for 20 years, most recently as the executive director of the agency’s Midtown Service and Treatment Center.
“I said, ‘I don't want to do a shelter, Salvation Army does not want to do a shelter where we bring people in overnight and then they're out on the street first thing in the morning,”’ Beck says. “‘If we're going to do an overflow shelter, it's going to be 24/7. They can come in, they don't have to be sober and all of that—we will bring them in, give them a place to stay, food, and then provide case management as we build rapport and relationship with them.”’
The county opted into Beck’s style of shelter right away, according to her, and started to incorporate Housing First policy into its homeless response strategies. In the years since Beck says the CoC has adopted Housing First policy, data demonstrates that chronic homelessness has reduced across the region.
In 2010, the City of St. Louis and St. Louis County CoCs reported a combined 1,974 individuals experiencing overall homelessness, according to HUD’s Annual Homeless Assessment Report. By 2021, the figure had fallen to 1,739 individuals—a decrease of 11.5 percent in 10 years.
“I think the Housing First model has been important, because we want to meet people right where they are,” Beck says. “We don't want people to have to jump through too many hoops to get to stable housing.”
Despite the progress, the effects of homelessness in the region are still acutely apparent. Mayor Tishaura Jones’ website reads, “St. Louis has a homelessness crisis on its hands.”
Five individuals experiencing homelessness froze to death in St. Louis the 2020-21 winter, according to a St. Louis Public Radio and APM Reports investigation. The St. Louis Post-Dispatch reported in the summer of 2021 that DeMarco McNeal, a homeless man, was shot and killed in an encampment positioned next to Square’s offices downtown.
In the City of St. Louis, about 949 individuals are homeless on a given night, according to the National Alliance to End Homelessness. In the county, that number is 450.
Anthony D’Agostino, the chair of the City of St. Louis Continuum of Care, says Housing First is essential for the city’s homelessness response.
“Since [the City of St. Louis CoC] is connected to HUD, I mean, there is no question about Housing First, that's how we operate,” D’Agostino says.
But with a new law, CoCs across the state could face hurdles in implementing the model.
Governor Mike Parson signed MO House Bill 1606 into law in June. In July, the St. Louis Post-Dispatch reported that Parson ignored the concerns of Missouri Department of Mental Health Director Valerie Huhn, who warned the bill could exacerbate problems for people living on the streets. It makes doing just that—unauthorized sleeping or camping on state-owned streets and lands—illegal. (Parson's office did not respond to a request for an interview from St. Louis Magazine.)
But the bill also says that state funds used for permanent housing will be diverted toward substance abuse and mental health recovery programs, alongside short-term housing programs. It's a law that departs from the principles closely aligned to Housing First, as it requires funds for permanent housing.
What could it mean for the future of the region’s homelessness response efforts?
What is Housing First?
Housing First is an assistance model that prioritizes connecting individuals who are experiencing homelessness to permanent housing, according to the National Alliance to End Homelessness. The approach moves away from strategies like Treatment First, which requires individuals to prescribe to recovery services and temporary housing before getting access to independent housing, according to a Community Mental Health Journal article.
Studies have shown that Housing First is an effective model for addressing homelessness and reducing stress on social and medical services.
A 2020 study demonstrated that Housing First reduced homelessness by 89 percent when compared to Treatment First. Additionally, a 2014 Canadian study with over 2,000 participants not only demonstrated that Housing First rapidly reduces homelessness, but showed that for every $10 spent on Housing First services per person resulted in nearly $22 in savings for the total care services provided for some individuals.
A turnaround in Houston
In the United States, Housing First has proven itself to be a successful method of reducing homelessness. One example is Houston.
Ana Rausch is the vice president of program operations at The Coalition for the Homeless, the lead agency of The Way Home, the CoC serving greater Houston’s Harris, Fort Bent, and Montgomery counties. Rausch says a community should turn toward data in building a successful CoC.
“Look at your data,” Rausch tells St. Louis Magazine. “It really does tell a story. It paints a picture of what is happening in your community.” And in Houston, the data looks pretty good.
The New York Times featured Rausch and Houston’s success in reducing homelessness through Headway, the publication’s initiative to explore “the world’s challenges through the lens of progress.”
The region’s CoC contained the sixth largest metropolitan homeless population in the United States in 2011, according to HUD’s report. By 2020, the region’s homeless population only ranked as the nation’s 21st largest, according to the report.
The success came after the CoC reoriented itself in 2011. Before then, Rausch says the region's care providers were not working together.
“The homelessness was skyrocketing,” she says. “We were spending millions of dollars, but not even making a dent. Homeless service providers were working in silos.”
As a result, Rausch says HUD designated Houston as a priority community. The agency sent technical assistance providers to the region who coordinated a gathering to bring together the region’s service providers into one facility.
“It was all of us, all the partners working together, to get on the same page and align our strategies and [create] more of a collective impact instead of trying to do things in silos,” Rausch says.
Out of the meeting came the name “The Way Home” and a five-year plan driven by data to create 2,500 units of permanent supportive housing, Rausch says. Each unit of housing came with subsidies that paid for rent and wrap-around case management services.
The plan, which Rausch says led to the effective eradication of homelessness among veterans in the city in 2015, rooted itself in the Housing First model.
“[Housing First is] a way to provide a service to someone where you house them first and then once they're safe, they have a roof over their head, and they have food in their bellies, then you focus on whatever supportive services they may need, and the supportive services are not required,” Rausch says.
When housed, Rausch says individuals can tap into the employment opportunities and supportive resources needed to stay housed. But without housing, it’s difficult for individuals to complete the tasks required to obtain housing, Rausch says.
“Imagine living on the street and you're trying to get a job,” Rausch says. “You're not going to be able to take a shower and have good, clean clothes that are ironed so you can look your best for job interviews. And then how are people going to contact you? How are you going to use the phone or the Internet to apply for a job? It's just not realistic to expect for someone that is living unsheltered or even in a shelter, to achieve all of the things that might be necessary to get them out of that situation.”
Between 2010 and 2020, the number of individuals experiencing homelessness in the Houston CoC dropped by 37.6 percent, from 6,368 to 3,974, according to the HUD report. Unlike programs that might place unsheltered individuals into temporary housing like hotel rooms, Rausch says Housing First is a permanent solution.
“Sometimes there's a need or political will to handle the immediate—like people living on the streets and, you want to get rid of that for the public, you want to touch on the visible signs of homelessness immediately,” she says. “But you have to focus on the long term.”
In St. Louis, CoC leaders aren't sure what's next
St. Louis and Houston share similar trends.
Overall homelessness in the St. Louis region has also decreased significantly, and both cities beat the national trend: In the United states, homelessness decreased by 8.9 percent between 2010 and 2020.
And in both St. Louis and Houston, CoC leaders cited Housing First as a source for their success. And now, it is becoming a national strategy.
House America—a Biden administration initiative between HUD and U.S. Interagency Council on Homelessness—encourages local leaders across the country to use American Rescue Plan funds to address homelessness through Housing First initiatives.
Through House America, St. Louis Mayor Tishaura Jones pledged to re-house 800 individuals and develop 500 units of affordable housing. Leaders in cities from Phoenix to Baltimore made similar pledges.
Despite national support, in Missouri, the new legislation could make it harder for local leaders to implement Housing First.
Beck says she is unsure of how exactly the implementation of the new bill will affect the region’s homelessness response.
D’Agostino says the bill’s writing is vague and leaves him with more questions than answers. But he has concerns that it could make it more difficult for unsheltered individuals to find housing.
“I don't know any situations where someone is sleeping outside in an encampment, and creating a Class C Misdemeanor and giving them 15 days in jail, $750 fine, and giving them now a record if they didn't already have one, is going to help housing them,” he says.
