In the last decade, people who have experienced homelessness have claimed increasingly active roles in research, policy, planning, and service delivery, and have furthered the expansion of choice-based alternatives to existing housing and service policies. We summarize here what the literature on these processes implies for the participating consumers; for homelessness research, policy, and service processes; and for efforts to end homelessness at a system or population level.
Implications of Consumer Involvement in Research, Policy, and Planning
Ethics and social justice argue for a prominent role for consumers who have experienced homelessness in research, planning, and policy-making, and a descriptive literature documents a large expansion of such roles. Qualitative accounts of experiences of consumers in these arenas make a persuasive case that, with adequate support, consumer involvement produces both benefits for consumers and improvements in research and policy.
- Individual-Level Impacts on Consumers
- With appropriate support, participation in research, planning, and policy offers consumers practical benefits (employment, skills) as well as personal growth and improved self-confidence.
- Implications for Research, Policy, and Planning Processes
- Effective consumer involvement in research, policy, and planning requires organizational support to address barriers, avoid tokenism, and authorize consumer decision-making.
- When supported, integration of consumers adds to the relevance, validity, and sensitivity of homelessness research, service planning and policy making.
- Implications for Ending Homelessness at a Population Level
- Local consumer advocacy groups have pressed for the structural interventions (e.g., affordable housing) necessary to end homelessness at a population level. Consumer voices can make a unique contribution to leverage what must ultimately be a broad collaborative effort to restructure the systems that have thus far failed to do this.
Implications of Consumer-Driven and Choice-Based Housing and Service Approaches
Over the last decade, consumer-driven approaches to homeless services particularly the housing first model have moved from the service and policy margins to a visible, and even central, place in many locales 10-year plans to end homelessness.
- Individual-Level Impacts on Homelessness
- Increasingly rigorous studies have shown that housing first produces better housing outcomes than alternatives that emphasize housing readiness for people with co-occurring disorders who experience homelessness. There is some research evidence that it reduces residential costs for participants.
- Harm reduction is integral to the housing first model. In studies of housing first, tenants have less contact with psychiatric and substance use services than do control groups engaged in usual services, but critics fears of escalating substance use and psychiatric symptoms in the absence of treatment and abstinence requirements have proven unfounded.
- Research is needed on new harm reduction housing for people with chronic addictions, which as yet have only anecdotal support as a strategy for ending homelessness.
- System-Level Impacts
- The endorsement of housing first in 10-year plans and the broad dissemination of this model currently underway implies significant change in homelessness policy and practice. Widespread adoption of the housing first model would both entail transformation of existing systems for delivering homeless services and housing.
- Since it relies on existing housing stock, any broad-based implementation of housing first in locales lacking adequate affordable housing must be accompanied by expansion of the supply of low-cost housing if it is to play a significant role in ending homelessness at the population level. This will require advocacy for affordable housing from broad sectors of society, extending well beyond those most affected by and concerned with homelessness.
- Because it challenges central features of current housing/service approaches (housing readiness, congregate housing, on-site services), widespread implementation must address the mismatch with existing funding and service models.