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Abstract
Background Homelessness is an urgent public health crisis. Still, most communities do not target resources effectively to the most vulnerable homeless populations, and no framework has traditionally existed for reducing homelessness methodically over time.
Objectives In 2010, we began working with +100 communities to increase the number of chronically homeless people being prioritised for available housing resources. In 2015, we redefined our aim to help communities end chronic and veteran homelessness outright.
Methods We have embedded quality improvement in local community teams, teaching them to set clear aims, test system interventions, and measure outcomes monthly. We initially sought to improve the number of people being housed each month. When this measure failed to correspond with reductions in homelessness, we developed a stock-and-flow benchmark for measuring an end to homelessness and asked communities to develop and apply monthly data to measure reductions. Communities now use by-name lists of all people experiencing homelessness, updated monthly, to measure inflow into homelessness and exits to housing, and to drive reductions in homelessness overall.
Results From 2010–2014, communities increased their monthly housing rates by 266% on average, housing 105,580 people. Since we began measuring reductions, rather than housing rates, 55 communities have achieved monthly data on homelessness, 30 are reducing homelessness month-over-month, and ten have ended chronic and/or veteran homelessness.
Conclusions Reducing homelessness requires a multi-variate improvement framework, inclusive of inflow, housing rates, and current rates of homelessness. By tracking and responding to these variables monthly, communities can diagnose problems more precisely and identify improvements more quickly.
