Decisions about and funding for research, policy, planning, and service delivery occur at national, state, and local levels, and are implemented in public, not-for-profit, and private organizational contexts. Several national-level government and advocacy organizations, notably the Interagency Council on Homelessness and the National Alliance to End Homelessness, have now adopted consumer-driven approaches as part of their push for 10-year plans to end homelessness, introducing choice-based housing and services in diverse locales. The National Association of State Mental Health Program Directors promotes state-level support for consumer self-determination of housing and services (NASMHPD, 2005).
Within federal departments that make policy and fund homelessness research, housing, and services, some agencies have strongly advocated consumer involvement. In the Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), which supports homeless services for people with mental health and substance problems and evaluates innovative approaches, has played a leading role. The Health Resources and Services Administration (HRSA) has set high standards for consumer participation in governance of community health centers, though less stringent standards apply to HRSA-funded Health Care for the Homeless programs. At the National Institutes of Health (NIH), which fund most academic research on homelessness, consumer involvement has not been a priority. The Department of Housing and Urban Development (HUD) has endorsed consumer involvement in continuum-of-care (CoC) planning and in the implementation of Homeless Management Information Systems (HMIS). A HUD pilot program to develop consumer roles in HMIS led to a national training initiative on consumer involvement in HMIS implementation.