Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. Accountability, Cost-Effectiveness, and Program Performance: Progress Since 1998.. Summary and Conclusion


Since 1998, progress has made in our understanding of how homeless assistance programs could be more cost-effective and more responsive to consumer needs; however, much more remains to be done. Considerable research has been conducted that shows that various supportive housing models are effective for ending homelessness among most people with severe mental illness. For people with histories of heavy service utilization, these interventions are likely to achieve significant offsetting cost reductions, or at least cost neutrality. This literature also suggests that service matching and other program targeting strategies are also indicated. Most homeless people with mental illness, even those who are not the target of experimental interventions, have short-term homelessness and positive housing outcomes, suggesting that a smaller subsegment of this population needs the intensive (and more expensive) housing and service interventions that have been tested in the literature. Research on chronic homelessness likewise suggests that a small subsegment of the homeless population consumes most of the homeless system resources and is likely to be unable to exit without significant housing and service supports. Thus, while not all people who experience chronic homelessness have severe mental disorders nor are they all heavy service users (service use may vary as a function of regional and other accessibility factors), it is likely that many are costly users of public services, including homeless system resources, and therefore, they would be the appropriate targets of the more intensive supportive housing interventions.

People who experience non-chronic homelessness, including most families and the vast majority of homeless people overall, would seemingly require less intensive interventions. Unfortunately, this is an area where the literature is quite limited. Research is needed to identify the various costs associated with these subpopulations, in part to inform the potential cost efficiency of alternative program models. Relocation programs, transitional rental assistance, and various service support models may be effective in reducing or preventing homelessness among these subpopulations, and future research could test such models. These can include programs specifically targeting people transitioning out of institutions, people with substance use disorders, and people with temporary economic or domestic crises. While cost-effectiveness or cost offsets may or may not be achieved, such research would identify if better outcomes can be achieved than from congregate shelters, and more efficiently.

Significant progress has been made in the area of standardized, automated information collection on homeless assistance program use. HUD’s HMIS initiative has led to the adoption of client tracking technology in hundreds of jurisdictions, and with sufficient coverage for jurisdiction-wide reporting in several dozen cities to date. Future research could take advantage of these data for local studies of homelessness service utilization patterns, as well as for analyses of multi-system services use and costs. More than 30 studies have recently attempted to track costs and cost offsets associated with chronic homelessness through the analysis of multiple service system databases. These efforts could be further expanded and standardized with appropriate federal support, and should take advantage of the implementation of HMIS programs in communities around the country.

The expansion of HMIS capacity has also made possible more rigorous program performance assessments. In this paper, best-practice case studies from Arizona and Columbus, Ohio, were provided that illustrated how these communities were able to implement a client assessment and tracking system that also formed the basis for measuring provider performance. Providers can be measured with regard to a peer group, and their outcomes tracked and compared over time. In Arizona, a process has been established whereby the agencies can share successes and strategies for program improvement, based on their quarterly performance reports. And in Columbus, yearly reviews by the Continuum of Care Steering Committee set expectations and goals for providers, and monitor annual progress in meeting those goals. Such systems hold the promise of making programs more accountable to consumers by assuring that target populations are served (not underserved), that the intended services are delivered, and that they are having their expected outcome. In so doing, a feedback process can be created that will help providers to continually improve their programs. Creating accountability systems is not without challenges. Some providers will be resistant to program performance measurement and to changes that may be required based on feedback. But including relevant stakeholders and an open process can help to insure that provider interests are addressed, at the same time that the community’s priorities can be achieved.

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