Episode 21: What to Do About Homelessness with Beth Shinn

Shane Phillips 0:04
Hello, this is the UCLA Housing Voice podcast and I'm your host Shane Phillips. Each episode we discuss a different housing research paper with its author, with the goal of better understanding the challenges we face and how to solve them. Our guests for this episode is Professor Beth Shinn of Vanderbilt University and my co-host is Mike Lens. Today we're talking about strategies for addressing family homelessness, our first episode on the specific topic of homelessness. As we'll discuss, Beth is the perfect person to be our first guest on this subject. As many of our listeners are aware, the way we talk about homelessness and people experiencing homelessness has taken a sharp turn in recent years, and in a pretty concerning direction. What felt like a very hopeful, compassionate response only a few years ago, now feels very punitive and reactionary. With a return to criminalization and victim blaming policies that we know don't work from decades of experience. Many people have lost faith in long-term solutions that address root causes. And too many are calling for homeless individuals to simply be locked up or shipped away. Beth's research is important for many reasons, but one is just the way it centers the conversation back onto solutions that have real empirical backing. One thing I want to know at the top here, this is a conversation focused primarily on homelessness experienced by families. But that's just one type of homelessness, or one group that experiences it. People with for example, severe mental health issues often require different kinds of interventions. And the same can be said of single adults who might be leaving an institutional setting such as a jail or foster care, or someone who recently lost a job, but may be able to get back on their feet with relatively little assistance. different interventions are best suited to different circumstances. But we rely on the work of people like Beth to know which goes with which. We're definitely planning to discuss other populations who experience homelessness, and what we know about helping them in future episodes. So stay tuned for that. The Housing Voice podcast is a production of the UCLA Lewis Center for Regional Policy Studies. If you want to help the show, give us a five star rating and a review. And if you have any feedback or show ideas, you can email me at Shanephillips@ucla.edu. With that, here's Professor Beth Shinn.

Our guest this week is Beth Shinn, professor in the Department of Human and Organizational Development at Vanderbilt University. She studies how to prevent and end homelessness and create opportunities for groups that face social exclusion. And she's also the co-author along with Jill Khadduri of a recent book titled 'In the Midst of Plenty: Homelessness and What To Do About It'. We'll spend most of our time today discussing a report that Beth co-authored. But we'll also be asking a few questions about the book. And we'll tell our listeners right now that they should go ahead and buy a copy of it. Beth, thank you for joining us today.

Beth Shinn 3:09
Thanks so much for having me. And thanks for the plug for the book.

Shane Phillips 3:13
And the co-host today. We got Mike Lens. Welcome back, Mike.

Michael Lens 3:16
Thank you very much, Shane. I've enjoyed listening to a few great episodes. While I have been less active as a podcaster than I have been before. It's great to be back. For the listeners. I'm still in London, but why would you care?

Shane Phillips 3:34
Okay, so to start, Beth, how about you just tell us a little bit about Nashville where Vanderbilt is based? If you were taking us on a tour of the city, what would you want to show us, you know, either as regular-ish people or urban planning and housing nerds?

Beth Shinn 3:51
Well, Nashville is sometimes called "music city". And one of the fun things about Nashville is the number of places that you can go and hear live music, and it's a much more varied selection of music than it's given credit for. So that's a lot of fun. There's also great access to nature areas. So you know, one of my favorites is a path around Radnor Lake where you're sure to see you know, deer and turkey and egrets, and there's an eagle and some owls and just a lot of fun.

Shane Phillips 4:22
That's great. So we'll start off with your book here. Once again, it's titled 'In the Midst of Plenty: Homelessness and What To Do About It'. And I'll admit, I haven't read it yet. But I've heard nothing but good things from a lot of people. And I know quite a few professors actually who have already assigned it to their students, which is, you know, pretty impressive for a book that's only been out a couple of years. As the title suggests, it's much more comprehensive in scope, than the report we're going to be discussing most of the time today, but I think a summary might be really helpful to kind of prime our listeners for that more in-depth conversation.

Beth Shinn 4:58
Um-hmm.

Shane Phillips 4:59
Could you tell us a bit about the book's main messages and kind of, you know, I think just some basics on what we know about who becomes homeless, and why would be great. And also, you know, what we know or don't know about strategies for ending and preventing homelessness generally.

Beth Shinn 5:17
Um-hmm. So as the title of the book suggests, our central message is that we have the resources as a society to prevent and end homelessness. And we have the knowledge, there have been a number of studies in the last decade or two decades, that have really shown us the way to end homelessness for different groups. And we know something about prevention. So we're in a position to end homelessness, if we're ready to devote the resources to doing so. So who becomes homeless there, maybe half a million people are homeless on a given night, there many more people who are homeless over longer periods of time, there are three and a half million who use shelters just in the course of a year. And there are a lot of different kinds of people. So you know, your image of somebody who might be homeless is probably a single man. Perhaps a derelict. The age at which you're most likely to be in a shelter in the United States is infancy.

Michael Lens 6:19
Yeah, that's tragic.

Beth Shinn 6:20
And so about a third of the folks who experience homelessness are people in families. And we know quite a lot about how to end homelessness for families. We'll be talking about that later in a particular study. We know how to end homelessness for individuals with serious mental illnesses and co-occurring substance use disorders. There have been great randomized controlled trials of housing first programs, and we can talk about those if you want to for that group. We've been able to cut homelessness among military veterans in half...

Shane Phillips 6:56
Yeah.

Beth Shinn 6:57
...because we've put the resources in. HUD and the Department of Veterans Affairs, put in the resources, mayors stood up to a Mayor's Challenge to end homelessness. The VA started asking everybody who came in for medical services, a couple of questions about their housing stability, and their projected housing stability, and referred folks to prevention. And we've shown that we can end homelessness, if we're willing to put in that kind of effort.

Shane Phillips 7:26
That's yeah, that's super helpful primering. I actually, sounds like Mike was aware, but I was not aware that the largest, and the most frequent user of shelters was infants. That is horrible.

Michael Lens 7:40
I'm only aware because I've read the book. I mean, just to kind of add on to to the praise there. I mean, I think, you know, what I struggle a lot in, as somebody who who does housing research, and of course, lives and works in Los Angeles, where homelessness is more on people's minds than I think in past years, and in other places, often, I really struggled to kind of understand and be informed really about the interface between housing and homelessness, and how housing policy interacts and affects homelessness, just because I don't strictly do, I don't really do research on people experiencing homelessness and interventions there. And the book is really a fantastic introduction, plus, you know, more, I think, for people who want to better understand like how we can, you know, we can use housing, and we can do policy, so much better for people experiencing homelessness. So I think I would very much encourage people to look at it.

Beth Shinn 8:53
Thanks so much. And homelessness is really all about affordable housing.

Michael Lens 8:57
Right.

Shane Phillips 8:58
Yeah, I think we'll come back to this, perhaps. But I have a question for later about how homelessness policy and housing policy I think are often treated as separate disciplines. And I think that's still true in many ways. But there's a growing recognition of the intersection between these two things and kind of them being, homelessness in particular, maybe being downstream of housing policy in many cases, but not all. So we'll get there. But let's start with, so the report that we're talking about is known as the 'Family Options Study'. And its purpose was to evaluate the effectiveness of several common strategies for helping homeless families find their way back into housing, and ideally, to stay housed and to change other aspects of their lives for the better. Things like income, food security, substance abuse, intimate partner violence, child well-being and so on. I'm going to summarize the study as quickly as I can here, and then we'll dive into the details with Beth and Mike. So, more than 2000 families were recruited from emergency shelters to participate in the program. And each was assigned to one of four groups. One group got priority access to a long-term housing subsidy, usually a housing choice voucher. And that might also include some assistance to find housing but no other supportive services really. A second group got priority access to short-term rapid rehousing subsidies that offered families temporary rent assistance, potentially renewable for up to 18 months and paired with limited housing-focused services to help families find and rent conventional private market housing. Our listeners are probably familiar with vouchers, but maybe less so with rapid rehousing. So this intervention is basically as it sounds, programs are designed to quickly get people experiencing homelessness back into housing, this prioritizes getting people back into housing as quickly as possible rather than focusing on other services or circumstances in their lives that might be contributing to their homelessness. The third group was the "transitional housing intervention", offering families temporary housing for up to 24 months in agency controlled buildings or apartment units paired with intensive supportive services. Transitional housing also is probably not super familiar to everyone and contrasts with rapid rehousing in some important ways. It's typically paired with services, and it tends to prioritize these services, at least as highly as quickly putting a roof over people's heads. Before we go any further, Beth, have I correctly defined rapid rehousing and transitional housing and the contrast between them or is there anything you want to add there?

Beth Shinn 11:40
No, I think that's right. In our study, people use rapid rehousing temporary subsidies for about eight months on average. And they use transitional housing, when they used it, for about 13 months on average, you can stay in transitional housing up for two years. But basically, the theoretical argument for transitional housing is a "fix the family" kind of argument that people experience homelessness, either came to homelessness because of difficulties in their lives or experienced trauma because they were homeless. And you can't, transitional housing advocates would argue, rehouse people until you've tried to deal with those issues that people may have, and you strengthen the families, the argument goes, to the point where they can be self-sufficient. We didn't find any evidence for that model.

Shane Phillips 12:32
Interesting. Yeah. And it's it's sort of the inverse of the housing-first model, which I think we'll talk about a little bit as well here. So there's a fourth group and this group received what is called "usual care". Families in this group could use any housing or services in the community that a family could access in the absence of immediate referral to other interventions. And that typically included at least some additional stay in an emergency shelter, but they didn't get priority access to any type of homeless or housing assistance. So they're not getting priority access is the key. They're essentially the control group in this study, and the others are different treatments. I should also note that assignment to the first three interventions was not a guarantee of participation in it, but rather, it just meant that the family received priority access if they wanted to use it. And similarly, families assigned to the usual care group could still access housing vouchers and other programs, but they wouldn't receive priority access. So in many cases, they might wait months, or even years to actually receive a voucher or to move into assisted housing. So in other words, these families got the usual range of options that would have been available to them if the study had not taken place. Outcomes for the families were tracked at 20 months, and then 37 months, and the experiment was set up so that researchers could compare each group against the others. So for example, they could see how housing vouchers compared to usual care as an intervention or how rapid rehousing compared to housing vouchers, or transitional housing compared to rapid rehousing, and so on. Beth and her fellow researchers also evaluated the relative costs of these different approaches, which is important because we don't have unlimited funding to address people's housing needs. And it might not make sense to prioritize an intervention that's say twice as effective as the alternatives, if it costs three or four times as much, or if it's very effective for those who really need it, but unnecessary maybe for families who might need different or less intensive assistance. Closing out my summary here, just a tease a few of the findings. Unsurprisingly, families assigned to the usual care group did not have great outcomes, the control group, and compared to the usual care group, those who received priority access to housing vouchers or long-term housing subsidies were much less likely to end up in shelters again within the 37-month period. And they saw other benefits including reduced psychological distress and a halving of intimate partner violence compared to the usual care group. More surprising, at least to me, was that the impacts of the rapid rehousing intervention were essentially indistinguishable from the usual care group, especially at the 37-month check-in. The transitional housing intervention was somewhat better in that it improved housing stability, compared to the usual care, meaning that families were less likely to end up back in a shelter. But the impact was much smaller than the housing voucher intervention and had fewer co-benefits. I do want to note that these are all average outcomes for each intervention. So rapid rehousing, transitional housing and usual care probably worked perfectly well, for many households. But worse overall, for permanent housing subsidies, I don't think we want to imply that there's not a place for these other options, just that, you know, maybe one is generally more effective than the others. Beth, how is that for a summary? We're going to dig into the details here. But is there anything I got wrong or maybe misstated that you want to correct there?

Beth Shinn 16:06
Um-hmm. No, I think that's basically right. We also tried to determine whether there were some families that would benefit more from one intervention than another. And we put our money on two kinds of characteristics of families. One was psychosocial challenges, things like substance abuse or domestic violence or psychological distress. And another was housing challenges, things like eviction records, or not having a rental history. And we couldn't find any evidence that any of the interventions work better or worse, depending on whether families were high or low in psychosocial challenges or in housing challenges.

Shane Phillips 16:50
That's really interesting. One of the reasons we chose this study for our first episode on homelessness is because it makes use of a randomized controlled trial design, or RCT. Mike, maybe you can explain to the listeners what an RCT is for the uninitiated and say a little bit about why you wanted to have an RCT for our first conversation about homelessness.

Michael Lens 17:14
Right. Yeah. So thanks, Shane. You know, I guess it is, at this point, cliché in policy evaluation and policy analysis to call randomized control trials or RCTs, like the gold standard. And the reason why we give it this lofty title is, it's really the only studies arguably, or the best study, certainly for really isolating the effect of a policy intervention, on the outcomes that you want to study. The reason why we can be very confident or much more confident in an RCT, if the randomization is done, right, is because random chance is what splits you into the groups that determine what kind of program you participate in. Right. So in this case, we had four groups. One of them's a control group, the usual care group, and then there's three other housing interventions that we're studying. And rather than the individual families choosing, which, you know, program they thought was best for them, which introduces selection bias that, you know, is correlated with some attributes of the family or characteristics of the family that we can't necessarily control for. Or it's, you know, it also wasn't Beth's decision, or her fellow research colleagues decision, it wasn't the program administrator's decision, you know, all these sorts of human decision making processes that would introduce selection bias in terms of you know, that would determined where people are going to go, right? We get rid of all that. And we roll the dice, right, and we say, okay, family, A, you know, just turn, you know, the dice said that you get rapid rehousing. family B, you know, the dice said, you get transitional housing. And so we have none of that selection bias. And we can assume that on average, all of these different groups are the exact same. And you know, that whatever outcomes that we observe about them in terms of their housing outcomes, or their family outcomes, are actually due to whatever program they participated in.

Shane Phillips 19:32
And, Beth, I think some listeners might wonder if it's ethical to assign some families to a usual care group to kind of roll the dice as opposed to saying, you know, we think as professionals in this field that based on your circumstances, this is the right option for you and and we're going to assign you to this treatment, or we're going to, you know, provide this service for you rather than a different one. What's the response to like why this approach is ethical and not, you know, setting people up for failure or what have you?

Beth Shinn 20:09
Um-hmm. That's an important question. One reason we think it was ethical is that we brought resources to the communities that we were studying that they wouldn't ordinarily have had. So ordinarily, people who are in homeless shelters don't have access to housing choice vouchers, they can get on the list. And they can wait a couple of years. And even...many of our usual care families eventually got various forms of housing subsidy. But they aren't usually offered to folks who were in shelter. So we brought resources to the communities, and the usual care families had access to everything that they would have had access to anyway. So we didn't take anything away from anybody. And we, of course, got informed consent, we explain the study to people and asked whether they wanted to participate. We only had 13 turn-downs in nearly 2300 families, because we were bringing additional resources to the community. And the idea that somehow workers could do a better job of figuring out what's the right solution for a particular family is really arguable. And the fact that we couldn't find out afterwards, which families would flourish more, depending on their characteristics and different kinds of housing, suggests that could just be worker bias as well.

Shane Phillips 21:35
Yeah, you can't even really figure it out, in retrospect, much less ahead of time. Yeah. And I do want to reiterate that the usual care group, the families in the usual care group still had access to all of the interventions, they could still get vouchers, they could still get into rapid rehousing, it's just, they would have to go through the same, you know, waiting process and all of that as anyone else. So let's get into some more specifics of the study, as you said, nearly 2300 families participated. And to be eligible, they had to be living in emergency shelter for at least seven days. What's the reasoning behind that seven-day threshold, and were there any other important eligibility requirements? And if you think it's appropriate, this might also be a good time to kind of sketch out some differences between short-term homelessness and long-term or chronic homelessness and why advocates and researchers might think they require different kinds of assistance.

Beth Shinn 22:35
Um-hmm. So the other requirement for families was they had to have a child 15 or under in shelter, and 15 or under was so that they'd still be around when we came back to do a follow-up.

Shane Phillips 22:49
Oh yeah.

Beth Shinn 22:50
The reason that we asked for families to be in shelter for seven days, is that there are a large number of people who are homeless quite briefly, for a day or two. So if you have some kind of housing crisis, you might go to a shelter. But if you've got resources, you might be able to figure out something to do that would get you out of there. In a few days. There's another group that might have serious psychosocial needs, serious mental illnesses, for example. And permanent supportive housing is an intervention that's been shown to work for people with long histories of homelessness, serious mental illnesses, often co-occurring substance use disorders. And if that's available in a community, we figured the shelters would be able to identify people within that first week, and set them up to get into permanent supportive housing. But if it wasn't available, then they were eligible for the study. So we weren't excluding people, because they might be high needs. But we wanted to give them the opportunity to get into something a little bit more with heavier duty services. If that was available to them. Mostly it wasn't.

Shane Phillips 24:05
Yeah, and this might be a good time actually to just review how permanent supportive housing differs from these treatments because it was not one of the treatment options.

Beth Shinn 24:15
Right. So permanent supportive housing has been tested mostly for individuals. There has been a big RCT for that in Canada...there is a small RCT that we did in New York years and years ago for the Pathways Housing First model...and then the At Home/Chez Soi study in Canada, a five-site study that showed that the Pathways Housing First model of permanent supportive housing really works. And in that model, people get housing with private landlords without any prerequisites for sobriety or participation in treatment, but with wraparound services: vocational, recreational, mental health, substance services, physical health services, but voluntary services only those that they choose because services work a lot better when people choose them than when they're foisted on folks. So in the supportive housing model, you've got wraparound services, but you also have permanent housing available. And that works very well for folks with serious mental illnesses and substance problems and long histories of homelessness.

Shane Phillips 25:19
Yeah, we actually did look at that study as an option for this interview, I think we might come back to it someday in the future, because it is kind of looking at a different kind of homelessness intervention. So in the report, you note that the typical family in the study was an adult woman with a median age of 29 years old, with one or two children living with her in the shelter, and that about 30% of families had two adults present mostly as couples, racial minority groups were over represented relative to the overall population, and even relative to the population of people experiencing or living in poverty. Some other things that stood out to me were that the participants had a median household income of just $7,400. That's annually. 26% had an eviction at some point in their history, and 35%, more than a third, had never held a lease themselves. Are those numbers pretty reflective of homeless families in general? And is there anything else we should know about the families in this study in terms of demographics, family structure, those kinds of things?

Beth Shinn 26:28
I think those are fairly representative figures for a cross-section of people who experience homelessness. So most people who are homeless, are homeless only once and fairly briefly, but those who have trouble extricating themselves or those who return are more likely to show up in a cross sectional survey. But yes, many people who experience homelessness have never had a place of their own. And most people who are found in the annual counts of people experiencing homelessness are not coming from places that they owned or rented. They're coming from doubled up situations, or in the case of single individuals, they may also be coming from institutions.

Shane Phillips 27:12
So as I said, in the summary, you were looking at three interventions in addition to usual care, those were long-term housing subsidies, rapid rehousing, and transitional housing. I gave a quick definition of each intervention. But could you go into a little more detail for us about what each of those interventions look like from the perspective of the homeless family, and then help us understand, we talked about this a little bit, the conceptual framework behind each approach, advocates and practitioners don't all agree on the origins of homelessness. And that does lead to different ideas about how it can be solved. So I'm curious how those conceptions are reflected in each intervention.

Beth Shinn 27:55
So the theory behind using housing subsidies to end homelessness is that homelessness is essentially a housing affordability problem. And if it's a long term rental subsidy, the idea is that this is an affordability crisis, it's not likely to be quickly resolved. And we have a lot of evidence for that, that was the intervention that worked by far the best, not only to resolve homelessness, but also to have radiating benefits for other aspects of family life. For an individual. This means finding a landlord who is willing to accept a housing choice voucher...

Shane Phillips 28:37
Um-yeah.

Beth Shinn 28:37
...and that can be difficult and leasing up. And we had much higher lease-up rates than in other studies of use of Housing Choice vouchers, because our families were more desperate. So about 88% of families who were offered Housing Choice vouchers managed to lease up with them.

Shane Phillips 28:56
How does that compare to the overall population of people receiving those vouchers?

Beth Shinn 29:01
That's higher. And I don't have a specific figure. I can make one up. But yeah, It'd be around 60%. But yeah,

Michael Lens 29:11
I would have said somewhere in the 60s. And I think, you know, Beth probably hit the nail on the head there. It's like, so many people who receive a voucher use the voucher in a place they already live in, right. And so this is a little bit of a different story where somebody doesn't have a place, right? And so they have to use the voucher in order to get a roof over their heads. If you already have the roof, which is the case for the vast majority of voucher holders. They, you know, they don't necessarily have to use the voucher and if the landlord that they have currently says no, well, then they might just stay there and pay.

Shane Phillips 29:53
Interesting. Yeah, and also maybe important to note that I'm sure that voucher utilization for the people who have them varies a lot from city to city, tighter rental markets, it's probably harder. There are also cities and states, California included that now ban source of income discrimination, at least in this way where you're not, at least on paper allowed to deny someone renting your place because they're using a voucher to pay yeah.

Beth Shinn 30:25
And there's an Urban Institute study that shows that in cities with source of income discrimination legislation, it's easier to use vouchers. It's still not easy.

Shane Phillips 30:34
Yeah, it's still only I don't know, 70%-80% as opposed to 50%-60%. Whatever. Yeah. It's better, though. So that's long terms, subsidy vouchers, how about the kind of ideological framework behind rapid rehousing and transitional housing.

Beth Shinn 30:52
So rapid rehousing has a similar take to the long-term housing subsidies. Again, it's thought that homelessness is a housing affordability problem. But the goal is to get folks back into the regular housing market as quickly as possible, and to give them only as much help as they need to stabilize. And what we found was that, to the extent that there were real effects of rapid rehousing, we missed them when we came back 20 months or 37 months later, folks used rapid rehousing subsidies, on average about eight months in our study, and rapid rehousing was certainly no worse than usual care. And it was cheaper than usual care. So to be preferred on those grounds. But we didn't have a lot of effects of rapid rehousing. Transitional housing, assumes that families have psychosocial needs that need to be addressed before they can be stable. And so those needs might arise from the trauma of homelessness, they might be needs that lead people to become homeless to begin with. But those needs need to be addressed in order for families to become stable. And we found no evidence for that approach. The transitional housing had no benefits for any of the psychosocial outcomes that transitional housing is supposed to address.

Shane Phillips 32:21
Um-hmm. I think we can talk a little bit more about the impacts here in some detail. So we've spelled out that long-term housing subsidies are more effective. What does that actually look like? So at 37 months, in particular, how are people who have received priority access to long-term housing subsidies doing better than the other groups?

Beth Shinn 32:44
They're less likely to be homeless, they're less likely to be doubled up with other households because they can't find or afford a place of their own. They have moved less frequently in recent months. So they're much more stable on every measure of housing. And then there are radiating benefits for other aspects of family life. So folks who got priority access to housing subsidies had lower levels of psychological distress, lower levels of substance abuse, lower levels of interpersonal violence than families who got simply usual care. That is the psychosocial problems that can sometimes lead to homelessness were improved. When families got access to affordable housing, affordable housing created a platform for them to solve whatever other problems they might have had on their own without any special assistance, they could use any kind of assistance that was available in the community, but no specialized assistance as part of the experiment. Kids moved less often between schools, and they had better school attendance, and they had fewer behavior problems and more prosocial behavior. Families were less likely to become separated. So parents were less likely to become separated from their children. In 20 months, there were fewer families or fewer kids that were going into foster care.

Shane Phillips 34:07
Which itself is...someone in foster care....is so much more likely to end up homeless as an adult than the average person. Yeah.

Beth Shinn 34:17
And families were more likely to be food secure, and experienced lower levels of economic stress. If they got the housing choice vouchers. The one clearly negative effect was that families were a little bit less likely to be employed. They didn't have lower incomes, but they're less likely to be employed at 20 months. And that was no longer significant at 37 months, but over the period of the study, it also seemed they worked for fewer months. Now these are families mostly with young children, fairly high levels of disability, and so they were able to maintain their families and have better food security with a little bit less work effort.

Shane Phillips 35:03
Yeah, it sounds like if they're working less but earning the same amount, that's not such a bad outcome.

Beth Shinn 35:09
That might not be a bad outcome.

Shane Phillips 35:10
Yeah, yeah.

Michael Lens 35:12
That's really a widespread set of positive outcomes there. And I guess, I can't help but to compare somewhat to the 'Moving to Opportunity' study, which is, of course, both an RCT and involves housing vouchers as a key or the key in that circumstance, on that study intervention. Where, certainly, you know, there's certainly plenty of positive outcomes there, but a lot of null findings, right?

Beth Shinn 35:47
Um-hmm.

Michael Lens 35:47
And and it's the the findings from this study seem to be, you know, really much more pervasive and affect, you know, different aspects of people's lives in a different way.

Shane Phillips 36:02
And do you think that's just because the Moving to Opportunity study was mainly people who already lived in public housing, moving somewhere else, as opposed to people who are homeless, kind of, you know, desperation or just different circumstances or something else?

Beth Shinn 36:18
Yeah, I think the the contrast is much bigger for us between homelessness. Moving to Opportunity was essentially offering people vouchers to move to better quality neighborhoods, or to maintain housing, with vouchers in poorer neighborhoods. And the long term effects of moving to opportunity are pretty interesting. So upfront, there weren't a lot of effects. But for youth who got access to better neighborhoods early on before they were teenagers, there's some long-term effects. And we're just now launching a 12-year follow-up to family options. And we're very excited to look at what happens to the young children who are now adolescents and the middle school children who are now young adults.

Michael Lens 37:09
Oh, that's fantastic.

Shane Phillips 37:11
Long-term housing subsidies seem to be more effective. Do you have a sense for why?

Beth Shinn 37:16
I think I really support the theory that homelessness for families is a housing affordability problem, you fix the housing affordability, you provide a stable platform for families to deal with whatever other problems they might have on their own.

Shane Phillips 37:31
It's a point in favor of the "just give people money" solution to many of our problems.

Beth Shinn 37:36
Oh, I think that's also very interesting solution. In this case, the money was essentially constrained to be used for housing. But I think the you know...

Shane Phillips 37:50
That's the next study.

Beth Shinn 37:53
...yeah, we're actually trying to raise money now for a study to give on conditional cash transfers to keep babies out of shelter in New York City.

Michael Lens 38:02
Oh, wow.

Beth Shinn 38:03
So I don't know whether we'll raise the money and be able to pull it off or not.

Shane Phillips 38:07
We'll have you back on for that one...

Michael Lens 38:09
Yes!

Shane Phillips 38:09
...in six years or whenever you're checking in on them?

Michael Lens 38:12
Yeah. If you know, Robert Wood Johnson or other funders are listening. Yes. Green light this, please. This is a great idea. Well, I do think this does have lined up well, with with thinking about alternatives for different populations and families. Not to hammer this point, too obviously, but it's just there really is a lot of I think, controversy or differences of opinion, however you want to say it, where some people think this is, you know, homelessness is a housing problem. And some people think, you know, homelessness is like a mental health or substance abuse problem. It's, you know, to me, it's absolutely not that simple. But like, there's so many people that feel very, very strongly on, you know, both sides or multiple sides there. And I could definitely see people listening to this conversation saying, Yeah, okay, you know, maybe families have fewer, you know, substance use issues, for instance, and, you know, the people that I encounter that are experiencing homelessness are these, you know, individuals on the street that, you know, seem troubled and like, maybe they just can't hold down a house or something, you know, I'm not speaking for myself, which is like this, I think, pervasive idea that's out there. I guess, Beth, do you feel as confident about a housing first model? Do you feel as confident based on your...You know, it's always hard to extrapolate findings to another population. How much do you think this applies to people who are, you know, individuals experiencing homelessness, for instance?

Beth Shinn 39:57
Yeah. Well, let me say three things about that. First, families are less troubled on average, than individuals who become homeless, they have lower levels of mental illness and lower levels of substance abuse, they're more likely to be depressed, less likely to have psychotic disorders. Second, seeing somebody who's homeless is seeing somebody who's at the worst point in their lives. And one thing we found in this study is even, we found that the experimental group, that the housing subsidy group, had reductions in psychological distress and substance use over time. But we found that that was generally true as families stabilized even if they didn't get housing choice vouchers, their psychological distress and their substance abuse went down. So families do better when they're not in the midst of an episode of homelessness. And if you see somebody in the midst of an episode of homelessness, you're seeing somebody who's not at a good point in their lives. But there is evidence for a housing first approach for individuals with serious mental illnesses. It's not housing only, housing first for folks with serious mental illnesses includes wraparound services, it's not just putting people in housing and going away. But it's getting people in housing, first, rather than first trying to deal with their substance abuse or their psychological problems, which are very difficult to deal with when people don't know where they're going to sleep tonight.

Shane Phillips 41:35
So one thing that I think looms large in all of this is the cost of these different interventions. And you measure the cost of them in two ways. And the difference, I think, illustrates something pretty important. One measure is the per family cost of a specific program, per month or per use, whether that's a long-term housing subsidy, emergency shelter, so on, that one's pretty straightforward. The second measure is the per family cost of all programs used by a family based on which intervention they were assigned, which group they're assigned to. So if a family was assigned to community-based rapid rehousing, you'd be looking at the cost of that program, as well as any other programs they ended up using during the 37-month period. It seems to me, that that measure more accurately reflects the real cost of each intervention. It's acknowledging that just because a specific intervention may not work for someone, that doesn't mean they just disappear and are no longer, you know, making use of any public programs. We know for a fact that they usually are. For both of these measures, what should we know about the monthly cost of each program and the costs for each intervention group?

Beth Shinn 42:49
Well, emergency shelters and transitional housing are expensive. emergency shelters are the most expensive option. But transitional housing is also quite expensive, because you're pairing services and supervision with the housing. And rapid rehousing is the cheapest intervention per month, because the subsidies tend to be a little lower than for housing choice vouchers. And housing choice vouchers are intermediate there. But I think you're right, that it's the cost of all the programs that people use. That is the fair comparison, right? So we're looking at the outcomes of the mix of things that people got into when they got priority offers for one or another intervention. And we should also look at the costs of those same things that people got into when they got those priority offers. And there, we were surprised at 20 months, it was almost a wash, that is housing choice vouchers, or access to long-term subsidies really didn't cost more than usual care at 20 months, by 37 months, the cost had diverged, because people continued to use the long-term subsidies and the people in the usual care group, were using fewer other kinds of programs. And so the long-term subsidies cost about 9% more than usual care. I think it's worth it.

Shane Phillips 44:18
Presumably that would, that gap, would continue to grow over time.

Beth Shinn 44:23
We expect it to continue to grow, it won't grow enormously. The last tracking interview we did with folks was at about six and a half years. And at that point, only about half of the long-term subsidy group was still using their long-term subsidies and more of the usual care group had gotten into subsidies...

Michael Lens 44:44
Oh! Yeah.

Beth Shinn 44:44
...so we we do expect the groups to continue to diverge but not in a decelerating way.

Michael Lens 44:52
Right, right.

Shane Phillips 44:53
That did stand out to me, looking at, you have some charts in the study that show, kind of, what services people were using over time, you know, what percent of each group. And what you see is even in the rapid rehousing and the transitional housing groups, that by 37 months, the plurality were well, the largest was probably using nothing. But then the next largest group was actually long-term housing subsidies, housing vouchers, basically, as opposed to the thing they were initially assigned to.

Beth Shinn 44:53
Um-hmm. That's right.

Shane Phillips 44:58
So again, the long-term housing subsidy option seems to be the superior in terms of the positive impacts for families experiencing homelessness. I know it's not, you know, it's more complex than this. And in some ways, it's because of the very long term, open ended nature of the intervention, that this is the case, it's very likely that some of the families that received a voucher would have turned out perfectly fine, they would have been okay, with a temporary and less expensive intervention, or maybe even no real intervention at all. And if we could identify those families, then we could save that money and spend more of it on the people who really need more assistance, or on any other number of important public priorities. The challenge, of course, is we're not really good at identifying who needs more or less intensive assistance, or what kinds of assistance from what I gather, I'm thinking actually of another study that I come back to very often, I think it was in San Mateo County, where they found that I think it was 5% of unhoused, individuals were incurring a huge share of public costs, mostly in terms of healthcare, you know, emergency room and criminal justice, police and jail and that kind of stuff. The average expenditure was over $100,000 per person in terms of public services, and that's per year, but the problem was that it wasn't the same people every year, and we couldn't predict in advance who those people might be. So could you talk a little bit about that challenge? And what role this plays in all of this? You know, you should maybe share some of the ways that practitioners try to identify the best interventions for different homeless families and individuals? Or maybe, you know, if, if the right answer is, is long-term subsidies for everyone, maybe that's not even necessary.

Beth Shinn 47:20
So the families who experienced usual care in our study used a lot of costly services, it was about $41,000, on average, over the three year period that we tracked it. So you know, usual care is not nothing, usual care is a variety of service programs that don't succeed in stabilizing very many families. But as you say, some families do fine. Without services, we weren't able to identify them. Now 2200 families isn't enough to really understand who benefits most from what, for the statistical nerds, you still don't have enough power to test statistical interactions. What that means is, you really need enormous samples to be able to tell what works for whom, when the signal is not very strong. And we weren't able to detect the signal. It wasn't strong enough to detect with the the families that we had. We've seen in some other situations. So I've done some work with New York City and trying to predict who is going to need preventive services. So people come into a program in New York City called "Homebase", and ask for services. And initially, workers were deciding to whom to give services. And we helped the city develop an empirical model that worked better than what the workers were doing in predicting who was going to come into shelter. And the workers erred on the side of giving services to, this is my term not there's, "the worthy poor", they're more likely to give services to high school graduates, but people who weren't high school graduates are more likely to become homeless, they're more likely to give services to people who are employed, but people who weren't employed were more likely to become homeless. And so we were able to build a model that predicted who would become homeless and help the city give the services to the people that would benefit most there. And in California, you've done some really interesting modeling using administrative services to try to understand who's going to become homeless and who's going to become homeless for long periods. But that prediction is hard to do. And you know, in the housing first model, basically, you let people choose you offer a variety of services and you let people choose what it is that they want to avail themselves of. And if you have the resources that seems like a pretty good model. Because as I said services work a lot better when people choose them than when they're foisted on folks.

Shane Phillips 50:07
I know this is a difficult question to answer because there are so many moving parts. But do you have a sense for, if we were to take this seriously, as you say, and use the resources at hand, what would it cost to provide a housing subsidy to everyone who needs it? Like, what would that look like in terms of who would receive them? Who would still have to wait that kind of thing?

Beth Shinn 50:32
Well, the Bipartisan Policy Commission a few years ago, calculated that it would be about 31 billion to provide housing subsidies to everyone who would use it whose income was below 30% of area median, we now give subsidies, we give subsidies to only about one in four households that are eligible, but we allow slightly wealthier households to get them. So you don't have to be below 30% of area median to get them you can be up to 50% of area median to get the housing vouchers. So if you restricted a little bit more tightly to folks that are hurting the worst, then they calculated a few years ago, 31 billion, the National Low Income Housing Coalition is asking for more money than that. And there was money in Build Back Better, that would have increased the availability of housing choice vouchers.

Shane Phillips 51:37
Yeah, and just for context, I don't have the figures off the top of my head, but the mortgage interest tax deduction that homeowners get cost the government maybe, it used to be more like 80 billion, I think now after the 2017 tax bill, it's closer to 30, or 40 (billion). But almost all of the benefit goes to households earning at least $100,000 a year, there's a capital gains exemption on home sales that costs us a similar amount. So the money's there, we're just spending a lot of it on homeowners rather than renters and unhoused people.

Beth Shinn 52:09
Right, we spend a lot more money subsidizing housing for rich people than for poor people.

Shane Phillips 52:13
Right, right.

Michael Lens 52:14
Yep.

Shane Phillips 52:15
We've been focused here on what I said at the beginning might be called "homelessness policy". But as we start to close this out, I'd like to hear your thoughts on the role of housing and land use policy. More generally, in all of this. I think, unfortunately, these are often treated as kind of separate disciplines. You're either a homeless person or you're a housing person. And, you know, the solutions to homelessness are sometimes seen as essentially separate from efforts to build more homes and cities and improve the housing market affordability generally. I don't think it's a coincidence, though, that the cities and metro areas that build the least housing and have the most kind of restrictions often also have the highest rates of homelessness, even when those places spend a lot more money trying to address homelessness than then less expensive cities. I do feel like there's a growing recognition that housing policy is often upstream of homelessness. And you, kind of said it yourself that a lot of this does just come down to affordability. And I think more groups are aligning in their efforts to address both and not just be focussed on one or the other. What are you observing in terms of the intersection between these two disciplines, whether it's in academia or kind of on the government and advocacy space?

Beth Shinn 53:32
Well, I think that our study shows the homelessness for families really is about housing affordability. And rates of homelessness are higher in cities where rents are highest. So there's a lot of evidence, converging evidence, I think that housing and homelessness are two sides of the same coin. Homelessness, you know, affordable housing, you have to ask affordable for whom. So affordable housing is often for folks who are below 80% of area median, folks who become homeless are going to be below 30%, or even 15% of area median. You pointed out that our families had a median income of $7,400 at the point that we recruited them, so it's pretty clear that they did not have incomes that would enable them to afford housing in the private market. And even three years later, a large number did not have incomes that would allow them to afford housing in the private market. So I think housing policy is homelessness policy. And if we want to prevent homelessness, I mean we can do targeted social services to people who are at highest risk. But if we want to prevent homelessness, we have to stop keeping to generate homelessness, we have to stop generating more.

Shane Phillips 54:55
Right, right.

Beth Shinn 54:56
And because homelessness is essentially a housing affordability problem, we can increase incomes for people at the bottom of the income ladder, or we can reduce their housing costs. So we can do both to make housing affordable. And there are lots of ways to do both. Housing Policy tends to be around the affordability of housing, reducing housing costs, they're also important ways to raise people's incomes. And to some extent, those different policies trade off with one another. So if incomes are high enough, you don't need to subsidize housing to the same extent, for example.

Shane Phillips 55:35
And I do, I really want to emphasize that point about, you know, the solutions, requiring kind of constant action and how this is not, there's not just like a stock of homeless people, people are becoming homeless all the time, people who have not been homeless in the past in many cases. And something I point to very often is here in Los Angeles, we passed Measure HHH, which is more than a billion dollars to fund mostly supportive housing, and also measure H at the county level, which is providing money for a lot of services. And we are helping more people experiencing homelessness than ever and helping more people become no longer homeless, move into housing. And yet, the number of people experiencing homelessness is rising even faster, because of these sort of unaddressed bigger picture housing market and policy issues. And I think that's likely to continue if we don't address the upstream side of things.

Beth Shinn 56:34
You know, many more people experience homelessness over time than are homeless on any given night. So Bruce link did a social survey back in 1990, early in the current epidemic of homelessness, and he asked people whether they'd ever been homeless. Now these are people reachable in conventional dwellings, no prisons, no mental hospitals, no homeless shelters, no barracks, 14% of people said, yes, they had been homeless.

Shane Phillips 57:02
Wow.

Beth Shinn 57:03
And he asked follow-up questions to say, well, was that what HUD would call "literal homelessness" was that on the streets, in shelters, in places not meant for people to live? And 7% of people said yes to that. So vastly more people pass through homelessness, that are homeless on any given night. And thinking about homeless policy as separate from housing policies, is essentially, thinking of homeless people (people who experience homelessness) as kind of a separate species of individuals.

Shane Phillips 57:35
Um-hmm.

Beth Shinn 57:36
And that's not the case. People who experience homelessness are among the poorest of our fellow citizens at the point that they experience homelessness. And over time, they will do better and other people will replace them, among the folks who are experiencing homelessness until we are able to attack income inequality and housing affordability.

Shane Phillips 58:02
Absolutely. All right. Beth Shinn, thank you so much for joining us today.

Beth Shinn 58:07
Thanks so much for having me.

Shane Phillips 58:12
You can read more about Professor Shinn's research and find our show notes and a transcript of the interview at our website. Lewis.ucla.edu. The UCLA Lewis Center is on Facebook and Twitter. I'm on Twitter @ShaneDPhillips. And Mike is @MC_lens. Thanks for listening. We'll see you next time.

Transcribed by https://otter.ai