Abt Associates’ Evaluation of the Conrad N. Hilton Foundation’s Chronic Homelessness Initiative


Inflow into Chronic Homelessness

Foundation’s Contribution to Community Progress

2018 Status: Indicators of the Foundation’s Contribution to Community Progress

Directing Engagement Indicator: Foundation staff advocates for inflow analysis as part of community research initiatives (Limited Impact)

Impact on community understanding of the annual inflow into chronic homelessness (community alignment indicator)

The Foundation continued to support this effort through both grant-making and direct engagement. In May 2018, the Foundation hosted a meeting for local community stakeholders at which Dr. Dennis Culhane (University of Pennsylvania) and Dr. Randall Kuhn (UCLA) presented their recent report, Housing Supports and Services for Aging Adults Who Experience Homelessness. Their research identifies healthcare utilization patterns and costs over the decade in Los Angeles, New York, and Boston. This research is important to Los Angeles, as the Los Angeles Continuum of Care saw an 8 percent increase in people experiencing homelessness age 62 and older between the 2018 and 2019 Point-in-Time Counts.77

Impact on testing new pilot prevention, diversion, and street homelessness programs and strategies (community functionality indicator)

During 2018, the Foundation began to explore relationships with other systems of care including workforce, board and care facilities, hospitals, and managed care organizations. These systems of care serve people who experience or are at risk of homelessness, and they often intersect with the homeless service system. Many of the strategies defined in the County Homeless Initiative require participation of these other systems in the community’s efforts to prevent homelessness and to help people return to housing before they experience chronic homelessness.

Impact on expanding existing prevention, diversion, and street homelessness programs (community sustainability indicator)

Impact on this indicator was made through the grant-making portfolio rather than through direct engagement during this reporting period.

Grant Making Portfolio Indicator: Inflow grant portfolio expands to identify or address inflow population (Strong Impact)

Impact on community understanding of the annual inflow into chronic homelessness (community alignment indicator)

The Foundation’s 2018 three-year, $1 million grant to the Homelessness Policy Research Institute, a partnership between Home For Good and the USC’s Sol Price Center for Social Innovation, continues to support HPRI’s core activities. These include convening its 40-member research committee and other key stakeholders; conducting, disseminating, and translating rapid-response research to policymakers, service providers, and community stakeholders; and using research as a platform to effect policy change. The researchers affiliated with HPRI cover the full spectrum of topics central to understanding and ending housing crises and homelessness, and several focus specifically on preventing homelessness. Their work is expected to contribute to policy decisions aimed at curbing inflow into the system. Moving forward, the Foundation’s funding will contribute to HPRI’s research activities: translating research into actionable policy, conducting outreach to inform key stakeholders, and disseminating research findings.

Three of the Foundation’s research-related grants ended in 2018. Economic Roundtable released a report entitled “The Escape Routes: Meta-Analysis of Homelessness in LA.” The report describes the geographic distribution of people experiencing homelessness, as well as a number of other factors that describe and affect experiences and durations of homelessness. The University of Pennsylvania’s final report, “The Emerging Crisis of Aged Homelessness: Could Housing Solutions Be Funded by Avoidance of Excess Shelter, Hospital, and Nursing Home Costs?” predicts that the number of older adults who experience homelessness will triple in the next decade. The report examines the impact that homelessness among an increasingly older population will have on service provision and funding decisions. Finally, the National Academy of Sciences published a report entitled “Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes among People Experiencing Chronic Homelessness.” Although the analysis found that “there is no substantial published evidence as yet to demonstrate that PSH improves health outcomes or reduces healthcare costs,” the researchers note that there are research gaps that should be filled to better understand the impact of PSH and individual factors on client health and other outcomes.

Impact on testing new pilot prevention, diversion, and street homelessness programs and strategies (community functionality indicator)

The People Concern completed the first year of its three-year, $810,000 grant to employ two full-time registered nurses (RNs) for the Westside Hospital Care Navigator Project. This project identifies hospital emergency room patients experiencing homelessness and links them to these RNs for care coordination, linkages to housing, and connection to supportive services. In the program’s inaugural year, The People Concern filled one of the two RN positions but noted that finding someone qualified and willing to work with this population in a mobile setting (rather than in a hospital’s acute care unit) had been a significant barrier. At the end of 2018, recruiters were continuing to try to fill this vacancy. The RN who was hired completed intensive training, formalized referral and coordination forms and processes, and trained hospital staff on these new protocols.

In spite of having only one RN instead of two, this program served 53 patients in its inaugural year. Of these patients, 35 further engaged in services beyond initial referral, including case management, mental health services, linkage to a primary care physician, and addiction services. Of those who engaged in case management, 85 percent (22 patients) moved into interim housing, and 11 percent (three patients) moved into permanent housing. The total number of referrals fell short of its goal (100 referrals), but The People Concern expects this number to increase once a second RN is hired.

The Foundation’s $2 million grant to Brilliant Corners to launch and implement the Breaking Barriers program ended in 2018. The program provides housing and employment services to adult felony offenders currently on probation, with the goal of reducing inflow into homelessness for this high-risk population. The program exceeded the number of clients it had aimed to serve and supported a high proportion of those clients in maintaining their housing and employment. Over the three-year grant period, Breaking Barriers enrolled and provided services to 387 clients, housing about 60 percent of them. About 84 percent of clients housed retained housing for at least 12 months. The program also provided employment services to 340 clients. Of these clients who received employment services, 54 percent became employed. The program’s record led the County DHS and the Probation Department to expand the program. Breaking Barriers is now permanently funded through Senate Bill 678.

The Foundation’s two-year, $100,000 grant to The People Concern to enhance its client engagement, outreach, and assessment in Malibu ended in 2018. Cumulatively, The People Concern’s Malibu outreach team made contact with 269 individuals experiencing homelessness. The outreach team connected people to supportive services, including on-going mental health treatment, substance use services, and medical treatment. This team’s work has raised visibility for the need for homelessness outreach and service provision in Malibu and has also garnered some political support for these efforts. For FY 2018-2019, the City of Malibu for the first time included homeless services in its public safety budget. The City contracted with The People Concern to continue outreach services in Malibu.

Impact on expanding existing prevention, diversion, and street homelessness programs (community sustainability indicator)

The year 2018 marked the first of the Foundation’s $3 million Program-Related Investment (PRI) to support the Just In Reach Pay for Success initiative (JIR PFS). A joint effort of CSH, DHS, the Los Angeles County Sheriff’s Department, and the County’ Chief Executive Office, the initiative aims to reduce recidivism, increase housing stability, and ultimately affect inflow into chronic homelessness for a high-risk population: individuals who are homeless and frequently incarcerated in the LA County jail system. During this first year, 156 clients enrolled in JIR PFS, and 138 remained housed as of the end of September 2018. The enrollment rate was slightly lower than expected, but the program plans to increase enrollments to reach its target by the end of 2019. Through September 2018, the six-month housing stability rate was higher than targeted, at 94 percent.