County health staff outline evidence for Housing First, supervisors press on scale and treatment

Jonathan Russell, Alameda County Health’s director for housing and homelessness services, told the Health Committee that Housing First is an evidence‑based, participant‑driven approach that prioritizes moving people into permanent housing quickly and offering voluntary, wraparound services.

"Housing First is first and foremost an evidence based...approach to housing people experiencing homelessness," Russell said, summarizing research produced by UCSF’s Benioff Homelessness and Housing Initiative and state studies that informed local practice. He cited HUD‑VASH as a national program that pairs vouchers with case management and has yielded sustained reductions in veteran homelessness.

Russell said local outcomes show progress: more than 4,700 people gained housing in the most recent fiscal year the county reported, a systemwide recidivism rate that fell from about 18% in 2020 to roughly 13% in 2025, and a flexible housing subsidy pool that produced a reported 93% retention for households served over two years.

Supervisors used the briefing to press on policy choices and capacity. Chair Supervisor Miley asked why homelessness persists despite large local investments — citing a $1.4 billion allocation to the Home Together initiative — and whether the real problem is underinvestment or lack of system scale. "If Housing First is such a sound evidence based model, why are we still dealing with homelessness?" the chair said.

Russell responded that the evidence supports strong outcomes where Housing First is implemented, but that the county — like other jurisdictions — lacks enough housing, services and sustained funding to apply the model to everyone in need. He described a three‑part strategy of prevention, shelter that moves people quickly to housing, and permanent housing with tenancy‑sustaining services.

Supervisor Lena Tam raised operational questions about the boundaries between city‑run shelters and county services, using the Mandela Homes site as an example. Russell said some shelter placements tied to encampment resolutions did not require coordinated entry for initial access, but that coordinated entry was later used to match people to permanent housing and that the county often funds navigation services billed through CalAIM when residents are eligible.

Public commenters emphasized gaps for a very small but high‑need group that may require higher‑level residential care ("board and care" settings) rather than standard permanent supportive housing. Tesla MacCarroll, executive director of Supportive Housing Community Land Alliance, said licensed boarding care can be an appropriate intermediate option and described an available project in West Oakland.

Russell acknowledged that boarding cares are part of the ecosystem and noted the county’s behavioral health housing support program funds licensed boarding care beds and related services. He also committed to follow up with supervisors about the status of specific hotel sites being considered for shelter or conversion to housing.

The committee did not take any formal actions at this meeting; staff said they would return with updates and additional details on site conversions, utilization of local shelter inventory, and the flexible housing subsidy implementation.