Holistic Solutions for Housing Systems

Homelessness is an issue with many causes; it’s often a combination of factors that lead to experiencing homelessness, not just one factor. Lack of affordable housing, unemployment or underemployment, gentrification, intergenerational poverty, race, domestic violence, mental illness, physical health, gender, sexuality, substance use disorders, PTSD, stagnant wages, lack of affordable health care, family conflict, food insecurity, and system failures can all contribute to someone becoming homeless.

Stigma states that experiencing homelessness is the fault of the person who doesn’t have a home. They did something wrong or made poor choices that led to their housing status. This stigma comes in part because those who are stably housed don’t want to admit that homelessness could happen to them. However, a 2019 study by Charles Schwab shows that 59% of Americans are just one paycheck away from homelessness. It’s easier to blame someone else for your housing insecurity than to accept that you, too, could find yourself in a similar situation.

Despite the stigma and assumptions about causes, there are complicated, often systemic, factors that lead to homelessness. The traditional housing system, a solution that has been in place for decades, provides only basic needs: Food and shelter. The system, or continuum of care, is a stepwise approach in which a person must meet certain criteria at each stage of the path to housing. Permanent housing is the final step in a series of supports that begins with emergency shelter; each step in the process has specific rules and requirements that must be met before moving to the next step.

Not surprisingly, this traditional system doesn’t appeal to everyone. Individuals often prefer to live unsheltered rather than adhere to the requirements of a shelter or transitional housing program. In addition, safety in shelters is a serious concern for certain groups of people, such as LGBTQ, disabled, and women or female. In a 2020 Vice article titled “This is why homeless people don’t go to shelters,” Esperanza Fonseca, who was homeless in 2018, is quoted on the issue of safety in shelters, “In the shelter, I was subjected to violence, threats, harassment and discrimination. That’s what we feared on the streets, but we still experienced it in the shelter too, just with more rules and expired milk.”

If homelessness is a problem with many different causes and factors, then the solution to homelessness should address all of these systemic problems and not just focus on the traditional food and shelter system.

So what solutions offer holistic supports?

Housing First

The Housing First model was introduced here in 2008 by Pathways to Housing PA. Housing First was designed to limit barriers and focus on housing first, then provide comprehensive wrap-around services to fully support an individual in stable housing. The evidence-based model was developed in New York City to support people with serious mental health disorders, and has since expanded around the world. Pathways to Housing PA was the first to adapt the model for individuals with opioid use disorder, and HUD launched the House America initiative in 2021 to end homelessness using the Housing First approach, leading to increasing adaptation to meet the needs of new populations.

Housing First is an approach that addresses more than food and shelter. The model includes the integration of behavioral, mental, and physical health care along with individualized case management services that support benefits, employment, education, community inclusion, and other needs identified by participants.

Whole Person Care

Another model that addresses homelessness holistically is Whole Person Care, a series of pilot programs launched in California in 2016. The program coordinates physical health, behavioral health, and social services for Medicaid-insured individuals with complex needs. WPC targets high-risk populations with complex needs, including those experiencing homelessness, who have high health care utilization. In addition to care coordination, WPC beneficiaries also receive services tailored to local needs and available resources, like housing navigation services, housing search assistance, coaching, landlord incentives, peer support specialists, and substance use services. Since the initial pilot, the WPC has expanded beyond California and continues to explore ways to support this community of individuals with holistic care.

Hospital to Housing

In Massachusetts, a three-year pilot program called Hospital to Housing was launched, in which community health workers provide real-time, client-centered support to connect high-risk individuals with primary and behavioral health services, transportation, food, and housing. One study found that use of community-based outpatient services increased by 23% due to stable relationships between service recipients and community health workers. Hospital discharge is a particularly sensitive time for individuals who are experiencing homelessness, and thus there is a growing movement to target discharge as a point of intervention.

Built for Zero

One tool to support organizations in their efforts to end homelessness is Built for Zero, a system for making data-driven, system-wide approaches. Built for Zero recognizes that no single actor is fully accountable in ending homelessness and provides the infrastructure to capture comprehensive, real-time data not only on those experiencing homelessness, but also on the conditions that lead to homelessness, so that measurable changes can be made. Built for Zero boasts that 100 cities and counties are using the tool and more than half have been able to reduce the number of people experiencing homelessness.

What Pathways to Housing PA participants want to see paired with housing.

“Education” They’d welcome more educational opportunities. Several were particularly proud of their high school diploma, and several participants in the conversation were interested in being able to apply those skills elsewhere.

“A haircut,” one participant cuts her own hair and has no experience in that.

“Dental services” along with housing, another participant had some issues in the past, but had a hard time finding a dentist who could help her.

“Driving lessons and assistance with applying for a driver’s license.”

“Assistance in applying for benefits and supplemental income.”

For disclosure: Pathways to Housing PA includes primary care, behavioral health care, medication management, employment services and community integration, so we already provide a lot of wraparound care.

The key takeaway:

Treat those experiencing homelessness as humans and not their experience. Listen to them and offer programs that meet their needs. This may look different depending on the needs of your community, but that is the key to addressing the various factors that lead to homelessness. It’s not enough to just provide a home.