Research on the impacts of system change itself is relatively rare, compared to research on the effectiveness of particular program models to serve particular populations (e.g., PSH to serve long-term homeless people with disabilities). Although we are unable to speak definitively about the impact of system change, many communities are able to report process measures and some impact information; therefore, we can say the following:
- Most works cited in this paper attest to the fact that explicit system change efforts can get previously uninvolved agencies to the table and involved in developing more effective approaches to serving homeless people and ending their homelessness.
- Process results, with relevant outcomes: System change efforts can succeed in increasing funding for and production of supportive housing.
- Most THCH sites stimulated significant new funding, and also brought new stakeholders to the table and strengthened and integrated the involvement of the original stakeholders (Burt & Anderson, 2006). Outcome: Added more PSH units to the pipeline in the first two years of their grants than they had expected to do in five years, and ended the homelessness of a corresponding number of chronically homeless people.
- San Franciscos Direct Access to Housing (DAH) approach grew out of a pipeline group of relevant agencies. Outcome: Added thousands of units of PSH to the San Francisco portfolio of programs to end homelessness (Corporation for Supportive Housing, 2004), with corresponding reductions in street homelessness.
- A confluence of events and history put Philadelphia in a position to develop a great deal of PSH rapidly (Wong et al., 2006) and couple it with a redesigned outreach system to help move street homeless people into the new housing. Outcome: Major reductions in street homelessness.
- Columbus, Ohios Rebuilding Lives Initiative changed the local homeless assistance system toward one designed to end homelessness. Outcome: Created more than 200 short-term shelter beds and upwards of 600 new PSH units (so far) with a combination of new and redirected funding. Almost 800 single adults have secured housing and left homelessness (www.csb.org). Other parts of the system concentrated on prevention.
- Impact results: Communities that have invested in permanent supportive housing on a significant scale are beginning to see the effects in reduced counts of unsheltered homeless people; likewise, there is some evidence that communities that have instituted new, integrated ways to address family homelessness have seen reductions in family shelter use, because housing crises are being resolved before they progress to the stage in which a family becomes homeless.
- Communities that have invested in permanent supportive housing are reporting reductions in street homelessness San Francisco, down about 20 percent between 2004 and 2006; Portland, down 20 percent and 600 people moved into PSH in past two years; New York City down 13 percent from 2005 to 2006 (all as described in a federal Interagency Council on Homelessness electronic newsletter, available at www.ich.gov); Philadelphia down more than 75 percent over five or six years (as described in Burt et al., 2004). Outreach and other mechanisms deliberately focused on bringing street people into housing can help this process.
- Integrated services that include housing can increase access to housing and successful housing outcomes for homeless people with serious mental illness (Mayberg, 2003; Rosenheck et al., 1998). Further, the effects last for some years (Burt & Anderson, 2005; Rothbard et al., 2004).
- Communities such as Hennepin County, Minnesota; Washington, D.C.; and Columbus, Ohio, that have focused on strategies for shelter diversion can dramatically reduce the numbers of people entering shelter. Strategies in those communities to reduce lengths of stay in shelter have enabled them to reduce shelter beds and apply those resources to other housing and services.
The knowledge gained from years in the system change trenches is being applied widely, thanks to active promotion through advocacy and technical assistance (Center for Mental Health Services 2003; Corporation for Supportive Housing 2002, 2004, 2005; and many others). But systematic evaluation of these change efforts in the homelessness arena remains all too rare.