Interview by Alexis Schroeder
Joe Finn has served as Executive Director of the Massachusetts Housing and Shelter Alliance since 2003. Prior to MHSA, Joe served as Executive Director of Shelter, Inc. (now Heading Home) in Cambridge and Quincy Interfaith Sheltering Coalition (now Father Bills & MainSpring) in Quincy. Throughout the 17 years he has worked on homelessness issues, Joe has focused much of his energy on the expansion of permanent supportive housing opportunities for individuals, including the chronically homeless, the most difficult segment of the homeless population to serve.
I originally met Joe Finn at one of MHSA’s Young Professional Group networking events in 2007. There I heard Joe speak about the Housing First movement and learned about MHSA’s partnership with physician advocate Dr. Jessie Gaeta. Dr. Gaeta is on staff at MHSA as well as at the Boston Health Care for the Homeless Program and is a faculty member at Boston University Medical Center where she regularly cares for the sickest homeless individuals in Boston.
NPi: What service does the Massachusetts Housing and Shelter Alliance provide?
JF: We’re a hybrid policy and advocacy organization that focuses on the unaccompanied homeless persons within Massachusetts, the so-called street people, alone and without shelter. To borrow a term from the private sector, we’re an incubator of innovations around new ideas meant to reduce the state’s reliance on emergency resources and [create long-term] solutions to homelessness. Our mission is to end homelessness, and we’re doing it not just because of the morality of it—which should be obvious to most, but isn’t necessarily—but because we believe it’s generally detrimental to society. Emergency services are costly and we feel leave public, state, and federal entities off the hook in terms of providing other core, essential resources citizens need—whether it’s substance abuse treatment, housing, or mental health services.
NPi: How is the work you do different from other organizations in the same field?
JF: Since the beginning of my involvement with MHSA close to 20 years ago, we’ve always been focused on how to change what’s creating the problem of homelessness. I think that that’s a fundamental difference between MHSA and a lot of organizations. [Other organizations] have their own particular piece of the pie, they address their piece of the problem, and they’re usually focused in the provision of a more direct product or service. Most are rather set in terms of their mission. They don’t always have the time to think about what it takes to change [the way they do things], to move in a different direction. This [adaptability] has been a key innovation of MHSA.
NPi: What is MHSA’s approach to solving the problem of homelessness?
JF: The standard approach we’ve had to homelessness has always been outcome-based. It’s one thing to say we shelter 1,600 people in a year, but what benefits are we actually providing to the community? Secondly, to what degree do our interventions make a difference? We used to just track the census data on a daily basis through the shelters to get a true picture of what our capacity was. In the mid-90s with regard to sub-populations, we began to ask how people ended up here in order to understand what it would take to prevent homelessness.
More recently we have focused on the Housing First movement, which is really a national movement. With Housing First, we essentially flip the paradigm upside down from a continuum of care that is a linear model with housing being the prize at the end of the continuum—the homeless person moves from the street to the shelter to transitional housing to their own housing—to one in which housing is placed at front of the continuum. Our first objective is bringing people into housing. As much as we do whatever it takes to get people treatment for substance abuse, we’re taking the emphasis off them being good clients and asking instead what it takes for them to be good tenants.
NPi: Can you speak more about your partnership with Dr. Jessie Gaeta?
JF: Sure. Long before Jessie Gaeta, MHSA had been focused on health care and housing particularly as it impacted the homeless. We’d already partnered with Massachusetts Behavioral Health Partnership (MBHP) on the Community Support Program for People Experiencing Chronic Homelessness (CSPECH) model, which provided Medicaid reimbursement for services to support tenants in housing. But unless we had a physician who actually embraced it, it wasn’t nearly as powerful.
The best things that happen to me happen purely by fate and serendipity. Dr. Jessie Gaeta walked into MHSA one day and said, “I’m just tired of patching people up and sending them out to the street. There’s no way people can get healthy this way.” She said, “Teach me advocacy. I have this grant idea.” It was funded through the Soros Foundation originally I believe and later went to Columbia University, and focused on physicians as advocates. [With Jessie’s help], MHSA’s program “Home For Good” suddenly became “Home & Healthy for Good.” The timing was unique because it was when health care reform was happening in Massachusetts in 2005. I can’t say enough about what a difference Jessie has made. Being a physician, Jessie is more familiar with the scientific methodology involved in these things. She has lent credence to the data that we wouldn’t otherwise have and makes a very compelling case as a physician talking to an administrator or a legislator.
NPi: Why housing first? Can you explain what the value is of placing housing at the front of the line of services rather than having it be the prize?
JF: When people ask that question it reflects the image we have about who the homeless person is. There’s a fundamental belief out there at a very deep level that people are homeless as a result of their own behaviors. Homelessness, in some respects, becomes a moral issue or a moral failing on the part of the individual. Of course this ignores the whole social reality of things that have happened in the world we live in. The truth is we’ve seen wholesale elimination of specific housing niches for the working poor, for marginalized people. We’ve seen drastic drops in single-person occupancy. We’ve seen the destruction of neighborhoods like Skid Rows through urban centers across the country. What’s the common denominator? It’s a lack of housing.
Particularly when you’re dealing with people who have a substance abuse issue or are disabled through mental illness, it’s going to be difficult for them to navigate the [traditional] system to get to the prize: housing. The term I’ve always disliked is “housing ready.” Most of these folks don’t present a problem with housing; their housing they can sustain. We wanted to take the emphasis off clinical outcomes. So often the goal is to make someone clean and sober first. There are lots of people out there who you’re never going to make sober. In fact, some of them live in some very high-end housing! That’s not always an achievable goal. However, it might be achievable to say this guy can successfully live in his own housing. Because if he doesn’t, he adds all these other costs as he continues to deteriorate whether he’s in the shelter system or on the street.
[The Housing First model] is also different in terms of delivery care. Years ago at Father Bill’s Place, there was a woman who was the most seriously mentally ill person in many respects I had ever met. She would only come into the shelter every couple of weeks or so to shower, get something to eat, and then be back out on the street. And she was such a nice person. I wrote the first Shelter Plus Care Grant, which was funded through the federal Department of Housing and Urban Development, before we had these continuums of care. Shelter Plus Care provided housing subsidies that were conditioned upon the person receiving or accepting services. I won the grant, and she was one of the first people to whom I offered the subsidy. I said, “I have great news! I’ve got an apartment for you. I can give you a subsidy.” She thought that was wonderful. Then I told her, “There’s only one catch. In order for you to get the subsidy you have to acknowledge that you’re mentally ill.” And her response was, “I can’t do that. That wouldn’t be fair. I can’t lie just to get housing.” What dawned on me was that she had no perception of herself as being mentally ill even though she was clearly seriously mentally ill. She was never going to work within a system that required her to acknowledge this at that point in time. I started wondering who really is in rougher shape? Is it us or is it her? So I went to the DMH (Department of Mental Health) and asked why she had to say she was mentally ill to get housing. Why don’t we just put her in the housing and then see what we can do to help ? They put her in housing and within a matter of weeks she was linked back up to DMH case management and had gone back on her medications. To the best of my knowledge she’s still living in her own housing, costs a lot less [to society], and is far more independent.
Some of the greatest resistance we’ve had to Housing First models comes from staff people because they’re so into a recovery-oriented model. They’re not housing-ready. You can’t put people in housing because they’re so sick… But even with people who are seriously mentally ill, many of the living skills are intact. What if we can provide a different model which wraps those [mental health] services around first providing housing?
NPi: Have you ever done outreach to other organizations to share your knowledge and increase the social impact?
JF: Home & Healthy for Good is unique in terms of its structure. MHSA is a member-driven organization, and so we have a creative tension that exists. If you push all of our members, they’ll probably say we’re about ending homelessness. But when you look closer, the tension between what we are now and what we could be is so great, people get very afraid. They get afraid of losing resources. Seen in its best possible light, the most compelling argument [against Housing First] is that moving away from the shelter system would be damaging if there is nothing to replace it with. It was the same thing with the deinstitutionalization of the mentally ill. It was supposed to be for the benefit of clients and yet, all it did was abandon people to the streets.
With regard to the Housing First model, we’re going out there trying to convince people they can do this. We’re not saying it’s easier. What we’re saying is it’s more effective and more cost-effective. It turns people’s lives around in ways you couldn’t ever imagine.
NPi: We’re talking about substance abuse?
JF: Yes, homeless people with substance abuse issues. The Housing First model is incredible because it fits the reality of substance abuse and addiction; it’s a recidivist disease… A hospital doesn’t kick the diabetic out just because they see him sneaking a candy bar into the hospital. But with alcoholism and drug addiction, in so many of the programs that exist, the minute you manifest the disease, you’re out, and yet you’re actually there because you’re trying to get help. That’s been a key idea for people who are slowly but surely starting to believe that the Housing First model presents all kinds of potential not just for homelessness, but for people to get into recovery-based programs.
NPi: What are some of the biggest impacts or successes you’ve had?
JF: The greatest success has been what we’ve done to view things from a cost-benefit analysis… We’ve demonstrated the social benefit of what we’re providing. And the Medicaid data that we have is astounding. The first people to go through 18 months of the Home & Healthy for Good program, their Medicaid costs (the mean cost) went from roughly $26,000 per year to about $8,500 per year. That’s more than $17,000 in savings annually per person, or a 67 percent reduction! This blew our minds. We thought there would be a savings, but we had no idea it would be that significant. Many of our [other] significant accomplishments have been in the realm of policy.
NPi: What are a few of the challenges you’re facing?
JF: The challenge right now is bringing this to scale at a time when the economy is so bad. It’s very hard to get people focused on change when they are nervous about resources. My fear is that the progress we’ve made in the last two years on housing will get overshadowed by the fact that now we have a whole new group of people at the front door trying to get into shelters.
NPi: Where could you use help as an organization?
JF: What we’re trying to do is change people’s impression of the reality of homelessness. We want to let people know that it’s not necessarily charitable to be out there always supporting the emergency resource or handing to blankets to people on the street, working in a soup kitchen, or serving meals at a shelter. These are all good things, but we want people to understand how costly they are. The question is, what can we do to get the philanthropic community to support us now that we’re doing things differently?
NPi: Supporting preventative care?
JF: Not just preventative care. It’s about service delivery and policy. Our focus right now is on communicating the message that housing, not temporary shelter, solves homelessness. It’s also a great deal for taxpayers. When individuals in the private sector invest in organizations that promote housing as the solution to homelessness, they’re investing in policies and programs that save lives and use society’s resources in more efficient and productive ways.
Click here to read Part II of our MHSA story, a conversation with the MHSA team about what they’ve learned doing the work they do and what keeps them coming to work every day.
Home & Healthy for Good was chosen as a 2010 Social Innovator by the Root Cause Social Innovation Forum. Click here for more details.
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