Community-Wide Strategies for Preventing Homelessness: Recent Evidence

Ana Stefancic; Sam Tsemberis


J Prim Prev. 2007;28(3):265-279. 

In This Article



Pathways to Housing (Pathways) and a Consortium of local agencies (Consortium) were contracted by the county to provide Housing First services, in the form of independent scatter-site apartments and ACT, to chronic shelter users with psychiatric disabilities. Each program was expected to house 60 individuals. The control group received the county's usual array of services that included shelter-based programs and transitional housing.

Data were collected from administrative records maintained by the Department of Social Services as well as the respective Housing First agencies. Each month, the two Housing First agencies submitted reports to the Department of Social Services indicating the number of consumers whom they had outreached/engaged, the number of consumers currently remaining in housing, and the number of consumers no longer housed. Residential data for Housing First consumers were available continuously for just under four years (47 months). Residential data for control participants were obtained through the county's computerized shelter tracking system, but were only available at the 20-month time-point. Because data were not available for all three groups throughout the study follow-up period, two types of housing outcomes are presented. The first outcome, housing status, was a single point-in-time count of the number of persons housed within the two Housing First groups and the control group at 20 months. The second outcome, housing retention, consisted of housing retention rates for the two Housing First groups for a period of 47 months. Rates of housing retention were calculated each month by dividing the number of consumers still maintaining housing by the number of consumers ever housed by the agency (currently in housing/ever housed). Finally, data are presented regarding the number of participants outreached/engaged and housed by each Housing First agency every month through 47 months. Staff at each agency conducted outreach by contacting participants and conducting their agency's intake assessment to determine participants' eligibility for entry into the Housing First program. Participants who had completed these assessments or were in the process of being scheduled for assessment, were counted as outreached/engaged. With the assistance of the county's DSS, each Housing First agency attempted to contact consumers who were randomly assigned to them by proceeding sequentially along their list and completing assessment interviews with potential consumers. However, not all consumers who completed this assessment were enrolled into the program and received housing. Only participants whom the agencies accepted and housed continued to receive Housing First treatment services.


Participant eligibility criteria for entry into the study included a diagnosis of severe mental illness and chronic shelter use. The county referred individuals with the longest histories of shelter use and with the most frequent interruptions in stay. Individuals were identified as having a psychiatric disability as a result of mental illness-based eligibility (Axis I diagnosis) for Supplemental Security Income (SSI) benefits. Persons diagnosed with a co-occurring substance use disorder were also eligible. Shelter residents who were under 18, diagnosed primarily with a developmental disability, or residing in the family shelter system were ineligible. In early 2001, a total of 260 clients were originally selected for the project from the county's DSS emergency shelter system and randomly assigned to one of three groups as follows: 105 to Pathways, 104 to the Consortium, and 51 to control. By the end of 2001, 52 additional consumers were referred to the project in a second round of assignment, increasing the numbers for Pathways and Consortium to 131 and 130, respectively, while the control remained at 51. Subsequently, approximately 80 additional participants were assigned to the Consortium throughout the course of the project.

As Table 1 indicates, the three groups as originally assigned (260 participants) were similar in terms of demographic characteristics and presence of psychiatric disorders. There were no significant differences among the groups in terms of sex, race, and alcohol use. Pathways participants had higher rates of current drug use or dependence (χ2 = 10.56, = .032) and tended to have higher rates of psychotic disorders (χ2 = 14.15, P = .093). As a whole, the sample was similar to other populations of shelter users with psychiatric disabilities studied elsewhere (Hopper et al. 1997; Kuhn and Culhane 1998).

It was the responsibility of each agency to contact and engage participants once they received the list of consumers that were randomly assigned to them. The agencies could, therefore, conduct outreach and accept consumers from the list at their discretion. Additionally, because enrollment into the Housing First programs was staggered, participants entered into housing at various stages of the program's existence.


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