Pima County Housing First Pay for Success Initiative

Pima County is a community of over one million residents, located along Arizona's southern border with Mexico; Tucson is the county seat. In part due to being one of the sunniest cities in the United States, Tucson struggles with a growing homelessness problem. The Tucson Planning Council on Homelessness (TPCH) estimates that the number of unsheltered individuals grew by 60% from 2019 to 2020, and forecasts that this will grow even more into 2021 due to the COVID-19 pandemic. In the 2020 “Homeless Count”, TPCH volunteers spoke with 578 unsheltered individuals; of that, 246 individuals identified as chronically homeless, 226 self-reported to have a serious mental illness, and 162 with a substance use disorder.

To address this problem, and in conjunction with its partners, Pima County launched the Housing First pilot program in 2019 with a goal of providing permanent supportive housing (PSH) with wrap-around services to 200 homeless individuals who have justice involvement. The program consists of two main components – rapid placement in transitional housing (once eligibility determined), and then into permanent supportive housing (via HUD voucher). At each step, Housing First supplements HUD vouchers and Medicaid funding with dedicated and highly trained staff who provide case management, supplemental resources (for example, “apartment kits”), and the integration with treatment services (medical, substance use, and mental health).  

The Housing First pilot, independently evaluated by RAND Corporation, was shown to reduce costs and lower recidivism. The total monthly cost per participant was equivalent to the cost of two days in detention. Since the launch of the program, of the 160 individuals that have been placed in PSH, 138 have remained in the Housing First program (22 individuals have been discharged; 10 of those are considered “positive” discharges due to no longer meeting the income requirements, clients taking over lease, or having other housing opportunities).  

To advance past the pilot phase it has been determined that, for the program to continue, several substantial changes must occur, including: 1) utilizing a validated assessment tool to prioritize placement for more at-risk clients, 2) incorporation of trauma-informed care throughout the program, including training of staff and use of the Adverse Childhood Event (ACE) screening tool, and 3) more clearly defined program “phases” to determine level-of-intervention needed, in order to direct higher levels of care to newer or more at-risk clients (and provide participants with clearly defined goals and incentives to achieve program graduation/completion).