MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. They're the people you see roaming the streets curled up on the sidewalk, the chronically homeless, those who've been on the streets for years and often suffer from addictions and mental illness. For years, experts said these people couldn't be housed until they started to fix their other problems. In the early '90s, psychologist Sam Tsemberis decided to try a different strategy, giving chronically homeless people a home, no strings attached. It's called Housing First, and nearly 20 years later, the strategy has spread from its origins in New York to other cities around the U.S., including the District of Columbia.

MR. KOJO NNAMDIWe looked at the Housing First program two years ago on this show, and we wanted to get an update on how it's fairing both here and nationally, especially in the midst of a down economy, so we invited Sam Tsemberis to join us. He's a psychologist and founder and CEO of Pathways to Housing. That's a New York-based organization that developed the Housing First model to address chronic homelessness. Sam Tsemberis, thank you for joining us.

MR. SAM TSEMBERISThanks for having me.

NNAMDIAlso with us is Christy Respress, director of programs and development with Pathways to Housing D.C. that provides housing and other services to chronically homeless people in the nation's capital. Christy Respress, thank you for joining us.

MS. CHRISTY RESPRESSThank you. It's a pleasure.

NNAMDIAlso with us is Sandra Coleman, a tenant with Pathways to Housing D.C. Sandra Coleman, good to see you.

MS. SANDRA COLEMANGood to see you also.

NNAMDIAnd we'd like to hear your voice in this conversation -- you can join us at 800-433-8850 -- what your ideas are for the best approach to chronic homelessness. 800-433-8850. You can go to our website, kojoshow.org, join the conversation there. Sam, you were working with homeless people on the streets of New York in the early '90s when you created Pathways to Housing. Generally speaking, what was the approach in those days to getting people off the street?

TSEMBERISThe approach then was basically to consider the problems that people had, the clinical problems, as both the ones that were causal in bringing people to homelessness and ones that needed to be solved in order for people to get back into housing. So if somebody on the street and the response, the initial response to homelessness, was for people who had mental health and addiction problems. The wisdom at the time was there was no way that this person could get back into housing unless first we took care of their symptoms and their addiction to prepare them. Housing readiness, I guess, was the short form of that, and in the belief that it was something about their addiction and their mental health problems that actually created the problem.

TSEMBERISIt turns out we were wrong about all of that, of course, but in the work I was doing at that time was street outreach. So what we would see are people living on the streets, in the parks, in the subway or Metro here, that needed treatment. And we would take people to the hospital. Some people we wouldn't see again because they were placed, but many people, we would see a few weeks later right back in the same spot. And the frustration of that repeated loop is what led to a very strong effort to do something different about what was going on in the current system.

NNAMDIThe general assumption then seemed to be that people could not handle their own physical needs because of their emotional and mental problems, but your observation was that, in fact, people were handling their physical and emotional needs. They were just doing it in the most stressful of situations.

TSEMBERISAbsolutely, it -- the skill set of people who are homeless, their survival skills, are typically invisible to somebody just walking right past the person who's homeless. What we don't see which would -- we would be able to see during the course of a day is that the person carefully picks a spot where they're gonna sleep, where it's safe. They know where meals are served throughout the city. They know who to trust with their things over time. They know how to avoid getting arrested, and they know where to seek help where it's absolutely necessary. All of...

NNAMDIThe skill set that we don't see?

TSEMBERISWe don't see because we're passersby.

NNAMDIDescribe the Housing First approach for people who may not be familiar with it.

TSEMBERISIt's an approach that basically is consumer centered, we call it person centered. It's an approach where the expertise for the solution lies not in the clinician but in the person receiving the services. That's how we got to Housing First. Housing First is really code for let the person be an expert of their own experience. So when you ask a homeless person with multiple problems, what is the thing that is most important for you for us to help you with? They typically say housing, and hence, housing is the first service we provided. And so we had to figure out a way in which to get that person into housing. Housing of their choice was typically an apartment of their own, something modest, something affordable, something safe and secure, that also had support services once the person was housed.

NNAMDIChristy Respress, Pathways D.C. just arrived a few years ago. At the time, Mayor Adrian Fenty had announced plans to move hundreds of chronically homeless people into permanent housing. Can you give us an update how many people are you working with now?

RESPRESSSure. I'd love to. When we were on the air with you back in March of '09, we were somewhere around 300 people or so or 285. We now in our program have moved close to 400 individuals into their apartments, into permanent housing.

NNAMDII guess, that would be in, by all accounts, a kind of success story, would it not?

RESPRESSIt's been incredible. Incredible success. And also that most of these individuals have stayed in housing once they've gotten there with our support of our really intensive teams.

NNAMDIIn case you're just joining us, we're talking about housing the homeless locally and nationally in general, but in particular, we're talking about Housing First, the program that was initiated by one of our guests, Sam Tsemberis. He's a psychologist and founder and CEO of Pathways to Housing. He joins us in studio with Christy Respress, director of programs and development for Pathways to Housing D.C. Sandra Coleman is a tenant with Pathways to Housing D.C. Sandra Coleman, tell us your story. How did you come to be homeless?

COLEMANThis time, I came to be homeless -- 'cause I've been homeless more than once. The first time was in Charlotte, North Carolina. I didn't pay the rent. And the second time, I was pregnant and homeless, mainly because I didn't pay the rent again. Now, this time with Pathway to Housing, which is really great. They, you know, could help me with the rent if I didn't pay it. You know, they can get me the money, and then, I will repay them. Pathway to Housing has been a wonderful help in my life.

NNAMDIWhy did you have a hard time paying your rent?

COLEMANMainly, because I am bipolar, schizophrenic, so that means that I'm not thinking straight all the time, and for whatever reasons, my disease would flare up.

NNAMDIHow did you hear about the Pathways program?

COLEMANWell, at the time, I was in Saint Elizabeth, and Pathway to Housing found me.

NNAMDIThey found you in Saint Elizabeth's Hospital. What was it like to get your own apartment again?

COLEMANFirst of all, I just have to say that the last apartment I was in, I played the music too loud. So this time, I decided to keep the music down low.

NNAMDIYeah, that would help. (laugh)

COLEMANAnd it was just a wonderful experience because I have a washer and dryer. I have a dishwasher, and also, I have a garbage disposal. And it's just really a nice apartment.

NNAMDIWell, I got kicked out for playing the music too loud when I was a student, but that's a whole another story. We're talking about housing the homeless locally and nationally. Inviting your calls at 800-433-8850. Christy, the National Alliance to End Homelessness recently released statistics that show overall homelessness is going up in the District of Columbia. Interestingly though, chronically homelessness is on the decline. Can you describe, characterize the state of homelessness in the city for us right now?

RESPRESSI think you just said it perfectly. You know, we've seen the reason that the number of chronically homeless individuals and families have gone down, which is really surprising, generally, is because there has been a really specific effort to do so. Mayor Fenty, as you mentioned, earlier in his administration really made ending homelessness at the -- he put it the forefront of his administration, and he put behind it the political will power to say, you know, if we come together across agencies and put our resources together with a very specific mandate, we can end homelessness in the District. And so we really focused specifically on individuals who've been chronically homeless, meaning longtime on the street or in the shelters with a disability, either physical disability, mental health and some other health -- perhaps like HIV, so it's a very focused and intentional decision to work with these individuals who use a lot of the resources in the city. And we know that they're on their own, not able to afford housing in the District.

NNAMDISam, looking at the nation as a whole, 20,000 people were added to the ranks of the homeless between 2008 and 2009. Is that a reflection of our down economy? What does that statistic say to you? Frankly, it seems, to me, to be a grossly understated statistic, but you're the expert.

TSEMBERISWell, you know, every expert has their opinion about the number of homeless people in the country, and I think if you ask advocates, the numbers tend to be much larger than the one quoted. If you ask politicians, they tend to be on the smaller side.

NNAMDIYeah.

TSEMBERISThe trend -- the foreclosure fraud has really created a lot of family homelessness, and I think that's the major rise in homelessness across the country and growing. The individual homeless...

NNAMDIBut a lot of those families have moved in with other families, and that's why I thought it may be understated because technically they may not be counted as homeless because they're living in a home someplace.

TSEMBERISAbsolutely. Absolutely. I think that that's going on, and the numbers that typically people, quote, as homeless are where people show up for homeless services and lots of people either double up or seek services on their own or manage some other creative solutions so it leaves them off the map, but I think the number is much larger. I think that the two things in what Sandra said and Christy said is that the problems of people, mental illness and addiction, are not the main cause of homelessness. The main cause of homelessness and why Sandra lost her apartments is that the fixed-income people live in -- live on, which is about $600 or $700 in most places is not enough to get you into an apartment.

TSEMBERISOnce you have a person on fixed income that becomes homeless, they are basically priced out of the market going back. There's no way on six or 700 a month they're going to be able to pay the first month's rent or security in order to get back into housing. They'll need a subsidy. The other thing that -- what Christy said about the city's approach to ending chronic homelessness is really important because in cities like D.C. where the Fenty administration had it as a priority, or in Philadelphia where Mayor Nutter had as a priority, or in Denver where then-Mayor Hickenlooper and now Governor Hickenlooper took homelessness on as a primary issue. The mayor is in a very key position to bring the interaction -- collaboration between those siloed agencies together to take on the problem and put the city's resources into it. Cities are mostly spending a lot of money on homeless services and some housing. The Housing First approach is both a program and a policy approach where you can actually invest more in permanent housing with services than paying for transitional services or housing readiness services over time. And this city has taken that on as a legislative priority, and I hope it continues under Mayor Gray.

NNAMDIWe're gonna talk about that in a second. But first, allow me to go to the telephones. We will start with Beau in Washington, D.C. Beau, you're on the air. Go ahead, please.

BEAUHi, Kojo. I just wanted to comment and make the point that I understand the point of a housing first model also is, by getting the chronically homeless off the street, it removes kind of the example to the other homeless who may be aren't as chronic, which is the majority of people who are just temporarily homeless so that you remove that normative standard so that others stop seeing homelessness as a long-term viable option, and that this is the reason why chronic homelessness is going down and homeless in general. And it -- I think the model was founded in the UK under Tony Blair and works so well in New York with the common ground example. And they've been advising D.C. and the Fenty administration and the national 100,000 homes project. So I just wanted to mention that.

NNAMDICare to comment on that at all, Sam?

TSEMBERISI think that the idea of taking chronic people off the street, in some way, may serve as an example, but I think that what it does highlight -- and I think Beau's right that the majority of people who are homeless don't have severe mental illness or addiction, and it really brings the discussion to the issue of poverty which really underlies all of these. And so, as we move up from people who are on fixed income, then we're talking about -- a lot of the families, for example, are living minimum wage jobs but still living in shelters, so that as we think about homelessness and how to really solve the problem on a large scale, we have to start having the difficult conversations about a living wage versus minimum wage and distribution of income and the building of real affordable housing at a national level.

NNAMDIDifficult may be an understatement for those conversations that we need to be having, but you are right. We need to be having those conversations. We've got to take a small break. When we come back, we will continue this conversation about housing the homeless locally and nationally in the Housing First program. You can still call us. Beau, thank you for your call. 800-433-8850 is the number. Have you or a loved one ever been homeless? What do you think is the best way to help people get off the street and get off the street permanently? 800-433-8850. Or you can send us a tweet @kojoshow. I'm Kojo Nnamdi.

NNAMDIWe're talking about housing for the chronically homeless and the Housing First program, which chooses the option of putting homeless people in housing first before dealing with any of the other problems they might have. The founder of housing first essentially is Sam Tsemberis. He's a psychologist and founder and CEO of Pathways to Housing, which is based in New York. They have developed the housing first model to address chronic homelessness. Also joining us in studio is Sandra Coleman who is a tenant with Pathways to Housing D.C. Christy Respress is director of programs and development with Pathways to Housing D.C., which provides housing and other services to chronically homeless people in the nation's capital. Christy, we've been talking about D.C. D.C. officials now say the city's revenue gap may be as high as $600 million, and the housing first initiative was a big priority as we've heard earlier of the prior mayor, Adrian Fenty. Have you gotten any indication, either from Mayor Vincent Gray or from the City Council, about whether it will continue to support this at the same level?

RESPRESSYou know, we haven't, but I'm very confident that given Vincent Gray's background in social work and social services that this will continue to be a priority, and I know the interagency council on homelessness is very committed again to continuing these programs in a very large way. So we remain hopeful, but we also know that there are significant, as you said, budget shortfalls and -- especially with our services as well. We are taking a 7 percent rate cut in our Medicaid starting February 1st which is, again, to help that budget shortfall. So we see the impact is coming. But we are very hopeful that the new administration will continue this phenomenal success of this program.

NNAMDIHave you had any conversations at all, either with Mayor Gray or members of his cabinet or members of the City Council about this so you can get any signals? Any indications?

RESPRESSWe are working on that. We'd like to. Yes.

NNAMDIAll right. On to the telephones. Here is Chris in Washington, D.C. Chris, you're on the air. Go ahead, please.

CHRISHi, Kojo. Good afternoon, everybody. I'm Chris. I've been working with the homeless population in D.C. for about a decade now. And I just want to set the record straight because Fenty, in this conversation, is getting a lot of credit for the Housing First program. There's a lot of problems with the Housing First program in this city, including reporting on the follow-up with how -- why people leaving the Housing First program and going back out on the street. But more importantly than that is the acute fact that emergency homeless shelters are always gonna be needed. Anybody can go homeless at anytime, yet in this city, in the last five years or eight years, we've seen three major homeless shelters shut down. The latest being La Casa here in Columbia Heights, the most recently before that is the big one downtown, Franklin Shelter. Fenty closed the Graham -- Council member Graham closed the shelters. So we're losing emergency homeless shelters, so people who are a paycheck away have no place to go. So I just -- and also...

NNAMDIOkay, Chris, for those people who may be joining this discussion for the first time, the Fenty administration emphasized Housing First program in the view of some activists at the expense of homeless shelters because the Fenty administration did close homeless shelters during its time in office. Chris, did you have a specific question?

CHRISYeah. My question is, I'm wondering if the numbers on -- you said that the chronic homeless population is decreasing. I would wonder though, is that stat as a subset of the greater pool of those who are going homeless, in other words, people who are suddenly homeless now are going up and that the chronic homeless, people who've been always out on the street. Just by the sheer fact that the numbers of homeless people going up, that number is gonna shrink. It's not the Housing First program, 400 people...

NNAMDINo. I'm not sure it's the proportion that is shrinking but I'll have Christy Respress address it. I think it's the actual number that is shrinking.

RESPRESSIt is the actual number and, we'll actually know more -- even more information. This Wednesday is the annual point in time count where we go out and count how many people on one of the coldest nights in January in shelter, but also on the street. And, you know, what's -- I find it really interesting this year is where the city's actually expanding the areas that they're going to count looking in even more parts of the city that traditionally have not done a count for. But I can tell you, in the downtown area -- and Chris is absolutely right about that closing of the shelter -- in the downtown area back in 2008, we went from about 145 people in that point in time count sleeping outside on that coldest night to 73 individuals or 75 people in 2010. So we know that a lot of these folks have gone into permanent housing. But, you know, he does bring up a good point that there will always be some need for emergency shelter. And maybe Sam, you want to speak to this. But...

NNAMDIWell, let me ask Sandra first. Did you -- Have you ever stayed in a shelter in the District of Columbia?

COLEMANYes, I -- excuse me. Yes, I've had. One of them was House of Ruth.

NNAMDISure.

COLEMAN...and Second and D.

NNAMDIYup.

COLEMAN(word?) House. And I can't remember the other...

NNAMDII'm familiar with all of those. But the reason I asked is because we've got this e-mail from Lori, who says, "I often wonder why we see homeless people on the street instead of in shelters. I asked a homeless man this question and his reply was bed bugs. Was he telling me the truth?" Have you had that experience at all in homeless shelters in the District?

COLEMANYes, there are bed bugs. And a lot of people don't really know how -- the hygiene to it all, (unintelligible) lice and everything. It's a little bit of everything that you can pick up when others have slept in the same bed.

NNAMDIWell, of course, when we talk about homeless shelters, we hope that there are homeless shelters in which people can stay without picking up any illnesses or that kind of thing. But, Sam, you wanted to address the issue that Chris raised?

TSEMBERISWell, I think that homelessness -- shelters as an acute response are useful. There's no disagreement there. It's a question of the people who are chronically homeless tend to stay in shelters for a long time. We've known for a long time that a small percentage of people who are living in the shelters have been there for months or years. And those are the people, typically, that have additional problems in addition to the one paycheck away. Most people go to shelters for two weeks and leave, but there's always that. But if we are going to invest limited resources that we have in homeless services, that particular group which is taking up 50 percent of staff time and resources, could be better served in an apartment with wrap-around services.

TSEMBERISI think that the other piece of this is that, in terms of the numbers of people, we're not talking about a fixed pool. We're talking about a problem that's much larger than any of these programs, whether they're shelters or Housing First or anything else who's going to fix, we're talking about models that work more efficiently than others. It's true the Housing First model is only 85 or 90 percent effective and there is a need for a more structured or supervised setting for people that don't manage well in apartments. But even with all of that, the real solution is a much larger solution. It's at the federal government level. It's the building of affordable housing. Otherwise, we're just quibbling about this model or that model. The fix this much larger.

NNAMDIHere is Louise in Columbia, Md. Louise, your turn.

LOUISHi. Good afternoon. First of all, I would like to say that Pathways to Housing program -- it does sound like it's doing great work for the majority of people with substance abuse and mental health issues. However, I would like to say, I have a family member who had been homeless for close to a year now. She has a small boy and we live in the suburbs -- consider the suburbs, Columbia, Md.

NNAMDIYes.

LOUISAnd there is a hidden -- there is a huge homeless problem here. And she had actually applied to the Pathways to Housing program, and she actually received a response, and I know because I get her mail that says that you have to be homeless for about three years to receive any type of housing. And another comment I wanted to make is she had tried to get temporary housing in Grassroots and was only to be turned away. And it seems to be unfortunately, that those with substance abuse problems are given almost priority. And I would like to know what type of help can be given to people who are -- who need immediate help who find themselves in these circumstances when family has done all they can.

NNAMDIYou mentioned Grassroots. That is the facility in Columbia, Md., is that correct?

LOUISEYes, that's right.

NNAMDIOkay.

LOUISEYes. I'm...

NNAMDIOkay. Here's -- go ahead. Here's Christy Respress.

RESPRESSYou know, we work primarily in D.C. -- or Pathways works primarily with individuals and -- in our program, because as Sam said, we're targeting a very specific group of people. Our funding is for individuals who are considered chronically homeless a year or more. But we get calls every day of people in the same situation you just described, desperate to not become the chronically -- next chronically homeless individual or family, to catch it early, which is why prevention is really important in putting some of our finances or financial resources towards helping people right and catching them quickly to get them back into housing. In the district, you know, there is one single point of entry for families, which is the Virginia Williams Family Resource Center. And people do go there and -- but the reality, as Sam has said repeatedly, is there's just not enough. But...

NNAMDILouise, thank you very much for your call and good luck with -- for you and your sister. Sam, I know in your addiction -- in your program, there are no prerequisites to deal with addiction or mental illness before receiving housing. But are there requirements or rules for people to follow once they are in their homes?

TSEMBERISYes. The rules are, as Sandra described, you have to be a tenant in the building and adhere to the same terms and conditions of a standard lease. That is a mandatory for everyone that -- because the housing is normal housing, and so, you have a community standard that's defined by that lease. You also have, on the clinical side, an agreement that the team will visit you. This is housing for people with multiple needs. We're not gonna let those needs get in the way of you getting into housing, but we are absolutely responsible for addressing them after you get into housing. And that's coded in the contract between the tenant and the program, by having this minimum weekly visit in which a clinician, social worker, a nurse, a peer counselor would go and visit with the tenant and begin to come up with a plan for addressing those other issues at the pace that the tenant sets, in the sequence they want to set it, but they will be addressed concerning those issues.

NNAMDISandra, can you talk about the services that you've been offered since you've moved into your housing?

COLEMANI have been offered excellent doctors. My psychologist, finally, after years , she's put me on the right medicine that is capable of relieving my depression. She has me on medicines that keep me low and balanced. That's one of the things that I like about Pathways. And also, they have given me an apartment and they gave me free furniture. (laugh)

NNAMDIHow about an MP3 player with earbuds so you can play your music in your own ears as loudly as you want? That could be...

COLEMANYou know, I'm not really into -- nothing but the radio and...

NNAMDISure.

COLEMAN...I like that a lot.

NNAMDIOkay. On now to David in Chevy Chase, Md. David, you're on the air. Go ahead, please.

DAVIDThank you for taking my call. I'm a board member with the Community Council for the Homeless at Friendship Place on Upper Wisconsin Avenue. And we are one of the six providers that have received grants under the Housing First program. And I must say, I was a skeptic about that model beforehand, because our experience has been with a more traditional-type program that moves people through a continuum of care. But any event, I have turned into an enthusiast, because our experience with the program has been excellent. We now have 175 consumers participating. I think all of them by now are housed. And we just conducted a study of the first 65 that we housed, who've now been in housing or should -- would have in housing for two years. And only one of those 65 actually voluntarily left the apartment and returned to the street. Most of the others are still housed in their original units. A few have left the program but have moved to other housing. And we really feel it's a wonderful working model and needs to be supported and hopefully expanded.

NNAMDISo you're retention rate is over 90 percent, isn't it?

DAVIDWell...

NNAMDINot necessarily the people who...

DAVID...I think we're well over 90.

NNAMDIYeah.

DAVIDI do need to be upfront here. And we have had a few deaths and a few of our consumers ended up being incarcerated mainly for offenses that they committed prior to being housed. But the point I wanna emphasize is those were involuntary separations, if you will, and only one person actually chose to leave and return to the street. And the others are still being housed and receiving services. And what is significant is that getting into that apartment and stabilizing their living arrangement creates an opportunity for them to (word?) work with their case manager to address issues, be it substance abuse or mental illness. And I just think people need to appreciate that this is, as the previous speakers have said, is a much more cost-effective public investment.

NNAMDIWe're going that -- we're gonna get to that aspect of it in a second, the cost-effectiveness. But Sam, to some extent, there are people who would listen to this and worry despite the retention rate, that a program like this fosters dependents. How do you respond to those critics?

TSEMBERISThere are many worries that people imagine before they start these programs. As the gentleman just said, the biggest fear typically is the liability issue. How can you put this person who has mental health and addiction problems into normalized housing? And one of the things that we've learned is that the motivation -- we've had the motivation all wrong, that we've worked so hard to entice people into treatment and sobriety in order to get housing. But when you give someone a home, really, their own home with the lease and furniture, their motivation shifts such that they are invested in their home and want to keep it, and then they're motivated to get into treatment. They don't have to be enticed. They want treatment as much as we want them to have it, but they haven't had the conditions in which they could actually participate in treatment. The dependency is sort of an American value. You're supposed to not be dependent. But people with severe mental illness or addiction, it is a dependency disorder, and that's what the services are for. The services are dependable. You -- the rent is dependable.

TSEMBERISPeople will need -- some people in our society will need some help, and we're there to provide it for as long as they need it. The help is designed so that people can be assisted in getting their own life together. The goal is always for independence and self-management, and employment, and getting back into the mainstream. But you have to be comfortable with the fact that people will need some help for a period of time before they're able to manage again on their own.

NNAMDIGot to take a short break. When we return, we'll continue this conversation about housing first as a solution to the problems of housing the chronically homeless. If you've already called -- and David, thank for your call -- stay on the line, we'll try to get to your call. We do have a few lines open so you can call us at 800-433-8850 or send us an e-mail to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWe're talking about trying to deal with the problems of the chronically homeless by the housing first approach. Sam Tsemberis is a psychologist and founder of -- founder and CEO of Pathways to Housing that's based in New York that developed the Housing First model to address chronic homelessness. Christy Respress is director of programs and development at Pathways to Housing D.C. And Sandra Coleman is a tenant with Pathways to Housing D.C. We got an e-mail from Gerard who said, "My name is Gerard and I'm a Pathways to Housing client. Pathways saved my life. I've been homeless for 20 years, wandering the streets right here on the nation's capital. Housing First works. I'd like to give a shout out to Linda Kaufman of Pathways. She has done a wonderful job." I guess you have to pass that shout out on, Christy Respress.

RESPRESSI will.

NNAMDIBut in terms of the experience that you have been having, Sandra Coleman, why do you think this approach has been working for you so far?

COLEMANI think this approach is working. The 12 people that you work with is like a team effort, and so many of the people that worked there, you know, helping any particular homeless person is like is a great job. And they take time with you. They talk with you and they come to your house. They reach out and give you medicine, you know, and then you see every -- the doctor every now and then. It's kind of like a support system.

NNAMDIOkay. And that's what works for you. Let's talk dollars and cents, Sam, because that was raised earlier. If you're providing someone with housing, a team of maybe nine people helping them out, providing them with all kinds of support for their health care, their substance abuse issues, job training, it sounds like this is a pretty expensive venture. How much are we talking about generally speaking per person, per day?

TSEMBERISPer person, per day, it's about $50, which when you consider what the options are, even to leave somebody homeless on the street, the police surveillance, the use of emergency rooms in the hospital or detox over the course of a year annualized comes to about the same amount. So it's not as if doing nothing -- and Dennis Culhane's research is really fantastic on this. The cost of homelessness is about the same cost as supported housing. Now, what we're usually up against is hospitalization and jail stays because the alternative in many cities, not just D.C., have moved to putting people in jail for typically crimes of poverty or, as David mentioned, past warrants or probation violations, and you have a cost of six or $700 a day in a jail cell, $1,600 a day for a hospital. So in the relative scheme of things of what is this costing...

NNAMDIFifty-seven dollars a day for an apartment, permanent housing is a lot cheaper.

RESPRESSWith services.

TSEMBERISAnd also those services.

NNAMDIWith services.

TSEMBERISI mean, and I can't emphasize enough that the reason this program works is the housing ends homelessness right away. That's absolutely essential. But if isn't for the services to follow up, you wouldn't get only one people -- one person out of 65...

NNAMDISo Christy Respress, it's costing me and other D.C. taxpayers less to have Sandra Coleman in an apartment than it would cost us if she was still at St. Elizabeth Hospital, or to be treated, or to be in another institution any place?

RESPRESSAbsolutely. And, you know, I was talking to Sandra on the way over here about the fact that you've been in your apartment now six months, right Sandra...

COLEMANYes.

RESPRESS...and not returned to St. Elizabeth's. But that was not the case when you were staying on the street, I think you shared.

COLEMANExactly. The doctor, I wanna say, gave me a happy pill, so...

COLEMAN...what it consists of is relieving my depression, it consists of relieving committing suicide. And it's a wonderful team, you know?

RESPRESSYeah.

COLEMANIt's a wonderful team and I love it.

TSEMBERISKojo, if I may, a month's stay in St. Elizabeth is somewhere between 30 and $40,000. A year's stay in an apartment with support services is somewhere around 20 or $25,000.

NNAMDISandra, stay in the apartment please. You're costing me less now.

NNAMDIWe go to Kathleen. Kathleen, you're on the air. Go ahead please.

KATHLEENHi, Kojo. This is Kathleen Reed. And the reason I'm calling today is on Martin Luther King's birthday, actually a week ago today, I suffered a two alarm fire on 2nd and Thomas that consumed everything in my house but me. I just happened not to be home that day and...

NNAMDISorry to hear about that.

KATHLEEN...yeah. I (unintelligible) and so my issue about not just -- not necessarily chronically homeless, but the issue about displacement. Like I'm alive and safe in my neighborhood where I've lived in Bloomingdale community for about 15 years. Because of a friend and my other neighbors and all of the embrace of the community, I was able to be sheltered in place, in fact I'm, you know, I'm staying in the middle bedroom with a colleague, friend of mine. But my contribution to this discussion is that there's rarely the discussion of homelessness or potential homelessness, I should say, that happens to professional people who are displaced and their interactions with the social services, i.e. embarrassment.

KATHLEENYou know, Sam is a psychologist, et cetera. There's one last thing. What I've decided to do since I have been, you know, radio, TV producer, et cetera, if I decided to give back to my community by engaging my Bloomingdale community with my experiences toward my recovery, and it's Kate Phoenix (sp?) Bloomingdale Virtual Resident because, you know, my cell phone, my e-mail -- in other words, the experiences that I'm going through. Just like being an embedded reporter in the Iraq war, I wanna be able to give back to the community of here are the lessons learned. Here's what you do.

KATHLEENHere's what you need. Here's how to shelter in place. Here's what each community needs to have like a database with the ICE numbers, in case of emergency, for each resident, et cetera, because I'm like in the belly of the beast and experiencing this. And I would be remiss if I didn't take my personal experience and share it with both the community and the city on how to prevent homelessness, but also how to understand that, like the young lady there who's gone through so much of her own personal turmoil -- a person like myself who's been professional and lived for 15 years -- actually, at a very fundamental level, she and I share a common experience.

NNAMDIIn addition to it, as Sam Tsemberis was pointing out earlier, you are acquiring a skill set that most of us are unfamiliar with. So the extent to which you can publicize that so that people who find themselves in that situation learn to use that skill set because you have publicized it will help them to cope. So that seems to be a very good thing that you're doing, Kathleen. Sorry to hear about what happened to you over the past week or so, and hopefully things will work out better for you in the future. And thank you very much for sharing that with us.

NNAMDIWe got an e-mail from Michael, who said, "If Housing First, one, makes so much sense clinically and socially; two, provides greater dignity to participants; three, is cheaper than institutional homelessness; four, is consistent with federal law requiring cities to house people with disabilities in the most integrated setting, then why isn't every city doing it?" (laugh)

TSEMBERISWhat a careful listener.

NNAMDIYes, yeah.

TSEMBERISThat's a great question. I think it has to do completely with political will and social values.

NNAMDIBut Canada, it's my understanding, is doing something of a national experiment with the Housing First model. Could you tell us a little bit about that?

TSEMBERISWell, the Canadian government decided to take on chronic homelessness across five Canadian cities. The Canadian population is only 35 million people. They invested $110 million to address this problem, and they're doing it with a randomized controlled trial. They want to understand exactly, in detail, what works and what works well in the cultural contexts of Canada. And I think it sort of demonstrates what can be done when the federal government takes on an issue and invests in it.

TSEMBERISThe bailout. Where is the bailout? It's clear we can do it for General Motors. We can do it for AIG. We can do it when we feel it is fundamental and when things cannot fail. What if we defined homelessness as something that we can no longer tolerate? Let's have a bailout on homelessness. It would cost, actually, less than the bailouts we paid before. It's a -- this is what I find most frustrating. It's -- we know it's fixable. We know how to fix it. All we need is the resources to make it happen.

NNAMDIYou know, Christy, one would assume that landlords would be reluctant to rent to people who have spent a long time on the streets. How do you convince landlords to take part? How do you convince service providers to take part?

RESPRESSThat's a great question.

NNAMDIWe had a conversation about that. Yes.

RESPRESSGreat question. And before I even start to answer it, let me say thank you to all of the landlords who've participated in this program, not just with Pathways but across the city, because without them, this doesn't work. You just hit it on the head. What the landlords love about this is that we have a services team on call 24/7 so that if something goes wrong, we're there. They call us, we're on their speed dial. And something Sam and Sandra both mentioned earlier is the guaranteed payment of rent. We are there to say we will make sure the rent is paid so that the person is not impacted by homelessness, again, just due to that inability to prioritize paying rent, but also that the landlord is made whole. And we've had some -- even, you know, in that 15 percent or 10 percent who don't make it in the first department, let's say, landlords come back to us consistently and say, you know, that didn't work with that tenant. Who else do you have? Let's continue to work together because it's the same in the fair market. You know, it doesn't work out with every tenant. So the rental payment and the support system really has been the selling points of this program. Now we have over -- I'd say over 70 landlords working with us, at least.

NNAMDIHere's Ruth in Northeast Washington. Ruth, your turn.

RUTHHello. Thanks for taking my call. I am in my 30s now. But when I was 16, my family became homeless because my father had died and my mother had some mental health issues. And it was obviously really hard on me and my sister, and we were very lucky. We actually lived in Southern Maryland and a local pastor took us in. So us kids stayed with her while my mother sort of squatted with no electricity and no running water. And, of course, it was very hard for us, but because we had a stable place, we went on to go to college and we're now, you know, contributing members of society. My sister is a social worker. But I'm just curious. You know, there's obviously a real cost with homeless families and children whose lives are just completely disrupted. And I'm curious, it sounds like most of the people in Pathways are individuals. And is there anything similar for family situations?

NNAMDIAnd I'm glad you mentioned that you're in Southern Maryland, Ruth, because it'll allow Sam to answer two questions at the same time because we think about this as being done mostly in big cities. But you've also got a program in a more rural setting in Burlington, Vt. How is that working? And you can also talk about -- to Ruth about whether you can deal with individual young people.

TSEMBERISAbsolutely. The model is flexible so that the housing is the same for everyone. A family would need a larger apartment than an individual. There are many wonderful examples of this program model working very well for families. Hennepin County in Minnesota comes to mind quickly. There are programs here in D.C. that are family programs that work very well. The support services are different because there are children involved. There isn't -- it isn't about addiction, mental illness. It's about some mental health supports, some child development issues, some benefits issues so that the services are different. The housing is simply larger, but the same. The housing is all integrated into the community. It's normal housing.

TSEMBERISAnd this is something we haven't discussed yet, but the callers, both Katherine and Ruth, talk about a support system that helps people not become homeless, not go all the way into homelessness. I think that the feeling of neighborliness and the feeling of we're all in the same boat whether we have problems or not is a core value in our willingness to take on homelessness. If homelessness is not about a person that is different from us on a park bench, but homelessness is about our neighbor or our relative, our feeling about their care becomes very different.

TSEMBERISThe reason that the model of using normalized housing like we do is so important is that it puts people in ordinary buildings where you are somebody's neighbor, and it includes people that have traditionally been either marginalized or institutionalized or somehow kept out of the mainstream. This program is also about integrating the mental health piece into society in a very normative way so that we're all neighbors together. The model does work well, whether it's an urban setting or a rural setting. It's just that the housing looks a little different. There's transportation challenges in Burlington that we don't have in Washington, D.C. But all of the practical issues other than that are totally manageable with telemedicine and different commute times and so on. We can adjust for that.

NNAMDIAnd I'm afraid that's all the time we have. Sam Tsemberis is a psychologist and founder and CEO of Pathways to Housing, which is based in New York and which developed the Housing First model to address chronic homelessness. Sam Tsemberis, thank you so much for joining us.

TSEMBERISThank you very much for having me.

NNAMDISandra Coleman is a tenant with Pathways to Housing D.C. Sandra Coleman, thank you for joining us. Good luck to you.

COLEMANThank you.

NNAMDIAnd Christy Respress is director of programs and development with Pathways to Housing D.C., which provides housing and other services to chronically homeless people in the nation's capital. Christy, thank you for joining us.

RESPRESSYou're welcome.

NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.