Prevention. Targeting prevention programs may be less difficult for individuals than for families, because of evidence that interventions that include housing reduce the use of expensive medical services by people with certain types of disabilities. Such high users can be targeted, as Californias AB2034 program does, to avert their becoming homelessness. Other obvious targets, because they are at such high risk of becoming homeless, are people with disabilities leaving psychiatric hospitals and correctional institutions (Burt & Pearson, 2005).
Safe havens and housing first. For programs serving individual persons with disabilities who become homeless, housing models with low-demand services have shown positive outcomes, especially for those who have been reluctant to enter or stay in transitional programs. Yet those with the most severe mental illness and substance abuse issues are still the most likely to leave, even from low-demand housing settings. Identifying risk factors in the program population is important as are services focused explicitly on retaining housing.
For communities with a sizable population of service-resistant individuals, safe havens can be an important part of a strategy to end street homelessness. The research evidence suggests that this approach can be costly, however.
Evidence also suggests that approaches that combine a low-demand approach with available intensive services help some succeed in permanent housing who otherwise would be at substantial risk of failing (Tsemberis & Eisenberg, 2000, Padgett, Gulcur, & Tsemberis, 2006; Siegel et al., 2006). Housing configuration seems to be less important than the service approach, although more research is needed to confirm this. Researchers have found positive housing retention outcomes in programs with a wide variety of housing configurations, from buildings dedicated to formerly homeless people with disabilities to mixed-occupancy buildings to scattered-site models. Services need to be available and adapted to the housing configuration. On-site support may work well in buildings where all the residents are program clients. In programs with scattered-site and/or mixed housing configurations, low client-to-staff ratios and frequent contact with clients are important in ensuring clients have sufficient support to maintain their housing. Balancing consumer choice and access to subsidies poses a policy dilemma in addressing the housing needs of homeless people who prefer scattered-site housing in their communities. There are not enough mainstream subsidies to meet the overall demand from people who are homeless and others of low-income, and people with mental illness or other disabilities may face greater barriers accessing the limited available subsidies.