The California Department of Health Care Services (HCS) in 2016 awarded the Alameda County Health Care Services Agency (HCSA) $140 million to implement a whole person care pilot program. The goal of the pilot, or AC3, is to build infrastructure that will improve integration, reduce unnecessary utilization of health care services, and improve health outcomes for homeless individuals and other ‘high utilizers’ of health care services.

With the understanding that individuals often need coordinated services across several departments and sectors, the vision of pilot is to create an integrated system across multiple systems that helps high‐need patients achieve optimal independence and health, in safe and stable housing. AC3 includes six critical components: 1) strengthening of care coordination by including comprehensive social resources into a person’s care plan; 2) improving and facilitating care integration between primary care providers, mental health providers, substance use programs, and family supports; 3) data sharing between partners in the form of a community health record (CHR); 4) housing and homelessness, focusing on fully implementing the Housing Resource Centers and Coordinated Entry; 5) BH Crisis Response System focusing on decreasing the revolving door acute to psychiatric care; and 6) improving the consumer and family experience.

The funding for AC3 comes from federal dollars through an 1115 waiver, or a Medi-Cal 2020. These waivers enable states to negotiate how Medicaid dollars are spent to allow flexibility with programs. The grant also requires a 50 percent match.

Since 2014, the City of Anaheim has transitioned 960 people from homelessness, with 92 percent still housed a year later.

Anaheim launched its comprehensive homelessness program, Coming Home Anaheim, in 2013. It focuses on weekly outreach, case management, access to services and stable, lasting housing. Since 2014, Anaheim has contracted with a nonprofit partner, City Net, to lead weekly outreach with the help of over 100 supporting churches and other nonprofits. Known as the Anaheim Homeless Collaborative, the group pools resources to find shelter space, transitional housing and long-term housing and supportive services.

The Anaheim Police Department’s Homelessness Outreach Team plays a key role in Coming Home Anaheim and works alongside City Net on weekly outreach. Anaheim police respond to 15,000 homelessness-related calls annually. Where necessary, the city turns to enforcement to address public safety and quality of life concerns, but enforcement is not seen as a solution to homelessness. Rather, it is another tool in a larger, comprehensive program. In some cases, enforcement — or the prospect of it — can be the impetus for someone accepting help and services and transitioning out of homelessness.

Anaheim’s annual contract with City Net totals $150,000. In December 2017, the city council allocated an additional $100,000 in funding to address homelessness. Anaheim uses its General Fund to support these efforts. The city also runs the Anaheim Housing Authority, which provides $580,000 annually in rent-assistance vouchers from HUD.

In May 2013, the City of Bakersfield partnered with the Bakersfield Homeless Center (BHC) on an agreement to help solve the problem of highway litter after state budget cuts reduced Caltrans’ resources to clean up highways. The partnership developed an innovative freeway litter clean up program on the local freeways by members of the homeless community. The program would provide job training skills and increase employment opportunities for the homeless population and the problem of highway litter.

The funding for this agreement came from Caltrans and the Kern Council of Governments. Through this partnership, clients of BHC were able to receive paying jobs to clean the freeways. As a result, over 50 homeless individuals were employed at minimum wage, about 250 family members were in housing and approximately 64 percent paid their own rent, without any subsidy. Additionally, local businesses have begun to participate in similar programs—the city now provides jobs in green waste sorting and animal care.

The successful program was able to not only reduce its highway litter problem, but also decrease its homeless population and create an emerging labor force, eager to work. Many of the individuals that participated in the program were able to receive better paying jobs in the private sector, and even within the city.

Founded in 2005, Downtown Streets Team is a nonprofit addressing homelessness by not only providing solutions to homeless men and women, but also challenging them to take an active role in their own recovery. This takes the form of having the homeless volunteer with Downtown Streets Team on beatification projects within their respective communities. In return, the volunteers or ‘Team Members’ receive necessities including a stipend, alongside vital health services and case management. The program offers a ‘ladder of success’ system where team members are able to continue to improve themselves and move up the ladder, while gaining additional work responsibilities with the potential to be promoted to managerial levels. Team members are also encouraged to share their stories with the community at schools, churches or business associations, helping to shift the negative perceptions of homelessness. The eventual goal is to transition Team Members to full time employment over the course of a year.

Downtown Streets Team is now operating in eight Bay Area communities (San Francisco, San Jose, Palo Alto, Santa Cruz, Hayward, Novato, San Rafael and Sunnyvale) and has serves over 750 homeless men and women every week. In addition, through its beautification efforts, the nonprofit has removed over 2.8 million gallons of debris in the last year alone.

Funding is different in each community, but sources can include Public Works/Parks and Recreation departments, CDBG (economic development and human services), environmental agencies (water districts, environmental services departments, EPA), corporate sponsorships, Business Improvement Districts, along with county and city funding.

In 2015, the City of Citrus Heights faced the growing need of providing services to its homeless population. Post-recession, the city had experienced the reduction of services into the urban core. To address the homelessness need, the Citrus Heights Police Department conducted a survey of the homeless community and found there was a predominate desire to stay within the boundaries of the city even though most homeless resources were not available within the city limits. Through the city’s partnership with Sacramento Self Help Housing (SSHH) and the Citrus Heights Homeless Assistance Resource Team (HART), the CH HART group expressed a need for a “Navigator” or case manager for the local homeless population. The model has been used in other communities to facilitate enrollment into HUD’s Coordinated Entry wait list and ranking system for available housing.

The Navigator, or homelessness coordinator, serves as the main point of contact in the county’s coordinated system and works to outreach to homelessness populations to connect them with services. In addition, the Navigator works directly in the field to engage individuals where they are located. Based on an initial ‘vulnerability’ test, the Navigator assesses what services might work best to connect homeless individuals to.

This position is fully funded with a combination of Community Development Block Grant funds and other funding from the City of Citrus Height

Launched in 2004, the Poverello House, a homeless shelter in Fresno, created the Village of Hope and in 2007, expanded to include the Community of Hope to meet an increasing demand for homeless shelters. The Villages consist of tiny homes, or Tuff Sheds, that accommodate about 124 clients every night. Homeless individuals staying in the Villages have access to services such as education, substance abuse counseling and life-skills training coordinated by a Client Services Coordinator.

With a motto of “take care of yourself, take care of others, and take care of this place,” the overnight clients are expected to provide their own security and clean-up after themselves. The simple shelter provides secure and temporary housing for individuals to make the transition into permanent housing.

On June 7, 2017, the Los Angeles County’s Homeless Initiative and LA Voice, a local multi-ethnic, interfaith organization of 60 congregations across LA County, hosted the county’s first Interfaith Summit on Homelessness, with support from the Conrad N. Hilton Foundation. The summit, titled “Pursuing the Promise Together,” focused on combating homelessness by building collaboration and a common vision between faith organizations and the county, highlighted Homeless Initiative Strategies on which the county and faith organizations can partner, and created avenues for faith organizations to connect to the Coordinated Entry System.

To support the faith organizations’ discernment process, the county developed a “Discernment Guide” to help faith organizations prepare for collaboration. Through this discernment process, 31 faith organizations expressed interest in exploring partnerships with the county in support of one or more specific Homeless Initiative strategies and are currently collaborating with county departments and the Los Angeles Homeless Services.

Authority to discern how each faith organization can support the countywide homeless system. The Homeless Initiative and LA Voice are committed to continued engagement with faith organizations to build capacity and partner in a meaningful way to combat homelessness. 

Aside from the support received from the Conrad N. Hilton Foundation, via a grant to LA Voice, there has been no cost for the county to pursue this collaboration with the faith community. 

The Discernment Guide can be accessed here.

In 2010, seeing the growing issue of homelessness in Los Angeles, United Way worked with the LA Area Chamber of Commerce to launch Home For Good. The partnership has managed to bring together various stakeholders from both public and private sectors to coordinate ways to address homelessness through permanent housing systems and solutions.

Home For Good works with over 300 cross-sector partners to create systems of change to end homelessness in LA County, starting with chronically homeless individuals and veterans. Home For Good focuses on creating a no-wrong door system that more effectively matches client needs with available housing resources; strategically investing in solutions through a Funders Collaborative that convenes philanthropy and public funders; engaging all Angelenos to be part of the solution through community-wide education and advocacy campaigns; and tracking of community progress towards a set of shared goals and metrics to ensure accountability and advancement. The Funders Collaborative is particularly unique by convening different sources of funding, including city and county, public and private sectors and nonprofits, to ensure that resources are effectively distributed.

Since its launch, the initiative has built systems and changed policies to prioritize those most in need that have ensured that over 40,000 of LA’s most vulnerable homeless neighbors have found their way home for good.

The effort is funded by a combination of private donations and foundation support.

In response to persistent high visibility people on the street who were also high utilizers of expensive services, Marin County community began piloting a new approach called HOT (Homeless Outreach Team). Marin created its version of HOT based on what was being done successfully in San Mateo. 

The HOT process in Marin involved:

1. Create a HOT list, which is a list of the most challenging and hard-to-serve individuals in downtown. The team consulted the Fire Department, Police Department, and downtown outreach workers to identify the chronic homeless. Outreach workers from the San Rafael Police Department and Community Action Marin engage candidates to build trust. Once a person grants permission, they are added to the HOT list.

1. Bring together every provider of services to the chronically homeless. In Marin, that was St. Vincent’s, Ritter Center, the City of San Rafael, Marin County Health and Human Services, County Mental Health, Probation, Marin Housing Authority, the District Attorney’s Office, Community Action Marin, and Homeward Bound. Create and implement a customized housing plan for each person on the HOT list. Each provider is accountable for completing action items to move a person on the list towards housing. At bi-weekly meetings, each provider reports out on what it accomplished since the last meeting. The goal is to place someone as quickly as possible in permanent housing appropriate for their needs.

1. Make sure front-line and senior staff are on the HOT team, so that in the process of helping individuals, system gaps that stifle effective service provision can also be addressed. Absolutely vital to this process is to have high level people on the team who can make things happen.

Success of the program is measured by not just housing someone, but keeping them housed. The intensity of services needed to do that require all our public and nonprofit providers to rethink and redesign how services are provided. Case managers ensure that the person is connected to all the services needed to keep him stably housed. With the initiation of the HOT teams, police contacts went from 38.46 per month to 0.04 per month.

The project manager is funded partly by the county, and partly by St. Vincent’s, who is the project manager. Additional contributions come from each of the service providers.  Additional information on the program: 

• County of Marin
• City of San Rafael
• City of San Rafael blog

The Housing Choice Voucher Program, or Section 8, is a huge investment of federal funds into the County of Marin. There were people in Marin holding vouchers who could not use them.They were hearing that landlords were hesitant to take vouchers due to a perception that voucher holders were bad tenants and would damage units. The Marin Housing Authority knew that the clear majority of voucher holders were good, hard working, tenants. The Landlord Partnership was established to incentivize landlords to accept vouchers. The result is that they overcame the negative perceptions about voucher holders, and new landlords began accepting vouchers. 

The incentives for landlords to accept housing choice vouchers are: Up to $2,500 for a security deposit; loss mitigation up to $3,500; up to one month of rent to a property owner while repairing excessive damage; waiver of building permit fees; and a 24-hour hotline for landlords to call with immediate issues.

The Landlord Partnership Program is exceeding the initial goals of the Partnership.  Sixteen months in, the program has 71 new landlords accepting Section 8 vouchers. Additionally, significant goodwill has been built with the landlords. 

The County of Marin entered into a contract in 2016 with the Marin Housing Authority, in the amount of $404,000 to fund the program. Federal funds can be tapped to offer property owners renting more than half of their units to holders of vouchers interest free loans of up to $25,000 for rehabilitation or repair of their units. Marin Housing Authority set up and is administering the Partnership.

Originally created in 2009, Sacramento Steps Forward (SSF) has become a leading nonprofit in the Sacramento region working to end homelessness. The nonprofit has taken a collaborative approach to addressing homelessness by developing a regional effort with multiple stakeholders and partners working collectively on managing resources and services. In addition, SSF has focused on a data-driven and outcomes-based approach to ensure it is implementing effective strategies and practices.

SSF is in a unique position to lead this regional effort as a nonprofit responsible for managing Housing and Urban Development funds for homelessness. The nonprofit uses a housing first approach to reduce reliance on temporary shelters, and increase transition into permanent housing.

SSF is funded by public and private partners through performance based grants, charitable grants, and contracted services.

Saint John’s Program for Real Change operates the largest shelter in Sacramento County, and the only one focused exclusively on homeless women and children. Its total daily capacity is 270, with an annual capacity of 1,000. Sacramento County’s point in time count in July of 2017 was 3,666 were counted as living without permanent shelter and 2,000 of those people living outside. 

Funded through a combination of private and public funders, including USDA, the California Department of Education, the California Wellness Foundation, Allstate Foundation, and Serving California, among many others, Saint John’s is a true public-private partnership. For every $1 in county funding received, Saint John’s raises $9 to serve more women and children with full programming.

Saint John’s Program is designed to support women and children in becoming permanently independent from “the system,” thereby making room for others in need. The average woman who comes to Saint John’s is 34 years old with two children. The challenges they face vary, however, 100% of the women lack stable work history/current employment. Other challenges include substance abuse (74%), domestic violence (68%), criminal history (60%), mental illness (54%), and lack of education (52% do not have a high school diploma or GED).

Originally founded as an emergency shelter in 1985, Saint John’s has expanded into a 12-18 month program that provides women with the education, tools and habits to learn how to work and how to live.

The program provides housing and meals in coordination with on-site intensive, structured and individualized support including mental health therapy, alcohol and drug counseling, budgeting classes, basic education, and hands-on employment training. Over the course of a year, each participant receives an average of 675 hours of service each month.

The program model also supports reunification of women and children through Child Protection Services processes, facilitating CPS required education, appointments, and supervised visits.  In 2016, 20 women were reunited with 46 children. 

Between 2014 and 2016, over 1,500 women and children were served through Saint John’s. In 2016 alone, reduction in homelessness thanks to the Program saved taxpayers a minimum of $13 million. 

Saint John’s Program for Real Change is majority funded by private donations and some public funds.

In 2016, the City of San Diego and the San Diego Housing Commission (SDHC) partnered to launch the Housing our Heroes initiative and committed to getting 1,000 homeless veterans off the streets and into shelters or housing. This initiative is part of Housing First – San Diego, the SDHC’s three-year Homelessness Action Plan started in 2014.

The initiative involves a $12.5 million investment (from federal, city, and SDHC resources) to provide housing opportunities for homeless veterans through coordinated efforts with landlords, financial assistance and supportive services. There are four key program components:

• Landlord Outreach: Incentives are provided to landlords to encourage more landlords to rent their units to homeless veterans. Specific incentives include a monetary payment for each unit that is rented out to veterans.
• Rapid Re-housing Assistance: This component will help homeless veterans and families who may become homeless due to unforeseen circumstances. Funds can cover up-front move-in costs and, at times, rental assistance.
• SDHC Federal VASH Vouchers: Vouchers will be eligible to assist chronically homeless veterans that have both a disability and honorable discharge with rental assistance and supportive health services.
• SDHC Federal Housing Vouchers with Supportive Services: These vouchers will be available to homeless veterans that are not eligible for the Federal VASH vouchers.

Over a two-year period, funds will be allocated into these four components to help the City of San Diego provide housing for up to a thousand homeless military veterans. Since 2016, the initiative had more than 700 homeless veterans enrolled in the program.

The initiative is funded by a combination of federal resources (VASH vouchers), city general funds, and SDHC funds.

San Diego County is home to the fifth largest homeless population in the nation. Project 25, a pilot funded by United Way, was a three-year (2011‒2013) project designed to determine if direct coordinated services for the community’s most frequent homeless service users could significantly reduce the costs of homelessness. The project was a collaborative effort coordinated by the homelessness charity, St. Vincent de Paul Village, in partnership with Telecare Corporation and under contract with the County of San Diego.

Project 25 identified the core homeless individuals that were the most frequent users of public services, such as ambulances or emergency rooms. A total of 28 individuals (between the ages of 22-61) were analyzed as part of this project and provided intensive individualized support including permanent housing provided through the San Diego Housing Commission. Other services included healthcare (medical, dental and psychological), drug and alcohol treatment, and information on how to manage money. This intense support was an important component of the program—some participants were visited by practitioners 4-5 times per week at the beginning of the project.

After completion in 2013, Project 25 resulted in significant savings and reductions.

• The 28 participants of the project used a total of approximately $3.5 million in expenses from all public services in the base year of 2010. In 2013, the expenses dropped to $1.1 million, resulting in a reduction of 67 percent in total costs.
• The net return on dollars spent for Project 25 was a 207 percent in 2012 and 262 percent in 2013.

To address the homeless crisis, the City of San José adopted a new ordinance in August 2017 that created a streamlined process for the allowance of temporary and incidental shelters without the requirement of an approved Development Permit. In ordered to be approved, the shelter must be registered with the city Housing Department and meet specific performance standards and other requirements.

This program defines an incidental shelter use as a shelter use that is incidental to the primary assembly use on the site, if it occupies less than 50 percent of the usable square footage of the building(s) that are primarily used for assembly use on the parcel. The maximum occupancy is 50 persons or as set forth by the Fire Code, whichever is more restrictive. A primary assembly use includes, but is not limited to all religious assemblies, and other places such as gymnasiums, libraries, movie theaters, nightclubs, schools and community centers.

In March 2016, the City of San Leandro (human services and police departments), partnered with Building Futures with Women & Children (a local nonprofit service provider) and the Rental Housing Association of Southern Alameda County (a landlord association) to form the San Leandro Homeless Compact, a collaborative dedicated to providing long-term housing and services to chronically homeless individuals in San Leandro. The compact represents the first of its kind in Northern California. The model features a housing first approach given the difficult housing and rental market. However, the key component of the compact is the collaboration between local government, non-profit and landlords to secure housing in tandem with vital services. The compact will provide 25 housing units for chronically homelessness individuals in San Leandro. The Rental Housing Association, along with the compact, will help coordinate landlords to provide the housing while Building Futures will provide a variety of supportive services for individuals staying in the units. Participants will be assigned case managers to help coordinate not only health services, but prepare them for success and independence.

The Compact is funded by a combination of city and county funding and HUD vouchers.

San Mateo LifeMoves is using a multifaceted therapeutic service model to end homelessness in San Mateo and Santa Clara Counties. The model includes using modern housing in conjunction with intensive and tailored health services.

One of its successful programs is its Homeless Outreach Team, a team of trained case managers that outreaches to homeless individuals on the ground level. The goal is to transition them off the streets and eventually, into stable housing. Because homelessness is a complex issue, HOT members typically work with a variety of different groups including local law enforcement, community stakeholders and business to successfully move homeless men and women into supportive housing. HOT members also provide homeless individuals with case management and connection to essential services. This proactive approach helps reduce costs and expenses related to medical and law enforcement services.

With over 17 sites throughout the Bay Area, the nonprofit serves about 1,000 homeless individuals each night.

LifeMoves Outreach services are largely funded by the County of San Mateo Human Service Agency with Measure A funding. LifeMoves services are funded through a combination of many city, county and federal government contracts and private donations.

Yolo County, the City of West Sacramento, and Yolo County Housing collaborated on a pilot project in 2014 to relocate an entire homeless encampment on a West Sacramento riverbank. The project relocated the encampment to a single motel where participants were offered temporary housing, case management and services.

Spearheaded by the West Sacramento Police Department, the pilot project featured a highly collaborative and comprehensive planning process with multiple stakeholders involved. The planning group, made up of public, private and nonprofits entities, met over the course of two months to develop the best strategy for relocating the homelessness encampment. After the planning process, the pilot included three assessments to get a better understanding of the needs and challenges of the homeless population living in the encampment. In addition, coordinated outreach was conducted to build relationships with the population. 

The program placed an emphasis on providing frequent and consistent on-site services. Through four months of temporary housing and intensive case management, participants were able to stabilize their lives, address health issues, and secure a housing voucher. Other services provided on-site were daily lunches, haircuts, mental health services, and harm reduction classes. Of 53 participants that completed the program, 42 of them remained engaged in services with case managers 12 months after exiting the program. Furthermore, 68 percent of participants were able to secure permanent housing.

The overall cost of the project was $152,238, $6,000 less than expected, and was funded primarily by the City of West Sacramento and County of Yolo (the rest of the cost was covered by donations).

In 2016, Yuba County collaborated with local non-profits, faith-based organizations and the private sector to launch a temporary shelter community for its local homeless population. Faced with the problem of several encampments along surrounding rivers, the county created a 20-unit ‘tiny’ village of Tuff Sheds to relocate some of the homeless population. The Tuff Sheds are 12’ x 8’ tiny shelters with beds, windows and insulation. They do not have electricity or running water, but there are lavatories on-site as well as a nearby homelessness center that offers meals and showers.

After a plan was fully formulated, the village was developed in just about two months and officially opened in July 2016. Meant to function as temporary shelter, the goal of the village is to provide individuals with shelter for 30 days with supportive resources to help move tenants into more permanent housing. Since it’s opening, the on-site case managers have helped over 100 people, coordinated nearly 900 service referrals and transitioned over 45% of persons exiting the program to a permanent destination.

The village was funded through county temporary relocation funds collected from countywide code enforcement activities, a small amount of general funds as well as financial and in-kind donations.