Implementing Cash Transfers in the Context of Local Homelessness Response Systems: Using Cash with Coordinated Entry

Background. Each year, approximately one in ten young adults in the United States experiences homelessness, highlighting the urgent need for interventions that promote rapid and sustained exits to stable housing. Unconditional direct cash transfers (DCTs) (i.e., financial resources provided without requirements) have shown promise globally in reducing poverty and improving well-being. However, evidence on their effectiveness in addressing youth homelessness, particularly when integrated with existing homelessness response systems, remains limited. This study evaluates the impact of a DCT pilot program on housing stability among young adults in San Francisco, with particular attention to differences by Coordinated Entry (CE) status. Within the CE system, youth are categorized into either "housing referral" status, which provides access to long-term housing services, or "problem solving" status, which focuses on short-term crisis resolution without ongoing housing support.

Methods. The Trust Youth Initiative (TYI) is a 24-month unconditional DCT intervention designed for young adults experiencing homelessness. The broader evaluation, referred to as the Pathways Study, is a longitudinal randomized controlled trial evaluating whether TYI effectively reduces housing stability for young adults (18-24) experiencing homelessness in San Francisco (SF; n=85). TYI participants (n=45) received unconditional DCTs comprised of two monthly payments equating to $1,500 per month, and a one-time lump sum of $4,500, coupled with optional supportive services for 24 months. The Residential Time-Line Follow-Back Inventory (RTLFBI) was used to collected data on housing trajectories for a total of 30 months, including 6 months post-cessation of cash. A series of paired t-test examined changes in the number of nights spent in stable housing, couchsurfing, and experiencing sheltered and unsheltered homelessness from baseline to month 18 (updated for the full 24-month intervention at time of presentation) for TYI and services-as-usual, considering CE status.

Results. The Trust Youth Initiative (TYI) led to significant improvements in housing stability over 18 months, with participants reporting more nights in stable housing across both Coordinated Entry (CE) statuses (Δ=5.4 nights, p<0.001). Couchsurfing decreased significantly among those in TYI designated problem-solving (not referred to housing; Δ=-2.6, p=0.02). Both TYI and services-as-usual groups showed reductions in sheltered homelessness, primarily among those with housing referrals (TYI Δ=-4.1 nights, p=0.02; SAU Δ=-2.6 nights, p=0.02). Notably, none of the TYI participants in the problem-solving group reported shelter use at month 18. Finally, TYI participants saw reductions in unsheltered homelessness, driven largely by those with housing referral status (Δ=-3.5 nights, p=0.004).

Conclusions and Implications. Unconditional DCTs significantly improved housing stability for young adults experiencing homelessness, across both housing referral and problem-solving groups. DCTs reduced couchsurfing and eliminated shelter use among those not referred to housing, highlighting their potential to fill gaps in the homelessness response system. These findings suggest that DCTs are a promising, low-barrier tool that can complement existing services and empower youth, particularly those with limited access to traditional housing support, to achieve more stable and self-directed housing outcomes.