Strategies for Managing Homelessness in Populations With Complex Needs

Homelessness is a chronic, non-discriminating, multigenerational issue that affects many communities. However, homelessness is not homogeneous. There is great diversity among those who are unsheltered, emergency sheltered, provisionally accommodated, or at risk of homelessness, with few commonalities other than their lack of adequate housing, adequate income to ensure housing, and/or the essential supports to maintain housing. Strategies to address homelessness follow two very different approaches: the Staircase or Treatment First model versus the Housing First approach. The difference between the two approaches is simple. In the treatment-first model, the client must meet specific criteria to progress toward secure housing, while in the housing-first approach, the client is given a place of residence, along with wraparound services to support a positive health trajectory. Here, we describe and compare these strategies for managing homelessness and propose the approach most appropriate for addressing complex health and social needs.