Report #6: November 9, 2025 Review of CCC’s Engaged Social Housing
On September 10, 2025, Central City Concern (CCC), the largest provider of homeless services in Multnomah County, published a paper titled “Engaged Social Housing: Sustainable Models for Housing and Clinical Services in Supportive Housing.” It is a 25-page study detailing shortcomings in Multnomah County’s implementation of the “Housing First” policy.
Housing First is a policy that has dominated homelessness response in the US for over a decade. Its requirements are baked into most HUD, metro, and county supportive housing grants. The National Alliance to End Homelessness summarizes:
“Housing First is a homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life. This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues.”
While this may sound reasonable in theory, the CCC paper and the Portland Voice Report #5 demonstrate the serious shortcomings of this view in the real world.
The Problem with Housing First
The core problem is two-fold. First, a large number of the chronically homeless have behavioral health (BH) problems with drug addiction and/or mental health issues. Second, a significant portion of them either don’t recognize they have BH problems or are not ready to work on correcting them. If you place people in Supportive Housing while they are still active addicts and their engagement in services is voluntary (per Housing First requirements), they will often drive out neighboring, sober tenants and/or damage the facilities.
This leads to high vacancy rates and skyrocketing repair costs. CCC reports its insurance premiums have increased sixfold over the past few years and that they now have to self-insure for water damage (a major “peril” in apartment buildings). They also report 50% annual staff turnover in positions directly dealing with clients. Staff physical safety is a major issue in current union negotiations.
All these factors severely impact the viability of its housing operations. And it extends beyond CCC. They cite a report from NOAH (Network of Oregon Affordable Housing) presentation that counts 80 affordable housing projects in the Metro area, with almost 6,000 housing units, financially at risk.
CCC Recommendation: “Engaged Social Housing”
To fix the problems they identified with Housing First, CCC delicately recommends what they call “Engaged Social Housing”, which is very similar to the “Transitional Housing” we discussed in our last Report.
Whatever the name, they recommend that people who have gone through withdrawal or been stabilized in their mental illness be provided with housing that includes 24/7 support by staff trained to handle recovering addicts and/or psychological problems. This can last for weeks, months, or even a year or more, depending on the individual. Only then are they ready for the standard Supportive Housing programs.
The key differences between the current system and what CCC proposes are:
| "Housing First" - Current Approach | "Engaged Social Housing" - CCC Proposal |
|---|---|
| Individual self-assessment | Individuals are screened and directed to the level of care appropriate for their needs |
| Engagement with BH or any other services is voluntary | Engagement in BH treatment is mandatory for those receiving housing |
| All Supportive Housing facilities offer similar levels of care | Engaged Social Housing facilities are segregated (and funded) by the level and types of care they provide |
| BH treatment is siloed in separate programs, not integrated into supportive housing | Funding for BH treatment is integrated into the shelter-to-housing continuum |
CCC piloted an Engaged Social Housing experiment at its Cedar Commons facility, paid largely out of its own reserves. While this showed good results, it is not sustainable over the long term without outside (i.e., government) funding.
CCC reports that current funding models do not accommodate these needs. Medicaid, which pays for most BH services, has strict time limits on how long it will pay for various treatment programs. Supportive Housing, following the Housing First theory, requires funding recipients to prioritize those with severe BH issues, forbids mandatory treatment, but does not pay enough to cover the support they need, much less for the damage they might cause.
Criticism
Our main criticism of the CCC study is that it pulls its punches. For example, it indicates that 20% of the homeless suffer from BH problems, while citing Health Share of Oregon (the largest Medicaid insurer in Oregon) data that about 7,600 of their BH clients in the Metro area are homeless or housing insecure. This is almost half the homeless population in the Metro area and only includes Health Share clients while omitting clients served by other providers and those with no coverage at all. This supports anecdotal experience of those working with the homeless on the street, placing the number who suffer from BH issues closer to 60% to 70%.
With even more caution, CCC proposes a new phrase to describe its recommendations, “Engaged Social Housing” with the implication that this is merely an adjustment or better implementation of Housing First. But, as described above, they are really talking about a change to most of the policies of the homeless services bureaucracies, requiring large changes in their operations and funding decisions.
We believe CCC’s reticence can be explained by the fact that many governmental agencies, the NGOs they support, the homeless activist groups, and many of the politicians are strongly committed to the current Housing First policies. They have an unfortunate history of shutting off any discussion of alternatives by labeling them as “cruel” and lacking “compassion”. But the real cruelty and lack of compassion is in the current policies, which allow 450 deaths on our streets each year, thousands of overdoses, the abandonment of people who cannot care for themselves, and bankruptcy for the service providers while endangering their staff.
Summary
The massive disconnect between the policies determining the funding flows and the reality on the ground goes a long way towards explaining our lack of progress in dealing with the homelessness crisis, despite enormous spending. This is exacerbated by the lack of coordination between the county’s homeless services bureaucracy and the (seriously underfunded) behavioral health system.
To fix this, we need specific data on the homeless in Multnomah County, i.e., what their individual needs are for a path toward full recovery and what barriers exist in the current funding and infrastructure to meet those needs. And more important than additional data, what we need now is cohesion around a set of principles that can be easily summarized and used to encourage local political leadership to adopt successful policies.
We need to structure the homeless services system around the needs of the homeless. For some, that means quickly finding them a place to get back on their feet, i.e., the Housing First model. For others, it means weeks or months in something like what CCC calls “Engaged Social Housing”. In all cases, it means collecting data on the individuals’ situation and channeling them to the appropriate services. And it means coordinating the service providers so that the individuals stay on a steady path to recovery, and do not fall through the cracks.
In the past, HUD drove the Housing First policy across the country. Now, under the Trump administration, it is promoting a “Treatment First” model. In the opinion of Portland Voice, the ideal solution is to combine medical services (treatment) and housing while tailoring the approach to the individual’s needs and keeping the overall goal in mind: transitioning the homeless person from homelessness and dependency back to being a productive citizen. We do not care what you call it. In this era of reduced budgets, we must stop doubling down on failed policies.
The CCC report is a good first step. We only regret that CCC was not more forceful with its recommendations.
Sources
Engaged Social Housing: https://centralcityconcern.org/blog/exploring-a-new-approach-to-housing/
National Alliance to End Homelessness, https://endhomelessness.org/resources/toolkits-and-training-materials/housing-first/
A perfect storm: Health Share’s ecosystem data analysis, Livingston (2024). https:hsd.multco.us/wp-content/uploads/2024/07/Copy-of-HealthShare-Ecosystem-Data-Analysis-slides.pdf
Housing Insecurity, Behavioral Health Disorders, and Acute Care Utilization: A Cross-Sectional Study of Medicaid Members in the Portland, Oregon Metropolitan Area (August 6, 2025) https://assets-eu.researchsquare.com/files/rs-7274049/v1/083597de-7388-4bb8-b90e-7b0f8ebdd413.pdf?c=1754493225
Can Housing First Beat Fentanyl, Meth, and Psychoses? The Crisis of Chronic Homelessness and the Case for Heterodox Housing Policy (September 2, 2025)
