The challenge facing researchers is that there are so many programs in the field, each influenced by its housing market, service delivery system, community funding, and institutional capacity. Authors of many of the multisite studies cited in the research findings above acknowledge that the researchers were not always comparing apples to apples. While programs in a multisite study may have similar overall approaches, the intervention can easily be different enough from site to site that the findings are difficult to compare. For example, differing credentials for case managers, varying landlord receptivity to housing homeless people, mixed housing types, different administrative procedures, or other factors can influence outcomes in ways that are difficult to observe or measure.
Thorough and accurate descriptions of both the service and housing interventions are crucial to expanding our knowledge. We need greater rigor in classifying exactly what the services are, how they are delivered, and how service approaches are linked to housing: how is the housing setting structured, what is the nature of the housing and services provided, and over what period of time? In addition to substantially improved methods for documenting and measuring the types and intensity of housing and services interventions, use of more rigorous experimental or quasi-experimental design studies would strengthen our knowledge of what works for whom. Given the challenges such studies entail, it is important to focus research efforts on the most critical questions. We offer several suggestions:
- What are the impacts of housing characteristics such as scattered-site vs. project-based settings, shared vs. individual housing, tenant-held leases vs. provider-held leases, and housing-based services vs. community-based services on housing stability, housing satisfaction, short- and long-term self-sufficiency measures?
- Do structured programs, whether transitional or permanent, with curfews, rules requiring sobriety, and expectations around service participation have different outcomes from programs with fewer rules but still intensive support modeled on the ACT approach?
- What are the most effective strategies for dealing with substance use in permanent supportive housing? What factors (age, length of time homeless, etc.) most influence the appropriate service approach for people with substance use disorders? In programs using a low demand approach, how much do tenants reduce their level of substance use and abuse? How does this come about?
- Given the promise of housing first models for families and individuals, what role should transitional housing play? Do transitional housing programs for families achieve outcomes other than helping families find and retain permanent housing for example, reunifying and stabilizing families, helping families to become financially self-sufficient, or improving the life chances of children? Is transitional housing cost-effective compared with other approaches to achieving these objectives?
- How should prevention programs identify precariously housed families and target limited prevention services to them? What family characteristics or immediate circumstances distinguish a family likely to become homeless from the large number of equally low-income families without severe disabilities who are doubled up or pay unsustainable portions of their income for housing?
- How effective is short-term rental assistance as a tool for prevention or for rapid exit from homelessness? Can families who have been homeless really sustain themselves in private market housing after the rent subsidy goes away? How does this differ by family characteristics and by type of housing market (the relationship between local housing costs and wage rates for low-wage workers)?
- What types of families in what types of housing markets need a housing subsidy over a longer period of time?
- What are the longer-term effects of permanent supportive housing on mental health status and substance use?
- What are the cost implications of different housing configurations and different models for combining housing and services? To what extent are mainstream benefit programs assisting people who are homeless?