Bridges and Barriers to Housing for Homeless Street Dwellers: The Impact of Health and Substance Abuse Services on Housing Attainment

¿Chronic¿ homelessness has been on the rise in the USA and elsewhere. This research project focuses on a group of ¿chronically¿ homeless street dwellers in Boston, Massachusetts in 2000-2002 who due to their poor health status are at high risk of death. This in-depth case study analyzes administrative data on health and substance abuse service use and associated outcomes. In addition, structured interviews with service providers and street dwellers provide information on the process of accessing services and housing outcomes. Research findings indicate that only 24 percent of street dwellers were housed at the end of 2002. Except for long respite care stays, health and substance abuse services had little impact on housing outcomes. Interview data point to service coordination and consistent staff support as bridges to housing. Barriers encompass lack of affordable housing, lack of support during transition from the streets to housing, lack of financial supports, program eligibility rules, and personal factors. Policy implications include the need for affordable housing, support systems for successful transitions between the streets and housing, and reducing bureaucratic barriers.