Our Community’s Pursuit of Ending Chronic Homelessness

Posted on October 21, 2016

1Johnson County is well-equipped with a number of service agencies that effectively address the needs of many people at risk of or experiencing homelessness in our community.  From mental health services to food banks, from addiction counseling to job training, there are a number of programs and services that support the work of our community’s shelter to address the diverse struggles individuals have as they try to avoid and overcome homelessness.

Last year, Shelter House provided shelter for 864 people experiencing homelessness in our community, the majority of whom were able to successfully move out of homelessness and into permanent housing through the services currently offered by Shelter House and other partnering agencies.  About 15 percent of the total homeless population, however, either do not engage with existing services or are not able to do so successfully.  For these people, homelessness becomes a chronic state of being.

For the majority, rules and expectations regarding sobriety, medication compliance, employment and other program requirements are integral parts of the work necessary to get and maintain employment and housing — leaving homelessness permanently in the past.

But for many of the chronically homeless, those expectations are barriers to accessing essential services. Indeed, the current service delivery model which is more consistent with a Housing Ready approach does not work for the chronically homeless. If change is to occur, a different approach is required.

A nationally recognized and evidence-based model known as Housing First has been shown to be an effective intervention and method for ending chronic homelessness. People who face barriers to service are first offered a home — Housing First.  Sobriety, med-compliance, and program participation are not prerequisites for obtaining or maintaining that home. Instead, the full spectrum of services is offered, but participation on the part of the tenant is voluntary. Shelter House, in partnership with the Local Homeless Coordinating Board of Johnson County, is working to bring the Housing First model to our community.

Within the chronically homeless population, there is an even smaller cohort referred to as Frequent Users due to their frequent use of high-cost interventions such as the emergency room, treatment centers, shelters and jail. More than two years ago, a stakeholder group formed to identify frequent users in our community and explore the feasibility of bringing Housing First to Johnson County.

2The group continues to meet today. It is comprised of representatives from the Abbe Center for Community Mental Health, the Housing Trust Fund of Johnson County, the Iowa City Housing Authority, the Iowa City Police Department, Johnson County Jail Alternatives, Mercy Hospital, Prelude Behavioral Services, Shelter House, United Action for Youth, and University of Iowa Hospitals and Clinics.

Police records were used to identify chronically homeless individuals with high levels of police involvement. From a list of just over two dozen people, we were able to get the necessary releases signed for four people known to be heavy users of services between hospitals, criminal justice, shelter and substance abuse treatment.

We compiled data regarding the cost of the services used by those four people. Over the research period, which spanned a little less than four years, these four people incurred $2.16 million in total costs cycling in and out of emergency services only to return, time-after-time, to life on the street.

“Over the research period, which spanned a little less than four years, these four people incurred $2.16 million in total costs cycling in and out of emergency services only to return, time-after-time, to life on the street.”

With no change in approach, this cycle will almost certainly continue, year after year costing our community more—only to result in men and women living and dying on the streets of our community.  In fact, last fall, one of the case study participants died on our streets due to a traumatic brain injury.

We can instead follow the lead of communities such as Charlotte, N.C., Hennepin County, Minn., and San Diego, Calif. Each of these communities has developed Housing First programs and targeted this frequent user population (also known as Frequent Users Systems Engagement — FUSE).  Providers in each of these communities have witnessed profound and transformative changes in people’s lives. As frequent users are housed and remain in their homes, they begin to stabilize, demonstrating increased self-care. Over time, they engage in stabilization services such as case management and counseling, addressing their mental illness, and working towards sobriety. They no longer engage in the old, habitual pattern of crisis interventions.

In addition to the individual and human benefit, there is a benefit realized by the broader community: In community after community that has implemented Housing First for frequent users, there is a consistent and well documented cost savings to the community: A drop of 40 percent between the pre-housing and post-housing costs.


Through the FUSE—Housing First project, Shelter House, in collaboration with our community partners, plans to develop up to 24 efficiency apartments offering permanent supportive housing to individuals who are chronically homeless and frequent users of local systems. Permanent Supportive Housing combines and links permanent, affordable housing with flexible, voluntary support services designed to help the tenants stay housed and build the necessary skills to live as independently as possible. The services made available through FUSE – Housing First will include mental health services, psychiatric care, on-site medical services, substance abuse services, life skills support and case management all under the same roof.

Through strong community partnerships across both the public and private sectors, the FUSE – Housing First project will go from being a well-researched “what if” topic to an active, life-changing and life-saving program in our community.  As Shelter House aims to be a catalyst and voice for systemic community change in the pursuit of ending homelessness, we recognize it takes a village to implement dynamic projects like FUSE – Housing First and to tackle issues as complex and encompassing as chronic homelessness. We are encouraged and inspired by the progress that has already been made and motivated by the possibility of ending chronic homelessness in our community.

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