Project 1811

DOWNTOWN EMERGENCY SERVICE CENTER
1811 "HOUSING FIRST" PROJECT

The 1811 Eastlake project was the subject of a 3-year study funded by a $400,000 grant from the Robert Wood Johnson Foundation.  The evaluation team included DESC and the Addictive Behavior Research Center at UW, which is part of the Department of Psychology. Mary E. Larimer PhD, professor of psychiatry and behavioral sciences and adjunct professor of psychology at UW, was lead author of the study.

On March 31, 2009, the Journal of the American Medical Association published the study:

"Providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. Stable housing also results in reduced drinking among homeless alcoholics, according to a Seattle-based study published today in theJournal of the American Medical Association (JAMA).

The study found that the program saved taxpayers more than $4 million dollars over the first year of operation. During the first six months, even after considering the cost of administering housing for the 95 residents in a Housing First program in downtown Seattle, the study reported an average cost-savings of 53 percent -- nearly $2,500 per month per person in health and social services, compared to the costs of a wait-list control group of 39 homeless people." View the press release in its entirety .

View the study abstract: Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems - The Journal of the American Medical Association (Vol. 301 No. 13, April 1, 2009)
January 2008 Preliminary Findings

In January 2008, Mayor Nickels announced the findings of studies on one-year outcomes at two Housing First projects: 1811 Eastlake and Plymouth on Stewart. Separate studies revealed similar findings. Preliminary research shows an estimated cost avoidance of over $4 million* because of fewer visits by these formerly chronically homeless individuals to the Harborview Medical Center and the Dutch Schisler Sobering Center, as well as less use of other crisis-treatment services.

*This figure is updated from the original press release. At that time the figure had been estimated at $3.2 million.

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Background Information
The project arose out of a King County sponsored 1997 "Housing Plan for Persons who are Chronically Publicly Inebriated (CPI)" developed by a task force of government and provider representatives from Seattle and King County.   An array of housing options were recommended to the community for development with the goal of improving recovery prospects for individuals and to reduce the "public health, economic and social impacts of chronic alcoholics living on the streets."  The recommendations included the 1811 Eastlake model: specifically a housing project providing support services and case management where "pre-recovery" individuals can be safe and encouraged to receive treatment services.
It is estimated that there are about 500 CPI in downtown Seattle on any given day.  These are people who are typically over 45 years of age, chronically homeless, have at least 15 years of chronic alcohol addiction history, and multiple, failed attempts at publicly-funded conventional alcohol treatment. This population consumes extraordinary amounts of public dollars in their utilization of emergency and hospital services, emergency transportation, detoxification services, court, jail and legal services.  A 2003 Mental Health Chemical Abuse and Dependency Services Division study estimated annual costs at nearly $42,000 per person compared to approximately $10,000 per person for housing-based supportive services.

Project Description
In response to this community effort and task force recommendations, the Downtown Emergency Service Center (DESC) developed 1811 Eastlake, a 75 unit residential project which will house chronic public inebriates.  Located in the Denny Triangle neighborhood, the building contains 49 studio apartments on its upper floors and 26 semi-private cubicles on the ground floor.  Each unit is furnished with a single bed, a lockable armoire and a chair.  The semi-private units are separated by partial walls to allow for effective and continuous intervention and  monitoring by staff and share restrooms, shower and dressing areas.   Also included on the ground floor are a community dining area, kitchen, offices for DESC staff and private spaces for services.  A roof top deck provides an outdoor area for residents.

The 1811 Eastlake project provides 24 hour -7 day a week staff support for its residents including chemical dependency counseling, nursing support, meals, and general supervision. The objectives of the project are to help residents achieve housing stability, reduce residents' use of the community's crisis response system, reduce public nuisances and encourage residents to undertake and follow through with alcohol treatment.

The project will limit alcohol use and prohibit its consumption in public areas both in and outside the building.  Alcohol consumption will be restricted to resident rooms, and visitors will not be permitted to come in the building and drink.  On site staff will continually support and encourage residents to reduce alcohol consumption, hopefully leading to abstinence. Prohibiting alcohol consumption by residents entirely would make the project unable to attract the very people it is designed to serve, but behavioral thresholds will be enforced for the sake of staff, resident, and neighborhood safety. Leases will include conditions that prohibit drinking in the neighborhood as well as other uncivil behaviors.  Activities in the building will be routinely monitored by staff and visitors will have to receive approval from staff before entering the facility.

1811 Eastlake is a place where "pre-recovery" individuals can be safe and encouraged to receive treatment, and focuses on reducing the public health, economic and social impacts of this population living on the streets.  

Capital funding sources, in addition to Office of Housing Levy and federal HOME funds, were the State, King County, HUD's McKinney Supportive Housing Program (SHP), the Federal Home Loan Bank, DESC cash and equity from the sale of 9% low income housing tax credits.  Service funding is provided by the McKinney SHP, and King County Mental Heath-Chemical Abuse Dependency Services Treatment Expansion dollars.  The project also receives operating support from the Office of Housing's Levy Operating and Maintenance program and 25 Section 8 Vouchers from Seattle Housing Authority.

Occupancy Information
The 1811 Eastlake was completed in mid December 2005.  Working with King County Mental Health Chemical Abuse and Dependency Services Division and the Public Health Department, DESC began a process to identify and engage chronic homeless individuals who have been high utilizers across multiple systems including emergency response systems, Harborview, jails, and sobering services.  The goal is to house those individuals identified as high utilizers.

Evaluation Component
The 1811 Eastlake project will be the subject of a 3-year study funded by a $400,000 grant from the Robert Wood Johnson Foundation.  The evaluation team includes DESC and the Addictive Behavior Research Center at UW, which is part of the Department of Psychology. The lead evaluator is Alan Marlatt who has an international reputation on substance abuse research.

The study will be based o
n the first 75 residents of 1811 Eastlake, plus a control group of 50 people.  The evaluation has two components:

a) Cost utilization:  cost of services from multiple sources including criminal justice (mostly the jail), Medicaid, DSHS, Harborview, and substance abuse programs such as the sobering center; and
b) Behavior changes: drinking and motivation to participate in treatment and other behavioral measures.

DESC was founded in 1979 to provide emergency shelter and survival services for men and women living in a state of chronic homelessness and who, due to their severe and persistent mental and addictive illnesses, were not being served by the existing shelters of the time. Today DESC is a recognized national leader in implementing innovative cost effective strategies that end homelessness.

Here's a look at where we've been and where we're going:

1979
On November 19, DESC opens its doors as an overnight emergency shelter in the ballroom of Pioneer Square's Morrison Hotel.

From 7 p.m. to 7 a.m., a staff of 14 welcomes nearly 200 homeless adults through its doors on a first-come, first-served system. DESC begins as a partnership between the City of Seattle, the Greater Seattle Council of Churches, and WAMI (Washington Advocates for the Mentally Ill) to address the shortage of services in the community.

1980
DESC is granted a license by the State to deliver mental health care, the first step in the development of a full continuum of care for clients.

1981
With increased demand for services, DESC extends its hours. The shelter is now open from noon to 7 a.m.

1983
With long lines at the shelter resulting in people being turned away, DESC develops a lottery system to replace the first-come, first-served method.

1984
DESC clients and staff arrive en masse at Seattle's Public Safety Building to publicly protest the lack of shelter beds. The act results in new community shelters, including the first severe weather overflow shelter opened by the City and King County.

DESC is featured in the nationally broadcasted PBS documentary, Shelter, produced by Seattle station KCTS.

1985
As one of only a dozen sites selected nationwide by the Robert Woods Johnson Foundation, DESC partners with the newly-created Health Care For the Homeless to further integrate chemical dependency, mental health, and nursing care into its shelter services.

1989
DESC begins coordinating downtown street outreach with DATEN (Downtown Access, Engagement & Transition Network) to establish first contact with Seattle's most vulnerable homeless adults. This eventually leads to DESC being selected for the Federal Demonstration program, ACCESS, and the current HOST program.

1990
Due to ever-increasing demand, DESC's shelter expands operations to 24 hours daily and opens an overflow winter shelter that accommodates an additional 50 clients.

DESC becomes the first agency to partner with Common Meals (now Fa restart) to serve weekend meals to its shelter clients.

1992
As demand continues to grow, the lottery method is replaced with a system to prioritize overnight beds for those individuals most vulnerable on the streets - those living with disabilities, women, and elderly men.

Union Hotel

1994
The Union Hotel opens, DESC's first supportive housing program featuring 24/7 on-site clinical and support staff for 52 previously homeless residents.

1995
DESC establishes SAGE, a program delivering Medicaid-funded mental health treatment to clients. This marks DESC's inclusion into the mainstream mental health service community.

DESC develops a scattered site housing program, to assist homeless clients enrolled in DESC's SAGE program in renting affordable apartments while receiving on-going care.

"Homeless women get less attention than homeless men do, even though women face the same difficulties men do plus hardships unique to them - the risk of rape or assault, child-care concerns and, in a majority of cases, histories of domestic violence or sexual abuse."

The Seattle Times, March 24, 1996

Lyon Building

1997
DESC assumes management of the Lyon Building. A 64-unit facility owned by AIDS Housing on Washington (now Building Changes). As DESC's first Harm Reduction Housing model, the program focuses on homeless adults affected by the HIV/AIDS, mental illness, and/or addiction.

Kerner-Scott House

DESC introduces to the region the concept known today as housing first by opening Kerner-scott House, which uses housing as a way to engage people into services. Its 40 apartments are designed to provide stability for homeless, mentally ill, and/or addicted adults with no previous connection to services.

1999
DESC becomes a licensed chemical-dependency provider, allowing both emergency shelter and housing clients with co-occuring mental health and chemical dependency problems to receive critical services.

DESC begins the Crisis Respite Program (CRP) Working in partnership with Harborview Medical Center and King County Medical Health Court, CRP provides shelter and case management for mentally ill homeless adults still emerging from a recent crisis or jail.

2000
DESC launches CHASERS, its internally developed electronic data system that enhances the agency's emphasis on highly integrated services and housing. The system is later adopted by other human services agencies.

2002
DESC's Kern er-scott House Women's Shelter Opens, providing 25 beds for Seattle's most vulnerable mentally ill homeless women.

The Morrison

2003
A $27 million renovation of the Morrison begins, resulting in a state-of-the-art shelter and day center, centralized administrative offices, and five floors of supportive housing. The Morrison becomes DESC's largest housing project, marking the turning point at which DESC houses more people than shelters them.

DESC extend its prioritization of vulnerability to daytime services, and implements an evaluation tool to objectively measure a client's vulnerability based on his/her health, disability, and level of functioning.

1811 Eastlake

2005
After two years of controversy and lawsuits surrounding the project, 1811 Eastlake opens, providing 75 units for chronically homeless people with severe alcohol problems who, previously, were the community's high utilizers of public services. In 2009, The Journal of the American Medical Association publishes a study revealing that 1811 Eastlake annually saves taxpayers $4 million dollars.

2006
DESC launches The Connections program, establishing a center where non-disabled clients can access showers, computers, job-counseling and other services to help them find employment, housing and independence.

2007
DESC launches PACT, a nationally recognized program that works with people with serious and persistent mental illness. The PACT model is distinguished by its intensive outreach and team-oriented, trans-disciplinary approach.

Evans House

Named for a former DESC employee, Evans House opens to provide supportive housing for 75 men and women with serious mental illness, including those who are developmentally disabled or addicted.

2008
An innovative employment program is established to match DESC clients with local employers. DESC's thrift store serves as a valuable training tool to enhance clients' basic job skills and prepare them for retail employment.

Rainier House

2009
Rainier House opens, providing an additional 50 supportive apartments in the Columbia City neighborhood.

DESC breaks ground on Canaday House, which will provide 83 supportive apartments, 25 of which will be designated for veterans. Canaday House is scheduled to open in the fall of 2010.

On November 19, 2009, DESC's Main Shelter will have been open for 10,957 consecutive days.

DESC continues to expand supportive housing and clinical treatment until there are no more people impacted by homelessness in our community.

Canaday House

2010
DESC opens Canaday House, an 83-unit supportive housing bundling named in memory of former DESC volunteer and advocate for ending homelessness, Nick Canaday. 25 units are designated for disabled veterans.