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.

Foreword by Nan Roman, President and CEO of the National Alliance to End Homelessness This book explains how to end the U.S. homelessness crisis by bringing together the best scholarship on the subject and sharing solutions that both local communities and national policy-makers can apply now. In the Midst of Plenty shifts understanding of homelessness away from individual disability to larger contexts of poverty, income inequality, housing affordability, and social exclusion. Homelessness experts Shinn and Khadduri provide guidance on how to end homelessness for people who experience it and how to prevent so many people from reaching the point where they have no alternative to sleeping on the street or in emergency shelters. The authors show that we know how to end homelessness—if we devote the necessary resources to doing so. In the Midst of Plenty: Homelessness and What to Do About It is an excellent resource for policy-makers, professionals in the homeless services system, and anyone else who wants to end homelessness. It also can serve as a text in undergraduate or masters courses in public policy, sociology, psychology, social work, urban studies, or housing policy. "The knowledgeable and thoughtful authors of this book—two brilliant women who know as much as anyone in the country about the nature of homelessness and its solutions—have done a great service by taking us on a journey through the history of homelessness, how our responses have changed, and how we can end it." —Nan Roman, President and CEO National Alliance to End Homelessness. "Shinn and Khadduri's new book is a thorough yet concise examination of what we know about the nature and causes of homelessness, and the crucial lessons learned. This critically important work provides a roadmap to restoring basic housing and income security as viable policy options, in the face of our daunting inequality divide that otherwise threatens millions with destitution and homelessness." —Dennis Culhane, Dana and Andrew Stone Professor of Social Policy, University of Pennsylvania "Marybeth Shinn and Jill Khadduri have combined their significant expertise to create an essential guide about the history of modern homelessness and to offer a clear path forward to end this American tragedy. Their policy recommendations on ending homelessness are culled from the best about what we know works." —Barbara Poppe, Executive Director US Interagency Council on Homeless, 2009-2014

As an evidence-based practice, Housing First has not only been proven to be successful in ending homelessness, but is also embraced as the most cost-effective solution. Today, the Housing First model is being implemented in hundreds of communities across the United States, Canada and Europe. As the model evolves one thing remains constant: Housing First ends homelessness. Housing First is simple: provide housing first, and then combine that housing with supportive treatment services in mental and physical health, substance abuse, education, and employment.Housing First details:solid, actionable information about the program's philosophy, operations, and administrationthe composition, staffing structures, and day-to-day operations of the clinical and support servicespractices in client assessment and engagementproperty management operationsthe best protocols for assisting clients with the search for housing, relationships with landlords, and the overall "settling in" processthe research evidence for the effectiveness of the Pathways modelThe Pathways model has been remarkably successful in ending chronic homelessness. Since its founding, housing retention rates have remained at 85 – 90 percent even among individuals who have not succeeded in other programs. Not only is Housing First effective at keeping people housed and working toward recovery, it has also proven to be incredibly cost-effective.

This book provides a unique portrayal of Housing First as a 'paradigm shift' in homeless services. Since 1992, this approach has spread nationally and internationally, changing systems and reversing the usual continuum of care. The success of Housing First has few parallels in social and human services.