Home Bound

accommodated: David Moore couldn't stay put in the shelter system. He says he's doing much better since being placed in a Powelton Village apartment.
Photo By: Michael T. Regan

Two unorthodox homeless programs make for unusual allies.

by Doron Taussig

This is David Moore's apartment. It's filled with his colorful trinkets, his stuffed animals, his three trash-picked television sets. Even the four flights of stairs are his to apologize for.

"Excuse the exercise," he says with a smile.

Visitors to Moore's apartment are invited to sit on his couch. Moore, an excitable man with jumbled speech, prefers to stand or lean his weather-worn 56-year-old frame against the radiator. Over the course of a visit, he will speak frankly about his mental illness ("they say I'm bipolar"), explain the finger missing from his right hand ("a burn is worse than a shot or a cut") and even share survival tactics from his 30 years of living on the streets. But before he does any of that, he has to say some thank-yous. First, he says, he wants to thank God for giving him a second chance. Then, he wants to thank his earthly enabler: New Keys, which is one of two Philadelphia programs changing the way America thinks about homelessness.

New Keys and its sister program, Home First, espouse a philosophy known as "housing first." For decades, housing programs have worked to make homeless people with mental-health or substance-abuse problems "housing ready," meaning they were required to undergo treatment for their problems before being offered their own housing. Housing first turns this concept on its head. It takes a homeless person and, regardless of afflictions or addictions, gives him a home. Only then does it flood him with services.

This reversal made a big difference to Moore. He couldn't stay put in transitional settings, but finds himself returning over and over to his one-bedroom in Powelton Village.

The Bush administration likes the personal-responsibility bent of housing first, and has funded the approach: Philadelphia is one of 11 cities currently implementing housing-first programs under a multimillion-dollar federal grant. The results have been encouraging. Of the 127 Philadelphians who have been placed in an apartment, 124 remain housed; more than 70 percent remain in the apartment where they were originally placed. And, there are indications that treatment flourishes in a housing-first environment as well. A recent study of 39 Home First participants showed that their admissions into drug-and-alcohol or psychiatric treatment facilities decreased by 79 percent since they began the program. All of this success has produced some unholy political alliances. But even as homeless advocates and Bushies circle each other warily, they are getting some ambitious ideas about the homeless problem. Specifically, they're thinking that they can end it.

New Keys, which is two years old, and Home First, which is one, are both contracted by the City of Philadelphia to a nonprofit called Horizon House. The clinical director of the programs is Bill Maroon, a friendly man with graying dreadlocks and a screen saver picture of himself playing Frisbee. Maroon, who used to do traditional supportive housing work at the Ridge Avenue Shelter, came to Horizon House because he thought housing first was a promising model. Ironically, this Bush-backed philosophy is the one thing keeping him in the country. "I can't stand what's going on here," he says in reference to the political situation. "If it wasn't for this program, I'd be in Australia."

Maroon leads two "teams" of clinical and social workers, one for New Keys, and one for Home First. Though New Keys targets street dwellers and Home First chronic shelter users, the programs work the same way. They seek out the most difficult cases — people with the most incarcerations, the most psychiatric hospitalizations, the most nights spent in shelters — and offer them their own apartments. According to Dennis Culhane of the University of Pennsylvania, 10 percent of homeless people with severe problems consume half of all shelter resources, as well as disproportionate shares of hospital, treatment and court time. By targeting the incorrigible, the programs hope to open up traditional resources to temporarily homeless people.

Many of those contacted are skeptical at first. They've had bad experiences with shelters or other programs. But after a few visits, most sign up.

Once a person enters a program, he or she becomes, in Horizon House parlance, a "consumer." Consumers get treated as if they have purchasing power. If they don't like an apartment, they are shown another, and another, until they're satisfied. The apartments are in private buildings, with other residents — no halfway houses — and Horizon House tries to find ones in areas with minimal temptations. Consumers currently live all over the city. Thirty percent of their income (usually a welfare or Social Security check) goes toward rent; any additional cost is covered.

After a consumer is housed, he or she is flooded with services, but unlike traditional models, which often require patients to navigate complex bureaucracies, Horizon House includes most services in its programs.

"The onus is on us to bring the service to them," explains Maroon. All services, except for one visit every two weeks, are optional. This approach gives the consumer a feeling of empowerment, which forges a commitment. "For the first time in a long time, they have something to lose."

The housing-first approach was pioneered in New York City in 1992 by Sam Tsemberis, a psychiatric outreach worker, and was first introduced locally by the Philadelphia Committee to End Homelessness (PCEH) in 2002. It was initially rejected by the supportive housing community. This was partially because it was so unorthodox, and partially, says PCEH's Roosevelt Darby Jr., because people were "protecting their own turf." In other words, "housing ready" workers felt threatened by the idea. The New York program proved successful, however, and soon Philadelphia and Horizon House were ready to try the model. In 2003, New Keys began, and the next year Philly received the federal grant that allowed it to add Home First.

These days, it's very hard to find someone in Philadelphia who opposes the philosophy, and the Horizon House staff is inspired by its work.

"We have a little joke around here that this is a revolution," says Maroon.

That's not to say there haven't been obstacles. There were concerns about the ability of people with mental-health or substance-abuse problems to maintain an apartment — what if someone gets high and starts a fire? — and indeed, though there haven't been any fires, the two programs have accumulated more than $24,000 in tenant damages. There were also concerns that people might turn their new apartments into crack houses, fall asleep in the stairwells or otherwise disturb their neighbors. Case manager Wendy Landrian says she's been cornered by people in the Northeast who were suspicious of their new neighbor.

But the programs don't kick people out. Even if a consumer gets evicted (which has happened), they're just moved somewhere else. This is how the programs hope to end homelessness: by keeping people housed.

Last Wednesday, New Keys and Home First hosted a party in the Arch Street United Methodist Church. As Maroon stood alongside Bush's homelessness czar, Philip Mangano (who, with a dark suit and silver hair, could not have looked more out of place), satisfied consumers praised the program to the high heavens.

"They allow me to be me," said Keith Kirkland of the programs.

A man with a name tag reading "Country" said that he's been able to reunite with his family.

Earlier, Patricia Baltimore, who is now working in a full-time job, came close to tears when she talked about her relief to be away from the humiliations of the streets and the shelter system.

"I was never afraid of dying, it was the dying where I was living that bothered me," she said.

The striking thing about their testimonies is that they don't just talk about being given housing. They emphasize the programs' services, too.

"This is the thing that we as homeless people need," said Baltimore. "It's a team with everybody. ... You can't catch the northbound and southbound train at the same time."

The immediate future looks good for housing first in Philadelphia. The approach will be prominently featured in the city's pending 10-Year Plan to End Homelessness, and Rob Hess, the city's homelessness czar, has made it a top priority in a federal budget request. In fact, though conventional wisdom has held that housing first wouldn't work with families, Hess says that Philly will be kicking off a program for just that demographic in the next week.

Mangano calls Philadelphia a "model," and the administration has proposed more funding for housing first. Whether this will be at the expense of more traditional housing programs remains to be seen, though if Mangano's talk about research-driven investment is to be believed, some resources may be shifted .

The only foreseeable roadblock for housing first is a possible difference of expectations. The Horizon House teams encourage consumers to pursue independence, but, they say, their consumers have severe problems and are likely to require heavy services for a long time. Mangano doesn't see it exactly that way. To him, housing first should be a stepping-stone to independence, and he expects programs to "start to wane away the services after a while." This raises the possibility that housing-first programs could succeed themselves out of existence.

But for now, this concern is far from the minds of the Horizon House consumers — they're too busy relishing in their newfound security. One man named Tyrone Sampson recently relapsed, and needed to be committed to an institution. When he came out, he says with a smile, there was a surprise waiting for him.

"I went away for 28 days, and guess what?" He reaches his hand into the pocket of his sweatpants and produces the sound of jingling keys.