In the past two years, the United States experienced a significant rise in homelessness, largely due to the migration crisis. Many individuals entered through the southern border, with Texas directing them to certain sanctuary cities. This resulted in nearly 200,000 people engaging with the Homeless Assistance Program nationwide.
Previously, the U.S. had nearly 15 years of declining homelessness, decreasing by 1% to 2% per year since around 2010. The 2009 HEARTH Act reauthorized federal funding and established Housing First as the strategy, focusing on prevention, rapid rehousing, and supported housing for the chronically homeless. Consequently, family homelessness declined by 35%, and veteran homelessness by 55%. This shift in policy prioritized housing programs over emergency services, ultimately demonstrating that a reoriented approach can make a significant difference.
This blog summarizes a March 2025 discussion between Lígia Teixeira, CEO of the Centre for Homelessness Impact in the United Kingdom, and Dennis Culhane, Professor at the University of Pennsylvania in the United States, on the U.S.’s efforts to move from a crisis response to prevention.
Introduction of Rapid Rehousing and Veteran Homelessness Prevention Programs
The U.S. began piloting rapid rehousing in 2006. The journey to develop a solid program design took some time, but our veteran’s program called Supportive Services for Veteran Families (SSVF) is a prime example of the national standard for rapid rehousing today. Through this program, which combines prevention and rapid rehousing, individuals can receive their first and last month’s rent, as well as a security deposit – essentially move-in assistance to escape homelessness – and can access up to two years of rental assistance.
Initially, the assistance started at six months and then expanded to a year, but we discovered that about 15-20% of participants were still unemployed and unable to sustain themselves financially. Therefore, we added a second year for those roughly 20% who, after a year, remained in need of support. The aim is to help people break free from their circumstances with the expectation that they’ll secure employment and manage their rent independently moving forward.
Additionally, it provides connections to various services. A case manager assists with obtaining housing while also facilitating access to necessary health and behavioural health services, as well as job training or coaching. This comprehensive package of services is offered alongside the housing assistance provided by the Veterans Administration.
The SSVF Program has undergone careful evaluation
It is nationally standardized, with consistent training provided to everyone throughout the country. Evaluations have consistently demonstrated that the program is effective. Politically, it enjoys great popularity in local communities because it provides funding to nonprofits. Therefore, local political leadership cannot afford to reduce the program and its funding, as the stakeholders are broad and highly invested.
According to administrative rules, 65% of the funds must be allocated for individuals in shelters, while 35% can be dedicated solely to prevention efforts aimed at stopping individuals from entering shelters. If we didn’t impose this 35% limit, there was a credible concern that the funds would only serve families and individuals who are needy but not literally homeless.
Evidence suggests that it is challenging to effectively target prevention for those at high risk of homelessness. In contrast, we can successfully reach our target population—those currently experiencing homelessness—because our focus is on assisting them. As such, the 65% allocation is intended to shorten the duration individuals spend in shelters, which should decrease the cost of emergency accommodation per family as more funds are directed toward helping them transition out.
Reductions in families experiencing homelessness explained
We believe the decrease in homeless families since 2010 is largely driven by fewer transitional housing options. The HEARTH Act legally minimizes the emphasis on transitional housing, which still exists to some extent but was primarily intended to limit long stays. Previously, families could remain in transitional housing for a year and a half or two years, which is very costly, averaging between $50,000 and $60,000 per year in many areas and up to $100,000 per year for a family in places like New York.
The goal was to shorten stays to around 60 to 90 days, during which families receive assistance in finding new housing, alongside moving-in support and temporary rent help for typically at least six months, if not a year. However, there is much discussion about whether the assistance should be deeper or longer. Of course, the ideal is that all families eligible for rental assistance receive it, but that is not the case in the United States.
Exploring Scalability of Homelessness Prevention Programs
Having a solid program idea and a successful model is great, but without scalability, you won’t achieve effective policy. In the U.S., we face a unique situation: we have veterans programs that are effectively scaled, while non-veteran programs remain unscaled. Only about 9-10% of individuals experiencing homelessness access either rapid rehousing or supportive housing. With that one-in-ten ratio, meaningful progress is challenging.
Los Angeles recently conducted an evaluation of their rapid rehousing program. While we label the program as rapid, this characterization is aspirational; the reality is that it generally takes three to six months, or even longer, for individuals to enter a program. Ideally, this process should occur within 30 to 60 days, or at most 90 days. Unfortunately, that’s not the case. The program’s supply is insufficient; we aren’t doing enough in this area.
Conversely, regarding chronically homeless veterans, we possess more housing vouchers than the number of veterans in that category. This means we could theoretically provide housing to all of them. In fact, 50% of these veterans secure housing within a year of being identified as chronically homeless, and 65% of veterans achieve rapid rehousing.
Additionally, we estimate that about 35% of homeless individuals self-resolve and find housing on their own within 30 to 60 days. Therefore, the 65% coverage among veterans indicates near-saturation. This example illustrates effective scaling: we’ve reduced veteran homelessness by 55% over eight years. However, the number of available programs for the non-veteran population remains significantly insufficient.
Understanding the Pathways to Homelessness
About 25 to 30% of single adults entering homelessness come from social welfare institutions, and the homelessness rates among individuals leaving those institutions are quite high. In the general community, predicting who will become homeless is very difficult. While some people can come forward and request assistance, many are unaware of the programs available to them, and they do not identify as homeless; they simply find themselves lacking housing on an emergency basis. They then must figure out what to do.
Identifying people in advance within the broader community is challenging
For every family or individual entering homelessness assistance, there are about 20 others in similar situations who do not. Predicting the 5% who seek help versus the 95% who don’t is very difficult because it’s not solely based on background characteristics, but also on their current life circumstances.
We have used machine learning and other methods to predict who might be at high risk of homelessness, and while we can estimate the likelihood of someone experiencing homelessness over a five-year period, predicting who will become homeless next month remains elusive. More information about individuals’ lives at that moment is necessary, as the circumstances are time-sensitive rather than merely based on risk factors.
The connection between institutional discharges and homelessness is evident
For the 25% of homeless adults who are coming out of institutions, we do know who they are, where they are, and when they are leaving these institutions. The highest percentage come from jail. The second is detox, where individuals who have faced a substance use emergency may not have a family willing to take them home right away, leaving them homeless. Additionally, smaller but notable groups come from psychiatric hospitals and individuals who have recently emancipated from foster care. Around one out of every three or four people experiencing homelessness comes from these institutions. We have effective program models that can help prevent homelessness for this group, as their homelessness rates are significantly higher—often around 25% to 40%. This makes targeting much easier.
One program is Critical Time Intervention (CTI), which has substantial evidence supporting its effectiveness. The critical period usually occurs within 30 to 90 days after a person has exited from one of these institutions. It is in that timeframe that they are at their highest risk of relapse into substance abuse, reoffending, or returning to homelessness. CTI functions as a rapid rehousing program with enhanced case management tailored for these individuals. In summary, our best evidence points to CTI as a key program.
Integrating Homelessness Prevention into Public Health Policy
The U.S.’s public health insurance initiative for low-income individuals is known as Medicaid. This program represents the largest social welfare expenditure at the state level, supported by the federal government. Many have long contended that homelessness qualifies as a health crisis due to its status as a significant social determinant of health, encompassing multiple challenges simultaneously.
Currently, six states have petitioned the federal government for approval to implement CTI funded by Medicaid. Medicaid has granted this approval, allowing for housing navigation services, case management, moving assistance, setup costs, and rental support for up to six months. Although the aim is to secure a year’s worth of rent, Medicaid will cover a maximum of six months.
This development is a major advancement, as these six states will now receive funding from the health insurance agency to aid individuals in escaping or preventing homelessness. Being a federal entitlement means that the program does not depend on discretionary spending from Congress, unlike our homeless assistance funds, which are entirely discretionary and subject to government funding decisions. In contrast, entitlements theoretically obligate the government to cover costs when services are provided. While the implementation isn’t entirely straightforward, the concept of integrating homelessness prevention into an entitlement program is crucial.
Collaboration and Coordination between Systems
In March 2025, the U.S. government disbanded the United States Interagency Council on Homelessness (USICH). Nevertheless, many states maintain their own versions, which have offered essential guidance and leadership. Although they lack a formal budget and do not manage funds, their influence remains significant. Interagency councils at the state level often hold greater sway because they can easily foster collaboration and coordination between agencies. This ensures that all organizations work towards a common objective instead of competing against one another regarding various programs.
It all comes down to funding.
If you have funds, you have something to partner around. For instance, there have been successful initiatives aimed at addressing chronic homelessness, such as those in Utah and in Houston, which are frequently cited for their success. Houston experienced a 60% reduction in chronic homelessness over five years, thanks entirely to collaboration. This theme of collaboration, similar to USICH, occurred on a local level, where various agencies worked together to take responsibility for different components of the intervention while prioritizing clients. This approach acknowledges their situation as a health emergency that warrants immediate action rather than asking them to wait for months for assistance. Thus, while there are notable examples, effective solutions typically require new resources or the pooling of existing resources, as these resources encourage collaboration, acting as both the carrot and the stick.
What Does it Cost to Prevent Homelessness?
In the U.S., the average prevention cost is approximately $1,000 per household. While some may incur expenses of several thousand, with amounts like $3,000, most fall within the $1,000 to $1,200 range. On a national scale, shelter costs about $30,000 per bed each year, but in New York City, it’s closer to $35,000. For a family of three, this totals $100,000 annually, making it extremely costly. In fact, for the price of one bed, you could accommodate six or seven families in an apartment for an entire year.
Beth Shinn and colleagues conducted a randomized controlled trial on prevention in New York City through a citywide homeless prevention program. Participants were randomly assigned to receive either cash along with case management or no assistance at all. The findings revealed that families receiving assistance had half the homelessness rate of those who did not. Specifically, 8% of those without support became homeless compared to 4% of those who received assistance, resulting in a net difference of four percentage points. While 92% of individuals remained housed regardless of assistance, the significant costs of shelter made it more efficient to allocate $1,000 to reduce homelessness from 8% to 4%.
It turned out that giving $1,000 to everyone who’s on the brink of homelessness is cheaper than doing nothing and waiting for the additional 4% of people to enter the homeless assistance system.
Conclusion
Basic safety net assistance is paramount. Ultimately, the U.S.’s challenge is not just housing supply but also income. Homelessness is fundamentally an income issue, and it’s one of the easiest problems to address since it involves simply writing cheques or larger cheques than usual. Timely basic income is arguably the most important preventative measure we can adopt.
Emergency cash assistance is also crucial because crises occur, and sometimes basic income isn’t sufficient to get through tough times. Thus, having basic emergency cash assistance is essential.
Lastly, focus on social welfare institutions where people face significant life challenges. This includes individuals emerging from detox programs, jails, or hospitals. Effective social work can assess individuals’ risks in these environments, facilitating a smoother transition back into the community. I believe that implementing these three strategies could go a long way toward preventing homelessness in a politically feasible manner.