Homelessness isn’t Hopeless: Evidence-Based Interventions

Homelessness in the United States can provoke a sense of intractable helplessness, not least in the policy space. The crisis continues to grow despite massive investment, including $3 billion annually through the Veterans Administration and almost $4 billion through the Homeless Assistance Grants program run by the Department of Housing and Urban Development (HUD). States spend even more on top of federal programs, ranging from millions to billions more per year per state. 

As Michael Tanner explained in Reimagining the Policy Approach to Homelessness, a 2024 FREOPP white paper: 

• California spends $7.2 billion annually fighting homelessness. New York City alone spends $2.2 billion per year on homelessness. And[…]the Biden administration is asking for $8.7 billion in federal spending per year. On average, according to the National Alliance to End Homelessness, each homeless person costs taxpayers roughly $35,000 per year. Other studies put the annual cost as high as $100,000 per homeless person. Most likely the real cost lies somewhere in between.
• These figures represent only direct spending on homelessness. [Deleterious health outcomes show] that homeless people are more likely to need medical treatment and access to hospital emergency rooms where care is often provided to those without the ability to pay. This means that uninsured homeless people impose additional costs on the health care system.

Despite all this money spent, the problem seems to be getting worse.  

However, meager results should not lead to a broader fatalism about homelessness ultimately being intractable. Instead, the wide array of programs and expenditures presents an opportunity to assess which investments make a meaningful difference and the ability to identify those that fundamentally fail to show results. By scaling up the most effective interventions, policymakers can ensure that resources are directed where they have the greatest impact. 

People often index the difficulty of a problem on the hardest cases. When it comes to homelessness, the end goal of zero homeless people often gets in the way of making a sizable impact and making sure that the right resources are available to prevent people from falling into long-term peril. The all-or-nothing mindset can be paralyzing. The most challenging cases of mental health struggles, substance abuse, crime, or antisocial behavior are not characteristic of most homeless people, and over indexing on them makes effective policy even harder to design.

By examining evidence-based solutions, policymakers can shift to a more hopeful narrative and then a hopeful reality. Targeted action can and does make a real difference, but poorly-constructed interventions can burn massive amounts of money to no noticeable effect. Progress is possible, but it can’t just be purchased. 

Evidence shows that each of the following interventions can make a difference, while respecting both individual autonomy and the impossibility of simply spending our way out of the problem. 

Evidence-based pathways 

Family reunification 

Many homeless people would prefer to be with their families rather than cycle between shelters, temporary housing, their cars, and the streets. Through the cycle of homelessness, people become ashamed of their situation and don’t reach out for help. As they change locations, lose phone service, and are treated differently by larger society, they can enter a spiral that is hard to get out of as they run out of material and social resources. Sometimes in this process, they become lost and separated from people who care about them. 

In their captivating book, When We Walk By, Kevin Adler, Donald Burnes, Amanda Banh, and Andrijana Bilbija describe the idea of relational poverty (a deficit of social relationships) as an important factor differentiating a person who is down on their luck, but bounces back, from a person who enters homelessness:  

“Millions of housed individuals and families are right now living on the brink of financial disaster, and we as coauthors believe that the only thing keeping them from homelessness is the support of their networks. One out of every two Americans is a paycheck away from not being able to pay rent—given this harrowing statistic, it is rather astonishing that “only” 6 million Americans experience homelessness each year. Why aren’t tens of millions of us homeless?”

Kevin Adler’s nonprofit, Miracle Messages, was highlighted by Stand Together for its impactful work. Its purpose is to address relational poverty directly. Miracle Messages runs a program, Miracle Friends, which matches homeless people with volunteers who offer companionship and help with problem solving. 

Miracle Messages also runs a reunification service which helps homeless people reunite with loved ones whom they may have lost touch with. To date, Miracle Messages has shepherded over 1,000 people out of homelessness by reuniting them with their families. A person would record a video, and Kevin’s team would run a process of detective work to find the desired party.  

In the book, Kevin describes how he started by walking the streets and asking people one by one if there was somebody they wished to reconnect with. Since those early days, the organization has demonstrated the power of this approach on a much larger scale:

“Miracle Messages has organically received hundreds of “find them” case submissions from families desperately looking for their missing loved one, without ever advertising the service. The next time you visit a shelter, take a look at the bulletin board as you walk in: there is a good chance you will see a missing person flyer, with a plea to “call mom” or “please come home.”

Hope Atlanta has also reunited hundreds of families with their loved ones using digital detective tools, and provides subsidies for transportation for people to get home.

Elsewhere, according to data from the City and County of San Francisco’s Department of Homelessness and Supportive Housing, between March 2015 and February 2019, over 60 percent of the city’s successful shelter exits into stable housing (1,268 out of 2,094 people) occurred through family or friend reunification. This was double the 652 people who made a shelter exit through a placement into permanent housing. 

These outcomes underscore the profound impact of family reunification, which not only creates a sustainable route away from homelessness and a reliance on public assistance, but does so while honoring individuals’ dignity and their need for social connection.

Fast and flexible capital support 

Effective interventions reroute people away from the cycle of homelessness before it takes hold. Nearly half of Americans live paycheck to paycheck, meaning unexpected expenses can send a person or family into a downward spiral if they fall far enough behind on rent payments, utility bills, and other monthly costs that may ultimately lead to eviction.

Many people at risk of homelessness know what they need to stabilize their lives, but lack the resources to act. Because poorer Americans tend to live and interact most often with one another, they do not have the social connections to, for example, borrow money from a friend in a pinch because the people in their networks are as cash strapped as they are. Fast, flexible, direct payments can provide help at a critical leverage point in times of need.

There is a stereotype that homeless people, if given cash directly, would simply spend it on self-destructive behaviors – but studies show that this is not true. 

Contrary to common stereotypes, 70 percent of people entering homelessness do not report a substance abuse disorder; instead, crises like job loss or health emergencies often become the tipping point. 

From Tanner’s analysis: 

• According to 2018 point-in-time counts, roughly 20 percent of homeless people have a severe mental illness and 16 percent are chronic substance abusers. Other surveys put the numbers slightly higher, with some suggesting that between 25 and 40 percent of homeless individuals have a substance use disorder. Because most of those studies exclude families—who are far less likely to have such problems—the affected percentage is likely inflated.
• There is also something of a chicken-and-egg problem with these surveys. Many homeless people begin to abuse drugs or alcohol due to the stress of living on the street. And homelessness tends to exacerbate existing substance use disorders. Thus, substance abuse is often both a cause and effect of homelessness.

The rationale for direct payments is that by offering prompt financial support, we can help individuals and families uphold the structure and responsibilities they already manage, preventing further descent into homelessness. 

Even though somebody has entered a situation in which they cannot afford an apartment, this does not mean that the rest of their life is without structure or responsibility, that if maintained, would help them out of the situation: 37 percent of homeless individuals are with their families, and a significant number have jobs. As Tanner notes: 

• A 2021 University of Chicago study estimated that 53 percent of people living in homeless shelters and 40 percent of unsheltered people were employed, either full or part-time. We lack good data on how many hours they actually work—many may work just enough to produce a few hours on a W-2— nor do we have a good breakdown on differences between housed and unhoused homeless. Still, this suggests that most homeless people were capable of making reasonable decisions, caring for themselves, and otherwise functioning in society. Some factor beyond mental illness or substance abuse was, therefore, likely to have led to their becoming homeless. The evidence overwhelmingly points to housing costs and the interaction of high housing costs with poverty as the driving factors for a large portion of homelessness.

Several experiments have shown the promising results of direct payments. In the New Leaf Project, 50 people were given one payment of $7,500 each. The study concludes that over one year, “the cash transfer reduced days homeless, increased stable housing, savings, and spending, but without increased spending on temptation goods, and generated net savings for society via reduced social service use.” 

A pilot experiment called Miracle Money (run by Miracle Messages) provided 103 randomly selected homeless people a basic stipend of $750 per month for six months and concluded that people spend the money on food, housing, and other basic needs, and halved the proportion of people that reported that they had spent time unsheltered in the past month. 

Similar results were shown in the UK, in experiments run by the Centre for Homelessness Impact’s Personal Grants project, which is the first program to evaluate the impact of unconditional cash transfers in the UK:

“The list of things that people spend their money on is practical, and speaks to me of individuals trying to improve their lives in ways that are personal and meaningful to them: furniture, books, clothes, gym membership. Some thought of others rather than themselves, and sent money or bought gifts for members of their family, or supporting friends financially. Participants told us their wellbeing had improved, meaning they were happier, more socially connected, and able to make long term choices, aiding their progression out of homelessness.” 

These results show that targeted, flexible financial support can be an important tool to prevent and decrease chronic homelessness. 

Family-friendly transitional housing 

Almost one third of the homeless population is made up of families. Many shelters separate families by dividing men from women and adults from children. This separation can lead to increased distress, sleeplessness, and even the decision to avoid shelters altogether, forcing families to sleep in cars or unsafe environments.

In a study of over 2,000 homeless families in communities across the country, “One-third of children in families who experienced homelessness were separated from the family at the time of the shelter stay or had been separated at some time in the past.” Nearly 40 percent of homeless families in emergency shelters reported a child living away from them, either before or during their shelter stay. Most of these children were staying with other relatives, which highlights the complexity of these separations: while the study did not investigate whether these were voluntary or involuntary, and whether relatives were chosen as safer alternatives, the sheer number of families experiencing this kind of disruption is striking. The study also found that children who had previously been separated from their families were much more likely to experience separation again in the future.

Transitional housing (housing that is meant as a bridge between emergency shelters and permanent housing) that keeps families together is an important step in maintaining the kind of emotional stability and interpersonal coordination that is needed to get back on one’s feet. 

Family Promise is one organization that provides this and has found success with their methods. From their 2024 impact report: 

“Families make up 30 percent of the nation’s homeless population. Safe, secure shelter that keeps families together during a housing crisis helps ensure the best outcomes for long-term stability. While traditional shelters tend to separate families by age or gender, Family Promise keeps families together in safe settings with support from the local community. More than 80 percent of the families in our shelter program exit to stable housing.”

The Stand Together Foundation highlights the nonprofit Solutions for Change as an impressive case study of positive transformational results. 76 percent – more than 4,300 parents and children – have found stability after going through their program. Participants get an “empowerment coach” and live in temporary housing together in apartments that face a central courtyard. They “graduate” – usually in less than two years – when they have a stable job, long-term housing arrangements, and $3,000 in the bank. 

From Stand Together’s article describing the process: 

“Participants stay sober, take care of their children, attend life skills classes, show up for therapy, save money, and contribute to the community.” 

These family-centered approaches demonstrate that when families are supported and kept together, they can achieve lasting stability. 

Short-term vouchers

When a person doesn’t have an existing support system, government programs are meant to provide a safety net–but many people already have people who care about them in their communities. Moving into affordable housing often means leaving this community. 

To break the cycle of homelessness, people in need should be able to access stable housing without relocating for a new job, taking their children out of school, or otherwise upending their lives and leaving their already existing support systems. 

Typically, policymakers design housing vouchers with the shortage of affordable housing in mind. A person can use the voucher as a subsidy for a unit they select in the private market, in the neighborhood of their choosing. The voucher would make existing units cheaper to rent and create affordable housing in a variety of locations. This solution goes around the logistical challenges and high costs of building new housing in specific neighborhoods zoned for affordable housing. 

The subsidy is typically structured to cover only part of rental costs, not the entire amount. For example, in New York City, the subsidy bridges the gap between low wages and high rent, typically such that a recipient would not pay more than 30 percent of their income on housing. This means that a family can stay in their neighborhood, keep their current job, and avoid the life and work disruptions that often perpetuate homelessness.

The 30 percent threshold is used because it is commonly cited as the maximum portion of income that should be spent on rent in America. 

From the Furman Center: 

“What is more important than the size of the rental payment is the share of a household’s income that goes towards rent, or their rent burden. Households are generally deemed to be rent burdened if they spend more than 30 percent of their income on rent, and severely burdened if they spend 50 percent or more. 

Voucher holders through programs run by the NYCHA [NYC Housing Authority] and HPD [New York City’s Department of Housing Preservation and Development] have average rent burdens of 30 percent and 32 percent respectively. This is comparable to the national average rent burden for voucher holders, which is 32 percent. In spite of the higher rents in NYC, Housing Choice Vouchers are quite successful at lowering rent burdens of recipients. 

Nearly 90 percent of HCV households are not rent burdened, and those who are rent burdened are generally spending less than 40 percent of their income on rent. Only 1.8 percent of all HCV households pay 50 percent or more of their income on rent. By comparison, more than 80 percent of unassisted poor renter households in New York City are extremely rent burdened, spending more than 50 percent of their income on rent.”

Despite their potential, many voucher programs are not realizing their intended benefits. 

Once a person is accepted into a voucher program, they often can stay in it for a long time. In New York City, voucher holders spend over 15 years in the program. Elsewhere, recipients spend an average of 8 years in the program. However, applicants often have to wait years to get a voucher. 

According to the Center on Budget and Policy Priorities:  

“Among the 50 largest housing agencies, only two have average wait times of under a year for families that have made it off of the waiting list; the longest have average wait times of up to eight years. On average nationally, families that received vouchers had spent close to two and a half years on waitlists first, exposing many to homelessness, overcrowding, eviction, and other hardship while they wait.” 

These long wait times mean that the vouchers fail in their function as an impactful buoy for preventing the harmful consequences of entering homelessness. Instead, they end up functioning primarily as a source of long-term housing for those who eventually receive them.

Even if a person receives a voucher, the voucher can lapse if the applicant does not find an apartment that accepts it in time. Sometimes, the putative recipient has as few as 60 days to find a unit that accepts it, or the award will go to the next person on the waiting list. 

Many vouchers go unused. By state, successful usage rates in 2019 ranged from 36.2 percent in Nevada, to 76.91 percent in Maryland. The national success rate in 2022 was just 55 percent. 

Landlords often prefer tenants with higher incomes and no history of housing instability. Additionally, they can get nervous about inspection requirements and bureaucratic delays related to receiving a subsidy from the government. 

A few changes can make vouchers much more impactful.

Policymakers should help ease the concerns of landlords so that more units become available. Policymakers could also introduce low-stakes, short-term vouchers available right when a person needs it, rather than forcing families to wait many years. Such a program could be a lifeline that prevents cyclical disruption and instability before it starts. Families would be able to stay in the neighborhoods where they have jobs, friends, and other connections, rather than move to a housing project in a completely different neighborhood. This is better for both the individual and for the taxpayer, as individuals are able to use resources they already are connected to, rather than relying on taxpayer-funded programs.  

Policies centered on autonomy and dignity can make a real difference for families experiencing, or who are on the brink, of homelessness. Family reunification programs, flexible capital support, family-friendly transitional housing, and vouchers for housing choice are making measurable differences in both people’s individual lives and in homelessness rates broadly. These approaches honor the dignity and agency of each individual affected. 

The persistent myth that homelessness is a problem too big to solve only paralyzes progress while obscuring the real successes happening across the country. With the right interventions, hope can lead to a home. By focusing on what works, policymakers can move beyond despair and move toward lasting change.