Supporting the homeless population in NYC is a complex issue rooted in factors like the lack of affordable housing, mental illness, substance use, unemployment, and poor health conditions. Following the deinstitutionalization of the mentally ill, New York City (NYC) has grappled with a significant number of individuals and families seeking shelter. The late 1970s and Callahan v. Carey in 1981 paved the way for “The Right to Shelter,” yet stable and affordable housing support remains elusive.
Those experiencing homelessness often grapple with mental illness, substance use, chronic medical conditions, and higher mortality rates – four times the general adult shelter population and ten times for those living on the streets. They often face challenges navigating the health and mental health systems, resulting in a reliance on emergency department visits or inpatient hospitalizations. Limited access to healthcare results in dependence on emergency services, straining the healthcare system.
In 2019, NYC had 3,588 unsheltered individuals, with 2,178 in the MTA transit system, emphasizing the need to provide connections to housing services and support, benefiting both homeless individuals and the MTA’s 8 million daily riders. Unsheltered individuals using the train stations as dwelling places face challenges accessing shelter services. How many have been engaged in shelter services with no success is unclear. Furthermore, their chronic illnesses often go unaddressed, reflecting the broader societal struggle to support the homeless population.
Implemented in April 2022, Safe Options Support (SOS) is a joint effort between Coordinated Behavioral Care (CBC), the New York State Office of Mental Health, and well-known not-for-profit organizations that provide services to people experiencing homelessness. CBC is the SOS Hub, managing SOS referrals, quality, data and reporting, training, and the learning community. The 14 SOS teams, operating seven days a week by agencies within the CBC Independent Practice Association (IPA) network, including ACMH, Argus, Bronx Works, Services for the Underserved, Federation of Organizations, and The Bridge, provide direct care. Eleven teams cover daytime hours from 7 am to 9 pm, and three overnight teams cover the hours. The SOS programs cover outreach in New York City and are expanding to NYS Regions, such as Westchester County.
Tailored to support the unique needs of homeless individuals utilizing the train stations and adjacent areas as dwelling places, SOS employs a comprehensive approach to outreach, engagement, and support, primarily emphasizing facilitating the acquisition and retention of permanent housing. Each multidisciplinary SOS team comprises 12 staff members, including licensed clinicians, nurses, care managers, and peers.
Outreach and Engagement
Housing aspirations begin at the outreach stage. SOS extensively utilizes homeless outreach engagement techniques. The initial encounters can be characterized as compassionate, supportive, and person-centered. During this initial phase, SOS staff collaborates with stakeholders, including homeless outreach teams, public transit systems, public safety, law enforcement, hospitals, and community providers, to identify those needing support. This may include those living in public spaces, transit hubs, or deemed high-priority cases, with a specific focus on individuals chronically homeless with behavioral health conditions, substance use disorders, or other social challenges.
Outreach is performed with patience and persistence to establish trust and facilitate receptiveness. SOS engages in persistent outreach throughout NYC’s subway and terminals, making multiple visits per week. Assertive efforts are made flexibly, acknowledging some hesitancy in accepting help due to mistrust or negative past experiences with service providers. A trauma-informed approach is used, approaching with sensitivity, actively listening to stories, and avoiding re-traumatization.
Priority is building relationships by attending to what matters most, understanding immediate concerns, preferences, and challenges. It includes providing essential items like food, water, clothing, blankets, and necessary hygiene supplies, establishing survival support, and laying the foundation for building rapport. Peers, individuals with lived experience, are included to enhance understanding and provide hope. SOS understands that outreach is not just a one-time interaction. Instead, it is a diligent and tailored effort to engage, meet immediate needs, and gradually guide toward stable housing and supportive services.
When the member is ready, SOS secures emergency housing, addresses mental and physical health concerns, and fosters a support system for those transitioning from homelessness to stable housing. SOS has outreached thousands and completed over 13,000 outreach encounters, 61% of which occurred in the NYC transit system. The support, compassion, and willingness to meet the members where they are have contributed to the program’s success.
Path to Permanent Placement
Paramount emphasis is on housing obtainment. SOS’s approach involves a multifaceted strategy, commencing with intensive homeless support outreach designed to guide members from the streets to stable housing. Often, this may include a stay in emergency housing (i.e., shelter) toward a more permanent housing goal.
SOS tackles housing placement challenges by actively coordinating with the NYC Department of Homeless Services and streamlining access to essential shelter services. Recognizing the barriers individuals face in traditional shelters, SOS employs creative strategies, including Safe Havens and mental health shelters, to bridge the gap between street homelessness and stable housing. Partnerships with initiatives like ICL’s Launching Pad and the Transitional Housing Unit at Manhattan Psychiatric Center further enhance their reach. In addition, agencies such as Services for the Underserved utilized some of their housing stock to support placements.
The work is extensive yet rewarding. As members get a fresh start, SOS helps them obtain essential documents like ID cards, birth certificates, and social security cards to kickstart housing applications. The program assists with housing applications, scheduling and accompaniment to behavioral health and health appointments, and provides advocacy. To ensure stability, staff work on securing benefits like Food Stamps and SSI for members’ daily needs.
Obtaining housing is only the initial step. Central to SOS’s success is the use of critical time intervention (CTI), a time-limited, evidence-based approach that intricately tailors services to individuals during transitional periods. The CTI model allows for flexible service intensity, ensuring each member’s unique needs are met throughout their engagement. Upon entering housing, staff follow the CTI multi-phased model for up to nine months post-housing placement. The CTI model allows for flexibility and intensity of services, tailoring support to each member’s unique circumstance.
The comprehensive post-housing support framework encompasses practical assistance, emotional support, continuity of care, and community integration. Skill-building initiatives and practical help are offered, such as securing essential items. Continuity of care ensures seamless and uninterrupted support through active linkages to support systems, including formal and informal support. Community integration actively involves members in their local community, helping build connections, establish a sense of belonging, and engage in meaningful activities. Success in community integration is pivotal, supporting access to resources, forming social connections, and participating in activities that contribute to overall well-being – extending the focus beyond immediate housing needs for a holistic reintegration into society. This fortifies against potential challenges, preventing factors like loneliness from leading to a return to homelessness. Beyond mere housing placement, SOS adopts a holistic strategy, striving to create a sustainable and supportive environment that fosters lasting stability and well-being for those transitioning from homelessness to housing.
Thomas, a 42-year-old African American served by SOS at Services for the Underserved, exemplifies the program’s impact. Identified by the transit system as a top priority for intervention, Thomas embarked on a journey from chronic homelessness to stable housing. Thomas fell on hard times after leaving his mother’s apartment due to a rent increase. Working part-time as a hotel cleaner, he couldn’t afford rent or care for his daily needs. Thomas lost his housing and began sleeping on the streets and train in East Harlem.
Encountered by SOS clinicians in June 2022, SOS placed him in a shelter and initiated permanent housing placement and full-time employment. SOS teams provided immediate essentials and offered ongoing support, addressing Thomas’ unique challenges and guiding Thomas to independent living. By November 2022, Thomas secured a maintenance position within SUS, leading to a promotion to peer specialist in July 2023. He obtained permanent housing in November 2023. Thomas’ journey is a testament to SOS’s dedication to support homeless populations, illustrating that it’s never too late to transform your life with support.
Real-life testimonials from SOS members underscore the program’s pivotal role in their recovery journey.
- “SOS helped me with furniture, food, job leads, and weekly check-ups on my living and medical status. They are attentive to my needs and concerns.”
- “SOS assisted in receiving keys to my apartment within six months. I was welcomed with warmth and respect. My care manager is attentive and works daily to meet my every need. From providing me with clothing, food, and metro cards to going to job interviews and a place to do my laundry in peace.”
- “SOS helped with hygiene and shelter, an absolute blessing. I love you all for that; appreciate it.”
- “I was depressed, angry, and hostile in the shelter. The SOS staff were friendly and showed concern in helping me find an apartment. I feel more relaxed when speaking with the staff each week. This helped me be positive, and I achieved my goal of getting an apartment.”
Housing Placement and Retention Data
During the last 18 months, over 1,500 members have engaged and enrolled in SOS services. Most are males (76%), most 21% falling within the 31-40 age range (21%) and the 51-60 range (26%). 72% identifying as Black or African-American, and an additional 28% identifying as Hispanic/Latino. Remarkably, over 600 members have been relocated from train stations to shelters, and about 250 have been placed in permanent housing. Once housed, 94% have retained their housing throughout the intervention, typically lasting nine months post-housing placement. This challenges the conventional belief that engaging chronically homeless individuals takes months or even years, showcasing the program’s ability to effect change swiftly.
As SOS looks to the future, the program aims to perpetuate its collaborative, impact-driven approach. The intended system-level outcomes encompass modeling a more collaborative service system, creating a community of best practices, increasing access to supportive housing, and ultimately reducing the number of New Yorkers experiencing homelessness. Member outcomes will focus on temporary and permanent housing placements, maintaining entitlements, improved health self-management, increased community integration, enhanced daily living skills, and decreased hospitalizations.
Plans include specific action steps to achieve these outcomes. Initiatives will involve continued engagement with stakeholders, the exploration of innovative housing solutions, expanded outreach efforts, and ongoing data analysis to ensure the program remains responsive and adaptive to support the evolving needs of the homeless population in NYC.
Stay tuned for the following article on the SOS program: A Perspective from an Outreach Worker with Street Homelessness.
Gerardo Ramos, MPA, MSW, is Senior Vice President, and Barry Granek, LMHC, is Vice President at Coordinate Behavioral Care, Inc. Melissa Queliz, LMHC, is Associate VP at Services for the Underserved.
For more information about Safe Options Support, visit cbcare.org/innovative-programs/nyssos or call the 24-hour toll-free information line 1-866-SOS-4NYC.