Permanent supportive housing

Before making investments in this strategy, city and county leaders should ensure this strategy addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in permanent supportive housing. To measure these indicators and determine if investments in these interventions could help, examine the following:

• Housing stability: Number and share of public-school children who are ever homeless during the school year. These data are collected by local public school districts.

• Safety from trauma: Number of deaths due to injury per 100,000 people. These data are available from the National Center for Health Statistics’ Mortality File and the CDC’s WONDER database.

• Access to healthcare: Ratio of residents to primary care physicians. These data are available from the U.S. Department of Health and Human Services’ Area Health Resource File.
  

• Coordinated entry systems: Coordinated entry systems (CESs), which are mandatory under Continuum of Care (COC) guidelines, are the main gateway to the housing process in which individuals are assessed, prioritized, and placed in PSH. Many of these systems face challenges and constraints as the level of homelessness has grown. To improve efficiency, a CES should be able to track real-time data, free up staff capacity to facilitate systemwide improvements that benefit housing providers and clients, and establish low-barrier processes that lead to faster placement in housing. These systems should be designed to unify stakeholders, including housing authorities, landlords, and the VA, to unlock resources and serve more clients.
• Data management: Housing agencies use Homeless Management Information Systems (HMIS) to collect, manage, and report data on homeless populations, including intake and assessment information and tracking real-time data on system capacity, vacancies, and referral timelines. A well-managed system relies on quality and robust data collection, and information on client demographics, case management, service coordination, and regulatory compliance. There should also be features such as a secure client portal to submit information and documentation.
• Safety, security, and individual needs: All units in centralized-facility PSH programs should have adequate security, including an operable and lockable front door and a front desk person who monitors activity. Interiors should be well-lit, offer clear way-finding, ensure privacy, and also have designated community and outdoor spaces, and provide computer and multipurpose social rooms. In addition, there should be a mixture of unit sizes that allow for changes in a household. They should also be accessible for those with a disability, who are hearing or visually impaired, and who rely on a service animal, among other features of trauma-informed design. There should also be consideration for housing designated for special groups, including seniors, young people, and children in foster care, to accommodate specific needs.
• Client navigators: PSH programs often use client navigators to advocate for and guide clients through the PSH system to overcome barriers to entering programs, providing documentation, securing placement, and accessing services. They also educate clients on tenant rights and responsibilities, advocate on behalf of clients to address landlord issues, and provide ongoing support to ensure clients maintain housing stability. A client navigator in a permanent supportive housing (PSH) program serves as the participant's advocate and guide, helping them overcome barriers to find and maintain stable housing. They bridge the gap between clients, landlords, and various service providers, ensuring seamless access to necessary resources.
• Peer support: A key support mechanism for those experiencing homelessness is counseling from individuals who share a similar lived experience, a model that is used extensively in substance use treatment programs. Peer counselors for the homeless are trained to provide guidance, empathy, and connection to those in need. They build trust with clients to reduce isolation and build confidence and self-respect, and also offer practical assistance and support as they navigate the PSH process.
  

• Improve tracking: Implementing more reliable and detailed data tracking systems can give housing agencies a clearer picture of the overall homeless population, help staff determine who is being helped and how, and identify gaps in service to specific population groups. This data can inform improvements in operations to ensure that all vulnerable populations are receiving assistance.
• Reduce barriers to entry: For those experiencing chronic homelessness, access to documentation proving eligibility and detailing health conditions can be challenging and is often a significant barrier to program admission. One approach that can be effective in certain circumstances is to simplify and streamline the process by accepting a signed, written statement (known as self-certification) in place of third-party verification to meet PSH requirements.
• Collaborate on eligibility rankings: Because demand for PSH for the chronically homeless often exceeds availability, a vulnerability assessment tool is used by Continuum of Care organizations to rank and prioritize individuals, with those most in need receiving housing first. Assessment is based on a combination of factors, including the overall size of the homeless population, level of vulnerability, and correlation to risk, as well as the requirements of funding sources. The framework surrounding eligibility and prioritization should be transparent, with input from community groups, housing providers, and behavioral health experts, and feedback from clients.

• Individuals with lived experience: PSH services for the homeless are voluntary and made available to clients without preconditions, such as requiring individuals to enter a drug treatment program or receive mental health counseling. It is critical to understand the complex needs of the target population’s lived experience, the conditions that led to their homelessness, and the range of services they may need in addition to stable housing.
• Housing partners: Housing agencies, including city, state, and federal entities that fund the bulk of housing assistance, are responsible for identifying, referring, and placing individuals in supportive housing—and in some cases, managing the housing component. These groups collaborate with a network of landlords and property managers to increase the availability of units and ensure that the property is safe, clean, affordable, and meets housing standards.
• Veterans: Veteran homelessness has reached a record low, but more than 33,000 continue to experience both sheltered and unsheltered homelessness daily, with many suffering from mental illness and substance abuse problems. Coordinated outreach strategies are needed to make veterans aware of resources and support services, such as the National Call Center for Homeless Veterans, and to identify and engage with them on where to find resources. Case managers, working with the VA and the Department of Housing and Urban Development, along with landlords and community groups, connect veterans to stable housing, healthcare, education, and employment services.
• Service providers: To ensure the delivery of integrated services, PSH agencies establish key partnerships with both general health and mental health agencies, public health authorities, hospitals, workforce development programs, nonprofits, and community and faith-based organizations. These groups coordinate funding, share data, make referrals, and monitor access and outcomes as part of an integrated service package.
• Housing advocates: Organizations that advocate for the homeless are essential to formulate and advance policies and legislation to increase funding for PSH and expand the number of supportive housing units. They work with government agencies and other nonprofits to establish and maintain quality standards and build community support and political buy-in to expand services and develop new forms of supportive housing.

• Engage with landlords, developers, and architects: Partnering with landlords and developers is essential to ensuring adequate housing availability, and can help overcome their concerns about financial risks and other challenges associated with privately owned PSH. Also important is establishing communications and trust with landlords, to resolve problems that arise. Engaging with architects allows housing agencies to clearly articulate needs to ensure safety, security, and comfortable surroundings.
• Create a coalition and resource hub: Successful homelessness initiatives require a wide range of core competencies across government agencies, nonprofits, the private sector, and community-based organizations. They must work together to ensure that the entire process functions efficiently, and funding is secured, and housing and placement standards are maintained. A coalition can also develop a centralized resource hub for all the organizations that community residents can access for information about programs and services for the homeless.
• Consider a master lease arrangement: Landlord engagement strategies may include a master lease arrangement, in which the lease is held in the name of a government agency, or a stable nonprofit that leases the entire property. Under this model, the leaseholder (rather than the tenant) is responsible for rent payments and assumes full financial risk. This strategy can increase the number of available units, lower the risk of eviction, and secure a steady revenue stream for the property owner, while increasing the number of available units.
• Invest in technology and data capacity: Housing authorities rely on a Homeless Management Information System (HMIS) to collect client-level data on the provision of housing and services. A recent report notes, however, that most jurisdictions do not have visibility into real-time PSH vacancies. Instead, they often rely on manual systems (such as phone calls and spreadsheets) to track referrals, which increases human error, slows response time, and limits client visibility into the process. Implementing automated tools and technology allows for the frequent collection and the centralizing of real-time data on system capacity and vacancies to increase transparency, accuracy, and efficiency.

• Homelessness: PSH systems need general data on the size of the overall homeless population, available vacancies in supported housing, units offline, and inflows and outflows to shelters to determine patterns and trends toward chronic homelessness. The data, including length of stay, reflect the level of housing stability and will impact the demand for housing and other services, and inform policies on infrastructure, eligibility, and risk factors.
• Placement: Homeless response systems require real-time data on vacancy, referrals, and utilization rates to ensure that individuals are rapidly rehoused. To realize efficient processing, this data should also track the time required from referral to placement and moving in, as well as outcome data on how long an individual stays in PSH, satisfaction rates, and the reasons for leaving when the unit is vacated.
• Interactions with other services: Tracking individual interactions with the services related to PSH provides insight into engagement rates and effectiveness. Examples include if clients are visiting their assigned doctors or going to the emergency room, participating in preventive healthcare programs, and if they are picking up prescriptions and taking medications. This data should also track interactions with the criminal justice system to help individuals resolve legal issues that might affect housing eligibility.
• Housing market: The housing market, particularly the availability of affordable housing, directly impacts local homelessness trends. Data can measure overall housing needs, changes to housing supply, housing costs, and related economic factors. This is vital when developing a housing strategy aimed at increasing investment in affordable housing, a major factor in addressing homelessness.
• Job satisfaction: Housing agencies face staff retention issues due to stress and burnout, heavy workloads, and the lack of adequate tools, technology, and training. Tracking the level of job satisfaction and other work-related issues can help administrators improve conditions for the homeless services’ workforce, advocate for higher salaries, reduce bureaucracy, improve training, and fully automate processes.