In the early years of the 21st century, homelessness continues to be a social problem of enormous public health significance. In mid-20th century America, observed homelessness was rare. However, in the late 1970s, homelessness increased sharply and has persisted for nearly three decades.
The Department of Housing and Urban Developments Annual Homeless Assessment Report to Congress (HUD, 2007) indicates that on a single day in January, 2005 there were 754,147 sheltered and unsheltered homeless persons in the United States. This point-in-time estimate represents less than 0.3 percent of the total population. When contrasted with prior estimates, findings suggest that the size of the homeless population has not changed significantly in the past decade.
The majority of people who ever experience homelessness are able to return to conventional housing within a brief period of time. In a study of shelter use in Philadelphia, Metraux et al. (2001) found that three-quarters of the people who used emergency shelters were homeless only once or twice, and most stayed for less than 60 days. A smaller number of people, however, remain homeless much longer. At any point in time, this group comprises a large proportion of the homeless population. The one-week prevalence estimate in the National Survey of Homeless Assistance Providers and Clients (NSHAPC) indicated that about one-fourth of the homeless population experienced spells of homelessness lasting over four years or had numerous homeless episodes (Burt et al., 2001). These chronically homeless individuals present a huge challenge for providers and policymakers because they use a disproportionate share of public services but remain vulnerable to continued homelessness.
Despite the daunting challenges presented by chronic homelessness, there is a glimmer of optimism that the winds of change in policy and program development are thrusting new energy into the search for viable solutions. New approaches to service delivery and provision of housing targeted at this population have been developed. Some of these interventions are becoming widely recognized as evidence-based. In the last 5 to 10 years, there has been a convergence of opinion among advocates and policymakers at all levels of government that chronic homelessness need not exist in the United States. Momentum around this issue started to build in 2000 when the National Alliance to End Homelessness (NAEH) released a plan to end homelessness in 10 years. Shortly afterward, Secretary Mel Martinez of the U.S. Department of Housing and Urban Development (USDHUD) endorsed the goal of ending chronic homelessness, and the Bush Administration affirmed this goal in its FY2003 budget. In 2002, the Millennial Housing Commission, appointed by a bipartisan committee in Congress, called for ending chronic homelessness through the creation of 150,000 units of supportive housing, and the Administration reactivated the federal Interagency Council on Homelessness (ICH). Beginning in FY2003, the Collaborative Initiative to Help End Chronic Homelessness was launched with funding provided by the HUD, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Health Resources and Services Administration (HRSA) and the Department of Veterans Affairs (VA), with coordination by the ICH. Policy Academies on Chronic Homelessness in which teams implement a plan to address chronic homelessness have been established in every state and territory (see www.hrsa.gov/homeless).
Since 2003, a growing number of communities have developed policy and program strategies that are informed by more rigorous local estimates of the number of homeless individuals and an increased understanding of the nature of chronic homelessness. These efforts are starting to bear fruit. There are early signs that the number of chronically homeless people in shelters and in the streets is declining in some localities (NAEH, 2006a).
This manuscript is focused on chronically homeless single disabled adults, clearly a most vulnerable segment of the homeless population. While it is likely that some youth under the age of 18 also experience long-term homelessness, the lack of information on the course of youth homelessness underscores the need for further study of this population. Here we describe the numbers, characteristics, and service needs of adults who are chronically homeless, present a synthesis of the research literature on service and housing interventions, and discuss the implications of research findings for services and for future research on preventing and ending chronic homelessness. As a caveat, we note that most of the research on disabled homeless adults does not specify the extent of residential instability of study participants, although undoubtedly chronically homeless people have been included in such investigations. We present findings from studies of chronically homeless people when available, and extrapolate from studies of homeless people in general when homeless chronicity has not been specified.