Copyright 2015 American Medical Association. All rights reserved. Housing as a Remedy for Chronic Homelessness

Few sights are as distressing as a person living on the streets, under a freeway or in a bus shelter, in a cardboard box or a makeshift tent, pushing a wagon of possessions or draped in newspapers as protection against an oncoming rain. The chronically homeless have a high prevalence of mental ill-ness, substance use, and physical health problems, as well as higher use of emergency department visits, hospitalization days, and mortality.1 Ten years ago the dominant approach for addressing homelessness was a Continuum of Care approach, also known as a treatment-first or stepwise approach. It was assumed that homeless persons were not ready to be housed, that they first needed to achieve sobriety, comply with psychiatric treatment, and learn th