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City of Boston workers clear encampments in the area known as Mass and Cass.

Craig F. Walker/The Boston Globe via Getty Images

Alvin Powell

Harvard Staff Writer

Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues

It took seven years for Abigail Judge to see what success looked like for one Boston homeless woman.

The woman had been sex trafficked since she was young, was a drug user, and had been abused, neglected, or exploited in just about every relationship she’d had. If Judge was going to help her, trust had to come first. Everything else — recovery, healing, employment, rejoining society’s mainstream — might be impossible without it. That meant patience despite the daily urgency of the woman’s situation.

“It’s nonlinear. She gets better, stops, gets re-engaged with the trafficker and pulled back into the lifestyle. She does time because she was literally holding the bag of fentanyl for these guys,” said Judge, a psychology instructor at Harvard Medical School whose outreach program, Boston Human Exploitation and Sex Trafficking (HEAT), is supported by Massachusetts General Hospital and the Boston Police Department. “This is someone who’d been initially trafficked as a kid and when I met her was 23 or 24. She turned 30 last year, and now she’s housed, she’s abstinent, she’s on suboxone. And she’s super involved in her community.”

It’s a success story, but one that illustrates some of the difficulties of finding solutions to the nation’s homeless problem. And it’s not a small problem. A  December 2023 report  by the U.S. Department of Housing and Urban Development said 653,104 Americans experienced homelessness, tallied on a single night in January last year. That figure was the highest since HUD began reporting on the issue to Congress in 2007 .

Abigail Judge of the Medical School (from left) and Sandra Andrade of Massachusetts General Hospital run the outreach program Boston HEAT (Human Exploitation and Sex Trafficking).

Niles Singer/Harvard Staff Photographer

Scholars, healthcare workers, and homeless advocates agree that two major contributing factors are poverty and a lack of affordable housing, both stubbornly intractable societal challenges. But they add that hard-to-treat psychiatric issues and substance-use disorders also often underlie chronic homelessness. All of which explains why those who work with the unhoused refer to what they do as “the long game,” “the long walk,” or “the five-year-plan” as they seek to address the traumas underlying life on the street.

“As a society, we’re looking for a quick fix, but there’s no quick fix for this,” said Stephen Wood, a visiting fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and a nurse practitioner in the emergency room at Carney Hospital in the Dorchester neighborhood of Boston. “It takes a lot of time to fix this. There will be relapses; there’ll be problems. It requires an interdisciplinary effort for success.”

A recent study of 60,000 homeless people in Boston found the average age of death was decades earlier than the nation’s 2017 life expectancy of 78.8 years.

Illustration by Liz Zonarich/Harvard Staff

Katherine Koh, an assistant professor of psychiatry at HMS and psychiatrist at MGH on the street team for Boston Health Care for the Homeless Program, traced the rise of homelessness in recent decades to a combination of factors, including funding cuts for community-based care, affordable housing, and social services in the 1980s as well as deinstitutionalization of mental hospitals.

“Though we have grown anesthetized to seeing people living on the street in the U.S., homelessness is not inevitable,” said Koh, who sees patients where they feel most comfortable — on the street, in church basements, public libraries. “For most of U.S. history, it has not been nearly as visible as it is now. There are a number of countries with more robust social services but similar prevalence of mental illness, for example, where homelessness rates are significantly lower. We do not have to accept current rates of homelessness as the way it has to be.”

“As a society, we’re looking for a quick fix, but there’s no quick fix for this.” Stephen Wood, visiting fellow, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Success stories exist and illustrate that strong leadership, multidisciplinary collaboration, and adequate resources can significantly reduce the problem. Prevention, meanwhile, in the form of interventions focused on transition periods like military discharge, aging out of foster care, and release from prison, has the potential to vastly reduce the numbers of the newly homeless.

Recognition is also growing — at Harvard and elsewhere — that homelessness is not merely a byproduct of other issues, like drug use or high housing costs, but is itself one of the most difficult problems facing the nation’s cities. Experts say that means interventions have to be multidisciplinary yet focused on the problem; funding for research has to rise; and education of the next generation of leaders on the issue must improve.

“This is an extremely complex problem that is really the physical and most visible embodiment of a lot of the public health challenges that have been happening in this country,” said Carmel Shachar, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation. “The public health infrastructure has always been the poor Cinderella, compared to the healthcare system, in terms of funding. We need increased investment in public health services, in the public health workforce, such that, for people who are unhoused, are unsheltered, who are struggling with substance use, we have a meaningful answer for them.”

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Wood, a nurse practitioner in the emergency room at Carney Hospital.

Kris Snibbe/Harvard Staff Photographer

Experts say that the nation’s unhoused population not only experiences poverty and exposure to the elements, but also suffers from a lack of basic health care, and so tend to get hit earlier and harder than the general population by various ills — from the flu to opioid dependency to COVID-19.

A recent study of 60,000 homeless people in Boston recorded 7,130 deaths over the 14-year study period. The average age of death was 53.7, decades earlier than the nation’s 2017 life expectancy of 78.8 years. The leading cause of death was drug overdose, which increased 9.35 percent annually, reflecting the track of the nation’s opioid epidemic, though rising more quickly than in the general population.

A closer look at the data shows that impacts vary depending on age, sex, race, and ethnicity. All-cause mortality was highest among white men, age 65 to 79, while suicide was a particular problem among the young. HIV infection and homicide, meanwhile, disproportionately affected Black and Latinx individuals. Together, those results highlight the importance of tailoring interventions to background and circumstances, according to Danielle Fine, instructor in medicine at HMS and MGH and an author of two analyses of the study’s data.

“The takeaway is that the mortality gap between the homeless population and the general population is widening over time,” Fine said. “And this is likely driven in part by a disproportionate number of drug-related overdose deaths in the homeless population compared to the general population.”

Inadequate supplies of housing

Though homelessness has roots in poverty and a lack of affordable housing, it also can be traced to early life issues, Koh said. The journey to the streets often starts in childhood, when neglect and abuse leave their marks, interfering with education, acquisition of work skills, and the ability to maintain healthy relationships.

“A major unaddressed pathway to homelessness, from my vantage point, is childhood trauma. It can ravage people’s lives and minds, until old age,” Koh said. “For example, some of my patients in their 70s still talk about the trauma that their parents inflicted on them. The lack of affordable housing is a key factor, though there are other drivers of homelessness we must also tackle.”

The number was the highest since the U.S. Department of Housing and Urban Development began reporting on the issue to Congress in 2007 .

Most advocates embrace a “housing first” approach, prioritizing it as a first step to obtaining other vital services. But they say the type of housing also matters. Temporary shelters are a key part of the response, but many of the unhoused avoid them because of fears of theft, assault, and sexual assault. Instead, long-term beds, including those designated for people struggling with substance use and mental health issues, are needed.

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Petrie-Flom’s Wood. “The data is pretty solid on this issue: If you have a substance-use disorder there’s likely some underlying, severe trauma. Yet, when we go to treat them, we address one but not the other. You’re never going to find success in the system that we currently have if you don’t recognize that dual diagnosis.”

Services offered to those in housing should avoid what Koh describes as a “one-size-fits-none” approach. Some might need monthly visits from a caseworker to ensure they’re getting the support they need, she said. But others struggle once off the streets. They need weekly — even daily — support from counselors, caseworkers, and other service providers.

“I have seen, sadly, people who get housed and move very quickly back out on the streets or, even more tragically, lose their life from an unwitnessed overdose in housing,” Koh said. “There’s a community that’s formed on the street so if you overdose, somebody can give you Narcan or call 911. If you don’t have the safety of peers around, people can die. We had a patient who literally died just a few days after being housed, from an overdose. We really cannot just house people and expect their problems to be solved. We need to continue to provide the best care we can to help people succeed once in housing.”

“We really cannot just house people and expect their problems to be solved.”  Katherine Koh, Mass. General psychiatrist

Koh works on the street team for Boston Health Care for the Homeless Program.

Photo by Dylan Goodman

The nation’s failure to address the causes of homelessness has led to the rise of informal encampments from Portland, Maine, to the large cities of the West Coast. In Boston, an informal settlement of tents and tarps near the intersection of Massachusetts Avenue and Melnea Cass Boulevard was a point of controversy before it was cleared in November.

In the aftermath, more than 100 former “Mass and Cass” residents have been moved into housing, according to media reports. But experts were cautious in their assessment of the city’s plans. They gave positive marks for features such as a guaranteed place to sleep, “low threshold” shelters that don’t require sobriety, and increased outreach to connect people with services. But they also said it’s clear that unintended consequences have arisen. and the city’s homelessness problem is far from solved.

Examples abound. Judge, who leads Boston HEAT in collaboration with Sandra Andrade of MGH, said that a woman she’d been working with for two years, who had been making positive strides despite fragile health, ongoing sexual exploitation, and severe substance use disorder, disappeared after Mass and Cass was cleared.

Mike Jellison, a peer counselor who works on Boston Health Care for the Homeless Program’s street team, said dismantling the encampment dispersed people around the city and set his team scrambling to find and reconnect people who had been receiving medical care with providers. It’s also clear, he said, that Boston Police are taking a hard line to prevent new encampments from popping up in other neighborhoods, quickly clearing tents and other structures.

“We were out there Wednesday morning on our usual route in Charlesgate,” Jellison said in early December. “And there was a really young couple who had all their stuff packed. And [the police] just told them, ‘You’ve got to leave, you can’t stay here.’ She was crying, ‘Where am I going to go?’ This was a couple who works; they’re employed and work out of a tent. It was like 20 degrees out there. It was heartbreaking.”

Prevention as cure?

Successes in reducing homelessness in the U.S. are scarce, but not unknown. The U.S. Department of Veterans Affairs, for example, has reduced veteran homelessness nationally by more than 50 percent since 2010.

Experts point out, however, that the agency has advantages in dealing with the problem. It is a single, nationwide, administrative entity so medical records follow patients when they move, offering continuity of care often absent for those without insurance or dealing with multiple private providers. Another advantage is that the VA’s push, begun during the Obama administration, benefited from both political will on the part of the White House and Congress and received support and resources from other federal agencies.

The city of Houston is another example. In 2011, Houston had the nation’s fifth-largest homeless population. Then-Mayor Annise Parker began a program that coordinated 100 regional nonprofits to provide needed services and boost the construction of low-cost housing in the relatively inexpensive Houston market.

Neither the VA nor Houston was able to eliminate homelessness, however.

To Koh, that highlights the importance of prevention. In 2022, she published research in which she and a team used an artificial-intelligence-driven model to identify those who could benefit from early intervention before they wound up on the streets. The researchers examined a group of U.S. service members and found that self-reported histories of depression, trauma due to a loved one’s murder, and post-traumatic stress disorder were the three strongest predictors of homelessness after discharge.

In April 2023, Koh, with co-author Benjamin Land Gorman, suggested in the Journal of the American Medical Association that using “Critical Time Intervention,” where help is focused on key transitions, such as military discharge or release from prison or the hospital, has the potential to head off homelessness.

“So much of the clinical research and policy focus is on housing those who are already homeless,” Koh said. “But even if we were to house everybody who’s homeless today, there are many more people coming down the line. We need sustainable policies that address these upstream determinants of homelessness, in order to truly solve this problem.”

The education imperative

Despite the obvious presence of people living and sleeping on city sidewalks, the topic of homelessness has been largely absent from the nation’s colleges and universities. Howard Koh, former Massachusetts commissioner of public health and former U.S. assistant secretary for Health and Human Services, is working to change that.

In 2019, Koh, who is also the Harvey V. Fineberg Professor of the Practice of Public Health Leadership, founded the Harvard T.H Chan School of Public Health’s pilot Initiative on Health and Homelessness. The program seeks to educate tomorrow’s leaders about homelessness and support research and interdisciplinary collaboration to create new knowledge on the topic. The Chan School’s course “Homelessness and Health: Lessons from Health Care, Public Health, and Research” is one of just a handful focused on homelessness offered by schools of public health nationwide.

“The topic remains an orphan,” said Koh. The national public health leader (who also happens to be Katherine’s father) traced his interest in the topic to a bitter winter while he was Massachusetts public health commissioner when 13 homeless people froze to death on Boston’s streets. “I’ve been haunted by this issue for several decades as a public health professional. We now want to motivate courageous and compassionate young leaders to step up and address the crisis, educate students, motivate researchers, and better inform policymakers about evidence-based studies. We want every student who walks through Harvard Yard and sees vulnerable people lying in Harvard Square to not accept their suffering as normal.”

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Homelessness and Public Health: A Focus on Strategies and Solutions

David a. sleet.

1 School of Public Health, San Diego State University, San Diego, CA 92182, USA; moc.liamg@teelsadivad

2 Veritas Management, Inc., Atlanta, GA 30324, USA

Louis Hugo Francescutti

3 School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada

4 Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada

5 Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada

On any given night, hundreds of thousands of people are homeless in the United States and Canada. Globally, the problem is many times worse, making homelessness a global public health and environmental problem. The facts [ 1 ] are staggering:

• On a single night in January 2020, 580,466 people (about 18 out of every 10,000 people) experienced homelessness across the United States—a 2.2% increase from 2019.
• While 61% percent of the homeless were staying in sheltered locations, the remainder—more than 226,000 people—were in unsheltered locations on the street, in abandoned buildings, or in other places not suitable for human habitation.
• Homelessness has increased in the last four consecutive years.
• The increase in unsheltered homelessness is driven largely by increases in California.
• In 2020, 171,575 people in families with children experienced homelessness on a single night.
• A total of 3598 homeless people were children under the age of 18 without an adult present.
• Veterans comprised 8% of all homeless adults (over 46,000 veterans struggle with homelessness).
• People of color are significantly over-represented among those experiencing homelessness.

A layman’s definition of homelessness is usually “a person that has no permanent home”. However, many scholars have divided the broad group of people characterized as homeless into three (or more) categories:

• - People without a place to reside;
• - People in persistent poverty, forced to move constantly, and who are homeless for even brief periods of time;
• - People who have lost their housing due to personal, social, or environmental circumstances.

While this definition refers specifically to homeless individuals, it is equally applicable to homeless families.

Homelessness is closely connected to declines in physical and mental health. Homeless persons experience high rates of health problems such as Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and Hepatitis A infections, alcohol and drug addiction, mental illness, tuberculosis, and other serious conditions. The health problems facing homeless persons result from various factors, including a lack of housing, racism and discrimination, barriers to health care, a lack of access to adequate food and protection, limited resources for social services, and an inadequate public health infrastructure. Legal and policy interventions have often been used to attempt to address homelessness, although not always from a public health perspective.

In health care, for example, if someone experiencing homelessness comes to an emergency department for medical aid, once treated, the only alternative is to release the patient back onto the street. This creates an endless cycle of emergency department visits, increasing costs and expending resources in the health care system.

Recent work [ 2 ] has emphasized the important role of public health, the health care system, and health care providers in homelessness prevention. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), we have brought together researchers, practitioners, and community organizers to articulate the public health problem of homelessness and identify clear strategies to reduce homelessness and provide more adequate health care and housing for this population. We also explore solutions for important subpopulations, including adults, families with children, adolescents, women, transitional aged youth, and those suffering from mental illness, PTSD, alcohol dependency, mental illness, adverse childhood experiences, and chronic homelessness.

We address many of these issues in the context of public health and explore the public health implications and potential solutions to homelessness, focusing on contemporary and emerging research and innovative strategies, and highlighting best practices to address homelessness among key populations. The papers in this Special Issue attempt to answer several questions related to homelessness and public health, such as:

• What is the extent of homelessness and why do people become homeless?
• What are the public health and health services implications of homelessness?
• What role does housing play as a precursor to and potential solution for homelessness?
• What public health and health care interventions are being employed, and what effectiveness is being achieved?
• What long-term strategies can be developed to prevent homelessness?

The 13 research papers and one commentary in this Special Issue are summarized as follows:

• Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness. This study by Abdel–Samad et al. [ 3 ] focuses on a novel, interdisciplinary academic–practice partnership model for addressing the problem of homelessness. Whereas singular disciplinary approaches may fall short in substantially reducing homelessness, this approach draws from a collective impact model that integrates discipline-specific approaches through mutually reinforcing activities and shared metrics. The paper describes what is necessary for capacity-building at the institution and community levels, the complementary strengths and contributions of each discipline in the model, and future implementation goals to address homelessness in the Southern California region using a cross-disciplinary approach.
• Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness . Iwundu et al. [ 4 ] conducted a retrospective study and evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness. The results indicated that mental illness (as a reason for current homelessness) and severe mental illness comorbidities were each associated with increased odds of youth-onset homelessness, providing a basis for agencies that serve at-risk youth in order to address mental health precursors to youth homelessness.
• Well-Being without a Roof: Examining Well-Being among Unhoused Individuals Using Mixed Methods and Propensity Score Matching. Ahuja et al. [ 5 ] found that the mean overall well-being score of unhoused participants was significantly lower than that of matched housed participants, with unhoused participants reporting lower mean scores for social connectedness, lifestyle and daily practices, stress and resilience, emotions, physical health, and finances. The unhoused participants had a statistically significantly higher mean score for spirituality and religiosity than their matched housed counterparts. The qualitative interviews highlighted spirituality and religion as a coping mechanism for the unhoused.
• Combatting Homelessness in Canada: Applying Lessons Learned from Six Tiny Villages to the Edmonton Bridge Healing Program. Authors Wong et al. [ 6 ] discuss the Bridge Healing Program in Edmonton, Alberta, a novel approach to combatting homelessness by using hospital emergency departments (ED) as a gateway to temporary housing. The program provides residents with immediate temporary housing before transitioning them to permanent homes. The paper discusses effective strategies that underlie the Tiny Villages concept by analyzing six case studies and applying the lessons learned to improving the Bridge Healing Program and reducing repeat ED visits and ED lengths of stay among homeless individuals.
• Change in Housing Status among Homeless and Formerly Homeless Individuals in Quebec, Canada: A Profile Study. Kaltsidis et al. [ 7 ] used a cluster analysis to develop a typology of the housing status change for 270 currently or formerly homeless individuals who were residing in shelters and temporary or permanent housing. The findings suggest that the maintenance or improvement in the housing status requires the availability of suitable types and frequencies of service use (enabling factors) that are well-adapted to the complexity of health problems (needs factors) among homeless individuals. Specific interventions, such as outreach programs and case management, are prioritized as necessary services, especially for individuals at a higher risk of returning to homelessness.
• Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness. To investigate the simultaneous impact of intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) and their association with homelessness, Hernandez et al. [ 8 ] recruited homeless adults from six homeless shelters in Oklahoma City who self-reported urban life stress, distress tolerance, social support, major depressive disorder, and PTSD symptoms. Based on the resulting associations, their findings stress the importance of implementing interventions aimed at increasing social support for homeless persons, something that may also increase skill development for distress tolerance and indirectly lead to a reduction in depression and PTSD.
• “I Felt Safe”: The Role of the Rapid Rehousing Program in Supporting the Security of Families Experiencing Homelessness in Salt Lake County, Utah. Garcia and Kim [ 9 ] describe their research into The Road Home (TRH) program, which provides services to homeless individuals and families. TRH is known for their emergency shelters and also administers the Rapid Rehousing Program (RRHP), designed to help homeless families transition back into stable housing. After collecting qualitative data from focus groups with participants and families, landlords, case managers, and service providers, they make recommendations for program improvements that can increase the residential security of families experiencing homelessness.
• “It’s Just a Band-Aid on Something No One Really Wants to See or Acknowledge”: A Photovoice Study with Transitional Aged Youth Experiencing Homelessness to Examine the Roots of San Diego’s 2016–2018 Hepatitis A Outbreak. In this study, Felner et al. [ 10 ] examined the experiences and needs of transitional aged youth (TAY) aged 18–24 experiencing homelessness who may have been uniquely affected by an unprecedented outbreak of hepatitis A virus (HAV). The findings documented a stigmatization of TAY, interventions that failed to address root causes of the outbreak, and interactions with housing- and social support-related resources that limited rather than supported economic and social mobility. The findings have implications for understanding how media and public discourse, public health interventions, and the availability and delivery of resources can contribute to and perpetuate stigma and health inequities faced by TAY experiencing homelessness.
• Predictors of Overnight and Emergency Treatment among Homeless Adults. Iwundu et al. [ 11 ] aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, Texas and were predominantly uninsured, low-income men and women from various social and ethnic groups. In logistic regression models, gender emerged as the only predictor of overnight treatment in a hospital and treatment in an emergency department. Women were more likely than men to be treated overnight and use emergency care. The authors concluded that interventions and policies targeted toward homeless women’s primary health care needs would reduce health care costs.
• Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women. In a study on alcohol use and food insecurity among homeless men and women, Reitzel et al. [ 12 ] investigated the link between problematic alcohol use and food insecurity among homeless adults in Oklahoma. Problematic alcohol use was measured using the Alcohol Quantity and Frequency Questionnaire and the Patient Health Questionnaire. Food insecurity was measured with the USDA Food Security Scale-Short Form. The results indicated that heavy drinking and probable alcohol dependence/abuse were each associated with increased odds of food insecurity. The results question whether alcohol may take precedence over eating or food purchases among this population of homeless individuals.
• Exploring Tiny Homes as an Affordable Housing Strategy to Ameliorate Homelessness: A Case Study of the Dwellings in Tallahassee, FL. “Tiny Homes” is an emerging strategy to combat homelessness, and Jackson et al. [ 13 ] raise a number of questions about the intentions, efficacy, and policy feasibility of this strategy. The paper seeks to understand the strategies used by stakeholders to plan, design, and implement a “Tiny Homes” strategy, and to assess their effectiveness. Using a case study, they examined how the community was planned, the experiences of residents, and the constraints to success. Their findings highlighted how funding constraints and NIMBYism (Not in My Backyard-ism) stymied stakeholder efforts to achieve equity and affordability, resulting in the inability to achieve project aims to develop affordable housing that served homeless populations.
• Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness. The study by Gabet et al. [ 14 ] assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with a current or previous experience of homelessness. Participants were recruited from types of housing in Montreal, Quebec (Canada) and were interviewed about their ED use at baseline and again 12 months later. The findings revealed two needs factors associated with ED use: having a substance use disorder and low perceived physical health. Two enabling factors—the use of ambulatory specialized services and stigma—were also related to ED use. ED use was not associated with the type of housing. The authors suggest that improvements are needed to manage substance use disorders and the physical health of homeless individuals in order to reduce ED use.
• Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home. The Mabhala and Yohannes article [ 15 ] examines the stories of homeless people and their perceptions of their social status using interviews in three centers for homeless people in Cheshire, in the English Northwest. Education, employment, and health were three domains that provided a theoretical explanation for the reasons that led to their homelessness. Participants catalogued their adverse childhood experiences, which they believe limited their capacity to meaningfully engage with social institutions for social goods, such as education, social services, and institutions of employment. They conclude that, although not all people who are poorly educated, in poor health, and unemployed end up being homeless, a combination of these together with multiple adverse childhood experiences may weaken resilience and contribute to homelessness.
• Commentary: Investing in Public Health Infrastructure to Address the Complexities of Homelessness. In a final commentary, Allegrante and Sleet [ 16 ] introduce the notion that investments in public health infrastructure are needed to address the complexities of homelessness, including the continued threats posed by SARS-CoV-2 (COVID-19) and its variants. The lack of affordable housing, widespread unemployment, poverty, addiction and mental illness, which all contribute to the risk of homelessness, would be well-served by improving the fundamental public health infrastructure. They argue that homelessness is exacerbated by system-wide infrastructure failures at the municipal, state and federal governments and from the neglect to invest in public infrastructure, including a modern public health system.

In conclusion, shelter is a basic human need. Thus far, we have an inadequate understanding of all the medical and nonmedical, public health, and infrastructural influences that drive homelessness and why so many people are living without adequate shelter. Housing is one of the most critical factors in addressing homelessness and one of the best-researched social determinants of health. Several articles here focus on innovative approaches to providing temporary or permanent housing for those who need it, and it is well known that selected housing interventions can improve health and decrease health care costs. From that perspective, some professionals in the field contend that housing equates to health [ 17 ] and that improved housing options for homeless individuals and families would advance population-level health.

Many of the articles in this Special Issue [ 18 ] focus on specific aspects of life, quality of life, and co-morbidities related to behavioral and social variables influencing homelessness. Explored in detail are factors such as lack of housing, distress, wellness, emergency department use, mental health, drug and alcohol addiction, poverty, low educational attainment, inadequate health care and social services, adverse childhood experiences, ongoing infections, unemployment, and public health infrastructure. In addition to highlighting the impact these factors can have on the likelihood that someone would become homeless, many of the articles also provide recommendations for relevant policies, practices, and interventions that could help reduce homelessness and improve overall well-being.

The intersection of environmental, behavioral, and social factors, in addition to the lack of an adequate infrastructure, must also be considered when studying the determinants of homelessness and designing appropriate interventions. Our ultimate goal in producing this Special Issue of IJERPH is to encourage the development of better evidence to inform public health, social services, and medical care policies and practices that will result in better health for homeless populations.

Acknowledgments

We thank the authors and reviewers for their commitment to preparing and editing these manuscripts and for adding to the knowledge base of this important public health problem.

Conflicts of Interest

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Homelessness in US cities and downtowns

Subscribe to transformative placemaking, the perception, the reality, and how to address both, hanna love and hanna love fellow - brookings metro , anne t. and robert m. bass center for transformative placemaking @hannamlove tracy hadden loh tracy hadden loh fellow - brookings metro , anne t. and robert m. bass center for transformative placemaking @lohplaces.

December 7, 2023

• Homelessness is not uniform. There are significant variations in the types, prevalence, and service delivery ecosystems of homelessness across U.S. cities and regions—requiring policies tailored to those people and places rather than a “one-size-fits-all” solution.
• Despite perceptions of rising homelessness in the aftermath of the COVID-19 pandemic, homelessness rates in three of the four cities studied (New York, Philadelphia, and Chicago) declined over the past decade, including through the pandemic. Seattle was the stark outlier.
• Above any other factor, regional housing market dynamics—particularly when rents rise by amounts that low-income residents cannot afford—drive geographic variations in the prevalence of homelessness and correlate with higher homelessness rates.
• Evidence-based policy recommendations for reducing homelessness require root cause approaches, including reforming housing plans, scaling alternative crisis response models, stopping the jail-to-homelessness cycle, leveraging the capacity of place governance organizations, and taking a regional, data-driven approach to homelessness.
• 26 min read

A rare bipartisan consensus is emerging in many U.S. cities on one key issue: the need to address homelessness, particularly in downtown central business districts . Many on both the right and the left are calling for strategies such as encampment sweeps , increased enforcement of quality-of-life offenses , and even scaling back federal dollars for evidence-based “housing first” policies to quell rising fears of public disorder, homelessness, and crime in “hollowed out” downtowns.

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Hanna Love, Tracy Hadden Loh

February 5, 2024

The problem with this growing consensus is that it has led many local leaders further away from proven root-cause solutions for reducing homelessness, and toward costly and ineffective punitive measures that pose significant risks to people experiencing homelessness, and, paradoxically, increase the general risk of making homelessness worse.

Rather than responding to this latest reactive, “complaint-based” push that tends to over-criminalize people experiencing homelessness, we argue that local leaders must double down on evidence-based policies that address where, why, and how homelessness actually occurs within U.S. cities to meaningfully reduce homelessness and achieve economic recovery in the nation’s downtowns.

With these goals in mind—while also remaining responsive to constituents’ growing concerns about homelessness—this report presents an overview of recent pandemic-era trends in homelessness, compares perceptions of homelessness with data from four large cities, and reviews the evidence about cost-effective, humane, and root-cause approaches to reducing homelessness.

Taken together, our research supports the need for U.S. cities to engage in both short- and long-term policymaking targeted at the structural challenges associated with homelessness spanning, from reentry services to affordable housing, rather than crafting reactive homelessness policies rooted solely in perceptions, stereotypes, and fear. By doing so, local leaders can not only help cities and their downtowns recover from current economic disruptions, but they can also cultivate a sustainable regional ecosystem in which access to housing, economic stability, and opportunity is a human right.

Brookings Metro’s Future of Downtowns Project: This report is part of the  Future of Downtowns mixed-methods research project   that seeks to understand the future of American cities and their downtowns through interviews, spatial data analysis, and direct engagement with local leaders in New York, Chicago, Seattle, and Philadelphia. To gauge perceptions of cities’ downtown health and recovery, we interviewed nearly 100 business leaders, major employers, public sector officials, and residents in these four cities in fall 2022, 1  then juxtaposed qualitative findings with spatial analysis of employment , transit and travel , real estate , crime , and homelessness data impacting downtown recovery. This report synthesizes findings related to homelessness.

Homelessness trends, types, and service delivery ecosystems vary considerably across US cities

Before diving into recent homelessness trends impacting U.S. cities and their downtowns, it is important to first distinguish between different types of homelessness that affect cities and regions, how the prevalence of homelessness varies considerably nationwide, and the vast differences in the local and regional ecosystems that coordinate homelessness services and funding (also known as “Continuums of Care” ) across U.S. metro areas.

The different types of homelessness affecting US cities and regions

Most fundamentally, the tenure of a city’s homelessness population (e.g., whether people are unsheltered or in other temporary housing situations such as emergency or transitional shelters) can hold significant and often underappreciated ramifications for local policymaking. For instance, the most visible form of homelessness—when people are unsheltered and live in public spaces like parks, subway stations, or streets—represents only one-third or less of the unhoused population in most cities, despite capturing the bulk of resident and media attention , as well as significant city resources .

In New York and Philadelphia, for instance, most homeless people are not unsheltered, but rather reside in temporary shelter or transitional housing (94% and 82%, respectively) (Figure 1). In Chicago, most of the homeless population resides in either emergency shelter (46%) or transitional housing (20%), with 33% living unsheltered. Seattle is the stark outlier in the sample: Over 57% of its homeless population is living without shelter. These variations matter because a city like Seattle that is struggling with over half of its homeless population living unsheltered will require a different set of policies than a city like New York, whose “right to shelter” mandate has helped secure temporary shelter for most people experiencing homelessness.

Variations in the prevalence of homelessness across the US cities and regions

Stark regional variations in the prevalence of homelessness across U.S. cities and regions also matter significantly for policymaking. As Table 1 demonstrates, cities on the West Coast have higher homelessness rates than other regions—representing seven of the 10 cities with the highest total homelessness rates per capita. San Francisco, for instance, has a total homelessness rate that is nearly 20 times higher than Houston’s. West Coast cities also stand out for higher shares of their homeless population living without shelter. In addition to Seattle, West Coast cities including San Francisco; Long Beach, Calif.; Los Angeles; Portland, Ore.; Oakland, Calif.; Sacramento, Calif.; San Jose, Calif.; and Fresno, Calif. all have unsheltered homelessness rates above 50%.

These findings generally align with research showing that above any other factor, regional housing market dynamics—particularly when rents rise by amounts that low-income residents cannot afford— drive geographic variations in the prevalence of homelessness across U.S. regions and correlate with higher homelessness rates (Figures 2 and 3). In Seattle, however, even pandemic-era reductions in asking rents were not enough to curb homelessness.

While these regional variations can make it difficult to adopt a “one-size-fits-all” approach to reducing homelessness in the U.S., they can provide insight into the local policies and socioeconomic conditions that work to facilitate homelessness reduction.

Different service delivery ecosystems for homelessness across US cities and regions

Finally, differences in regions’ Continuums of Care (CoCs) boundaries add another important layer to both understanding and solving the challenge. CoCs are the local or regional planning bodies that coordinate housing support, social services, funding, and reporting across service providers, hospitals, businesses, advocates, and government agencies (e.g., school districts, law enforcement, and public housing authorities).

As Figure 4 demonstrates, metropolitan areas such as Houston 2  and Seattle take a “regional approach” to homelessness , in which funding and service delivery are consolidated across an integrated CoC area that includes both cities and suburbs to eliminate redundancies across agencies, fill gaps for underserved populations, and match resources with the scale of the challenge. On the other hand, metro areas such as Chicago and Philadelphia divide their homelessness services across a more fragmented and localized patchwork of providers, which limits the potential for regional collaboration. Understanding these nuances in the resources and ecosystems for homelessness prevention and reduction is critical for crafting effective policy.

Why focus on homelessness downtown, specifically? Downtowns play a critical role in local economies—serving as regional job hubs for both high- and low-wage work, supplying an outsized share of tax assessable value that maintains city budgets, and supporting clusters of small businesses that represent opportunity for entrepreneurs, artists, and creatives. People experiencing homelessness concentrate in downtowns for many of the same reasons that others do: a combination of highly accessible transit services, great density of public spaces and other amenities, and the concentration of critical public-serving institutions. In many cities, downtowns represent the most visible hub for people experiencing homelessness to gather, and this uneven spatial distribution often places pressure on a small number of downtown leaders to “solve” homelessness—even when its causes are rooted in structural challenges that extend far beyond downtown boundaries.

Comparing perceptions and realities of homelessness trends in New York, Philadelphia, Chicago, and Seattle

When conducting qualitative interviews for the Future of Downtowns project in fall 2022, we asked nearly 100 residents, workers, visitors, and employers in four of the largest U.S. cities about the top barriers preventing them from returning downtown—spanning issues from the changing nature of office work to different preferences for commuting and in-person interaction. To our surprise, we heard remarkably consistent results across the four cities: Interviewees told us that increased fear of public disorder, crime, and homelessness in the wake of the pandemic was the primary barrier preventing them from returning downtown—not changing office or residential patterns. This section compares these perceptions with quantitative analysis of pandemic-era homelessness trends in each city.

Respondents across all four cities perceived significant increases in homelessness since the pandemic, often describing “new negotiations” in public spaces with unhoused people and rates of public disorder not seen since the late 20th century. They frequently made statements such as:

Homelessness wasn't even like this during the crack cocaine 80s. It is terrible. Interview Respondent in Philadelphia

There are more homeless people in more places now than there were pre-pandemic. I would say that's true of every city I've been in. Interview Respondent in Chicago

The top thing we hear from employers is about the experience on the street with safety and chronic homelessness. Interview Respondent in Seattle

In the pandemic, my neighborhood changed meaningfully in terms of the crime rate and just the level of homelessness Interview Respondent in New York

Yet when we crunched the numbers to determine how perceptions of rising homelessness during the pandemic bore out in data, we found a significant mismatch between perception and reality in three of the four study cities. Interview respondents in Chicago, Philadelphia, and New York perceived that homelessness was increasing exponentially and leading to a level of public disorder not seen since the 1990s. However, total homelessness rates in these cities actually significantly declined in the past decade (by 42%, 25%, and 16%, respectively). And it continued this decline during the pandemic (Figure 5). Seattle remained the stark outlier, with total homelessness increasing by 23% since 2015. 

In New York, Chicago, and Philadelphia, we found a similar pattern with trends of unsheltered homelessness. They had not “ballooned” during the pandemic, as most interviewees supposed, but rather remained steady for the past decade and declined between 2020 and 2021 (Figure 6). Seattle, again, was a stark outlier—seeing an 88% jump in unsheltered homelessness since 2015, which continued during the pandemic.

Our findings from Chicago, Philadelphia, and New York generally align with recent research from the U.S. Department of Housing and Urban Development , which found that the nation was able to hold off a spike in homelessness during the pandemic due to federal relief authorized between 2020 and 2021, including eviction moratorium orders, emergency rental assistance, boosted unemployment benefits, and the expanded child tax credit. Seattle, however, demonstrates that even these vital federal supports were not always sufficient to reverse a decade-long spike in homelessness. The gap between perception and reality may in part be explained by significant changes in downtown foot traffic , which made unsheltered homelessness more visible given the relative reduction in other foot traffic.

Why fluctuations in homelessness—such as recent increases in unsheltered asylum seekers in cities like New York—can be difficult to capture: Because most CoCs conduct and report “point-in-time” counts annually or every other year, it can be difficult to measure temporary or seasonal changes in cities’ homelessness rates. Recently, this has presented a challenge in understanding the impact of new waves of migrants and asylum seekers arriving from Latin America on homelessness in cities such as Chicago, New York, and Washington, D.C. 3 For these data availability reasons and other more substantive ones—including the unique circumstances surrounding recent migration and its toll on a limited set of large U.S. cities —this report does not seek to respond to the intersection between homelessness and asylum seekers’ migration. Instead, we focus on the long-standing structural drivers of and evidence-based tools to address the persistent challenge of homelessness that cities have been wrestling with, even absent acute changes in global migration and asylum policies.

In addition to the fact that respondents perceived significant increases in homelessness during the pandemic, they also overwhelmingly conveyed a strong sense that homelessness was linked to criminality. Rather than discussing the challenge as one rooted in larger economic and regional market forces, respondents tended to focus on the behaviors of individual homeless people that made them uncomfortable (such as sleeping outside or public drug use), and thus were drawn toward interventions directed at individual behavior through the criminal legal system.

In fact, respondents often described crime and homelessness in the same breath, with statements such as:

There’s just lawlessness in the public realm. There’s garbage, there's a guy smoking pot, there's a homeless person I just stepped over, there's somebody who's crazy following me, there are vendors everywhere. Interview Respondent in New York

The homeless population has ballooned here, which makes people feel uneasy and unsafe. Crime has always existed in Chicago, but this is different. Interview Respondent in Chicago

There is a fair amount of violent crime that kind of emanates from those encampments. We see a lot more people unsheltered, a lot more drug use, a lot more organized retail theft. Interview Respondent in Seattle

There's a lady over there…She sits there all day. We tell her you can't sleep on a bench. She just sits on the bench. That's criminal. Interview Respondent in Philadelphia

It is notoriously difficult to determine whether a criminal offense involves a person experiencing homelessness (either as a victim or perpetrator), since most police departments do not track or report that data. However, research does suggest that the criminalization of homelessness is costly and counterproductive, as arrests make it more difficult for homeless people to get back on their feet and access housing due to the heightened barriers navigating employment, services, and housing with a criminal record.

Taken together, our analysis and existing evidence indicate that perceptions alone are insufficient to inform local decisionmaking on homelessness, and that a clear understanding of data, regional market variations, and local service delivery ecosystems is necessary to craft effective policy. The next section presents five recommendations to better align data and evidence and reduce homelessness through root-cause approaches.

An evidence-based policy framework for reducing homelessness and strengthening regional economies

The ability to spend time downtown without encountering public disorder such as visible drug use or harassment is a basic necessity of city life—as is the desire to have a safe place to sleep, bathe, and eat. Fortunately, there are evidence-based policies that can bring cities closer to this dual imperative in a humane, cost-effective, and sustainable manner. We offer five key recommendations below:

Ensure that housing policy is homelessness policy

Inadequate housing supply, particularly of affordable units, is consistently shown to be the primary driver of homelessness in the U.S.—significantly outweighing factors such as substance use, poverty, and mental health. Zoning and land use restrictions are examples of local governments’ dysfunctional fiscal and regulatory structures that disincentivize or prevent housing production and contribute to a widespread structural challenge in which the poorest people within cities cannot afford average asking rents for available apartments. Despite this evidence, a study from Community Solutions found that of the nation’s 100 largest cities, only 54% had homelessness plans, and of those, only 30% mentioned zoning and land use changes.

To craft policy that addresses the root causes of homelessness, we recommend that local governments align their long-term housing, land use, and homelessness plans to increase the supply of all types of housing, remove barriers to affordability and shelter construction (such as single-family-only zoning, parking minimums, and parcel shape regulations), and adopt evidence-based “housing first” models. For shorter-term solutions, cities should adopt and scale the pandemic-era preventative measures that helped avoid a spike in homelessness, including investments in emergency rental assistance, eviction defense, tenants’ rights, and economic stimulus, as well as mitigation measures such as converting hotels into temporary housing. For cities such as Seattle, where shelter bed capacity is incredibly overburdened (Figure 7), the need for these measures is particularly acute.

Case study from New York: How ‘housing first’ programs can be a proven, humane, and cost-effective strategy for reducing homelessness

New York’s Housing First program has been in place for over three decades to provide housing supports for people experiencing chronic street homelessness without preconditions—a recognition that stable housing is a critical foundation for individuals struggling with psychiatric and substance use disorders to transition from homelessness. The program has a 70% to 90% success rate in maintaining stable housing for participants over two to three years, outperforming traditional housing programs. Additionally, it has proven to be a cost-effective strategy (Table 2) that reduces public expenditures in the criminal justice and health care systems associated with homelessness.

The Housing First program’s effectiveness can be seen in its Frequent Users Service Enhancement (FUSE) initiative , which has been successful in breaking the homelessness-to-jail cycle. FUSE provides long-term rental assistance and supportive services, resulting in 86% of participants remaining stably housed after two years and a 40% reduction in jail time , while also achieving significant cost savings in annual jail, shelter, and crisis health care costs.

Scale alternative crisis response models to better respond to people with behavioral health and substance use emergencies while improving public safety

Research indicates that punitive approaches to policing homelessness—such as criminal arrests or fees for public behaviors associated with homelessness (e.g., camping, sleeping in public, eating in public, sitting on sidewalks, etc.) or mental health episodes—make it more difficult to solve homelessness. These approaches heap a criminal record onto people experiencing homelessness, making it difficult for them to rent an apartment or get a job on top of other challenges, while also straining police resources.

Instead, an emergent and promising body of research demonstrates that non-police crisis responders—alternatives to 911 with trained mental health professionals—can better respond to lesser infractions involving homeless people. In places such as Denver, non-police crisis responders were more effective than even alternative crisis response models that deploy both social workers and the police together (sometimes referred to as “co-responder models”). Moreover, supportive housing programs such as those mentioned above have successfully reduced arrests and jail stays for people experiencing homelessness; for example, New York’s FUSE initiative lead to an average of 95 fewer days spent in jail for homeless New Yorkers.

Despite this evidence, a Community Solutions survey of mayors found that homelessness policy is intertwined with police enforcement in most cities. For instance, 78% of survey respondents said that police have influence over shaping homelessness policy in their city, 59% said police enforce quality-of-life charges against homelessness people, and 22% had their homelessness staff co-located in police departments. This has led to a phenomenon in which jurisdictions are using jails as substitute shelters. For example, in Atlanta, one in eight of all city jail bookings  in 2022 involved a person experiencing homelessness.

To better address safety concerns surrounding homelessness, mental health, and quality-of-life offenses, local leaders should act on evidence from Denver , Eugene, Ore. , and other cities to adopt and scale non-police alternative crisis response models. In doing so, they should take care to not only prioritize crisis response models that provide an alternative for low-level offenses (such as substance use or homelessness), but also include models that address intimate partner violence—another area where victims are disproportionately likely to experience homelessness as a result of the circumstances surrounding victimization .

Case study from Denver: How ‘alternative response models’ can reduce the homelessness-to-jail pipeline

In June 2020, Denver launched its Support Team Assisted Response (STAR) program to redirect nonviolent 911 emergency calls from police to a team of mental health specialists and paramedics. Inspired by the evidence-based CAHOOTS model in Eugene, Ore., the STAR program focuses on providing appropriate care and resources to individuals facing mental health crises, substance use issues, or homelessness—particularly in low-income and at-risk communities. Funded through the city’s general fund and a grant from the Caring for Denver Foundation , the STAR program aims to alleviate the burden on police resources, ensuring law enforcement can concentrate on more serious crimes.

The model has been found to produce effective results , with a 34% reduction in lower-level crimes in areas served by STAR, leading to 1,400 fewer criminal offenses. Furthermore, the direct costs associated with the STAR responses were found to be four times lower than those incurred with police-only responses, with the average direct cost per response being $151—significantly less than the $646 typically incurred for minor criminal offenses handled by the police.

Strengthen housing and employment supports for those reentering from incarceration

It is well established that homelessness and incarceration are inextricably linked in the U.S., with many people cycling between jails and prisons and homelessness on the front end (due to the criminalization of low-level “survival” crimes) and on the back end (due to the lack of support for returning citizens to access employment and housing because of the significant barriers that criminal records pose). But often, less attention is paid to preventing those being released from jail or prison from entering into homelessness.

In New York, for instance, over half of people released from prison move directly into the shelter system . In California , which does not require returning citizens to have a place to live upon release, many move directly into street homelessness. Nationwide, formerly incarcerated people are nearly  10 times more likely  to experience homelessness than the general population.

To better address the pipeline between incarceration and homelessness, study after study shows that bolstering reentry supports—particularly access to housing and employment—is critical to reducing recidivism and homelessness, while also improving public safety. Effective policies include reducing barriers for returning citizens to enter public housing , providing tailored services for those most at risk for homelessness prior to release (including workforce and housing supports), and explicitly addressing the unique needs of returning citizens in regional housing and homelessness plans, among other reforms .

Case study: How Cuyahoga County and Houston are curbing the prison-to-homelessness-pipeline through new supports for returning citizens

In response to growing evidence indicating the need to reduce the prison-to-homelessness pipeline, in 2023, Cuyahoga County, Ohio (where Cleveland is located) launched a  $37-million Housing Justice Plan that seeks to develop 105 housing units available to individuals with criminal backgrounds, provide short-term funding to subsidize housing costs for those leaving prison, and pilot a program to provide down-payment assistance or lease-to-own opportunities. For those in jail, Houston is operating a  Healthcare for the Homeless  jail in-reach program that provides intensive medical case management to incarcerated people, as well as counseling, psychiatry, substance use treatment, dental care, housing, employment, help with navigating public health benefits, and help obtaining identification.

Leverage the capacity of place governance organizations to humanely address homelessness, particularly in central business districts

While public sector officials hold the bulk of the power to address the structural causes of homelessness, downtown place governance organizations (such as business improvement districts and other special-purpose districts) also play an outsized role. 4 The International Downtown Association estimates that there are over 2,500 place management organizations in North America with the capacity to leverage millions of dollars in special tax assessments. Many of these organizations have high exposure to challenges associated with homelessness.

Special districts such as business improvement districts (BIDs) have at times been complicit in the act of displacing homeless people and embracing hostile architecture . However, they have also been pragmatic, effective leaders in innovating and implementing inclusive management practices aligned with a public health approach by employing community ambassadors; providing access to drinking water and public restrooms; supporting placemaking activities and other built environment improvements that enhance safety, vibrancy, and belonging in the public realm; and connecting residents to social services, employers, and workforce development providers.

Case study from Philadelphia: How place-based partnerships and place governance organizations can support and bolster city services for homelessness reduction and care

Most emergency shelters in Philadelphia are closed during the day, meaning that the homeless population transitions from being sheltered to unsheltered and back again on a daily basis. In 2011, Project HOME , a nonprofit homelessness service provider in Philadelphia, sought to tackle this challenge by creating a drop-in day center for homeless people close to transit and City Hall.

Through place-based, cross-sector partnerships with city government and the regional transit authority, Project HOME was able to open the day center, Hub of Hope , for people to access food, health care, social services, laundry, showers, and fresh coffee provided by Wawa. It is the only drop-in center on transit property in the U.S. and currently serves approximately 200 people per day .

As part of its cross-sectoral approach, Project HOME also collaborates with Center City District (Philadelphia’s downtown place governance organization) and other private and public sector partners on a street outreach effort, the Ambassadors of Hope , which fields interdisciplinary outreach teams on the streets of Center City Philadelphia to engage chronically homeless people and connect them to help customized to their needs. Since 2018, over 700 people experiencing homelessness have received services and transportation off the street.

Philadelphia, Penn. / Authors’ original photo

Take a regional, data-driven approach to homelessness

There is growing consensus among homelessness service providers and city and regional officials that no one institution, organization, funding source, or level of government can solve homelessness alone. To respond to the structural challenges that prevent people across a region—not just within city boundaries—from accessing affordable housing, there is a movement to establish regional homelessness authorities that correspond to merged, regional Continuums of Care and align resources and service delivery programs across a region.

Cities and counties from the East Bay area to Spokane, Wash. to Houston have adopted a “regional approach” to homelessness to coordinate on cross-jurisdictional challenges to addressing homelessness by aligning regional funding, communications, coordination, social delivery infrastructure, data collection, performance management, and training and capacity-building. This helps regions understand the extent of homelessness in their region and transparently report performance metrics, which are critical to assembling the collective will and funding necessary to end it.

Case study: How cities and counties are working together on a regional approach to homelessness

Since 1994, the Metro Denver Homeless Initiative has coordinated data and services regionally—an early national leader on the regional approach that includes building, maintaining, and using a single “Coordinated Entry System” with real-time rather than annual data. Similarly, service providers, governments, philanthropy, and more came together in the Houston metro area in 2011 to form the Way Home —another regional approach that has successfully implemented the “housing first” model. Recently, the King County Regional Homelessness Authority (KCRHA) was established in December 2019 through an inter-local agreement between King County and the city of Seattle—representing a consolidated and regional approach to tackle a critical homelessness challenge that has spiked in the last decade. Even in places with less jurisdictional fragmentation, Continuum of Care participants can come together in more collaborative ways to create a regional approach. For example, in 2015, Strategies to End Homelessness was named the “Unified Funding Agency” for the Cincinnati/Hamilton County CoC.

These leading and innovative regional approaches have more in common than just high levels of cooperation, data, and streamlined funding. These initiatives seek to address a spectrum of socioeconomic challenges associated with homelessness, including through homelessness prevention, particularly focusing on communities of color such as Black and American Indian/Alaska Native populations, which are disproportionately affected.

Their work is characterized by clear planning and performance metrics, such as the KCRHA inter-local agreement that provides a community-driven, racially equitable, and data-informed methodology and operates in alignment with the Regional Action Framework, which outlines clear visions, policies, strategies, and success metrics while striving to balance immediate actions with long-term solutions. Many emphasize the importance of input from individuals with lived experience of homelessness . These metro areas have shown that a “regional approach” requires system integration, coordinated service delivery, and performance management.

Public, private, and civic sector leaders have the evidence at their disposal to advance pragmatic solutions that can not only reduce visible homelessness in downtowns, but also chart a future in which all residents of a region have access to more effective and humane service delivery ecosystems for housing, employment, and reintegration. This holistic, place-based approach to homelessness creates a foundation for a strong labor market and vibrant regional economy. Understanding the why, where, and how of homelessness across and within regions is critical to not only respond effectively to the needs of people experiencing homelessness today, but also to prevent people from experiencing homelessness in the future.

While the state of homelessness in a city like Philadelphia is not the same as in Seattle, the recommendations provided within this report—from increasing the supply of all types of housing to strengthening organizations that provide holistic, place-based support to bolstering reentry services for returning citizens—provide a roadmap based on evidence and root-cause approaches that a jurisdiction of any size can adopt and scale, with the right support and resources, to come closer to the goal of solving homelessness . This will require sustained commitment and coordination from local, regional, state, and federal leaders. Initiatives such as the Biden-Harris administration’s “ALL INside” —which is accelerating local efforts to reduce homelessness in Los Angeles, Dallas, Phoenix, and several other cities—are promising examples of how federal funds can be leveraged to escalate the response.

A large, unsheltered homeless population is not an inevitable part of human or urban life, and there is real harm and risk involved when solutions are not implemented early or are underfunded: both the harm to individuals experiencing the profound traumas of homelessness and incarceration, as well as the damage to regional economies and institutions that is visible in downtowns, emergency rooms, transit systems, and courthouses every day. Allowing the root causes to continue unabated creates the real “doom loop” : a homelessness challenge that becomes harder to solve the longer we wait.

All residents of a region deserve to feel safe walking free of public disorder within their central business districts, but so too must all people within a region have access to the opportunity for stable housing, food, and services. To this end, federal, state, and local leaders must deploy investments and interventions in a manner that is most effective and humane in achieving that goal.

The authors would like to thank Jira Trinetkamol for his excellent research assistance on this piece. They also extend their sincere gratitude to Alan Berube, Annelies Goger, Glencora Haskins, Paul Levy, and Joy Moses for reviewing earlier drafts of this piece. Any errors that remain are solely those of the authors.

• All qualitative interviews capture respondents’ perceptions from fall 2022—reflecting a point in time that may not capture improvements or heightened challenges that have happened since.
• Houston was included in Figure 4 to provide an example from a city that has intentionally embraced a homelessness reduction framework rooted in coordinated service delivery for the past decade.
• While preliminary data from a supplemental PIT Count conducted by the city of Chicago in light of increased migration reports a significant recent increase in homelessness since the 2022 PIT Count, it will be difficult to gauge how sustained the impact will be moving forward.
• For more on place governance organizations and homelessness, see Madison, E. and J. Moses. (2022) “How Should Place Governance Support People Experiencing Homelessness?” in Hyperlocal: Place Governance in a Fragmented World. Washington, DC: Brookings Institution Press.

Placemaking

Brookings Metro

Anne T. and Robert M. Bass Center for Transformative Placemaking

Joseph W. Kane, Fred Dews

March 28, 2024

Jennifer B. Ayscue, Kfir Mordechay, David Mickey-Pabello

March 26, 2024

Glencora Haskins, Joseph Parilla

March 22, 2024

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Homelessness in the U.S. hit a record high last year as pandemic aid ran out

Jennifer Ludden

The latest national count taken in January found more than 650,000 people living in tents, cars and shelters. Business Wire Via AP hide caption

The latest national count taken in January found more than 650,000 people living in tents, cars and shelters.

Homelessness in America spiked last year, reaching a record high, according to an annual count that provides a snapshot of one night in January. The report, released today by the department of Housing and Urban development, found more than 650,000 people were living in shelters or outside in tents or cars. That's up a whopping 12% from the year before.

To advocates, it hardly comes as a surprise.

"We simply don't have enough homes that people can afford," says Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness. "When you combine rapidly rising rent, that it just costs more per month for people to get into a place and keep a place, you get this vicious game of musical chairs."

Homelessness has been rising since 2017 in large part because of the country's massive shortage of affordable housing. There was a pause during the pandemic, and Biden administration officials say that's because of sweeping federal aid that kept people from getting evicted. But last year, in a triple whammy, that aid started running out . Inflation spiked to its highest level in a generation, and median rent hit a record high . Research has found that where rents rise, so does homelessness.

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This year's big jump was driven by people who lost housing for the first time, which Biden administration officials say reflects the sharp rise in rent. The largest increase was among families, and the count also finds a significant rise among Hispanics. Nearly 40% of the unhoused are Black or African-American, and a quarter are seniors. The annual count does not include the many people who couch surf with friends or family, and who may be at high risk of ending up on the street.

One family sleeps in a Walmart parking lot

In July, Takia Cheeks and her four children joined the surge in families losing housing for the first time.

They'd moved to Virginia so she could take a higher paying job at a corrections facility, and Cheeks was excited to no longer have to live "paycheck to paycheck." But it did not go well. Two of her children have disabilities, and she kept having to miss work to get them enrolled in school and set up with accommodations. After six days' absence, her employer let her go.

Meanwhile, the family's new apartment turned out to have no hot water or AC, not even screens to be able to open the windows. Cheeks had complained, and after losing her job she was evicted in a court hearing where she had no lawyer. She put the family's belongings in a storage unit and they all slept crammed into her Ford Fiesta in a Walmart parking lot.

"I'm not getting sleep because I'm watching over my children, because it's a lot of people walking around," she says. She would get everyone up at 6:00 in the morning to go to a Wawa across the street. "Therefore I know it's not that many people in the bathrooms, for my children just to wash up," she says.

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It was so hot in the car that Cheeks's daughter got first and second degree burns. "I had to take her to the hospital," she says. Their rescue dog Max was also suffering so she gave him up, even though he'd been an emotional support animal for her son with autism.

After a few weeks, Cheeks got another job making deliveries for Amazon, and that let the family stay in a motel for a couple months. In October, they finally moved into a house with rental assistance, but that aid is temporary.

Migrants likely added to the higher numbers in some places

The surge in migrants showing up at shelters around the country likely also helped push up the numbers, says Ann Oliva, CEO of the National Alliance to End Homelessness. It's not clear how many may have been included, because back in January the volunteers conducting the count did not ask whether someone was seeking asylum. But Oliva says homeless service providers who'd already been overwhelmed are now struggling with this added population.

"We saw it in the state of Maine, in Minneapolis, in Chicago," she says. "Our big concern is that there is a huge inflow of folks that are coming into these systems without any resources for these systems to serve them."

Oliva's group wants the Biden administration to make it easier for migrants to legally work, and to have their asylum cases heard more quickly. She also says the federal government needs to provide far more rental assistance. Unlike food and healthcare, housing aid is not an entitlement, and only a quarter of people eligible for it actually receive a subsidy.

A few places did see a decrease in homelessness

The annual count found homelessness numbers down from the previous year in Houston, Newark and Chattanooga. "Homelessness is solvable and should not exist in the United States," HUD Secretary Marcia Fudge said in a statement .

The Biden administration says it's stepped up funding and streamlined the process for housing vouchers, among other things, and that helped move more people into permanent housing this year. They also point out that a record number of new apartments — about a million — were under construction.

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Inflation has also eased, but housing and food remain much more expensive than just a few years ago. Food pantries say they continue to see large numbers of people. And while rents on luxury condos in some places may be coming down, the massive housing shortfall is worst for the lowest-income renters, many of whom pay more than half their income on rent .

To really bring down these numbers, advocates say there should be far more federally subsidized housing. Right now only one in four people who are eligible actually gets it, but expanding that would need more funding from Congress.

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California Today

How Los Angeles Is Approaching Homelessness

A conversation with the Times reporter who wrote about Mayor Karen Bass’s flagship program to solve homelessness.

By Soumya Karlamangla

About 171,000 people living in California are homeless, a total that has grown significantly over the past decade. If you live here, this has surely not gone without notice, as encampments have popped up on sidewalks and in public parks across the state in recent years.

Though California accounts for 12 percent of the nation’s population, the state is home to 30 percent of all homeless people in the United States.

My colleague Jill Cowan recently wrote about a new program spearheaded by Mayor Karen Bass of Los Angeles that’s aimed at eliminating the most visible encampments in the city. Bass took office in late 2022, and the program, Inside Safe, is at the core of her efforts to solve homelessness.

The program provides motel rooms for homeless residents who agree to leave encampments, a shift from sweeps in which officials clear encampments and force people to leave. But while Inside Safe has moved more than 2,100 people into shelters, only 400 of them have since moved into permanent housing. That’s drawn criticism that the program is only a short-term fix and perhaps more for optics than helping Angelenos most in need.

You can read Jill’s full article here.

I spoke to Jill about her article and her reporting, which spanned more than a year. Here’s our conversation, lightly edited:

Why did you decide to focus on Inside Safe?

Because it was the mayor’s focus — it was the program she touted the most and it was meant to address some of the people who need it most.

You reported that through Inside Safe and other programs, L.A. moved 21,000 people off the street and into temporary housing in 2023, about 4,000 more than it did in the prior year. How are Bass’s efforts seemingly more effective than her predecessors’?

There were a few things that Bass has done differently and not all of them are related to Inside Safe, but it’s a useful place to start. The level of coordination and focus on a specific encampment were new for Inside Safe: It was important to follow through on promises of shelter, and for that shelter to be individual rooms, as opposed to big congregate shelters, which make a lot of homeless people feel unsafe or like they don’t have privacy. Bass has also emphasized her relationships across government agencies, like with members of the Los Angeles County Board of Supervisors and with leaders in the federal government, to help get everybody rowing in the same direction, which experts say is a bigger change than you might think.

You live in L.A. When you drive or walk around the city, does it feel as if the reduction in encampments is noticeable?

I think so. It certainly isn’t true to say that there are no encampments anywhere. But there are also a lot of public spaces where there were wall-to-wall tent encampments covering sidewalks or in parks, and many of those are no longer there. Venice is an example that many of the mayor’s allies point to, and the difference there is really striking. I live near Echo Park Lake, and during the pandemic there were a lot of encampments around that area, but I have seen very few tents in the last year or so.

What’s the pushback to the program been?

A longtime criticism of Los Angeles’s — and many cities’ — approach to homelessness is that it prioritizes the experience of housed residents at the expense of stably getting people experiencing homelessness into homes. To be clear, a lot of progressives and homeless advocates say they prefer Bass’s general approach to sweeps, where people are forced to leave encampments.

But they say that Inside Safe still essentially closes off large parts of public space to people who may not have homes but still have a right to be in public. Because once an encampment is gone, the city or other agencies often put up barriers or, in some cases, enforce the city’s anti-camping ordinance to ensure people don’t come back to that area.

What has Bass said in response to this criticism?

She has been open about the fact that making visible progress for the benefit of voters is a top priority and she says that Inside Safe, for all its imperfections, is getting people in need off the street quickly. Leaving them there while they’re on a waiting list for temporary or permanent housing is not an option, in her view. She sees her work now as almost like triaging the situation in the time it takes to get more housing built.

Wait, she’s been open about the fact that Inside Safe is somewhat for image? Or is she casting it in some other less cynical way?

She has been open about the fact that it’s designed in part to satisfy voters.

Fascinating. OK, anything else about the story you want to share?

Just that this is an ongoing issue. Experts on housing and homelessness told me they were optimistic about Bass’s work and approach, but she needs time.

The rest of the news

A Los Angeles Times analysis of data from the Bureau of Labor Statistics shows that California has the lowest job growth in the United States , particularly in rural counties.

Researchers with U.C. Santa Barbara and the NASA Jet Propulsion Laboratory report that water consumption in the U.S. could be cut by about 93 percent if California farmers planted less thirsty crops, CalMatters reports.

Southern California

A bill introduced in the California Legislature will seek reparations for the families of people who were displaced from their homes in Los Angeles in the 1950s on land that became the site of Dodger Stadium.

The Murrieta Police Department, which has been using Lego heads and emojis to cover suspects’ faces in social posts, has been asked by the Lego company to stop , The Associated Press reports.

Nancy Valverde, an L.G.B.T.Q. activist, died on Monday at her home in Hollywood, ABC News reports. She was 92 .

Northern California

Berkeley will stop enforcing a ban on natural gas piping in new homes and buildings in response to opposition in court by the California Restaurant Association, NBC Bay Area reports.

San Francisco’s 4/20 festivities in Golden Gate Park, a celebration of cannabis and cannabis culture, will not take place this year, The San Francisco Chronicle reports.

Amid all the upheaval of the pandemic, there have been moments of hope and positive change. What have been your pandemic silver linings? Tell us at [email protected] .

And before you go, some good news

Stacey Terterian grew up in Fresno, but during a recent visit to Armenia she discovered a deep connection to the country she says feels like home.

Terterian, whose family has roots in Armenia, decided to join a service program called the Armenian Volunteer Corp in August 2023 after a challenging period in her personal life. The trip brought her to Armenia for the second time in her life.

Terterian’s volunteering involved assisting Armenians who were affected by the ongoing conflict in Nagorno-Karabakh, an ethnic enclave of Armenians in Azerbaijan. Then, in September 2023, Azerbaijan attacked Nagorno-Karabakh, taking control of the region and causing more than 100,000 Armenians to flee. Suddenly, Terterian found herself on the front lines of the crisis, providing aid to the refugees and, through that experience, locating a deep connection to Armenia and its people.

Terterian describes the course-changing visit in a recent essay in The Fresno Bee . “A picturesque land, rich in both beauty and history. Armenians know despair; they know resilience as well. My journey embodies that spirit,” she wrote.

Thanks for reading. I’ll be back tomorrow. — Soumya

P.S. Here’s today’s Mini Crossword .

Maia Coleman and Briana Scalia contributed to California Today. You can reach the team at [email protected] .

Sign up here to get this newsletter in your inbox .

Soumya Karlamangla reports on California news and culture and is based in San Francisco. She writes the California Today newsletter. More about Soumya Karlamangla

As homeless crisis grows, states and cities are turning to voters for affordable housing

As the country's homeless crisis worsens , cities and states are trying to build more affordable housing to prevent their residents from ending up on the streets or in shelters.

But more money is needed to turn construction plans into a reality − and in many cases residents must approve tax revenue increases to foot the bill.

This month, voters in Chicago and California were given the choice: Raise taxes to fund housing and homeless services? Or keep things status quo?

Results were mixed. California's Proposition 1 , which would provide more mental health services for people experiencing homelessness passed by razor-thin margins after weeks of ballot counting. In Chicago, ballot question 1, dubbed Bring Chicago Home, which would have raised taxes on the sales of million-dollar real estate, failed with 52% voting against it.

State lawmakers in Iowa and New Hampshire also are debating legislation that would allow more real estate transfer tax revenues to fund affordable housing. Last year, Delaware passed a law to put more transfer taxes toward affordable housing funds in three counties, and New York did the same for part of Long Island in 2021. Similar efforts in recent years failed in Colorado, Illinois and Maine, according to data compiled by the National Conference of State Legislatures.

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

More elected officials throughout the country are running on promises to reduce homelessness. But the problem is growing even as leaders try to solve it. Last year, the U.S. homeless population reached a high of more than 650,000 , according to the Department of Housing and Urban Development Annual Homelessness Assessment Report, and housing experts warn rent increases and evictions will push more people into homelessness until cities build cheaper housing. When funding for affordable housing fails to get approved, the time frame for reducing homelessness gets pushed further, advocates warn.

But cities face an uphill battle passing new funding measures to support brand-new housing initiatives, especially when voters are invested in keeping real estate taxes flat.

In Chicago, one of the main groups opposing the Bring Chicago Home campaign said raising taxes could also raise housing costs, hurting homeowners and renters alike.

"Tax increases hurt affordability, they are actually drivers of housing instability," said Jeff Baker, CEO of Illinois Realtors.

Bring Chicago Home fails to pass after years of organizing

After first launching in 2018, the Bring Chicago Home measure failed to pass last week, leaving longtime grassroots homeless advocates disappointed and frustrated with the results.

"The number of people experiencing homelessness grows every year, it is a matter of life and death," said Hannah Gelder, the organizing director for ONE Northside in Chicago, a social justice group on the referendum's steering committee.

Gelder said advocates for the homeless in years past fought at the state level to increase taxes to fund affordable housing, but state lawmakers said they didn't want to consider legislation on the issue. That meant Chicago, where homeless people number more than 60,000, had to go directly to voters in this year's election.

Bring Chicago Home would have increased the real estate transfer tax to 2% for properties sold for $1 million or more, while lowering them for more than 92% of buyers purchasing property worth less than $1 million, according to the proposed policy . The plan would have raised about $900 million for new construction over 10 years, the campaign said. Proponents first started organizing around the cause back when Rahm Emanuel was mayor.

"It was an uphill battle to persuade voters to vote on a tax referendum," Gelder said.

Illinois Realtors, a real estate lobbying group, said it had $1 million to spend on its opposition campaign, which argued the new sales tax would hurt Chicago's residential, commercial and rental real estate markets.

"This proposal was actually going to hurt the ability of the city to address homelessness," Baker said.

But, the Bring Chicago Home campaign said their proposed tax would not hurt renters, citing recent studies from Northwestern University and the University of Chicago that found landlords wanting to maintain their return on investment for multifamily buildings worth more than $1 million could do so by raising monthly rents by less than $5.

While grassroots homeless advocates were on the ground talking to their neighbors about Bring Chicago Home and trying to "win hearts and minds," Gelder said, ads led some voters to believe the new tax would be like writing the city government a "blank check."

"It played to voters' distrust of government," Gelder said.

Baker told USA TODAY he agreed cities across the U.S. need to increase their supply of below market rental units. But, he said zoning restrictions and costly development requirements make "building these homes way too expensive" for real estate owners.

To make the case for the funding, some experts point to growing evidence showing paying for affordable housing saves money long-term because having a large homeless population is costly for cities, said Sarah Gillespie, a housing researcher at the Urban Institute focusing on city budgets.

"It is a choice. You may choose to pay for housing, and if you don't, then you're choosing to pay for arrests, jail stays and emergency department visits," she said.

FLORIDA: State bans homeless people from camping in public spaces

California Prop 1 barely passes

California is home to nearly a third of the country's unhoused population, and data released last year shows the vast majority of unhoused people there said they had a period in their lifetime when they experienced a serious mental health condition. About 27% of California's more than 170,000 homeless residents have been hospitalized for a mental health condition before, according to the report from Benioff Homelessness and Housing Initiative at the University of California, San Francisco.

California's Proposition 1 scraped by with barely more than 50% of the vote in a heavily Democratic state.

Gov. Gavin Newsom pushed hard for the measure, which will fund thousands more mental health and substance use treatment slots and housing units.

"Now it's time to get to work − repairing the damage caused by decades of broken promises and neglect to those suffering from severe mental illness," Newsom wrote on X, formerly Twitter, celebrating the election results.

Proposition 1 authorizes the state to  shift $6.38 million in bonds  against county mental health budgets, redirecting most of the money toward new affordable housing.

The money would be borrowed against income taxes already imposed on people who earn over $1 million annually.

Individual cities in California, and elsewhere in the West , have voted by wider margins to raise taxes to fund homeless services, like last year, when Seattle renewed its housing levy for another seven years.

Seattle voters support property taxes for affordable housing

In the Seattle region, another area on the West Coast struggling with a large homeless population, a majority of voters have for years approved a levy on property taxes to fund affordable housing.

In an off-year election, 69% of Seattle voters in 2023 approved a housing tax that will fund the creation of more than 3,100 affordable rentals and homes for purchase, and rental assistance to prevent evictions for an estimated 9,000 low-income families, according to the city .

Homeless advocates in Seattle see more support from voters because the housing tax has been in place for decades, and residents have seen positive results, said Sharon Lee, executive director of the Low Income Housing Institute in Seattle. Affordable housing complexes are spread evenly throughout the city, and "you can't tell that it's low-income," she said.

"They look market rate, they're well maintained and there isn't a stigma," Lee said.

It could be harder to rally voters to approve increased funding for similar projects in America's older cities, where the phrase "affordable housing" calls to mind "buildings that are falling apart or vacant," she said.

Atlanta mayor, City Council approve millions of dollars for affordable housing

Instead of turning to voters, last year the Atlanta City Council was able to approve hundreds of millions of dollars for affordable housing, through a bond spread out over the better part of a decade.

The city, which grew by 66,000 residents from April 2022 to April 2023, also is benefitting from more property tax revenue without having to raise or pass new measures, the mayor's office said.

Philanthropic groups also worked with the city to allocate millions as part of the plan.

There's still broad public support for it less than a year later, said Joshua Humphries, policy advisor to Atlanta's mayor. Atlanta residents saw firsthand that the bond was working in a matter of months, he said. In 2023, 14 stalled affordable housing projects − representing 1,238 affordable units − got off the ground because of the money .

In 2023, Atlanta had an unhoused population of 2,679 , according to that year's annual count.

The funds will continue to be used for more new construction, as well as preserving existing housing and developing underutilized public land, Humphries said.

"Affordable housing is the most pressing public policy issue in the country right now, and every city is going to have to grapple with the question of how do they want to be part of making sure that their city has adequate housing stock," he said. "You need to have the political will and financial investment."

Contributing: Terry Collins, USA TODAY; Kathryn Palmer, Desert Sun

Portland former church, future site of a tiny home village for homeless families, now in hands of Native organization

After years of negotiation, future generations collaborative officially owns the former presbyterian church of laurelhurst, and can move forward with creating a tiny home village and early childhood center for indigenous families experiencing homelessness..

Future Generations Collaborative members hold a freshly signed ownership agreement for the former Presbyterian Church of Laurelhurst on March 15, 2024. Left to right: Jennifer Pertile, her five-month-old son Gray, Jillene Joseph, Natalyn Begay and Chenoa Landry.

Jarrette Werk / Underscore News / Report for America

Dozens of Indigenous elders, youth and church members filed into the former Presbyterian Church of Laurelhurst on a March afternoon. It was the last time people would enter the building as a church. As they passed an abalone shell filled with smoldering sage, each person picked up a penny from a small bowl.

Inside, attendees placed their pennies on a red cloth. Next to the cloth was a stack of papers. Once signed, they would finalize the transfer of the church to Future Generations Collaborative (FGC), an Indigenous-led organization founded to prevent fetal alcohol syndrome disorder.

On Friday, March 15, ownership of the former Presbyterian Church of Laurelhurst was officially transferred to FGC in exchange for $1, marking its historic return to Native hands for the creation of Barbie’s Village — a tiny home village and early childhood center for Indigenous families experiencing homelessness.

“Everybody took a penny or two when you came into this room,” Jillene Joseph, Aaniiih citizen, engagement lead for Future Generations Collaborative and executive director of Native Wellness Institute, said to the people sitting in a circle. “There’s 100 of them because 100 pennies equals $1, and that’s what we’re buying this for, is $1.”

Over six dozen people attended the transfer of ownership event held on March 15, 2024. Each person placed a penny or two on a red prayer cloth until they added up to 100, or $1, the symbolic price of the former Presbyterian Church of Laurelhurst.

After eating, folks funneled into the sanctuary room that will one day be transformed to resemble the inside of a traditional long house. They sat in a circle and listened as friends and family shared memories of Barbie Jackson Shields (Atwai), the person who inspired the project, and its namesake.

“[It] was a historic event, because after over three years of meetings, building relationships, building trust, and proving ourselves over, and over, and over to different levels of the church, the church finally gifted the land back, or ‘Land Back’ as we call it,” Joseph said.

Land Back years in the making

Since 2012, FGC has sought to support the health and healing of the urban Native community in Portland.

Barbie’s Village has been a dream in the works for more than three years now, named after and honoring the legacy of Barbie Jackson Shields (Atwai), a citizen of the Confederated Tribes of the Warm Springs, and an original Natural Helper — a role central to the mission of the FGC. Shields was dedicated to addressing public health disparities among Indigenous communities, particularly those experiencing homelessness on their homelands.

Kenny Shields, center, is the husband of the late Barbie Shields. With his help, Future Generations Collaborative brainstormed the idea of creating Barbie's Village as a way to honor her legacy.

Barbie’s husband, Kenny Shields, Anishinaabe and Sioux, said that this moment was important to him and his family. He was joined by two of their daughters, Tacori, 10, and Ashah, 8, who proudly wore their yellow and blue fancy shawls.

“To be able to sit back and witness the signing of this process after years of delegation has been meaningful to me,” Kenny said.

Shields said he and his wife had often dreamt about creating a safe place for Native families who, like them, had small children and needed a place to turn to when struggling to secure safe and affordable housing.

In 2018, Barbie suffered a brain aneurysm that took her life before she could see that dream come true. To honor her dream and legacy, Joseph told Shields that she wanted to name the project after his late wife.

The decision to gift the land and property to FGC came after a vote last fall by Presbytery of the Cascades, the regional governing body for over 90 congregations in Oregon and Washington state. Members voted 135 to 24 to gift the land and building of the former Presbyterian Church of Laurelhurst to Future Generations Collaborative for $1.

Now, Joseph says, FGC will begin to transform the former church into Barbie’s Village — a tiny home village with six to 10 tiny homes and a resource center to provide wrap-around services for Indigenous families experiencing housing insecurity and homelessness.

“We are very grateful for this gift,” Joseph said. “We understand how big this gift is and we accept it full of love, honor, care and respect.”

In this file photo taken on Oct. 30, 2023, Rev. Chris Dela Cruz serves as head of the Barbie’s Village Task Force, where he and members took on the responsibility of knocking door-to-door to answer questions, as well as inform and educate the community members living in the neighborhood near where Barbie’s Village will soon be built.

Allyship and healing

Getting to this point was not easy. It required years of establishing trust, allyship and relationship building, and most of all, the healing of generational wounds and trauma at the hands of the church.

Three years ago, The Barbie’s Village Task Force was created. Under the leadership of Rev. Chris Dela Cruz, Future Generations Collaborative, Leaven Community Land and Housing Coalition and the Westminster Presbyterian Church worked together to address homelessness and fulfill the need within the community, while simultaneously returning the land to Indigenous stewardship and providing opportunity for the church to begin the path to repatriation and reconciliation.

“This is the first time I’ve ever experienced an ally standing up for me,” Joseph said. “That was just like a really profound awareness for me, and it just made me that much more grateful for everything that we’re doing.”

Members of the Barbie’s Village Task Force took on the responsibility of knocking door-to-door to answer questions, as well as inform and educate community members living in the neighborhood that Barbie’s Village would soon be a reality.

This is work that Rev. Dela Cruz said is “incredibly personal” as a Filipino American who “puts on a collar that bears the weight of the saints and sins of the Church.”Dela Cruz shared how his ancestors had land taken over by both European and American powers in collusion with the Church, which resulted with many aspects of Filipino Indigenous culture and peoples being systematically erased because of colonization.

“This act of Land Back is but a drop in the bucket in the need for the American Church, and indeed, my own Presbytery, to reckon with its own complicitness in white supremacy and do the work of repair with the Indigenous community,” said Rev. Dela Cruz during his speech on March 15. “But in truth, Barbie’s Village is a gift to us, the church, for it allowed us to make a concrete real act of repair that must be a model for the church to continue to pursue if we are to be true of our calling.”

“Today, Indigenous peoples will claim this as their land once again, to steward for the good of all,” Rev. Dela Cruz added.

Every attendee went home with braids of sweet grass as a way to say thank you for showing up and supporting Barbie’s Village. “We're gifting you one of my favorite traditional medicines, the sweet grass,” said Jillene Joseph. “We're gifting this to you so when you look at this, or hold it, or pray with it, or smudge with it, that your prayers will also continue to include Barbie's Village.”

‍What’s Next

Last fall, Multnomah County Chair Jessica Vega Pederson announced an emergency measure to get money into the hands of the nonprofits working to address homelessness. A portion of that package included an initial $300,000 grant to assist with startup costs associated with Barbie’s Village.

Joseph says FGC is applying for additional grants to help cover construction of six to 10 tiny homes with indoor plumbing and heating, as well as outdoor child playscapes. Joseph said she hopes to hire multiple contractors simultaneously, to speed construction and renovations to the existing building.

“It also depends on how far the money will go,” Joseph said. “We have the initial $300,000, and then we just wrote an almost $2 million grant to the Portland Clean Energy Fund that will likely do everything we need. So we’re starting with what we have funding for and then we’ll go from there.”

During the event on March 15, Jennifer Pertile shared memories of Barbie Shields. “The last time I saw Barbie and stayed with Barbie, she actually came and found me on the streets, because I was lost in my own addiction at the time,” Pertile said. “She just wanted to come and bring me home and take care of me. She had a way of really getting to you and letting you know that she cared and loved you and wanted something better for you.”

Strings attached

Although this is a historic Land Back achievement, there are still lingering doubts on the church’s end, according to Joseph.

“There was that reversionary clause in there, that said, if for some reason the FGC should fold, then the building would default and go back to the church,” Joseph said. “The church would decide what other Native nonprofit that it would go to.”

The agreement, put together by a separate task force under the larger regional church organization the Presbytery of the Cascades, states that the property will revert to the Presbytery of the Cascades if any of the following happens: FGC becomes insolvent, the property is no longer used for charitable purposes, the property is vacant for more than one month, FGC is no longer an active nonprofit corporation in good standing, or FGC sells or proposes to sell its assets or its interest in the property.

Joseph says the inclusion of such restrictions introduces doubt into an otherwise positive exchange. She said gift giving means not leaving strings attached.

“Part of our work is to heal ourselves from the lasting impacts of colonization and we know that the church has their healing work to do, too,” Joseph said. “We hope that the church does their healing work, so that the next time Land Back happens, it won’t be with the strings of oppression attached.”

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Some of Trump’s allies in Congress already support his 2025 ideas on deportations and Jan. 6 pardons

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As Donald Trump campaigns on promises of mass deportations and pardons for those convicted in the Jan. 6, 2021, riot at the Capitol , his ideas are being met with little pushback and some enthusiasm by a new era of Republicans in Congress.

It’s a shift from the first time around when the presumptive Republican presidential nominee encountered early skepticism and, once in a while, the uproar of condemnation.

Rather than being dismissed as campaign bluster or Trump speaking his mind to rouse his most devoted voters, his words are being adopted as party platforms, potentially able to move quickly from rhetoric to reality with a West Wing in waiting and crucial backing from key corners on Capitol Hill.

“We’re going to have to deport some people,” said Republican Sen. J.D. Vance of Ohio, one of Trump’s biggest supporters, days after campaigning alongside Trump in his home state.

While Democratic President Biden and his allies are sounding alarms about Trump’s proposed agenda for a second term — and his promise that he would be a “dictator” but only on Day One — the Republican Party in Congress is undergoing a massive political realignment toward Trump’s “Make America Great Again” movement.

Senate GOP leader Mitch McConnell of Kentucky, who clashed with Trump at times particularly over the Capitol riot while also pushing through dozens of his judicial picks, is preparing to step down from his leadership role at the end of the year. House Speaker Mike Johnson (R-La.) faces constant threats of his ouster.

Rising in the churn are MAGA-aligned newcomers such as Vance, who wasn’t yet elected during Trump’s presidency, and Rep. Marjorie Taylor Greene of Georgia, who was elected as Trump lost to Biden in 2020. Both Vance and Greene are considered potential vice presidential picks by Trump.

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Greene, who recently filed a motion to potentially force Johnson from the speakership, said it’s too soon to be discussing a second-term policy agenda or who will fill West Wing positions.

As she campaigns for Trump, she said her priority is just winning the election.

Other Republicans in the House and Senate often simply shrug when asked about Trump’s agenda, pointing to policies they like and others they might support.

Meanwhile, a cast of former Trump White House officials in Washington is pushing out policy papers, drafting executive actions and preparing legislation that would be needed to turn Trump’s ideas into reality. These efforts are separate from Trump’s campaign, whose senior leaders have repeatedly insisted that outside groups do not speak for them, though many group leaders would be in line to serve in a new Trump administration.

If Trump wins, “we are going to have a plan — and the personnel — ready to roll,” said Paul Dans, a former Trump administration official who heads the conservative Heritage Foundation’s Project 2025, which is collecting thousands of resumes and training staff for a potential second Trump administration.

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Trump himself has suggested having a “very tiny little desk” on the Capitol steps so he can sign documents on Inauguration Day, Jan. 20, 2025.

“On Day One of President Trump’s new administration, Americans will have a strong leader,” said Karoline Leavitt, the campaign’s national press secretary.

Congress pushed back at times during the first Trump administration, a stable of Republicans joining with Democrats to halt some of his proposals.

Republicans and Democrats resisted a White House effort to commandeer funds for a U.S.-Mexico border wall, leading to the longest government shutdown in history. Republican Sen. John McCain of Arizona, who died in 2018, famously gave a thumbs-down to Trump’s effort to repeal the health law known as the Affordable Care Act.

And after Trump supporters stormed the Capitol to try to reverse his 2020 loss to Biden, 10 Republicans in the House voted to impeach Trump for inciting the insurrection and seven Republican senators voted to convict him. Many of those lawmakers have since left Congress. One, Sen. Mitt Romney of Utah, is retiring at the end of his term. Had the Senate convicted Trump, it could have then moved to bar him from holding federal office again.

As a result, there are fewer lawmakers now in Congress willing or able to stand up to Trump or publicly oppose his agenda as he has effectively commandeered the party apparatus, including the Republican National Committee, as his own.

“Those people are all kind of flushed out,” said Jason Chaffetz, a former GOP representative who is close to Trump allies on and off Capitol Hill.

Trump still falsely argues the 2020 election was stolen and is claiming he should be immune from a four-count federal indictment alleging he defrauded Americans with his effort to overturn the results. He has made Jan. 6 a cornerstone of his 2024 campaign and often refers to those imprisoned for the attack as “hostages.”

GOP Sen. Josh Hawley of Missouri, a leader of the effort to challenge the certification of electors on Jan. 6, said he does not agree with the idea of a “blanket pardon” for those convicted in the riot — some 1,300 people have been charged.

But he said he is closely watching the upcoming Supreme Court case contesting that rioters obstructed an official proceeding, which could call into question hundreds of cases, including some of the charges against Trump.

“My view is, let’s see what the Supreme Court says on that,” Hawley said.

Sen. Ted Cruz (R-Texas), once a Trump critic after their fierce rivalry during the 2016 campaign, said anyone who engaged in violence at the Capitol on Jan. 6 should be prosecuted. But Cruz, who also helped challenge the 2020 election that day, was open to pardons for others.

Perhaps Trump’s most enduring campaign promise in 2024 is his repeated pledge to launch the “largest domestic deportation operation in American history” — reviving the immigration and border security debates that helped define his presidency.

He points to the Eisenhower-era roundup of immigrants as a model, one that goes far behind his 2017 travel ban on migrants from mostly Muslim countries or the family separations at the U.S.-Mexico border.

Sen. Marco Rubio (R-Fla.) has been a leader on immigration issues, particularly the 2013 bill that provided a 10-year path to citizenship for immigrants in the U.S. without legal documentation, though it ultimately failed to become law.

But with migrant crossings hitting record highs during Biden’s term, Rubio said, “Whether they’re deported through the hearings that they’re waiting for, they’re deported through some effort to expedite it, something’s going to have to happen.”

“No one’s saying it would be easy, but something’s going to have to happen with all the people that have come here,” he said.

Added Vance: “I think you have to be open to deporting anyone who came to the country illegally.”

Vanessa Cardenas, a former Biden campaign official who now heads the advocacy organization America’s Voice, said she was worried that Trump allies in a second term would “actually know how to work the levers of government.”

“I worry that there’s a little bit of amnesia about how cruel his policies were,” she said, describing the fear in migrant communities. “Our tolerance level for his language and his ideas keeps increasing.”

Mascaro is an Associated Press congressional correspondent. AP writer Jill Colvin in New York contributed to this report.

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