Low-Threshold Services: Addressing Housing Structural Barriers for BIPOC Unsheltered Bostonians who Use Drugs

Type: Oral Presentation
Date: March 2024


Desmarais J, García K, Braverman Bronstein AHoyos-Céspedes CAGoodwin N, Clark M, Miah S, Ojikutu B. “Low-Threshold Services: Addressing Housing Structural Barriers for BIPOC Unsheltered Bostonians who Use Drugs”, Grayken Center for Addiction Together for Hope: Boston Addiction Conference 2024 (oral presentation)


Background: In 2022, the City of Boston and other organizations launched a new initiative to create low-threshold sites (LTS) for unsheltered people who use drugs living on the street in the Melina Cass and Massachusetts Avenue area. LTS are transitional, temporary living spaces that do not have strict entry requirements related to abstinence or engagement in treatment. After documenting initial successes in connecting LTS guests to housing, Boston Public Health Commission (BPHC) partnered with Institute for Community Health (ICH) to better understand the equitable access and outcomes of LTS implementation, in particular for Black and Hispanic/Latinx participants. 

Objective: To understand outcomes, challenges, and learnings of the LTS program through a structural racism framework.   

Methods: A mixed-methods evaluation of the LTS program was conducted from February to September 2023. ICH analyzed administrative program data, including demographic characteristics and move-out outcomes of LTS guests. Additionally, a sample of 23 individuals identifying as people of color living in the six LTS sites were interviewed. A thematic analysis was performed focusing on barriers and facilitators to shelter, access and stay experiences, and policy recommendations focusing on structural racism. 

Results:  There were 501 LTS guests from January 2022 to June 2023, 40% identified as white non-Hispanic, 21% as Black non-Hispanic, 20% as Hispanic; 26% of the guests have been placed in permanent housing, with Hispanic and female guests having lower odds of placement. In qualitative interviews, guests reported experiencing stigma and discrimination associated to homelessness and drug use prior to moving into a LTS. Guests reported the LTS program helped them address structural barriers to access housing such as identification, CORI checks, and housing navigation. They also reported being treated equitably, with dignity, and respect, which they did not always experience in traditional shelters. Most experienced changes in mental and physical health, and improved housing access since enrolling in the program. However, some guests expressed concern about long-term support once they receive permanent housing. Policy recommendations from guests to better serve unsheltered people who use drugs include increasing affordable housing supply, engaging unsheltered people in policy development, and expanding the LTS program.

Conclusions: Guests largely benefited from LTS stays, and staff support played a pivotal role in overcoming structural barriers. The findings underscore the importance of ongoing exploration to enhance engagement, address specific community needs, and ensure sustained equitable housing solutions for vulnerable populations.