Existing law establishes the California Interagency Council on Homelessness to oversee the implementation of Housing First guidelines and regulations, and, among other things, identify resources, benefits, and services that can be accessed to prevent and end homelessness in California. Existing law requires a state agency or department that funds, implements, or administers a state program that provides housing or housing-related services to people experiencing homelessness or at risk of homelessness to revise or adopt guidelines and regulations to include enumerated Housing First policies. Existing law specifies the core components of Housing First, including including, among others, services that are informed by a harm reduction philosophy that recognizes drug and alcohol use and addiction as a part of tenants lives, where tenants are engaged in nonjudgmental communication regarding drug and alcohol use, and where tenants are offered education regarding how to avoid risky behaviors and engage in safer practices, as specified, and prohibiting the use of alcohol or drugs, in and of itself, without other lease violations, from constituting a reason for eviction.

This bill would provide an exception to that prohibition, authorizing the eviction prohibition described above to authorize a tenants eviction based upon the use of drugs or alcohol, without other lease violations, when children are housed in the same location. The bill would also authorize a state department or agency to authorize programs to fund recovery housing or housing models that, in conjunction with nonclinical substance use-specific services, peer support, and physical design features that support individuals and families on a path to recovery from addiction, emphasize abstinence from substance use, if the program uses at least 75% of its funding in each county on housing or housing-based services that use a harm reduction model and meets other specified requirements. The bill would require the authorizing state department or agency to conduct periodic monitoring of the abstinence-focused recovery housing to ensure compliance with these requirements.

Existing law establishes the California Interagency Council on Homelessness to oversee the implementation of Housing First guidelines and regulations, and, among other things, identify resources, benefits, and services that can be accessed to prevent and end homelessness in California. Existing law requires a state agency or department that funds, implements, or administers a state program that provides housing or housing-related services to people experiencing homelessness or at risk of homelessness to revise or adopt guidelines and regulations to include enumerated Housing First policies. Existing law specifies the core components of Housing First, including prohibiting the use of alcohol or drugs, in and of itself, without other lease violations, from constituting a reason for eviction.

This bill would provide an exception to that prohibition, authorizing a tenants eviction based upon the use of drugs or alcohol, without other lease violations, when children are housed in the same location.

SENATE COMMITTEE ON HOUSING

Senator Nancy Skinner, Chair

2023 - 2024 Regular

Bill No: SB 1438 Hearing Date: 4/2/2024

SUBJECT: Housing First: sober housing

DIGEST: This bill would change the “core components of Housing First” to: (1) allow the eviction of a resident for the use of drugs or alcohol if children are housed in the same location; and (2) include “recovery housing” programs, as specified.

ANALYSIS:

Existing law:

1. Establishes the California Interagency Council on Homelessness (Cal-ICH) with the purpose of coordinating the state’s response to homelessness by utilizing Housing First practices.
2. Requires agencies and departments administering state programs created on or after July 1, 2017 to incorporate the core components of Housing First.
3. Defines “Housing First” to mean the evidence-based model that uses housing as a tool, rather than a reward, for recovery and that centers on providing or connecting homeless people to permanent housing as quickly as possible. Housing First providers offer services as needed and requested on a voluntary basis and that do not make housing contingent on participation in services.
4. Defines, among other things, the “core components of Housing First” to mean:
5. Acceptance of referrals directly from shelters, street outreach, drop-in centers, and other parts of crisis response systems frequented by vulnerable people experiencing homelessness.
6. Supportive services that emphasize engagement and problem-solving over therapeutic goals and service plans that are highly tenant-driven without predetermined goals.
7. Participation in services or program compliance is not a condition of permanent housing tenancy.
8. Tenants have a lease and all the rights and responsibilities of tenancy, as outlined in California’s Civil, Health and Safety, and Government codes.
9. The use of alcohol or drugs in and of itself, without other lease violations, is not a reason for eviction.
10. Establishes the Homeless Housing Assistance and Prevention Program (HHAPP) to build on the now closed out Homeless Emergency Aid Program (HEAP) and provide funds to help local jurisdictions combat homelessness.

This bill:

1. Provides that the “core components of Housing First” allows for the eviction of a resident merely for using drugs or alcohol if children are housed in the same location.
2. Provides that the “core components of Housing First” would allow for state housing funding to be used for “recovery housing” or housing models that in conjunction with non-clinical substance use specific services, peer support, and physical design features supporting individuals and families on a path to recovery from addiction, emphasize abstinence from substance use, if at least 75% of the programs funding in each county is used for housing or housing based services that use a harm reduction model and the program complies with all of the following:
   • 1. The individual or family is offered options and chooses recovery housing.
     2. The recovery housing otherwise complies with all other components of Housing First.
     3. Participation is self-initiated.
     4. Outcomes emphases long-term housing stability and minimize returns to homelessness.
     5. Policies and operations ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint, as well as uninterrupted access to housing.
     6. Holistic services and peer-based recovery supports are available to all program participants along with services that align with participants’ choice and prioritization of personal goals of sustained recovery and abstinence from substance use.
     7. The housing abides by local and state landlord-tenant laws governing grounds for eviction, and
     8. Relapse is not a cause for eviction from housing and instead tenants shall receive relapse support
     9. Eviction shall only occur when a tenants behavior substantially disrupts or impacts the welfare of the recovery community.
     10. The housing provider shall offer assistance in accessing housing operated with harm reduction principals if the tenant is no longer interested in living in a recovery housing model.
3. The program complies with periodic monitoring by the authorizing department or agency to ensure that all of the requirements are met.

COMMENTS:

1. Author’s statement. “SB 1438 is a very limited clarification of homeless housing funding eligibility to programs that provide housing and treatment of substance use disorders. It includes valuable safeguards to ensure that if a recovery residence participant no longer chooses to participate in drug-free living, that person is not penalized or returned to homelessness. Expanding clarity on funding options to programs that work to help people (and especially parents) address their addiction issues will help protect children and families by opening more housing program options, getting them the services they need and setting them on the path to stability. This is an incremental common sense approach.”
2. What are the effects of homelessness? Homelessness increases the risk of developing health problems, and it increases the possibility of trauma, especially as a result of physical or sexual assault. It can also turn a relatively minor health problem into a serious illness. Unsheltered individuals experiencing homelessness possess major and worsening health conditions while homeless. According to the Health Conditions Among Unsheltered Adults in the U.S. report by the California Policy Lab, unsheltered individuals experiencing homelessness were nearly three times as likely as sheltered individuals experiencing homelessness to report that mental health conditions contributed to loss of housing (50% to 17%).^[1] Unsheltered individuals experiencing homelessness face harsher living conditions, putting them at higher risk of using alcohol and other substances to cope, which may result in disrupting relationships, loss or prevented employment, or inability to locate housing. The California Policy Lab also found that unsheltered individuals experiencing homelessness are more than five times as likely to report a substance use condition (75% vs. 13%).

Single unsheltered homeless women in particular are at risk of developing substance abuse issues while living on the streets. They are more at risk of sexual assault and use drugs to stay awake at night to protect themselves from attack. Some individuals need services in addition to housing and would benefit from the range of safety net and behavioral health services available from their city or county.

1. Why are so many experiencing homelessness in California? Modern housing and homelessness policy can be traced back to the 1970s and ‘80s as national social and economic policies towards housing began to change. At that time, public housing, created to provide safe and affordable rental housing for low-income families, the elderly, and people with disabilities under the National Housing Acts of 1934 and 1937, began to deteriorate due to poor maintenance. In 1974, the Housing Community and Development Act ended most new construction of public housing and the Housing Choice Voucher Program (Section 8) was created in its place. This new program allowed eligible tenants to pay only a portion of their rent (based on their income) and shifted funds from public housing authorities to the private sector. The goal was to eliminate concentrations of low-income people in housing developments. In 1981, the Reagan administration dismantled federal affordable housing funding. From 1978 to 1983, the funding for low- to moderate-income housing decreased by 77%. Social policies contributing to the rise of homelessness included the deinstitutionalization of the mentally ill during the mid-1980s. Additionally, in the 1980s, the proportion of the eligible low-income families who received federal housing subsidies declined. In 1970, there were 300,000 more low-cost rental units (6.5 million) than low-income renter households (6.2 million). By 1985, however, the number of low-cost units had fallen to 5.6 million, and the number of low-income renter households had grown to 8.9 million, a disparity of 3.3 million units.

In recent years, an increasing number of people, including unaccompanied youth, older adults, and families, have found themselves living on the street, in shelters, or in other transitional housing arrangements, such as living with friends and family, for the first time. The causes of homelessness are varied and complicated. Economic hardship, high cost of housing, separation from the family, domestic violence, death of the family breadwinner, mental or behavioral health, and substance use disorders can all contribute to a person experiencing homelessness.

While there may be a perception that people experience homelessness due to inability or disinterest in sustaining employment because of mental health or substance use issues, many individuals and families experiencing homelessness have, or recently had, jobs. A study by the California Policy Lab found that 74% of homeless individuals in Los Angeles County had a record of employment between 1995 and 2018 prior to becoming homeless; 47% were employed within four years before their first experience of homelessness; and 19% were employed in the quarter in which they became homeless^[2]. However, the average annual earnings of study participants was only $9,970 in the year prior to experiencing homelessness.

So what are the primary drivers leading to increases in homelessness?

• 1. Available housing is not affordable. The lack of affordable housing plays a significant role in causing individuals to become homeless or creates obstacles for individuals experiencing homeless to transition into stable housing. The median home price in California is $771,270 in 2022, which is double the nationwide median. In addition, almost three million enter households, almost half of rental households in California, are low-income (50-80% of the Area Median Income, or AMI), very low-income (30-50% AMI), or extremely low-income (0-30% AMI). As a result, many Californians are rent burdened (spend more than 30% of their income on rent). By income level, almost 90% of extremely low-income, 85% of very low-income, and 63% of low-income households are rent burdened.
  2. There is not enough housing. The lack of supply is the primary factor underlying California’s housing crunch. The state Department of Housing and Community Development (HCD) estimates that California needs to build 180,000 new homes a year to keep up with population growth^[3]. More recently, HCD noted in its statewide housing plan that California must plan for more than 2.5 million homes over the next eight-year cycle, and no less than one million of those homes must meet the needs of lower-income households. This represents more than double the housing planned for in the last eight-year cycle.^[4]

1. What are the primary solutions to ending and preventing homelessness? Simply put, we need more housing; more housing at all income levels, and in particular, more housing affordable to the lowest income earners.

According to the United States Interagency Council on Homelessness, in a May 2019 report, “when housing costs are more affordable and housing opportunities are more readily available, there is a lower likelihood of households becoming homeless, and households who do become homeless can exit homelessness more quickly and with greater likelihood of sustaining that housing long-term. To reduce the negative impacts of housing instability, and to end homelessness as quickly and efficiently as possible, communities are increasingly focused on expanding the supply of housing that is affordable to renter households at lower income levels, as well as ensuring that people experiencing and exiting homelessness have access to such housing.”^[5]

A report released by the National Low Income Housing Coalition on April 21, 2022 found that in the Sacramento metro area, very low-income renters face a shortage of more than 78,000 affordable and available homes.^[6] Additionally, the report found that only 41 affordable and available rentals exist in the Sacramento region for every 100 very low-income renter households, according to the coalition’s analysis. The shortage is exacerbated by the fact that low-income renters find themselves competing against higher-income renters in the private market, which cannot sufficiently compensate for the deficit. The report, focused on federal solutions, stated that the shortage can only be addressed through sufficient long-term federal investments in affordable housing programs designed to serve households with the greatest needs. The same conclusion, however, can be attributed to the entire state of California.

1. What is the state doing to end and prevent homelessness? Beginning largely in 2017^[7], the State of California and the voters have taken significant steps to invest billions of dollars for affordable housing construction, homeownership opportunities, and flexible homelessness solutions, as well as investments in infrastructure necessary to support these projects.^[8] The Legislature has also created streamlined development approval processes and reduced opportunities for local governments to disapprove of quality permanent housing projects and homeless shelters, which have sped-up the approval of these processes, and reduced costs associated with unreasonable project delays.^[9] Further, the state has increased planning requirements so that local governments create an environment to facilitate the creation of housing, and in particular, affordable housing construction^[10], and provided grants directly to local governments for these purposes.

According to Cal-ICH, between 2017 and 2020, Continuums of Care (CoCs) across California have increased efforts to address the homelessness crisis by serving 40% more people experiencing homelessness (176,412 in 2017 compared to 246,142 in 2020)^[11]. In many areas of the state, despite these efforts, for every person housed, another two fall into homelessness.

There is no denying more can and should be done; however with limited resources and looming budgetary challenges, the state should focus limited investments on evidence-based programs that ensure housing stability.

1. What is Housing First? Housing First approaches homelessness by providing permanent, affordable housing for families and individuals as quickly as possible, then providing supportive services to prevent their return to homelessness. This strategy is an evidence-based model that focuses on the idea that homeless individuals should be provided shelter and stability before underlying issues can be successfully addressed. Under the Housing First approach, anyone experiencing homelessness should be connected to a permanent home as quickly as possible, and programs should remove barriers to accessing the housing, like requirements for sobriety or absence of criminal history. It is based on the “hierarchy of need;” people must access basic necessities—like a safe place to live and food to eat—before being able to achieve quality of life or pursue personal goals. Housing First values choice in not only where to live, but whether to participate in services. This approach contrasts to the “housing readiness” model where people are required to address predetermined goals before obtaining housing. In other words, housing readiness means housing is “earned” and can also be taken away, thus returning to homelessness.
2. What type of housing is considered Housing First? Programs using Housing First generally fall into two categories:
3. Supportive housing, which is a home made affordable through long-term rental assistance, paired with intensive services promoting housing stability.
4. Rapid re-housing, which connects a family or individual to a home affordable through short-to medium-term rental assistance, along with moderate services designed to allow that household to increase their income sufficiently to be able to afford the apartment over the long-term.
5. Who else employs Housing First principles? The federal government has shifted its focus to Housing First over the last decade, starting under the Bush administration, and housing programs financed by HUD utilize core components of this strategy. Since the implementation of the Housing First model, chronic homelessness in the U.S. experienced a 27% decrease between 2010 and 2016.

In 2005, over 10 years before California, Utah implemented a statewide Housing First model prioritizing permanent, affordable housing to people experiencing homelessness without mandating participation or continuation in supportive services to receive or retain that housing. Housing First reduces the overall costs incurred when localities provide social services to people where they live, rather than allowing them to continue to cycle through jails, emergency rooms, and treatment centers. Since its implementation, Utah has decreased its chronically homeless population from 1,932 in 2005 to 493 in 2019, a 74% decrease. Using Utah as the model, Housing First was embraced by California in 2015 through SB 1380 (Mitchell, Chapter 847, Statues of 2016) which requires all housing programs in the state to adopt this model.

1. Housing First fact-checks. Those who criticize Housing First tend to argue three main points: (a) Housing First is “one size fits all”, (b) Housing First does not provide adequate treatment to clients, and (c) Housing First is not effective.
2. Housing First is the flexible, low-barrier homelessness solution. Housing First is not housing only, nor does it preclude financing emergency shelters or other interim housing solutions. Rather, it means that the needs of people experiencing homelessness vary person by person, family by family. To that end, some people merely need stable, affordable housing while struggling with economic hardships, while others need wraparound services to address physical, behavioral, or substance abuse challenges.
3. Housing First does not mean housing only – it means housing “first”. Housing First means that a person does not have to earn housing, whether interim or permanent; rather people are provided Housing First, and in addition to any additional supports specific to their individual or familial needs. If anything, Housing First is the opposite of “one-size-fits-all.”
4. Housing first does not preclude evictions of disruptive tenants. Those opposed to Housing First falsely allege that tenants cannot be evicted under state law. However, state law governing Housing First specifically provides that landlord/tenant right and responsibilities extend to these programs; Housing First provides that “the use of drugs or alcohol in and of itself, without other lease violations, is not a reason for eviction.” In other words, a tenant that is otherwise disruptive to other residents or engaging in other lease violations may be evicted.
5. Housing First does not preclude court ordered sobriety. Some seeking to fund non-Housing First programs falsely claim that those who are serving a court order to maintain sobriety cannot comply with Housing First principles; this is of particular importance for mothers seeking custody of their children. According to the opposition, however, Housing First does not hinder a court order from standing, and bears no relationship to a person’s housing situation. Should a person violate a court order, specified sanctions provided by the court will occur (such as penalties related to child custody). This would be no different from anyone living in a non-state subsidized housing unit who is subject to a court order.
6. Housing First is the data driven solution keeping people housed, longer. According to the National Alliance to End Homelessness, Housing First has been tested again and again, and the overwhelming volume of research supports Housing First; this is why federal and state homelessness programs currently require applicants to comply with Housing First principles. For example, the Benioff Homelessness and Housing Initiative at the University of California San Francisco conducted a randomized control trial of a permanent supportive housing intervention in Santa Clara County on a Housing First basis for those with the highest needs. Of those who received treatment, 86% were successfully housed and remained housed for three years. There was also a sharp drop in utilization of emergency psychiatric services among the treatment group. Further, providing people experiencing homelessness with housing and wrap around services is incredibly cost effective and reduces burdens on the taxpayer, who pay for emergency services and jails^[12].
7. Housing First does not hinder homeless shelters or navigation centers from receiving state funds. For example, awardees for both HEAP and HHAPP have utilized funds for homeless shelters.
8. Housing First saves the taxpayers money. According to the most comprehensive homelessness cost study conducted in the United States released in 2015, by prioritizing housing opportunities for persistently homeless individuals with the highest costs, it is possible to obtain savings that more than offset the cost of housing. In Santa Clara County, the average pre-housing public cost was $62,000 and the average post-housing cost was $20,000, or a nearly $43,000 annual reduction^[13]. Another cost study, conducted in Los Angeles in 2009 found that public costs are overall reduced by 79% when homeless individuals are provided with permanent supportive housing^[14].
9. Housing First topline takeaways. The federal and state government recognized that Housing First is the only evidence-based model for solving homelessness. Here are the key reasons:
10. Tenants accessing Housing First programs are able to move into housing faster than programs offering a more traditional approach.
11. Tenants using Housing First programs stay housed longer and offer more housing stability than other programs.
12. Over 90% of tenants accessing Housing First programs are able to retain housing stability.^[15]
13. In general, tenants using Housing First programs access services more often, have a greater sense of choice and autonomy, and are far less costly to public systems than tenants of other programs.
14. Evictions for relapse. This bill would modify the core components of Housing First by allowing landlords or property owners to evict residents merely for using drugs or alcohol if there are children housed in the same building. As noted above in Comment (9)(c), Housing First already provides that a disruptive resident or a resident taking other actions in violation of the lease agreement may be evicted. Housing First provides, however, that “the use of drugs or alcohol in and of itself, without other lease violations, is not a reason for eviction.” This bill would have the absurd result of evicting formerly homeless families back to the streets. As noted by the opposition, relapse is a normal part of recovery for people with substance abuse disorders and should not be penalized with a return to homelessness. Children experience unique trauma and other health and educational setbacks from the disruption associated with homelessness and housing instability.
15. What is recovery housing? Recovery housing is a model that is abstinence-focused and offers peer supports for people recovering from substance abuse issues. After treatment for substance abuse, whether by prison, hospital-based treatment programs, or therapeutic communities, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of relapse. As a consequence, alcohol and substance use recidivism following treatment is high for both men and women. Recovery housing offers participants an option to live with other abstinence focused residents and are offered supports through the recovery process.
16. Who oversees recovery housing? Unlike Housing First there is no commonly established implementation model. Additionally, there is no federal regulation or standards to address recovery housing, nor are there regulations in California or state oversight over these programs.

The committee may wish to consider the efficacy of providing state funds to housing programs without robust state and local oversight mechanisms.

1. Is recovery housing effective? According to the opposition, there is little data available to demonstrate the efficacy of recovery housing programs. For example, one study evaluated Oxford Homes, one of the largest recovery housing providers. While the report highlighted the importance of choice, there was little evidence to demonstrate the overall efficacy of these programs^[16]. In 2019, the US Department of Health and Human Services published a report reviewing the efficacy of various housing program types that served individuals with opiod use disorder (OUD), including recovery housing programs.^[17] The report concluded:

“While this project identified research and promising models relating to serving individuals with OUD who are experiencing homelessness, there were significant gaps in the evidence base…. No literature was found related to rapid re-housing and individuals with OUD, nor was literature found relating to the success of transitional housing in the population of individuals with OUD, despite extensive funding for transitional housing programs. We did not identify any studies with side-by-side comparisons of various housing models to serve people with OUD.” (emphasis added).

1. What about “successful” non-Housing First programs? Those who wish to see state funds diverted to non-Housing First models, such as transitional housing and recovery housing, point to a handful of programs operated in California that have demonstrated “positive results.” These programs are laudable for the work they do to help those that are indeed successful, but as a general matter, the evidence does not support the notion that non-Housing First programs are successful in keeping people housed. Additionally, the committee has not been provided with any data demonstrating the efficacy of these specific programs at keeping people housed over the long-term.

The committee may wish to consider that, as a state policy, and with limited resources and even possible funding cuts, whether the state should focus on solutions that are evidence-based and data driven, reduce barriers to maintaining and accessing housing, and are least likely to return people to the streets. Should non-Housing First programs wish to continue to operate and demonstrate success on an individual basis, they can access local and private investments.

1. Let’s be clear. This bill would authorize state housing funds for people experiencing homelessness to be spent on recovery housing programs.

With the increased focus on accountability and state priority towards investing in data-driven programs that solve homelessness, this would divert funds from programs proven to reduce and end homelessness to those with little to no oversight.

The committee may wish to restore the requirement for Housing First policies to be a threshold requirement for state homelessness funds.

1. Gutted. This bill was gut and amended by the author, which, due to spring recess, did not appear in print to the public until April 1, 2024. The prior version of the bill would have allowed state funded housing first programs to evict residents solely on the basis of using alcohol or drugs if there were children present in the same building.
2. Opposition. The opposition are concerned about eroding housing first policy in California. According to the National Alliance to End Homelessness, “there is little evidence on the effectiveness of recovery housing and sober living settings in assisting individuals to both obtain and retain their housing while simultaneously supporting their recovery. By contrast, programs utilizing existing Housing First models, grounded in harm reduction principles, have extremely robust data on their effectiveness at supporting a range of outcomes, including housing retention and recovery.” The ACLU California Action and Western Center on Law and Poverty (WCLP) write that sober living facilities are “for-profit facilities that are unregulated, known to often offer no services to support residents’ substance use recovery, and place people in deplorable living conditions. Given that our State already struggles to make available sufficient financial resources for homelessness programs, and it is a challenging budget year, it would be harmful to allow these predatory facilities to siphon funding away from California’s other best-practice programs. Even though the amendments add new requirements that attempt to improve the quality of sober living programs, we have significant concerns about oversight and monitoring.” Additionally, they are concerned that this bill would put unstably housed families with children at risk of housing insecurity and homelessness. The AIDS Healthcare Foundation opposes the prior version of the bill.
3. Double-referral. This bill was also referred to the Judiciary Committee.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

POSITIONS: (Communicated to the committee before noon on Wednesday,

March 27, 2024.)

SUPPORT:

California Consortium of Addiction Programs and Professionals (Sponsor)
Anaheim Lighthouse
California Alliance for State Advocacy
Opus Health
Orange County Recovery Collaboration
Recovery Advocacy Project California
The Purpose of Recovery
The Villa Center
Young People in Recovery

OPPOSITION:

ACLU California Action

AIDS Healthcare Foundation

Disability Rights California

National Alliance to End Homelessness

Western Center on Law and Poverty

-- END --

1. Janey Rountree, Nathan Hess, and Austin Lyke. “Health Conditions Among Unsheltered Adults in the U.S.” (California Policy Lab, October 2019). https://www.capolicylab.org/wp-content/uploads/2019/10/Health-Conditions-Among-Unsheltered-Adults-in-the-U.S.pdf ↑

2. Till Von Watcher, Geoffrey Schnorr, and Nefara Riesch. Employment and Earnings Among LA County Residents Experiencing Homelessness. (California Policy Lab, February 2020). https://www.capolicylab.org/wp-content/uploads/2020/02/Employment-Among-the-Homeless-in-Los-Angeles.pdf ↑

3. California’s Housing Future: Challenges and Opportunities. (California Department of Housing and Community Development, February 2018). https://www.hcd.ca.gov/policy-research/plans-reports/docs/sha_final_combined.pdf ↑

4. A home for every Californian. (Department of Housing and Community Development, March 2022). https://statewide-housing-plan-cahcd.hub.arcgis.com/ ↑

5. The Importance of Housing Affordability and Stability for Preventing and Ending Homelessness. (US Interagency Council on Homelessness, May 2019). https://www.usich.gov/resources/uploads/asset_library/Housing-Affordability-and-Stablility-Brief.pdf ↑

6. Yoon-Hendricks, Alexandria. 78,000 low-income Sacramentans can’t find an affordable home to rent, report finds. (Sacramento Bee, April 21, 2022). https://www.sacbee.com/news/equity-lab/article260609137.html?ac_cid=DM636661&ac_bid=-371228598 ↑

7. “2017 Legislative Housing Package”. (Senate Housing Committee, October 2017). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/2017%20Housing%20Legislative%20Package.pdf ↑

8. “Background on Financing Programs for Affordable Housing”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/Housing%20Finance%2010.2021.pdf ↑

9. “Overview of Housing Issues in California”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/Overview%20of%20housing%20issues%20-%2010.2021.pdf ↑

10. “Housing Element and RHNA Law: Recent Reforms”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/RHNA%20reform%20fact%20sheet%20-%2010.2021.pdf ↑

11. California Interagency Council on Homelessness. “Homeless Data Integration System”. (2021) https://bcsh.ca.gov/calich/hdis.html ↑

12. Maria C. Raven, Margot Kushel, Matthew J. Niedzwiecki. A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services. (University of California San Francisco, September 2020). https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13553 ↑

13. Daniel Flaming, Halil Toros, and Patrick Burns. Home Not Found: The Cost of Homelessness in Silicon Valley (Economic Roundtable, 2015). http://economicrt.org/wp-content/uploads/2015/05/Home_Not_Found_2015.pdf ↑

14. Daniel Flaming, Patrick Burns, and Michael Matsunaga. Where we Sleep: Costs when Homeless and Housed in Los Angeles. (Economic Roundtable, 2009). http://economicrt.org/wp-content/uploads/2009/11/Where_We_Sleep_2009.pdf ↑

15. Ann Elizabeth Montgomery, Lindsay L Haill, Vincent Kane, and Dennis P. Culhane. Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH. (Journal of Community Psychology, March 2013). https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21554 ↑

16. Jason Leondard and Joesph Ferrari. Oxford House Recovery Homes: Characteristics and Effectiveness. May 2011. Accessible here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888149/ ↑

17. US Department of Health and Human Services. Choice Matters: Housing Models that May Promote Recovery for Individuals and Families Facing Opiod Use Disorder. June 2019. Accessed here: https://aspe.hhs.gov/sites/default/files/private/pdf/261936/Choice.pdf ↑

SENATE COMMITTEE ON HOUSING

Senator Nancy Skinner, Chair

2023 - 2024 Regular

Bill No: SB 1438 Hearing Date: 4/2/2024

SUBJECT: Housing First: sober housing

DIGEST: This bill would change the “core components of Housing First” to also include “recovery housing” programs, as specified.

ANALYSIS:

Existing law:

1. Establishes the California Interagency Council on Homelessness (Cal-ICH) with the purpose of coordinating the state’s response to homelessness by utilizing Housing First practices.
2. Requires agencies and departments administering state programs created on or after July 1, 2017 to incorporate the core components of Housing First.
3. Defines “Housing First” to mean the evidence-based model that uses housing as a tool, rather than a reward, for recovery and that centers on providing or connecting homeless people to permanent housing as quickly as possible. Housing First providers offer services as needed and requested on a voluntary basis and that do not make housing contingent on participation in services.
4. Defines, among other things, the “core components of Housing First” to mean:
5. Acceptance of referrals directly from shelters, street outreach, drop-in centers, and other parts of crisis response systems frequented by vulnerable people experiencing homelessness.
6. Supportive services that emphasize engagement and problem-solving over therapeutic goals and service plans that are highly tenant-driven without predetermined goals.
7. Participation in services or program compliance is not a condition of permanent housing tenancy.
8. Tenants have a lease and all the rights and responsibilities of tenancy, as outlined in California’s Civil, Health and Safety, and Government codes.
9. The use of alcohol or drugs in and of itself, without other lease violations, is not a reason for eviction.
10. Establishes the Homeless Housing Assistance and Prevention Program (HHAPP) to build on the now closed out Homeless Emergency Aid Program (HEAP) and provide funds to help local jurisdictions combat homelessness.

This bill:

1. Provides that the “core components of Housing First” would allow for state housing funding to be used for “recovery housing” or housing models that in conjunction with non-clinical substance use specific services, peer support, and physical design features supporting individuals and families on a path to recovery from addiction, emphasize abstinence from substance use, if at least 75% of the programs funding in each county is used for housing or housing based services that use a harm reduction model and the program complies with all of the following:
   • 1. The individual or family is offered options and chooses recovery housing.
     2. The recovery housing otherwise complies with all other components of Housing First.
     3. Participation is self-initiated.
     4. Outcomes emphases long-term housing stability and minimize returns to homelessness.
     5. Policies and operations ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint, as well as uninterrupted access to housing.
     6. Holistic services and peer-based recovery supports are available to all program participants along with services that align with participants’ choice and prioritization of personal goals of sustained recovery and abstinence from substance use.
     7. The housing abides by local and state landlord-tenant laws governing grounds for eviction, and
     8. Relapse is not a cause for eviction from housing and instead tenants shall receive relapse support
     9. Eviction shall only occur when a tenants behavior substantially disrupts or impacts the welfare of the recovery community.
     10. The housing provider shall offer assistance in accessing housing operated with harm reduction principals if the tenant is no longer interested in living in a recovery housing model.
2. The program complies with periodic monitoring by the authorizing department or agency to ensure that all of the requirements are met.

COMMENTS:

1. Author’s statement. “SB 1438 is a very limited clarification of homeless housing funding eligibility to programs that provide housing and treatment of substance use disorders. It includes valuable safeguards to ensure that if a recovery residence participant no longer chooses to participate in drug-free living, that person is not penalized or returned to homelessness. Expanding clarity on funding options to programs that work to help people (and especially parents) address their addiction issues will help protect children and families by opening more housing program options, getting them the services they need and setting them on the path to stability. This is an incremental common sense approach.”
2. What are the effects of homelessness? Homelessness increases the risk of developing health problems, and it increases the possibility of trauma, especially as a result of physical or sexual assault. It can also turn a relatively minor health problem into a serious illness. Unsheltered individuals experiencing homelessness possess major and worsening health conditions while homeless. According to the Health Conditions Among Unsheltered Adults in the U.S. report by the California Policy Lab, unsheltered individuals experiencing homelessness were nearly three times as likely as sheltered individuals experiencing homelessness to report that mental health conditions contributed to loss of housing (50% to 17%).^[1] Unsheltered individuals experiencing homelessness face harsher living conditions, putting them at higher risk of using alcohol and other substances to cope, which may result in disrupting relationships, loss or prevented employment, or inability to locate housing. The California Policy Lab also found that unsheltered individuals experiencing homelessness are more than five times as likely to report a substance use condition (75% vs. 13%).

Single unsheltered homeless women in particular are at risk of developing substance abuse issues while living on the streets. They are more at risk of sexual assault and use drugs to stay awake at night to protect themselves from attack. Some individuals need services in addition to housing and would benefit from the range of safety net and behavioral health services available from their city or county.

1. Why are so many experiencing homelessness in California? Modern housing and homelessness policy can be traced back to the 1970s and ‘80s as national social and economic policies towards housing began to change. At that time, public housing, created to provide safe and affordable rental housing for low-income families, the elderly, and people with disabilities under the National Housing Acts of 1934 and 1937, began to deteriorate due to poor maintenance. In 1974, the Housing Community and Development Act ended most new construction of public housing and the Housing Choice Voucher Program (Section 8) was created in its place. This new program allowed eligible tenants to pay only a portion of their rent (based on their income) and shifted funds from public housing authorities to the private sector. The goal was to eliminate concentrations of low-income people in housing developments. In 1981, the Reagan administration dismantled federal affordable housing funding. From 1978 to 1983, the funding for low- to moderate-income housing decreased by 77%. Social policies contributing to the rise of homelessness included the deinstitutionalization of the mentally ill during the mid-1980s. Additionally, in the 1980s, the proportion of the eligible low-income families who received federal housing subsidies declined. In 1970, there were 300,000 more low-cost rental units (6.5 million) than low-income renter households (6.2 million). By 1985, however, the number of low-cost units had fallen to 5.6 million, and the number of low-income renter households had grown to 8.9 million, a disparity of 3.3 million units.

In recent years, an increasing number of people, including unaccompanied youth, older adults, and families, have found themselves living on the street, in shelters, or in other transitional housing arrangements, such as living with friends and family, for the first time. The causes of homelessness are varied and complicated. Economic hardship, high cost of housing, separation from the family, domestic violence, death of the family breadwinner, mental or behavioral health, and substance use disorders can all contribute to a person experiencing homelessness.

While there may be a perception that people experience homelessness due to inability or disinterest in sustaining employment because of mental health or substance use issues, many individuals and families experiencing homelessness have, or recently had, jobs. A study by the California Policy Lab found that 74% of homeless individuals in Los Angeles County had a record of employment between 1995 and 2018 prior to becoming homeless; 47% were employed within four years before their first experience of homelessness; and 19% were employed in the quarter in which they became homeless^[2]. However, the average annual earnings of study participants was only $9,970 in the year prior to experiencing homelessness.

So what are the primary drivers leading to increases in homelessness?

• 1. Available housing is not affordable. The lack of affordable housing plays a significant role in causing individuals to become homeless or creates obstacles for individuals experiencing homeless to transition into stable housing. The median home price in California is $771,270 in 2022, which is double the nationwide median. In addition, almost three million enter households, almost half of rental households in California, are low-income (50-80% of the Area Median Income, or AMI), very low-income (30-50% AMI), or extremely low-income (0-30% AMI). As a result, many Californians are rent burdened (spend more than 30% of their income on rent). By income level, almost 90% of extremely low-income, 85% of very low-income, and 63% of low-income households are rent burdened.
  2. There is not enough housing. The lack of supply is the primary factor underlying California’s housing crunch. The state Department of Housing and Community Development (HCD) estimates that California needs to build 180,000 new homes a year to keep up with population growth^[3]. More recently, HCD noted in its statewide housing plan that California must plan for more than 2.5 million homes over the next eight-year cycle, and no less than one million of those homes must meet the needs of lower-income households. This represents more than double the housing planned for in the last eight-year cycle.^[4]

1. What are the primary solutions to ending and preventing homelessness? Simply put, we need more housing; more housing at all income levels, and in particular, more housing affordable to the lowest income earners.

According to the United States Interagency Council on Homelessness, in a May 2019 report, “when housing costs are more affordable and housing opportunities are more readily available, there is a lower likelihood of households becoming homeless, and households who do become homeless can exit homelessness more quickly and with greater likelihood of sustaining that housing long-term. To reduce the negative impacts of housing instability, and to end homelessness as quickly and efficiently as possible, communities are increasingly focused on expanding the supply of housing that is affordable to renter households at lower income levels, as well as ensuring that people experiencing and exiting homelessness have access to such housing.”^[5]

A report released by the National Low Income Housing Coalition on April 21, 2022 found that in the Sacramento metro area, very low-income renters face a shortage of more than 78,000 affordable and available homes.^[6] Additionally, the report found that only 41 affordable and available rentals exist in the Sacramento region for every 100 very low-income renter households, according to the coalition’s analysis. The shortage is exacerbated by the fact that low-income renters find themselves competing against higher-income renters in the private market, which cannot sufficiently compensate for the deficit. The report, focused on federal solutions, stated that the shortage can only be addressed through sufficient long-term federal investments in affordable housing programs designed to serve households with the greatest needs. The same conclusion, however, can be attributed to the entire state of California.

1. What is the state doing to end and prevent homelessness? Beginning largely in 2017^[7], the State of California and the voters have taken significant steps to invest billions of dollars for affordable housing construction, homeownership opportunities, and flexible homelessness solutions, as well as investments in infrastructure necessary to support these projects.^[8] The Legislature has also created streamlined development approval processes and reduced opportunities for local governments to disapprove of quality permanent housing projects and homeless shelters, which have sped-up the approval of these processes, and reduced costs associated with unreasonable project delays.^[9] Further, the state has increased planning requirements so that local governments create an environment to facilitate the creation of housing, and in particular, affordable housing construction^[10], and provided grants directly to local governments for these purposes.

According to Cal-ICH, between 2017 and 2020, Continuums of Care (CoCs) across California have increased efforts to address the homelessness crisis by serving 40% more people experiencing homelessness (176,412 in 2017 compared to 246,142 in 2020)^[11]. In many areas of the state, despite these efforts, for every person housed, another two fall into homelessness.

There is no denying more can and should be done; however with limited resources and looming budgetary challenges, the state should focus limited investments on evidence-based programs that ensure housing stability.

1. What is Housing First? Housing First approaches homelessness by providing permanent, affordable housing for families and individuals as quickly as possible, then providing supportive services to prevent their return to homelessness. This strategy is an evidence-based model that focuses on the idea that homeless individuals should be provided shelter and stability before underlying issues can be successfully addressed. Under the Housing First approach, anyone experiencing homelessness should be connected to a permanent home as quickly as possible, and programs should remove barriers to accessing the housing, like requirements for sobriety or absence of criminal history. It is based on the “hierarchy of need;” people must access basic necessities—like a safe place to live and food to eat—before being able to achieve quality of life or pursue personal goals. Housing First values choice in not only where to live, but whether to participate in services. This approach contrasts to the “housing readiness” model where people are required to address predetermined goals before obtaining housing. In other words, housing readiness means housing is “earned” and can also be taken away, thus returning to homelessness.
2. What type of housing is considered Housing First? Programs using Housing First generally fall into two categories:
3. Supportive housing, which is a home made affordable through long-term rental assistance, paired with intensive services promoting housing stability.
4. Rapid re-housing, which connects a family or individual to a home affordable through short-to medium-term rental assistance, along with moderate services designed to allow that household to increase their income sufficiently to be able to afford the apartment over the long-term.
5. Who else employs Housing First principles? The federal government has shifted its focus to Housing First over the last decade, starting under the Bush administration, and housing programs financed by HUD utilize core components of this strategy. Since the implementation of the Housing First model, chronic homelessness in the U.S. experienced a 27% decrease between 2010 and 2016.

In 2005, over 10 years before California, Utah implemented a statewide Housing First model prioritizing permanent, affordable housing to people experiencing homelessness without mandating participation or continuation in supportive services to receive or retain that housing. Housing First reduces the overall costs incurred when localities provide social services to people where they live, rather than allowing them to continue to cycle through jails, emergency rooms, and treatment centers. Since its implementation, Utah has decreased its chronically homeless population from 1,932 in 2005 to 493 in 2019, a 74% decrease. Using Utah as the model, Housing First was embraced by California in 2015 through SB 1380 (Mitchell, Chapter 847, Statues of 2016) which requires all housing programs in the state to adopt this model.

1. Housing First fact-checks. Those who criticize Housing First tend to argue three main points: (a) Housing First is “one size fits all”, (b) Housing First does not provide adequate treatment to clients, and (c) Housing First is not effective.
2. Housing First is the flexible, low-barrier homelessness solution. Housing First is not housing only, nor does it preclude financing emergency shelters or other interim housing solutions. Rather, it means that the needs of people experiencing homelessness vary person by person, family by family. To that end, some people merely need stable, affordable housing while struggling with economic hardships, while others need wraparound services to address physical, behavioral, or substance abuse challenges.
3. Housing First does not mean housing only – it means housing “first”. Housing First means that a person does not have to earn housing, whether interim or permanent; rather people are provided Housing First, and in addition to any additional supports specific to their individual or familial needs. If anything, Housing First is the opposite of “one-size-fits-all.”
4. Housing first does not preclude evictions of disruptive tenants. Those opposed to Housing First falsely allege that tenants cannot be evicted under state law. However, state law governing Housing First specifically provides that landlord/tenant right and responsibilities extend to these programs; Housing First provides that “the use of drugs or alcohol in and of itself, without other lease violations, is not a reason for eviction.” In other words, a tenant that is otherwise disruptive to other residents or engaging in other lease violations may be evicted.
5. Housing First does not preclude court ordered sobriety. Some seeking to fund non-Housing First programs falsely claim that those who are serving a court order to maintain sobriety cannot comply with Housing First principles; this is of particular importance for mothers seeking custody of their children. According to the opposition, however, Housing First does not hinder a court order from standing, and bears no relationship to a person’s housing situation. Should a person violate a court order, specified sanctions provided by the court will occur (such as penalties related to child custody). This would be no different from anyone living in a non-state subsidized housing unit who is subject to a court order.
6. Housing First is the data driven solution keeping people housed, longer. According to the National Alliance to End Homelessness, Housing First has been tested again and again, and the overwhelming volume of research supports Housing First; this is why federal and state homelessness programs currently require applicants to comply with Housing First principles. For example, the Benioff Homelessness and Housing Initiative at the University of California San Francisco conducted a randomized control trial of a permanent supportive housing intervention in Santa Clara County on a Housing First basis for those with the highest needs. Of those who received treatment, 86% were successfully housed and remained housed for three years. There was also a sharp drop in utilization of emergency psychiatric services among the treatment group. Further, providing people experiencing homelessness with housing and wrap around services is incredibly cost effective and reduces burdens on the taxpayer, who pay for emergency services and jails^[12].
7. Housing First does not hinder homeless shelters or navigation centers from receiving state funds. For example, awardees for both HEAP and HHAPP have utilized funds for homeless shelters.
8. Housing First saves the taxpayers money. According to the most comprehensive homelessness cost study conducted in the United States released in 2015, by prioritizing housing opportunities for persistently homeless individuals with the highest costs, it is possible to obtain savings that more than offset the cost of housing. In Santa Clara County, the average pre-housing public cost was $62,000 and the average post-housing cost was $20,000, or a nearly $43,000 annual reduction^[13]. Another cost study, conducted in Los Angeles in 2009 found that public costs are overall reduced by 79% when homeless individuals are provided with permanent supportive housing^[14].
9. Housing First topline takeaways. The federal and state government recognized that Housing First is the only evidence-based model for solving homelessness. Here are the key reasons:
10. Tenants accessing Housing First programs are able to move into housing faster than programs offering a more traditional approach.
11. Tenants using Housing First programs stay housed longer and offer more housing stability than other programs.
12. Over 90% of tenants accessing Housing First programs are able to retain housing stability.^[15]
13. In general, tenants using Housing First programs access services more often, have a greater sense of choice and autonomy, and are far less costly to public systems than tenants of other programs.
14. What is recovery housing? Recovery housing is a model that is abstinence-focused and offers peer supports for people recovering from substance abuse issues. After treatment for substance abuse, whether by prison, hospital-based treatment programs, or therapeutic communities, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of relapse. As a consequence, alcohol and substance use recidivism following treatment is high for both men and women. Recovery housing offers participants an option to live with other abstinence focused residents and are offered supports through the recovery process.
15. Who oversees recovery housing? Unlike Housing First there is no commonly established implementation model. Additionally, there is no federal regulation or standards to address recovery housing, nor are there regulations in California or state oversight over these programs.

The committee may wish to consider the efficacy of providing state funds to housing programs without robust state and local oversight mechanisms.

1. Is recovery housing effective? According to the opposition, there is little data available to demonstrate the efficacy of recovery housing programs. For example, one study evaluated Oxford Homes, one of the largest recovery housing providers. While the report highlighted the importance of choice, there was little evidence to demonstrate the overall efficacy of these programs^[16]. In 2019, the US Department of Health and Human Services published a report reviewing the efficacy of various housing program types that served individuals with opiod use disorder (OUD), including recovery housing programs.^[17] The report concluded:

“While this project identified research and promising models relating to serving individuals with OUD who are experiencing homelessness, there were significant gaps in the evidence base…. No literature was found related to rapid re-housing and individuals with OUD, nor was literature found relating to the success of transitional housing in the population of individuals with OUD, despite extensive funding for transitional housing programs. We did not identify any studies with side-by-side comparisons of various housing models to serve people with OUD.” (emphasis added).

1. What about “successful” non-Housing First programs? Those who wish to see state funds diverted to non-Housing First models, such as transitional housing and recovery housing, point to a handful of programs operated in California that have demonstrated “positive results.” These programs are laudable for the work they do to help those that are indeed successful, but as a general matter, the evidence does not support the notion that non-Housing First programs are successful in keeping people housed. Additionally, the committee has not been provided with any data demonstrating the efficacy of these specific programs at keeping people housed over the long-term.

The committee may wish to consider that, as a state policy, and with limited resources and even possible funding cuts, whether the state should focus on solutions that are evidence-based and data driven, reduce barriers to maintaining and accessing housing, and are least likely to return people to the streets. Should non-Housing First programs wish to continue to operate and demonstrate success on an individual basis, they can access local and private investments.

1. Let’s be clear. This bill would authorize state housing funds for people experiencing homelessness to be spent on recovery housing programs.

With the increased focus on accountability and state priority towards investing in data-driven programs that solve homelessness, this would divert funds from programs proven to reduce and end homelessness to those with little to no oversight.

The committee may wish to restore the requirement for Housing First policies to be a threshold requirement for state homelessness funds.

1. Gutted. This bill was gut and amended by the author, which, due to spring recess, did not appear in print to the public until April 1, 2024. The prior version of the bill would have allowed state funded housing first programs to evict residents solely on the basis of using alcohol or drugs if there were children present in the same building.
2. Opposition. The opposition are concerned about eroding housing first policy in California. According to the National Alliance to End Homelessness, “there is little evidence on the effectiveness of recovery housing and sober living settings in assisting individuals to both obtain and retain their housing while simultaneously supporting their recovery. By contrast, programs utilizing existing Housing First models, grounded in harm reduction principles, have extremely robust data on their effectiveness at supporting a range of outcomes, including housing retention and recovery.” The ACLU California Action and Western Center on Law and Poverty (WCLP) write that sober living facilities are “for-profit facilities that are unregulated, known to often offer no services to support residents’ substance use recovery, and place people in deplorable living conditions. Given that our State already struggles to make available sufficient financial resources for homelessness programs, and it is a challenging budget year, it would be harmful to allow these predatory facilities to siphon funding away from California’s other best-practice programs. Even though the amendments add new requirements that attempt to improve the quality of sober living programs, we have significant concerns about oversight and monitoring.” Additionally, they are concerned that this bill would put unstably housed families with children at risk of housing insecurity and homelessness. The AIDS Healthcare Foundation opposes the prior version of the bill.
3. Double-referral. This bill was also referred to the Judiciary Committee.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

POSITIONS: (Communicated to the committee before noon on Wednesday,

March 27, 2024.)

SUPPORT:

California Consortium of Addiction Programs and Professionals (Sponsor)
Anaheim Lighthouse
California Alliance for State Advocacy
Opus Health
Orange County Recovery Collaboration
Recovery Advocacy Project California
The Purpose of Recovery
The Villa Center
Young People in Recovery

OPPOSITION:

ACLU California Action

AIDS Healthcare Foundation

Disability Rights California

National Alliance to End Homelessness

Western Center on Law and Poverty

-- END --

1. Janey Rountree, Nathan Hess, and Austin Lyke. “Health Conditions Among Unsheltered Adults in the U.S.” (California Policy Lab, October 2019). https://www.capolicylab.org/wp-content/uploads/2019/10/Health-Conditions-Among-Unsheltered-Adults-in-the-U.S.pdf ↑

2. Till Von Watcher, Geoffrey Schnorr, and Nefara Riesch. Employment and Earnings Among LA County Residents Experiencing Homelessness. (California Policy Lab, February 2020). https://www.capolicylab.org/wp-content/uploads/2020/02/Employment-Among-the-Homeless-in-Los-Angeles.pdf ↑

3. California’s Housing Future: Challenges and Opportunities. (California Department of Housing and Community Development, February 2018). https://www.hcd.ca.gov/policy-research/plans-reports/docs/sha_final_combined.pdf ↑

4. A home for every Californian. (Department of Housing and Community Development, March 2022). https://statewide-housing-plan-cahcd.hub.arcgis.com/ ↑

5. The Importance of Housing Affordability and Stability for Preventing and Ending Homelessness. (US Interagency Council on Homelessness, May 2019). https://www.usich.gov/resources/uploads/asset_library/Housing-Affordability-and-Stablility-Brief.pdf ↑

6. Yoon-Hendricks, Alexandria. 78,000 low-income Sacramentans can’t find an affordable home to rent, report finds. (Sacramento Bee, April 21, 2022). https://www.sacbee.com/news/equity-lab/article260609137.html?ac_cid=DM636661&ac_bid=-371228598 ↑

7. “2017 Legislative Housing Package”. (Senate Housing Committee, October 2017). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/2017%20Housing%20Legislative%20Package.pdf ↑

8. “Background on Financing Programs for Affordable Housing”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/Housing%20Finance%2010.2021.pdf ↑

9. “Overview of Housing Issues in California”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/Overview%20of%20housing%20issues%20-%2010.2021.pdf ↑

10. “Housing Element and RHNA Law: Recent Reforms”. (Senate Housing Committee, October 2021). https://shou.senate.ca.gov/sites/shou.senate.ca.gov/files/RHNA%20reform%20fact%20sheet%20-%2010.2021.pdf ↑

11. California Interagency Council on Homelessness. “Homeless Data Integration System”. (2021) https://bcsh.ca.gov/calich/hdis.html ↑

12. Maria C. Raven, Margot Kushel, Matthew J. Niedzwiecki. A randomized trial of permanent supportive housing for chronically homeless persons with high use of publicly funded services. (University of California San Francisco, September 2020). https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13553 ↑

13. Daniel Flaming, Halil Toros, and Patrick Burns. Home Not Found: The Cost of Homelessness in Silicon Valley (Economic Roundtable, 2015). http://economicrt.org/wp-content/uploads/2015/05/Home_Not_Found_2015.pdf ↑

14. Daniel Flaming, Patrick Burns, and Michael Matsunaga. Where we Sleep: Costs when Homeless and Housed in Los Angeles. (Economic Roundtable, 2009). http://economicrt.org/wp-content/uploads/2009/11/Where_We_Sleep_2009.pdf ↑

15. Ann Elizabeth Montgomery, Lindsay L Haill, Vincent Kane, and Dennis P. Culhane. Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH. (Journal of Community Psychology, March 2013). https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21554 ↑

16. Jason Leondard and Joesph Ferrari. Oxford House Recovery Homes: Characteristics and Effectiveness. May 2011. Accessible here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888149/ ↑

17. US Department of Health and Human Services. Choice Matters: Housing Models that May Promote Recovery for Individuals and Families Facing Opiod Use Disorder. June 2019. Accessed here: https://aspe.hhs.gov/sites/default/files/private/pdf/261936/Choice.pdf ↑