Chronic homelessness is a highly complex social problem of national importance. The problem has elicited a variety of societal and public policy responses over the years, concomitant with fluctuations in the economy and changes in the demographics of and attitudes toward poor and disenfranchised citizens. In recent decades, federal agencies, nonprofit organizations, and the philanthropic community have worked hard to develop and implement programs to solve the challenges of homelessness, and progress has been made. However, much more remains to be done. Importantly, the results of various efforts, and especially the efforts to reduce homelessness among veterans in recent years, have shown that the problem of homelessness can be successfully addressed.

Although a number of programs have been developed to meet the needs of persons experiencing homelessness, this report focuses on one particular type of intervention: permanent supportive housing (PSH). Permanent Supportive Housing focuses on the impact of PSH on health care outcomes and its cost-effectiveness. The report also addresses policy and program barriers that affect the ability to bring the PSH and other housing models to scale to address housing and health care needs.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON AN EVAULATION OF PERMANENT SUPPORTIVE HOUSING PROGRAM FOR HOMELESS INDIVIDUALS
• Preface
• Abbreviations and Acronyms
• Summary
  • COMMITTEE'S STATEMENT OF TASK
  • CONCLUSIONS AND RECOMMENDATIONS
• 1. Introduction
  • RELATIONSHIP BETWEEN HOUSING, HOMELESSNESS, AND HEALTH
  • COMMITTEE'S STATEMENT OF TASK
  • COMMITTEE'S APPROACH TO THE TASK
  • ORGANIZATION OF THE REPORT
• 2. Addressing Homelessness in the United States
  • CURRENT STATE OF HOMELESSNESS IN THE UNITED STATES: DATA AND TRENDS
  • HEALTH OF INDIVIDUALS EXPERIENCING HOMELESSNESS
  • FEATURES AND LEVELS OF HOUSING FOR INDIVIDUALS EXPERIENCING HOMELESSNESS
  • FUNDING SOURCES FOR PSH
  • SAMHSA
  • SUMMARY
• 3. Evidence of Effect of Permanent Supportive Housing on Health
  • EVIDENCE OF THE IMPACT OF PERMANENT SUPPORTIVE HOUSING FOR HEALTH OUTCOMES
  • A NEW PARADIGM FOR CONSIDERING THE IMPACT OF PERMANENT SUPPORTIVE HOUSING
  • CONCLUSIONS
• 4. Cost-Effectiveness of Permanent Supportive Housing
  • GENERAL COST-EFFECTIVENESS PRINCIPLES
  • A COST-EFFECTIVENESS FRAMEWORK FOR PSH
  • ASSESSMENT OF EXISTING STUDIES
  • CONCLUSIONS
  • ANNEX 4-1: COMPUTATIONAL DETAILS
• 5. Effect of Individual and Program Characteristics on Outcomes in Permanent Supportive Housing
  • INDIVIDUAL CHARACTERISTICS AND OUTCOMES
  • PROGRAM CHARACTERISTICS AND OUTCOMES
  • CONCLUSIONS
• 6. Impact of Permanent Supportive Housing on Families and Youth
  • FAMILIES
  • FAMILIES INVOLVED IN THE CHILD WELFARE SYSTEM
  • UNACCOMPANIED HOMELESS CHILDREN AND YOUTH
  • CONCLUSIONS
• 7. Program and Policy Barriers to Permanent Supportive Housing
  • FRAGMENTED AND UNCOORDINATED FUNDING SOURCES, POLICIES, AND PRIORITIES
  • CHALLENGES OF PROVIDING SERVICES TO RESIDENTS IN PSH
  • THE ROLE OF INNOVATION TO ACHIEVE PSH SCALABILITY
  • CONCLUSIONS
• 8. Research Gaps
  • HARMONIZATION OF PSH DEFINITIONS AND PROGRAM CHARACTERISTICS
  • UNDERSTANDING WHO BENEFITS MOST FROM PSH
  • IMPROVING THE QUALITY OF EVIDENCE EXAMINING PSH AND HEALTH
  • APPLYING NEW TOOLS TO INTEGRATE AND LEARN FROM DATA SYSTEMS
  • BUILDING UNIVERSITY-AGENCY PARTNERSHIPS FOR BETTER DATA AND ANALYSIS
  • TESTING INNOVATIONS IN PAYMENT MODELS TO SUPPORT HOUSING AND SERVICES
  • CONCLUSIONS
• 9. Conclusions and Recommendations
  • CONCLUSIONS
  • RECOMMENDATIONS
• References
• APPENDIXES
  • Appendix A. Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless Individuals: Biographical Information
  • Appendix B. The History of Homelessness in the United States
  • Appendix C. Counting the Number of Individuals Experiencing Homelessness
  • Appendix D. Examples of Homeless Service Programs in Denver and San Jose
  • Appendix E. Studies of Effectiveness of Permanent Supportive Housing

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2018. Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25133.