The pathway and impacts of permanent housing: Guest and provider insights on the transition from low-threshold shelter (LTS) sites to permanent housing

Citation

Desmarais, J., Garcia, K., Decklar, E., Ladner, S., Clark, M., Singh, S., Miah, S., & Ojikutu, B., The pathway and impacts of permanent housing: Guest and provider insights on the transition from low-threshold shelter (LTS) sites to permanent housing. Presentation at BMC Grayken Center Together for Hope Conference, Boston, MA.

Authors

Jeffrey Desmarais
Erika Decklar
Sofía Alejandra Ladner

Background

There is an over-representation of Black and Latinx individuals experiencing substance use disorder (SUD) among the homeless population in Boston, MA. In addition, there has been an increase in overdose deaths in recent years, particularly among Black individuals. Low threshold housing with comprehensive services have emerged as an effective and evidence-based strategy to support individuals living with substance use disorders who are experiencing unsheltered homelessness. As a response to the increasing number of individuals who experience both unsheltered homelessness and SUD, in January 2022, the city of Boston established six low-threshold sites (LTS). The Boston Pathways project aimed to evaluate this policy with a focus on racial equity.

Objective

The Boston Public Health Commission (BPHC) partnered with the Institute for Community Health (ICH) to conduct an equitability evaluation of the LTS. Given the LTS’s emphasis on getting guests housed, it was critical for the evaluation to identify factors that impact housing placement and retention, and to explore the experiences of guests who have been placed in permanent housing.

Methods

Data Collection

  • In person and virtual semi-structured interviews with 10 key informants (LTS and housing case management staff) and 8 interviews with former LTS guests between March 2025 and July 2025 to explore housing placement processes, factors impacting obtaining and maintaining housing, experiences being housed, and recommendations .
  • Supplemented sample with 3 transcripts from interviews conducted in 2024 for the Boston Pathways evaluation with individuals recently housed from the 727 site.

Data Management and Analysis

  • Transcribed interviews and developed codebook
  • Coded transcripts using qualitative data analysis software Dedoose
  • Interviews analyzed using framework analysis approach

Results

Conclusion

Despite changes and federal policy landscapes, low-threshold Housing First approaches to unsheltered homelessness and the overdose crisis remains a powerful and equitable tool that policy makers can utilize. While transitioning into housing may be challenging for some individuals, it can have myriad benefits even for those with chronic histories of unsheltered homelessness.