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.

Providing permanent supportive housing has been shown to improve outcomes predictive of upward mobility. These outcomes, identified by the Urban Institute, are housing stability, safety from trauma, and access to health services.

City and county leaders can assess local conditions for each of these outcomes using the metrics below, identified by the Urban Institute. This assessment can be used to determine whether this strategy is appropriate for their community. (Note: these metrics are a starting point for self-assessment and are not intended to be comprehensive.)

All cities and counties with populations over 75,000 can receive a customized data sheet here.

  • Measuring housing stability in your community: Examine the number and share of public-school children who are ever homeless during the school year. These data are collected by local public school districts.

  • Measuring safety from trauma in your community: Examine the 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.

  • Measuring access to health services in your community: Examine the 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.

  • 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).

Evidence-based examples

Providing condition-free, rapid access to permanent housing for individuals experiencing homelessness
Stable and healthy families Supportive neighborhoods
Affordable rental housing that provides social services on-site or on-site referral services
Stable and healthy families Supportive neighborhoods