Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research. People Who Experience Long-Term Homelessness: Characteristics and Interventions. Research on Promising and Effective Strategies to Address Chronic Homelessness


The patterns of service use characteristic of chronically homeless people have prompted service innovation to improve the engagement of this vulnerable population in the treatment and housing support services needed to end their residential instability. Creative efforts directed at this objective have involved changing the locus of psychiatric and medical treatment from hospitals and clinics to the street, shelter, and housing settings where people vulnerable to chronic homelessness can be found. Outreach to homeless people living on the street and in shelters, delivery of case management and assertive community treatment services on site in shelters and community housing settings, integration of mental health and substance abuse treatment services, and permanent and transitional supportive housing are some of the innovative efforts to better meet the needs of this disabled population and engage them in a process of recovery and stable tenure in the community. As communities nationwide accelerate their efforts to address chronic homelessness, these innovative efforts can guide program development.

We note that some communities have already made significant strides in establishing a community-wide approach to program development for people who are chronically homeless. For example, the City of Portland recently reported a 39 percent drop in the number of people sleeping outdoors (City of Portland, 2007). Other cities reporting reductions in street and chronic homelessness include Dallas; San Francisco; St. Louis; Atlanta; Norfolk, VA; and Quincy, MA (USICH, April 18, 2007). Communities that have made significant strides in reducing chronic homelessness have adopted clear goals that guide a communitywide approach that includes some or all of the following program elements, which are often implemented by multidisciplinary teams or multi-agency collaborative partnerships (Burt et al., 2004; City of Portland, 2007).

  • Outreach. Outreach is a critical first step in connecting chronically homeless people with the services they need. Many communities have restructured these efforts to include multidisciplinary teams designed to increase engagement, develop positive relationships with clients, and more effectively link them with housing, treatment services, and other resources. A small but growing number of communities have empowered outreach workers to immediately offer chronically homeless people direct access to permanent housing, targeting housing opportunities to people who have been living on the streets or in shelters for the longest periods of time.
  • Housing. Housing with attached supportive services is designed to help ensure residential stability for chronically homeless people coming directly from the streets or shelters. A range of different models provides this type of housing, including permanent supportive housing and Safe Havens. In addition, some housing is available for people who have not yet achieved sobriety or stability. These housing models do not require participation in treatment or other activities as a condition of entering or keeping housing if tenants are otherwise meeting the requirements of any leaseholder.
  • Discharge planning. Given the frequency with which chronically homeless people cycle between institutions and life on the streets or in emergency shelters, effective processes for discharging people from jails, treatment facilities, and hospitals can provide opportunities for engaging chronically homeless people as well as preventing chronic homelessness for some of the most vulnerable homeless adults with disabilities. Effective strategies properly assess clients service needs, help them make connections with service providers upon release, and arrange for appropriate post-release housing as an alternative to discharging people to the streets or emergency shelters.

In the following sections we describe the different approaches in services and housing that have been developed in the past decade and present findings on their efficacy.

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