Permanent supportive housing
Strategy overview
- Accessing housing first: Strategies addressing chronic homelessness — that is, being without stable housing for over a year, and, often, suffering from a disabling condition— generally use a “Housing First” approach. Those experiencing chronic homelessness are connected with stable, unconditional housing. After housing is secured, residents are connected to other services as needed, like mental health and substance use treatment.
- A mix of central locations and scattered sites: Unconditional, permanent supportive housing can be provided in various forms, including centralized facilities with services provided "in house," or in privately-owned units throughout a jurisdiction, where service providers visit tenants regularly. Initiatives in their early stages often rely more heavily on scattered sites as they work towards building larger, more centralized facilities.
- Signing leases: Generally, tenants sign a standard rental agreement without conditions beyond those of any other renter (though income requirements are waived). Housing First initiatives typically include a major rental assistance component, which can be subsidized by a range of sources, including federal housing vouchers (primarily Section 8 and related programs), local investments, private donations, and more. Those funds are applied either to a jurisdiction’s cost of operating a public facility or as a rent payment to a private landlord.
- Supplementing housing with social and medical services: Many "Housing First" strategies provide a range of on-site supports for tenants, including substance use treatment, mental and physical health care, career coaching, crisis intervention services, and more.
Multiple recent systematic reviews of rigorous scientific studies found that high-quality chronic homelessness prevention programs effectively reduced homelessness and increased housing stability.
- A 2018 systematic review of 43 randomized control trials found that case management housing programs were consistently effective at reducing homelessness and increasing the amount of time spent in stable housing.
- A 2018 systematic review of rigorous scientific studies found that relative to "treatment first" approaches, "Housing First" clients experienced, on average, an 88% decrease in homelessness, a 41% increase in housing stability, and a significant (ranging from 7%-36%) reduction in hospitalizations.
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.
Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.
One indicator in the E-W Framework may be improved with investments in this strategy. To measure this indicator and determine if investments in this strategy could help, examine the following:
Access to affordable housing: Ratio of (1) the number of affordable housing units to (2) the number of households with low and very low incomes in an area (city or county). Housing units are defined as affordable if the monthly costs do not exceed 30 percent of a household’s income. Households with low incomes are defined as those earning below 80 percent of area median income (AMI), and very low-income households are defined as those earning below 50 percent of AMI.
- Launch a coalition: Homelessness prevention initiatives often require a wide range of core competencies, including financing housing developments, delivering medical services, providing case management for individuals, engaging with landlords, and more. An administrative leader (often a local government) should consider bringing together private, public, and nonprofit entities to collaboratively address chronic homelessness.
- Take a “Housing First” approach: The evidence-based housing model secures stable housing for individuals experiencing chronic homelessness before providing any other services. With housing in place, additional services (like on-site support services, education, training, and more) are more likely to be effective.
- Partner with landlords: One of the most significant challenges in addressing chronic homelessness is the lengthy period it can take to identify and lease available units. To address this, program leaders should cultivate a network of property owners who are open to leasing units to individuals previously experiencing chronic homelessness. With a preexisting relationship, landlords are more likely to demonstrate flexibility on payment plans, accept various vouchers, and waive minimum income requirements, all of which can help expedite securing the unit.
- Invest in data capacity and analysis: Oftentimes, homelessness prevention approaches rely on annual point-in-time data, which can convey an inaccurate or incomplete picture. Incorporate the capacity for frequent data collection and analysis at each touchpoint (such as during outreach with individuals experiencing homelessness, during case management sessions, etc.). Doing so will help the program deploy existing resources to ensure better outcomes for tenants and help shape future plans (such as whether to build new housing).
Resources
Evidence-based examples
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Outcome Area |
This ranking reflects how these approaches are scored in one of the major government- or philanthropy-led clearinghouse resources. For more: https://catalog.results4americ... |
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Providing condition-free, rapid access to permanent housing for individuals experiencing homelessness
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Stable and healthy families Supportive neighborhoods |
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Affordable rental housing that provides social services on-site or on-site referral services
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Stable and healthy families Supportive neighborhoods |
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