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1811 Eastlake Study Released: Housing First Saves Lives and Money

The 1811 Eastlake project was the subject of a 3-year study funded by a $400,000 grant from the Robert Wood Johnson Foundation.  The evaluation team included DESC and the Addictive Behavior Research Center at UW, which is part of the Department of Psychology. Mary E. Larimer PhD, professor of psychiatry and behavioral sciences and adjunct professor of psychology at UW, was lead author of the study.

On March 31, 2009, the Journal of the American Medical Association published the study:

"Providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. Stable housing also results in reduced drinking among homeless alcoholics, according to a Seattle-based study published today in the Journal of the American Medical Association (JAMA).

The study found that the program saved taxpayers more than $4 million dollars over the first year of operation. During the first six months, even after considering the cost of administering housing for the 95 residents in a Housing First program in downtown Seattle, the study reported an average cost-savings of 53 percent -- nearly $2,500 per month per person in health and social services, compared to the costs of a wait-list control group of 39 homeless people." View the press release in its entirety.

View the study abstract: Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems - The Journal of the American Medical Association (Vol. 301 No. 13, April 1, 2009)

January 2008 Preliminary Findings

In January 2008, Mayor Nickels announced the findings of studies on one-year outcomes at two Housing First projects: 1811 Eastlake and Plymouth on Stewart. Separate studies revealed similar findings. Preliminary research shows an estimated cost avoidance of over $4 million* because of fewer visits by these formerly chronically homeless individuals to the Harborview Medical Center and the Dutch Schisler Sobering Center, as well as less use of other crisis-treatment services.

*This figure is updated from the original press release. At that time the figure had been estimated at $3.2 million.

Background Information
The project arose out of a King County sponsored 1997 "Housing Plan for Persons who are Chronically Publicly Inebriated (CPI)" developed by a task force of government and provider representatives from Seattle and King County.   An array of housing options were recommended to the community for development with the goal of improving recovery prospects for individuals and to reduce the "public health, economic and social impacts of chronic alcoholics living on the streets."  The recommendations included the 1811 Eastlake model: specifically a housing project providing support services and case management where "pre-recovery" individuals can be safe and encouraged to receive treatment services.
It is estimated that there are about 500 CPI in downtown Seattle on any given day.  These are people who are typically over 45 years of age, chronically homeless, have at least 15 years of chronic alcohol addiction history, and multiple, failed attempts at publicly-funded conventional alcohol treatment. This population consumes extraordinary amounts of public dollars in their utilization of emergency and hospital services, emergency transportation, detoxification services, court, jail and legal services.  A 2003 Mental Health Chemical Abuse and Dependency Services Division study estimated annual costs at nearly $42,000 per person compared to approximately $10,000 per person for housing-based supportive services.

Project Description
In response to this community effort and task force recommendations, the Downtown Emergency Service Center (DESC) developed 1811 Eastlake, a 75 unit residential project which will house chronic public inebriates.  Located in the Denny Triangle neighborhood, the building contains 49 studio apartments on its upper floors and 26 semi-private cubicles on the ground floor.  Each unit is furnished with a single bed, a lockable armoire and a chair.  The semi-private units are separated by partial walls to allow for effective and continuous intervention and  monitoring by staff and share restrooms, shower and dressing areas.   Also included on the ground floor are a community dining area, kitchen, offices for DESC staff and private spaces for services.  A roof top deck provides an outdoor area for residents.

The 1811 Eastlake project provides 24 hour -7 day a week staff support for its residents including chemical dependency counseling, nursing support, meals, and general supervision. The objectives of the project are to help residents achieve housing stability, reduce residents' use of the community's crisis response system, reduce public nuisances and encourage residents to undertake and follow through with alcohol treatment.

The project will limit alcohol use and prohibit its consumption in public areas both in and outside the building.  Alcohol consumption will be restricted to resident rooms, and visitors will not be permitted to come in the building and drink.  On site staff will continually support and encourage residents to reduce alcohol consumption, hopefully leading to abstinence. Prohibiting alcohol consumption by residents entirely would make the project unable to attract the very people it is designed to serve, but behavioral thresholds will be enforced for the sake of staff, resident, and neighborhood safety. Leases will include conditions that prohibit drinking in the neighborhood as well as other uncivil behaviors.  Activities in the building will be routinely monitored by staff and visitors will have to receive approval from staff before entering the facility.

1811 Eastlake is a place where "pre-recovery" individuals can be safe and encouraged to receive treatment, and focuses on reducing the public health, economic and social impacts of this population living on the streets.  

Capital funding sources, in addition to Office of Housing Levy and federal HOME funds, were the State, King County, HUD's McKinney Supportive Housing Program (SHP), the Federal Home Loan Bank, DESC cash and equity from the sale of 9% low income housing tax credits.  Service funding is provided by the McKinney SHP, and King County Mental Heath-Chemical Abuse Dependency Services Treatment Expansion dollars.  The project also receives operating support from the Office of Housing's Levy Operating and Maintenance program and 25 Section 8 Vouchers from Seattle Housing Authority.

Occupancy Information
The 1811 Eastlake was completed in mid December 2005.  Working with King County Mental Health Chemical Abuse and Dependency Services Division and the Public Health Department, DESC began a process to identify and engage chronic homeless individuals who have been high utilizers across multiple systems including emergency response systems, Harborview, jails, and sobering services.  The goal is to house those individuals identified as high utilizers.

Evaluation Component
The 1811 Eastlake project will be the subject of a 3-year study funded by a $400,000 grant from the Robert Wood Johnson Foundation.  The evaluation team includes DESC and the Addictive Behavior Research Center at UW, which is part of the Department of Psychology. The lead evaluator is Alan Marlatt who has an international reputation on substance abuse research.

The study will be based on the first 75 residents of 1811 Eastlake, plus a control group of 50 people.  The evaluation has two components:

a) Cost utilization:  cost of services from multiple sources including criminal justice (mostly the jail), Medicaid, DSHS, Harborview, and substance abuse programs such as the sobering center; and

b) Behavior changes: drinking and motivation to participate in treatment and other behavioral measures.

The final report will be published in 2008 along with academic articles.  While there is no timeline for interim reports, preliminary results will be useful for funding and program design for other developments targeted at high users of associated public services.

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