Ending Chronic Homelessness: Strategies for Action. What Treatments and Services Are Effective?

03/01/2003

Responding to the needs of people who experience chronic homelessness poses significant challenges. Their needs include a broad range of services, from food, clothing and emergency shelter to treatment and income support, and cross many service systems.

However none of these services are as effective without safe, affordable housing. Years of federal demonstration programs and the experience of community and faith-based providers have shown what is effective in preventing and ending homelessness among people who have serious health and behavioral health disorders. Implementing evidence-based and promising practices is essential for a comprehensive, integrated service system that effectively reduces chronic homelessness.

The following services and treatment needs are organized into core and supportive services. The core services include those that are needed to move people from the streets into housing and to stabilize their conditions. The supportive services include those that are needed to reintegrate people into the community, such as with jobs, education and socialization. The full definitions for each of the services are presented in Appendix C. Appendix D lists representative published citations of the effectiveness for each service.

Core Services

  • Information and Referral
  • Outreach and Engagement
  • Health Related and Home Health Services, Including HIV/AIDS
  • Alcohol and Drug Abuse Services
  • Mental Health and Counseling Services
  • Inpatient Services
  • Supportive Case Management Services
  • Intensive Case Management Services
  • Income Management and Support
  • Residential Treatment Services
  • Discharge Planning

Supportive Services:

  • Life Skills Services
  • Child Care Services
  • Education and Training Services
  • Employment Services
  • Legal Services
  • Transportation Services

To be effective, these services must be accessible and provided in a coordinated and flexible manner. This includes the option of being offered in non-office based settings (e.g., on the street or in shelters) and during non-standard operating hours, being able to increase or decrease service levels to accommodate changing needs over time, and keeping case files open even during periods of inactivity so that eligibility does not have to be re-established when an individual is ready to engage or re-engage.

Providers need the flexibility to operate with a "no wrong door, no reject" policy, meaning that services are made available to individuals no matter where they enter the system and whether or not they are willing to accept specific interventions that may be indicated. In addition, strategies such as co-location of services not typically offered under the same roof can help reduce fragmentation and increase access to services.

 

HHS, HUD, and VA have agreed on the characteristics of persons experiencing chronic homelessness and use the following definition in their collaborations:

An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or has had at least four (4) episodes of homelessness in the past three (3) years.

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