Homelessness Interventions: Models, Data, and the Missing Ingredient of Dignity

Models Over Outcomes?

For years, policymakers and service providers have argued over which intervention is “best”—Housing First, rapid rehousing, transitional housing, permanent supportive housing. I’ve worked in and around all of them. I’ve seen them succeed, and I’ve seen them fail.

The truth is:

The model doesn’t determine the outcome. The way it’s staffed, resourced, and—above all—delivered with dignity does.

Programs that treat people as human beings can stabilize lives. Programs that treat people like data points just recycle them back into homelessness.

The research proves these models can work. The lived reality shows why they often don’t.

Housing First: The Promise vs. The Reality

Housing First is the most studied model. A CDC/HUD review found it reduced homelessness by 88% and improved housing stability by 41% compared to treatment-first programs.

In Canada’s At Home/Chez Soi trial, participants spent 73% of days stably housed versus 32% in traditional models.

Seattle’s 1811 Eastlake program cut public costs by $2,449 per person per month, saving the city more than $4 million in a single year.

But a deeper look reveals cracks.

Between 2018 and 2023, permanent supportive housing (PSH) units in the U.S. grew by 31%, yet the chronically unsheltered population grew by 60%.

In California, the unsheltered population rose 50% even as 25,000 new PSH units were added .

Most striking:

Even though people housed under Housing First often stay housed, their health outcomes don’t necessarily improve. The National Academies found no compelling evidence that Housing First improves long-term physical or mental health .

Case studies from San Francisco showed housed individuals still generating massive public costs through ER visits and ambulance trips—16 people alone cost nearly $1 million each in services, with 79% of spending tied to emergency healthcare .

This is usually due to lack of holistic supportive services.

From the field, I’ve seen people handed keys to unfurnished apartments, left with inconsistent or nonexistent case management or support of any kind.

Some ended up evicted

Others destroyed units

Many cycled back to shelters or the streets.

Housing First isn’t broken by philosophy—the danger comes when it’s treated as the end point instead of the starting point.

Without clear pathways for growth and transition, the system risks creating dependency, clogging up housing stock, and draining already limited resources.

When done right, Housing First, just like most models, aims for stability as a launchpad by helping people build independence when possible, or providing consistent, holistic support that honors dignity and adapts to each person’s reality.

Permanent Supportive Housing: Predictability Without Support

HUD data shows 96% of people in PSH remain housed or move into another permanent home within six months. Retention can reach 98% in some programs .

But stability without support is fragile. Poorly staffed PSH sites can generate safety issues—drug use, crime, and spillover problems for neighbors . 

I’ve seen buildings open without enough staff or security, becoming hubs of crisis instead of places for healing and recovery.

Supportive housing has to include supported pathways out.

If residents achieve stability but remain locked in PSH with no 'move-on' strategy, units clog up, new clients can’t get in, and neighborhoods feel the strain.

With an annual exit rate of only about 12.8%, the system risks becoming a cul-de-sac instead of a springboard.

PSH works best when it’s “supportive empowerment first,” not just “housing first.”

Without robust, permanent, well-resourced services, PSH becomes a holding tank, not a stabilizer.

Rapid Re-Housing: When the Bridge Leads Back to the Street

Rapid Rehousing (RRH) offers short-term rental assistance, typically lasting from six months up to two years depending on the program, paired with case management support.

It is most effective for households with moderate barriers to housing stability, but often proves too unstable for people with the highest vulnerabilities.

• About 10% of RRH households return to homelessness within a year, and 76% move residences at least once (Cunningham et al., 2015).

  
  

• Nationally, only 32% of exits from shelters, transitional housing, and RRH combined lead to permanent housing (HUD, 2023).

  
  

I’ve seen it first-hand: people taken from encampments, dropped into bare apartments, and left to figure it out. RRH can be a bridge, but without sustained support, it’s a bridge back to the street.

The lesson from RRH seems obvious:

Time-limited support without empowerment is a setup for failure. Independence must be the goal, not just the expiration of a subsidy.

Otherwise, people just cycle back into shelters, and the system ends up burning resources while trust erodes.

Interim & Transitional Housing: The Waiting-Room Purgatory

The Family Options Study found transitional housing costs $2,706 per family per month, compared to $1,162 for long-term subsidies and $880 for rapid rehousing—without delivering better outcomes. That’s a lot of money for a holding pattern.

In practice, transitional or interim housing often feels more like a waiting room in purgatory than a true pathway. People enter with the promise of “empowerment,” but rules and timelines are enforced inconsistently—extensions quietly granted to some, denied to others.

What should build empowerment instead turns into more barriers.

What should drive progress instead slips into mission drift.

I’ve seen programs extend stays for months or even years with no structured exit plan. Some residents are quietly allowed to stay because they’re seen as “more vulnerable” or simply preferred, while others fall through the cracks—deemed too stable to be a priority, yet not supported enough to actually transition out.

When those people are eventually pushed out, they end up back on the street all the same.

The result is clogged systems, burned-out staff, and a cycle where dignity depends less on need and more on arbitrary judgment.

Transitional housing isn’t inherently bad—it can provide critical breathing room for people in crisis. But unless it’s paired with clear expectations, empowerment supports, and real pathways forward, it’s just an expensive waiting room with better branding.

Emergency Shelters: The Invisible Holding Pen

Emergency shelters are often positioned as the “front door” of the system, but for many they’re little more than holding pens.

Nationally, only 32% of exits lead to permanent housing, and 22% of people who leave return to homelessness within 24 months. A recent analysis showed the exit rate for shelters and rapid rehousing combined was only 27% in 2023, with returns to homelessness peaking at 27% in 2022.

The system has the same success rate as flipping a coin and calling it “strategy.”

I’ve worked in and managed some of these spaces, and I’ve seen the same pattern over and over:

line up, lay down, get pushed back out in the morning. Staff are stretched thin, case managers overloaded, and the services people need to move forward are absent or inconsistent. The result is not stability, but churn.

I’ve also seen these environments horribly under-served. People fed food no one should be asked to eat. Residents bullied by staff. Conditions so unlivable they’d never be tolerated anywhere else—yet normalized because the city depended on the nightly volume these shelters could absorb.

The study validates this reality: in New York, the average shelter stay for adult families is 885 days (2.3 years), and for single adults it’s 509 days (1.4 years)—a far cry from “emergency”.

The failures aren’t just human—they’re financial. A single shelter bed costs about $49,640 annually, compared to $24,820 for supportive housing. Worse, the churn drives reliance on ERs, hospitals, and jails, where daily costs can run from $1,414 to $3,609.

When shelters reduce human beings to bed counts, the system burns money, breaks staff, and strips people of dignity while never moving them forward.

Until they are resourced, restructured, and held accountable for housing outcomes, not just occupancy, they will remain revolving doors.

Sometimes, “housing outcomes” means counting the same people three times as they cycle through.

Sanctioned Encampments & Tiny-House Villages: Fragile Experiments

Sanctioned encampments and tiny-house villages are still fragile experiments, but the data shows they can work when done right.

In Seattle, city-funded tiny houses saw 46% of residents exit to permanent housing in 2024, well above HUD’s national benchmark of 32%.

Just like any other approach, if these spaces are staffed well, services are consistent, and dignity is prioritized, they become communities where people can stabilize and move forward. When corners are cut, they quickly slide into containment zones—out of sight, out of mind, and ultimately ineffective.

I've not yet had the opportunity to work directly in one yet, but I’ve seen enough to know that the same rule applies:

Staff, dignity, commitment...

or collapse.

Treatment-First: The Old Staircase Model

Treatment-First required sobriety and compliance before people could even touch stable housing. The data shows how brutal and ineffective it was. In Canada’s At Home/Chez Soi trial, those in treatment-as-usual spent only 32% of days stably housed, compared to 73% in Housing First. 

Retention rates in traditional programs have been found as low as 27%, far below the 90–98% seen in Housing First models. And while PSH units in the U.S. increased by 31% between 2018 and 2023, the chronically unsheltered population still grew by 60%—a bottleneck that is fueled in part by the rigidity of treatment-first practices. 

The model punished relapse instead of planning for it, pushing people back onto the street and compounding trauma. 

To a lot of people this is accountability, but in practice it results in abandonment dressed as care.

The Missing Ingredients: Dignity and Empowerment

Every model has evidence it can work. Every model also has evidence of failure. The deciding factors aren’t just funding or philosophy—they’re whether the system is delivered with dignity and whether it builds toward empowerment.

Dignity means the basics are respected.

Furnished apartments, food that nourishes, staff who treat people like human beings, and environments that feel safe rather than punitive. Without dignity, programs become warehouses that process bodies instead of pathways that restore lives.

Empowerment means creating actual movement.

Stage-based supports, clear exit strategies, and opportunities for independence when people are ready. Without empowerment, the system bottlenecks, permanent housing clogs, rapid rehousing collapses, and shelters recycle people endlessly.

Dignity isn’t optional.

It’s the difference between stabilization and collapse—for tenants, for neighborhoods, for entire systems.

Stop Arguing About Models

The squabble over which model wears the crown is theater. Housing First, rapid rehousing, transitional housing, supportive housing, sanctioned encampments—they can all work when delivered with fidelity, staffed adequately, and centered on dignity.

They all fail when stripped down to the cheapest, fastest version.

What fails people isn’t philosophy. It’s shortcuts, underfunding, and disregard for humanity.

Let’s stop measuring success by bed counts and start measuring lives moved forward.

Reach Out!