PSH+: Where Housing Meets Health

Affordable housing and homelessness

Central LA County of Los Angeles (select only if your project has a countywide benefit) City of Los Angeles (select only if your project has a citywide benefit)

Pilot or new project, program, or initiative (testing or implementing a new idea)

Over our 60 years of providing services to people experiencing homelessness, we have seen many clients with severe needs move indoors, only to return to the streets when they don’t receive the necessary level of care. While 92% of the people we support in housing stay housed, there is a subset of the population for whom the current model is not effective and who need more help than they are getting. High-acuity individuals working with multi-disciplinary outreach teams and receiving street-based wrap-around care are often destabilized by the stark transition to a new environment and reduction of services. While providing the needed stability for many, the traditional Permanent Supportive Housing (PSH) model does not always offer the services required to support high-needs individuals and help them retain housing. The solution is PSH+, where high-acuity individuals have access to a higher level of care than the existing system supports.

The PSH+ model will prevent the most vulnerable people from falling through the gaps by offering multi-disciplinary services on-site that address their full needs and allow them to retain their housing, stabilize medically and psychiatrically, and ultimately thrive.
Inspired by the success of the multi-disciplinary approach to street outreach and interim housing, PSH+ is an innovative and in-depth development of the current PSH model that provides the services required for individuals with the highest levels of acuity to stabilize. Located in Skid Row, the PSH+ pilot program will serve an anticipated 50 individuals over 3 years who previously could not receive the level of care they require in other PSH programs. This pilot is entering the second of three years. The multi-disciplinary resources centralized within the housing site include case managers, supportive service specialists, substance use specialists, mental health and psychiatric support, registered nurses, and people with lived experience. Unlike traditional PSH, where residents work with a single case manager to problem-solve and refer them to off-site providers, PSH+ automatically connects people to on-site services without the complexity or extended wait time of navigating outside support systems. Over the course of the program, PSH+ will strive to increase stability for an entire building by ensuring that individuals at varying acuity levels get the support they need.

Of the 75,000 unhoused people in LA County, 6% can be characterized as high-acuity and in need of expanded or specialized care. While the county currently provides wrap-around services for high-needs homeless individuals living on the street, this support ends once they become housed. Returning to the street, worsening outcomes, and even death remain very common within the first year. If the existing outreach model is expanded to housing throughout the county, eliminating barriers to care, it can keep high-needs individuals housed and safe. PSH+ will greatly reduce the number of high-acuity people living on the streets throughout LA County by expanding permanent housing services to better address and manage their greater mental and medical health needs. When that 6% of people with elevated needs receive the level of care they require, they are much more likely to retain their housing and not return to the streets of Los Angeles.