01:00 AM EDT on Wednesday, June 8, 2005

WASHINGTON

AFTER TWO DECADES of response, where are we on homelessness? Most would say not far enough. Aren't we still seeing the same people in the same doorways and under the same bridges? Or, sadly, their replacements?

More people are coming to the doors of agencies and faith communities, crowding our best sleeves-rolled-up efforts. For the people on the frontlines, the feeling is often that we're bailing the leaking homelessness boat -- some people move out while others fall in. All add to the burden of what has been called compassion fatigue.

Of course, we know that there have been individual successes -- those near-miraculous stories that almost every homeless agency can point to. The street alcoholic who not only recovered but is working on a master's degree while holding a full-time job.

We're thankful for such "miracles," but they are too few. Our revitalized effort on homelessness is to make the miracles commonplace: to initiate our way beyond personal and community compassion fatigue and public-policy "solution fatigue."

In his remarkable book on public policy, The Tipping Point, Malcolm Gladwell's research tells us that modest new resources and intelligent action can create a "tipping point" for change in a complex social problem.

Our national initiative on chronic homelessness is intended to create the tipping point for the most vulnerable. In President Bush's budget message for the past few years, he has called on us to end the homelessness of those who are the most disabled -- those most visible on our streets or long-term in shelters -- within the next decade.

Researchers have informed us that the chronically homeless make up 10 percent of all people in homeless programs, but they consume about 50 percent of program resources. They also disproportionately ricochet through expensive primary-health-care and behavioral-health-care systems, affecting hospital emergency rooms and the acute side of mental-health and addiction treatment.

While there is a growing body of knowledge about the cost of homelessness, no single study has been as informative as one conducted in San Diego. In that Southern California mecca for vacationers and retirees, with its 330 days of sunshine, a growing number of homeless people -- drawn there for similar reasons -- were assumed not to be expensive to the public purse.

To test the hypothesis, the University of California at San Diego was engaged to follow 15 street people for 18 months, to determine their impact on a variety of systems.

What was learned changed how San Diego responded. Why? The study found that in those 18 months those 15 people cost the city and county $3 million -- an average of $200,000 per person in emergency-room visits, ambulances, emergency medical technicians' services, hospital stays, acute mental-health and addiction treatment, law-enforcement interventions, and periods of incarceration.

Given that level of expenditure, some people said that penthouse condos with servants would have been a less expensive intervention for the homeless people. It would have!

San Diego learned what other cities across the country are learning, through similar studies. The old status-quo response to homelessness, based on uncoordinated crisis interventions, is more expensive and less effective than a response that would stop the recycling of homeless people through the existing systems.

Why is it less effective? What caused the most frustration in San Diego -- even beyond the $3 million expenditure -- was that after the study's 18 months and $200,000 had been expended, the 15 homeless subjects were in the same situation as they had been in before: in the same doorways and under the same bridges.

This led to change in San Diego, and similar studies are now driving political will for change across America.

What is creating change?

First, intelligent action. We are applying a management strategy -- a business plan -- to end chronic homelessness. The President's Management Agenda calls for investment to be research- and data-driven, performance-based, and, most important, results-oriented. We are forming partnerships with states and communities across the country to create such outcome-oriented plans.

Increased investment. This administration has increased the resources to be invested in homeless people every year for four years, and the president's budget for next year proposes an 8.5-percent increase -- which for the first time would bring the federal investment in targeted homeless assistance to over $4 billion. Included in his proposal would be the new $200 million Samaritan Initiative at the Department of Housing and Urban Development, to create housing and support services for those disabled and on the streets or long-term in shelters.

Prevention. We have placed a priority on the prevention of homelessness. Why wait until a person or family falls into the tragedy of being without a home?

In the president's budgets for the last few years, a deeper investment has been made in better outcomes for those at risk of homelessness: people leaving prison, aging out of foster care, or needing addiction, mental-health, and primary-health care. These investments will help prevent homelessness before it begins.

New technologies. Permanent housing with support services works for people who have experienced chronic homelessness. We've learned over 30 years that when vulnerable populations -- whether frail elderly or people with mental illness -- receive supports in their housing, those who have been on the streets or long-term in shelters maintain their tenancies.

Federal partnerships. Across the country, alliances are forming to end chronic homelessness, beginning in Washington, where the revitalized U.S. Interagency Council on Homelessness has brought together 20 federal agencies to make their policies and resources more available for homeless people.

The increased coordination has produced such new initiatives as an 11-city investment made by HUD and the departments of Health and Human Services and Veterans Affairs. This Chronic Homelessness Initiative has moved more than 600 people off the streets and out of shelters and into permanent housing. It is the first targeted investment to end the tragedy of homelessness in our country, and is making the individual miracles an everyday occurrence. The people who have been moved into permanent housing represent 3,800 years of homelessness.

The federal partnerships are thus good for the homeless -- and also for the cities, in reducing expensive acute treatments and law-enforcement interventions.

Partnerships with governors. In the past 20 years we've learned that no one level of government can care for the homeless alone, nor can any one sector. We've also learned that in this effort, partnership trumps partisanship: Here there are no Democrats or Republicans, but only Americans allied to end a national disgrace.

So nonpartisan partnerships now extend from the White House to the streets. Twenty federal agencies and 52 governors (we include the territories) have created State Interagency Councils on Homelessness, mirroring the U.S. Interagency Council on Homelessness, in Washington, to make their resources more available for homeless people.

Partnerships with mayors and county executives. Federal and state partnerships are important, but it is local communities that are on the frontlines of homelessness. The U.S. Interagency Council on Homelessness is now a partner with 192 cities and counties in the creation of results-oriented "business" plans to end chronic homelessness in their communities.

These are business plans in the sense that they do more than bring together an expansive group of stakeholders: hospitals, law enforcement, Chambers of Commerce, the United Way, Downtown Business Associations, treatment agencies, providers, and homeless people -- the customers of all our partnership and planning. The business plans also ensure the rigor of establishing baselines with which to quantify the problem, benchmarks of remedy, and budget implications of both new investment and cost savings.

We are, after all, learning that the results-oriented solutions of the future may be less expensive than the ad-hoc responses of the past.

Partnerships with the private sector. Through the local planning processes, the private sector is being re-engaged in an issue that seemed to have become immune to a solution-oriented approach. New resources from business and philanthropy are being invested in the plans that promise results. Nowhere is this more tangible than in Atlanta, where Mayor Shirley Franklin's plan in the past year and a half has attracted $16 million from private philanthropy. These funds are considered an investment in a return: fewer people on the streets and fewer long-term in shelters.

Faith- and community-based agencies that for years have been on the frontlines of homelessness, as well as the homeless themselves, are part of the expansive community planning that mayors are conducting.

Results. When results-oriented "business plans" are implemented, measurable outcomes follow: in Philadelphia, a 75-percent reduction in homeless street people in the center city; in Columbus, Ohio, and Miami, Fla., the numbers on the streets also fallen; and in San Francisco, which has the most visible street homelessness in America, the new outcome-oriented strategies, implemented for a year, have reduced chronic homelessness on the streets by 21.7 percent.

Around the country, homelessness is yielding to partnerships, innovation, and unprecedented political will focused on solutions. The goal to abolish chronic homelessness is achievable, and if Malcolm Gladwell is right, our success will "tip" the larger issue.

As Dr. Martin Luther King Jr. reminded us, we cannot move ahead if we leave any behind.

Philip F. Mangano is executive director of the U.S. Interagency Council on Homelessness.