Best Practice | August 11, 2006
Founded in 1992, Pathways to Housing offers scattered site permanent housing to homeless individuals with psychiatric disabilities and addictions. Despite the challenges this population presents, Pathways is unique in what it does not require of its residents: "graduation" from other transitional programs, sobriety, or acceptance of supportive services. The vast majority of clients are moved directly from the streets into permanent, private market housing. The program then uses Assertive Community Treatment (ACT) teams to deliver services to clients in their homes. The ACT teams help clients to meet basic needs, enhance quality of life, increase social skills, and increase employment opportunities. The program currently serves over 400 people.
Pathways to Housing is designed to end homelessness for people living on the streets with concurrent mental illness and addiction. In order to be eligible for the program, an individual must be homeless, must have a psychiatric disability that compromises their ability to function, and must be willing to meet with a service coordinator twice a month during the first year of tenancy. Priority is given to women and elderly people because they are at greater risk of victimization.
The program provides an alternative to the more common "linear residential treatment programs," which move people through a continuum of services beginning with outreach, some intermediary housing which helps people become "housing ready", and ending with permanent housing. Pathways provides clients with housing first, and then offers services and treatment to people in their homes.
Most clients are contacted through the outreach efforts of Pathways staff. Other referrals come from city outreach teams, shelters and drop-in centers. 1999 data showed that 65% of tenants had last lived on the streets, 18% in shelters, 7% in treatment facilities, and the remainder had lived with friends, at the Y, or in transitional facilities.
Pathways to Housing staff assist clients in locating and selecting private market rental housing. The housing department keeps logs of new vacancies and the over 200 landlords they work with, and works to negotiate leases and complete Section 8 applications. The greatest challenge to the program is finding vacant apartments at fair market rent. Landlords are amenable to renting to Pathways' clients because they get guaranteed rental payments. Tenants pay 30% of their income towards rent, and Pathways pays the remaining amount if the client does not have a section 8 voucher.
The agency also leases two transitional apartments for use by clients who have been accepted into the program, but have not yet found an apartment of their own. The average length of stay in these units is 15 days.
Pathways to Housing uses Assertive Community Treatment (ACT) teams to deliver services to clients in their homes. The teams are interdisciplinary and are on-call 24 hours a day, seven days a week. However, the tenant determines the type, frequency, and sequence of services. Service requirements are that the tenant meet with a service coordinator twice a month and participation in a money management program. Refusal to participate in sobriety or other treatment programs does not disqualify an individual, nor does a history of violence or prison time.
ACT teams consist of up to ten service coordinators, each with a particular expertise. The team leader is responsible for supervising the work of the team. The primary goals of the ACT teams are to meet basic needs, enhance quality of life, increase social skills, and increase employment opportunities. Each team sees approximately 70 clients. When a team cannot provide the services directly, tenants are referred and accompanied to the relevant programs. After the rent is paid tenants are required to develop a monthly budget with the service coordinator. The goal is for tenants to eventually manage their own money.
Pathways to Housing employs 4 staff responsible for housing services, 40 service coordinators, 5 team leaders, 2 psychiatrists, 2 nurses and a vocational specialist. The staff make-up is culturally and racially similar to the population the program serves. Program success is attributed in part to staff composition that includes 50% consumer representation (i.e. people in recovery) that serve as role models.
Source of Funding
Funding for the Pathways program comes in two parts: housing subsidies and services. Around sixty-five tenants have Section 8 vouchers, and the remainder are subsidized by grants from the HUD Shelter Plus Care program and the New York State Office of Mental Health. The latter also provides funding for the ACT teams. Each unit costs approximately $20,000 per year.
Service Utilization/Outcome Data
Data from 2000 showed that 88% of the program's tenants remained housed after five years. Furthermore, Pathways staff contends that its residents have greater satisfaction with their housing, and greater psychological well-being because they were given a choice as to where to live, and what activities to engage in.
For More Information Contact
Pathways to Housing
55 West 125th Street, 10th Floor
New York, NY 10027
(212) 289-0839 Fax