The blog of the Urban Institute
May 9, 2019

Five Ways the HEARTH Act Changed Homelessness Assistance

May 9, 2019

In May 2009, Congress passed the HEARTH Act (Homeless Emergency Assistance and Rapid Transition to Housing). It is the first and only major reauthorization of the McKinney-Vento Homeless Assistance Act—the largest source of funding for homeless assistance programs.

Ten years out, HEARTH has changed how we respond to homelessness in five major ways, some of which we are still learning about. As Congress considers new homelessness legislation, we can learn from the HEARTH Act’s successes, missed opportunities, and remaining challenges.

1. Accelerating the shift from shelter to Housing First

Housing First focuses on helping people experiencing homelessness get into permanent housing as quickly as possible, rather than conditioning permanent housing on sobriety, treatment, employment, or other milestones.

The HEARTH Act helped entrench federal support for Housing First and expand the availability of permanent housing beyond people experiencing chronic homelessness to families, youth, and nondisabled, single adults. It authorized funds for rapid re-housing assistance to help people move into permanent housing and increase their incomes so they can remain housed without a long-term subsidy.

The figure below shows the increase in permanent housing beds for people experiencing homelessness from 2008 to 2018, which accelerated after many of the HEARTH provisions went into effect in 2012.

figure 1

2. Creating a Federal Strategic Plan to End Homelessness

HEARTH expanded the mission of the US Interagency Council on Homelessness (USICH) to “coordinate the federal response to homelessness,” creating partnerships across the government and with the private sector. It also directed the agency to develop a National Strategic Plan to End Homelessness.

This led to the 2010 release of Opening Doors: Federal Strategic Plan to Prevent and End Homelessness, which established a national goal of ending chronic homelessness and homelessness among veterans in 5 years and ending family and youth homelessness in 10 years. From the release of Opening Doors in 2010 to 2015, homelessness decreased by 11 percent overall, by 15 percent among people in families, by 22 percent among people experiencing chronic homelessness, and by 36 percent among veterans.

An Urban analysis of USICH concluded that the agency helped this progress by improving interagency coordination, increasing public accountability, and supporting local adoption of evidence-based practices.

3. Expanding the definition of homelessness

HEARTH expanded the definition of who should be considered homeless to include people at imminent risk of homelessness, previously homeless people temporarily in institutional settings, unaccompanied youth and families with persistent housing instability, and people fleeing or attempting to flee domestic violence.

This is in addition to the original definition of homelessness used by the US Department of Housing and Urban Development (HUD): “An individual or family who lacks a fixed, regular, and adequate nighttime residence.”

Although this expanded definition had the potential to increase access to homelessness programs, it is unlikely that it had much effect because it was not associated with the creation of new programs or an increase in funding for existing programs.

4. Creating systems performance measures

The HEARTH Act established system-wide performance measures for homeless Continuums of Care (CoCs). The performance measures relate to the national goal that homelessness be rare, brief, and nonrecurring. It includes measures of time spent in homeless programs, returns to homelessness after exit, and the number of people in the community experiencing homelessness for the first time.

The creation of community performance measures has spurred CoCs to use their data to better understand how their individual programs work together, or don’t, as a system. This has influenced their decisions about which programs to fund and the right mix of program options for their communities.  

5. Establishing coordinated entry

HEARTH committed CoCs to establish coordinated entry systems, creating a standard process for assessing people’s housing and service needs and connecting them to available resources. Coordinated entry, which received little attention when HEARTH was passed, marks a major shift in how communities address homelessness.

In the past, people experiencing or at risk of homelessness received assistance either by applying directly to a program or through a referral from a case manager or outreach worker. Under the new system, applicants submit their preferences and are matched based on an algorithm.

Creating a coordinated entry system is a complex, time-consuming process. HUD released the final requirements for coordinated entry systems in 2017, and many communities are in the initial stages of implementation.  

Coordinated entry has several potential advantages over the traditional referral process. It can expand access to assistance by quickly notifying applicants where they can go for help. It also prohibits homeless service providers from screening clients with higher barriers to housing, a common practice, particularly among transitional housing providers. Coordinated entry systems can make the homeless service system more efficient and reduce racial and ethnic disparities in who receives assistance.

Critics of coordinated entry worry that it creates extra layers of bureaucracy, which delay how quickly providers can fill open slots, and that the assessment tools are not always accurate or reliably administered. They also note that algorithms in social service programs often codify existing biases.  

Some early research supports the claims of both advocates and critics. A 2018 study (PDF) found that a standard assessment tool was effective in predicting which youth could self-resolve their homelessness and which needed more assistance.

But another study raises concerns about the same tool and how it is administered. Seventy percent of clients received a higher score the second time they took the assessment, suggesting that providers might be “misrepresenting scores in an effort to advocate for clients to attain housing.” Or, as one person who took the assessment multiple times told researchers (PDF), “Sometimes you have to lie in the assessment so you can get what you need.”

Where coordinated-entry has been successful at prioritizing assistance for the most vulnerable, it has helped communities save money through reduced use of crisis services like psychiatric hospitals. But programs have struggled to keep these higher-need individuals in housing.

Ten years after its passage, it’s clear that the HEARTH Act accelerated the shift to Housing First and improved coordination around homelessness assistance.

The full impact of HEARTH’s coordinated entry requirement remains to be determined. Now is the ideal time to be tracking its effects on who receives homelessness assistance, how long they wait to receive assistance, and their ability to find and keep permanent housing. Collecting and sharing this information will tell us whether coordinated entry is achieving its intended benefits and will help communities and policymakers respond to any unintended consequences.

Joe Meyer, 62, in his new apartment at Huston Commons in Portland, ME on May 3 2017. Huston Commons is Portland's third "housing first" program for people experiencing chronic homelessness. (Staff photo by Brianna Soukup/Portland Press Herald via Getty Images).

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