Overcoming Supportive Housing Placement Challenges

Background: Permanent supportive housing (PSH) integrates affordable housing with supports for vulnerable families and individuals who are homeless or at risk for homelessness. Over two decades of research finds that PSH promotes housing stability, improves health outcomes, and reduces time in institutional settings. New York City has committed substantial resources to expanding PSH and is working to streamline the PSH entry process. One focus of that effort is the substantial drop-off that occurs after clients are referred to an available unit. This increases time in shelter, keeps units vacant longer, and creates inefficiencies in staff time and resources. The Office of Evaluation and Research (OER) of the Department of Social Services led a multi-stakeholder, mixed-methods study focused on three key points of disconnect following referral: the client misses the initial meeting with the housing provider (“no-shows”), the client rejects the unit (“declines”), and the housing provider rejects the client after initial acceptance (“delinks”).

Methods: OER used administrative data from the city’s Coordinated Assessment and Placement System (CAPS) on 8,115 clients approved for supportive housing in calendar year 2021, including referrals and move-ins associated with those approved applications through 3/31/2023, as well as detailed placement tracking spreadsheets on 1,959 clients referred to vacant PSH units between 7/1/2022 – 6/30/2023. These were matched to the Department of Homeless Services case management system (CARES) to obtain shelter history and sociodemographic variables. In-depth key informant interviews were conducted with leadership, staff, and clients at 10 shelters to explore participants’ perspectives on the PSH entry process and recommendations for improvement.

Results: Among clients referred to a PSH unit, 44% had at least one no-show, and 20% of those who attended an initial meeting subsequently declined the unit or were delinked by the provider. We observed small but statistically significant differences by gender, race/ethnicity, and age, with women more likely to disconnect at each point compared to men. Clients with 5 or more no-shows accounted for 25% of all missed appointments, suggesting that this small repeated no-show group accounts for a disproportionate share of effort in the PSH placement process. The most common reasons for no-shows and declines cited by staff and clients included concerns about the unit’s location and living arrangements (e.g., shared kitchen and bathroom), stigma about supportive housing, and anxiety about moving out of shelter. Delinks most often occurred due to changes in clients’ eligibility, documentation issues, or loss of contact. Staff highlighted the importance of consistent and transparent communication with clients about supportive housing in general and the matched unit in particular, noting that clients with longer histories of homelessness and behavioral health conditions (the target population for PSH) were often challenging to engage.

Implications: A substantial minority of supportive housing assignments are disrupted by client no-shows / declines and provider delinks. Improved and standardized communication and interview protocols, better alignment of housing stock with client preferences, and targeted efforts to engage those at higher risk of dropping out of the PSH process could reduce inefficiencies and improve participants’ experiences.