Institute’s new director of research discusses housing the chronically homeless
In August, M. Lori Thomas moved into a new role at the UNC Charlotte Urban Institute as director of research and faculty engagement. She also began serving as interim director of the Institute for Social Capital.
As an associate professor in the School of Social Work, she has researched programmatic and systemic responses to homelessness and housing instability, particularly among older adults and people with physical or mental health problems. Her undergraduate degree in religion is from what is now Carson-Newman University in Jefferson City, Tenn. She earned a master of divinity degree from Baptist Theological Seminary in Richmond, Va., and both a master’s degree and a Ph.D. in social work from Virginia Commonwealth University in Richmond.
Since coming to UNC Charlotte in 2008, Thomas has focused her research mainly on issues of housing and homelessness – topics at the forefront of local civic discussions in recent years, as rising housing costs and stagnant wages have put stable housing out of reach for thousands of local residents.
She recently talked about her work with Mary Newsom, director of urban policy initiatives at the UNC Charlotte Urban Institute. The conversation, edited for clarity and brevity:
Much of your recent research has been in homelessness and housing. What’s some research you think is particularly important for the public and policymakers to understand?
My research in Charlotte has focused primarily on chronic homelessness. I’ve been really engaged in trying to test and understand our implementation of an intervention called Housing First permanent supportive housing.
Housing First does what it sounds like. It provides housing as an early step in an intervention with people who are experiencing chronically homelessness. Individuals who are chronically homeless have a disabling condition and extensive history of homelessness. Housing First uses housing as a first step or an early step in intervention, versus a system which we could call a treatment first system, which expects people to become clean and sober, to comply with their mental health medications, to get a job, do all sorts of things before they could get to housing. Research shows that housing actually stabilizes people so they can begin to work meaningfully on those other things.
I’ve been engaged in testing and understanding that intervention in Charlotte, first with a Moore Place study with the Urban Ministry Center. [Moore Place is the Urban Ministry Center’s 85-unit apartment complex for people with extensive histories of homelessness. Thomas’ 2015 study found that after two years, 81 percent of participants remained in permanent housing, emergency room visits dropped by 81 percent, days in the hospital fell 62 percent and nights in prison decreased 89 percent.] Now I lead the Housing First Charlotte-Mecklenburg Research and Evaluation Project, the area’s multi-sector effort to end chronic homelessness. It began in 2014-2015 and is trying to house every chronically homeless individual in Charlotte. They’ve housed over 600 folks. I was hired to understand the implementation process, to do a process evaluation, and also to understand the outcomes of the efforts. So how well are we doing at ending chronic homelessness? How well are the interventions working that we’re using? And how are people utilizing public health and human service resources before and after housing?
Do you have any conclusions you can share?
We don’t really have conclusions yet about the outcomes evaluation. Data collection ends in December of this year. The final reports are due in June.
I think we’re going to see, with a more rigorous study, some of what we saw in the Moore Place study – that once people are housed they use emergency health resources much less frequently. What is unique about this current study is that we’re also looking at how folks use other human services before and after they’re housed. How are they using DSS [Department of Social Services] differently? How are they using Crisis Assistance Ministry differently? Or are they? We’re really trying to understand how this intervention changes – or does it change? – the way people are engaging with our health and human services in Charlotte.
Do you have data yet on how many of those 600 chronically homeless who’ve been housed are now in stable housing and out of the system? Maybe they have jobs or enough income that they don’t need the special housing?
We don’t have that. There’s a great example of someone in Moore Place who went on to buy her own home. She got stably housed at Moore Place and eventually was able to get a job. I think she got some additional education and eventually became a homeowner. But for individuals who are chronically homeless, that outcome is not necessarily what we should be measuring. Some folks have severe and persistent mental illness, and “stable” looks a little different. It might look different if they have a chronic physical health disability. I’d be cautious about what we call “success” and “stability.” For some people it might indeed look like that path from Moore Place into homeownership. For some people, it’s going to mean remaining on a housing subsidy the rest of their lives because of a disabling condition. There’s nuance in what success means.
One person I interviewed in one of the focus groups lives in a permanent supportive housing program and has a severe and persistent mental illness, and she will need persistent, integrated supports in her housing. To me that’s a success, too. She is not on the street. She’s getting health care and proper nutrition. That in itself is success, as much as the story of buying a house. Every human being’s different, and people’s disabilities are different. It’s important to recognize that.
So you’re saying look beyond the sort of middle-class view of success: “Oh, you’ve bought your own house.”
Some folks are working. There’s one guy at Moore Place who probably volunteers 40 hours a week. But it looks very different across the board. We are still relatively young in Charlotte in our adoption of Housing First.
While I was finishing my Ph.D. I started Virginia’s first Housing First permanent supportive housing program in Richmond. It was supposed to be a pilot for the state. It was probably 2006 before we started the process. It takes a while. If you have been on the street and your health and your mental health and your spirit have been crushed – though in some cases there’s such resilience it’s amazing – but when your health and mental health have been so impacted by living in unstable housing, on the streets, in and out of shelter, it takes a while to build back up once you’re stable. There’s some initial research that shows increased use of health services – not emergency services but outpatient, primary care services. This was the case in Moore Place. In that first year, use of outpatient services went up because people hadn’t been able to proactively take care of their health. This process of stabilizing doesn’t take place overnight. It takes time for people to build their lives back. And those timetables look different for almost every person out there. For some folks it takes a while before they’re ready to deal with their addiction or before they’re able and ready to deal with their mental health disorder.
For some folks it’s getting stabilized on diabetes or heart medication, on mental health and behavioral medications. For others it’s tackling addiction in a way they haven’t been able to because they’ve been on the streets. Those stories range very broadly. The key piece of all this is that housing is the platform from which people can start to do these things.
You’re also interim director of the Institute for Social Capital. Can you explain what that is? Some people are familiar with it but, other people aren’t at all.
The Institute for Social Capital is a community integrated data system that pulls together individual-level administrative data from more than 40 service providers and institutions –examples are the Department of Social Services, sheriff’s office, the school system and the Homeless Management Information System. It allows us to integrate data across systems.
It’s an opportunity for the community to be able to understand how services are being utilized, how needs are being addressed. Integrated data systems can be used to understand what kind of situations predict problems that could happen later. We’ve had the integrated data system since 2004-05, and it’s been part of the UNC Charlotte Urban Institute since 2011-12.
If I were a DSS client I might worry about all my information being shared. Talk about ISC’s confidentiality.
We have a number of data security and data vulnerability protections in place. Researchers never get identifiable data. The identifiable data are only used to link databases to each other. Then that identifiable data is destroyed. The researchers get unidentified data. So there’s not the risk of a researcher ever having access to identifiable data.
Not only is the individual’s personal information protected, there’s also a data and research oversight committee that reviews any request to use the data. If that committee – faculty members and data-depositing partners from the community – if we’re concerned that the research is inappropriate or poor methodology or might lead to an unintended re-identification of a person or a group, then the research can’t be approved.
So there are several processes to protect the data and to assure that the research being done is beneficial.
Is there anything else you’d like to say today?
I’m a macro social worker by training, which means I practice at organizational, community and policy levels instead of primarily with individuals and families. What I’ve loved about this job so far is that I feel like I’m practicing macro social work. I’m working with partners. I’m trying to advance programming and ask questions that benefit the community. While this is a shift from the primarily academic role I’ve played for 10 years, in many ways I feel like it’s a return to my social work roots within and beyond the university. It’s the perfect intersection of my community and academic worlds.