Block 6 explores how to meet the health and social service needs of people experiencing homelessness, in light of the diversity in both the type and intensity of support needs across individuals. This block highlights the significant disparities in health outcomes for people experiencing homelessness, who are often at increased risk of various diseases and have a shorter life span, compared to the general population. It provides guidance to assess support needs, remove barriers to mainstream services, introduce low-barrier health and social services, and facilitate access to job training and opportunities for people who are able to work.
OECD Toolkit to Combat Homelessness
Abstract
There are vast differences in the type and intensity of health and social service needs among people experiencing homelessness (Pleace, 2023[1]). Some individuals experiencing homelessness primarily require help to secure long-term, stable housing, while others have multiple and/or more complex needs that require higher-intensity health and social services and support, in addition to housing (Block 5). Depending on the individual, service needs may relate to, among other things, health, substance use, trauma counselling, childcare, and/or employment and training. They can range from facilitating access to health insurance and housing assistance, to providing a broad spectrum of low-barrier health, social, and housing services. There is also scope to ensure more effective responses to issues relating to intimate partner violence (IPV), trauma, and child-related needs. Box 6.1 provides a non-exhaustive list of potential services that may be relevant for individuals facing homelessness or at risk of homelessness.
Access to appropriate services is crucial for people at risk of, or experiencing, homelessness. Research has found that health outcomes of people experiencing homelessness are systematically poorer relative to the general population: people experiencing homelessness are at increased risk of diseases, as well as mental health conditions, substance use, sexually transmitted diseases, and other health disorders (Fuller-Thomson, Hulchanski and Hwang, 2000[2]). Evidence from a range of countries has demonstrated that people experiencing homelessness tend to have significantly shorter life spans than the general population (see, for instance, (Cha, 2013[3]; Romaszko et al., 2017[4]; Ivers et al., 2019[5]; Tito, 2023[6]; Frankeberger et al., 2022[7])).
The following list is not exhaustive:
Emergency housing solutions, including overnight shelters (including accommodation for victims/survivors of intimate partner violence)
Housing-led and Housing First and services
Food services
Social assistance services
Health care services (including sexual and reproductive health services)
Outpatient clinics
Hospitals
Rehabilitation centres
Psychological and/or trauma support
Street medicine services
Family reconnection
Access to facilities for hygiene and personal care
Legal assistance and social services
Harm reduction services: Overdose prevention centres/safe injection sites
Eviction counselling centres
Employment/education services (including authority in charge of social assistance/housing benefits)
Access to medical services among the general population varies widely across countries (Figure 6.1). While access has improved for low-income households over time, gaps persist. Barriers to accessing social and health services are more prevalent among certain groups, such as migrants (Kaur et al., 2021[8]).
Unmet needs for medical examination due to financial, geographic or waiting time reasons, 2022 or latest year, percentage of the population
Notes: Data for 2023 instead of 2022 for Belgium, Czechia, Denmark, Estonia, Finland, Latvia, the Slovak Republic, Slovenia, Spain and Sweden. Data for 2021 instead of 2022 for Türkiye. Data for 2019 instead of 2022 for Iceland and the United Kingdom.
Source: Eurostat Database, based on EU-SILC and (OECD, 2021[9]).
There are opportunities to improve the provision of services to people experiencing homelessness throughout OECD and EU countries. The following set of operational questions is intended to guide policy makers and practitioners in strengthening different dimensions of service provision in their country, city or community context:
How to assess the support needs of people experiencing homelessness?
How to remove barriers to services faced by people experiencing homelessness?
How can low-barrier services supplement, or be incorporated within, mainstream services?
What opportunities exist to facilitate access to job training and job opportunities for people who are able to work?
How to assess the support needs of people experiencing homelessness?
Effectively meeting individuals’ needs relies on a timely needs assessment. Good-quality needs assessment tools are those that consider the unique circumstances of the population experiencing homelessness (Gordon et al., 2019[10]; Barile, Pruitt and Parker, 2019[11]; Oliveira et al., 2021[12]).
Comprehensive needs assessments to identify individual needs and circumstances of people experiencing or at risk of homelessness
In England (the United Kingdom), the Homeless Health Needs Audit (HNHA) serves as a data collection framework that allows local homelessness service providers to conduct surveys focused on health needs with people experiencing homelessness. These data enable organisations to collaborate with local authorities and housing and health agencies to enhance service co‑ordination and address gaps in service delivery (Homeless Link, 2022[13]). Since 2012, three waves of audits have been conducted. The last wave corresponds to the 2018‑21 period and found that 78% of respondents had a physical health condition and 82% had a mental health diagnosis, respectively. In addition, The Ministry of Housing, Communities and Local Government carries out the Rough Sleeping Questionnaire to identify specific support needs, inform service improvements, and estimate the fiscal costs associated with rough sleeping, which are notably higher for those with complex vulnerabilities. These insights aim to enhance targeted interventions and services for people who sleep rough and those at risk of sleeping rough (Ministry of Housing, Communities & Local Government, 2020[14]).
In the United States, a research project funded by the University of Utah conducted in-depth interviews with people experiencing homelessness to assess their needs, challenges in accessing support services and their perceived solutions to these challenges (Smith, Moore and Canham, 2021[15]). The study identified gaps in service delivery and showcased the importance of integrating the concerns of people experiencing homelessness into policy making so that services match their needs. The Basic Center Program (BCP) offers community-based emergency shelters for runaway and homeless youth under 18, providing up to 21 days of shelter, food, clothing, medical care, and counselling. A key component of BCP is facilitating family reunification whenever safe and appropriate, aiming to restore family connections and stability for these youth.
In Chile, the Gente de la Calle foundation assesses the needs of people experiencing homelessness and offers personalised support through targeted interventions. These assessments are conducted upon individual request or through the mediation of public authorities and civil society organisations. Depending on individual needs, specialists provide support in various areas such as substance use, physical health, mental health, pensions, and labour market integration (Fundación Gente de la Calle, 2024[16]). In 2023, the foundation organised public events in partnership with public authorities and other civil society organisations to provide basic assistance, such as support in applying for social benefits (Fundación Gente de la Calle, 2024[17]).
Ensuring individuals with high-support needs receive the services they need
In Denmark, Housing First programmes provide support services tailored to beneficiaries’ needs and goals. Specialised support is provided through three approaches: Critical Time Intervention (CTI), Intensive Case Management (ICM), and Assertive Community Treatment (ACT) (Socialstyrelsen, 2020[18]). CTI involves assigning a case manager who offers support throughout a defined period, typically nine months, to assist individuals transitioning from shelters to long-term housing. This support includes co‑ordinating with community providers and developing a personalised transition plan. ICM provides extended assistance where a case manager co‑ordinates beneficiaries’ access to support and treatment services until they no longer require it. ACT offers a comprehensive support system where social workers, psychiatrists, addiction specialists, counsellors, nurses, and other professional provide in-home assistance to beneficiaries. This approach is often used with people experiencing homelessness with complex needs, such as both substance use disorders and mental illnesses (Benjamin, 2013[19]).
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) and the Centre for Homelessness Impact (CHI) developed a set of evidence‑based guidelines for practitioners that provide a framework for integrating health and social care support for people experiencing homelessness. The guidelines offer recommendations on planning, improving access, involving peer roles, assessing needs, and managing transitions between settings, all aimed at fostering co‑ordinated, multidisciplinary care (National Institute for Health and Care Excellence (NICE), 2022[20]).
How to remove barriers to services faced by people experiencing or at risk of homelessness?
The provision of low-barrier services should be a fundamental aspect of a broader, inclusive approach to policy making (Block 1). In practice, this means removing administrative, logistical and social bottlenecks to service provision for people who may face (or expect to face) stigma, discrimination or rejection from mainstream service providers; lack required administrative documentation to access services; be subject to frequent moves and housing instability and thus face disruptions in ongoing treatment (Pleace, 2023[1]). Logistical barriers can also pose a challenge, including difficulties to physically access the location to apply for or receive services (if locations are hard to access via public transit), or a lack of childcare (making it difficult for parents to take part in some support programmes). The provision of low-barrier services has been shown to improve access to basic primary healthcare services by removing social (e.g. discrimination), logistical, and health-related barriers for people experiencing homelessness (Lynch et al., 2022[21]; Barile, Pruitt and Parker, 2020[22]).
Conducting research to assess what barriers to mainstream services exist, why and for whom
In Spain, a mixed-methods study based on surveys with over 130 homelessness service providers and semi-structured interviews with 20 women experiencing homelessness who had been victims of gender-based violence concluded that victims/survivors of domestic violence experiencing homelessness face challenges in accessing social, health, and judicial services (Matulič Domandzič et al., 2024[23]). Similarly, a study surveying people experiencing homelessness, as well as healthcare and social workers, found that people experiencing homelessness face significant barriers to accessing healthcare services, and typically seek care only when critically ill (Cernadas and Fernández, 2021[24]). These barriers can be administrative but may also stem from negative past experiences and/or fears of mistreatment or discrimination. This underscores the importance of raising awareness and providing training to mainstream providers to eliminate discrimination in access to support services.
In the United Kingdom, research conducted by the national LGBTI youth homelessness charity, akt, revealed that only 44% of LGBTQ+ youth who had experienced homelessness were aware of available housing support during their most recent instance of homelessness, while 24% reported complete unawareness of any such support (akt, 2021[25]). This highlights how limited awareness of existing programmes can significantly hinder access to essential services.
Reducing administrative, logistical and social barriers to mainstream services, including through training to service providers
In Tokyo, Japan, the NGO Sanyukai provides a bundle of services for people experiencing homelessness. These services include free medical care for those without a health insurance card, referrals to public services, lifestyle and health counselling, and outreach food distribution. In 2023, 1 696 health consultations were provided, 8 125 counselling cases were managed, and 820 meal distribution outreach activities were conducted (Sanyukai, 2023[26]).
In Istanbul, Türkiye, the Istanbul Metropolitan Municipality provides support to people experiencing homelessness by offering temporary accommodation, healthcare, elderly care, clothing, and food services (IBB, 2024[27]). Moreover, specific outreach campaigns are launched in the winter to increase coverage of the support services (IBB, 2024[28]). In Türkiye, temporary accommodation centres are managed by local governments and are set to increase in number in coming years (IMM, 2023[29]).
In New Zealand, LinkPeople, a community housing provider, offers housing solutions and supports individuals experiencing or at risk of homelessness in accessing local health and social services. The organisation provides housing support in three ways. First, LinkPeople assists individuals transitioning from care institutions or emergency housing into independent housing. Second, the organisation supports individuals at risk of losing their tenancies, collaborating with landlords and social service providers. Third, LinkPeople manages housing units leased from private owners, which are rented to individuals in need of housing. Once housed, individuals receive assistance in accessing social and health services that best suit their needs (LinkPeople, 2024[30]).
Co‑ordinating and co-locating services to provide targeted care to meet individuals’ needs that extend beyond housing
With IPV a leading cause of homelessness among women (OECD, 2023[31]), the Kukui Center in Hawaii, the United States, is an example of an integrated programme that serves families impacted by IPV (OECD, 2023[31]). The centre co-locates ten non-profit agencies and offers emergency, short, and medium-term shelter for children, adolescents, and families. In the suburbs of Paris, France, the Maison des Femmes (Women’s House) is a structure located on the grounds of a public hospital that provides interdisciplinary support to survivors of gender-based violence by co-locating health, social, and judicial services. Several similar structures have been opened in Bordeaux, Marseille, and other French cities.
Co-located services in the form of “family centres” for people leaving prisons are common in Nordic countries, where multidisciplinary teams of specialists are located in a single room. For example, the Red Cross re‑entry house in Oslo, Norway, provides state and municipal services in the same building. Similar one‑stop-shops have been introduced in other countries, such as in the United Kingdom. At the EU level, the European Family Justice Center Alliance operates family centres that offer targeted support to victims of sexual violence, child abuse, gender-based violence, and domestic violence. Services include legal advice, accommodation planning, and psychological assistance, among others (European Family Justice Center Alliance, 2024[32]).
Supporting migrants experiencing or at risk of homelessness through comprehensive low-barrier services
Migrants’ legal status often determines their access to housing assistance and other social welfare services for people experiencing homelessness. Depending on the country, they may or may not be entitled to social benefits and/or housing assistance; emergency social and care services (including healthcare); social benefits (including housing assistance) only if they possess permanent residence or protection status, or if they have a job.
Access to social benefits (including housing assistance) for EU mobile citizens is summarised in Box 6.2. In several European countries, financial instruments under the European Social Fund Plus (ESF +), have been mobilised to fund projects providing support to EU mobile citizens experiencing homelessness. An example is the MOCT- Berlin Bridge towards Participation in Germany. This project encompasses a wide range of services, including assistance with securing a livelihood, accessing healthcare, and obtaining childcare support (Haj Ahmad and Busch-Geertsema, 2024[33]).
An EU mobile citizen is a national of an EU member state who lives in another member state of the Union. The right to free movement of EU citizens across EU countries is safeguarded and regulated by Directive 2004/38/EC of the European Parliament and the Council (European Union, 2004[34]). The eligibility of EU mobile citizens for social benefits, including those who are experiencing homelessness, depends on their status. Three categories can be distinguished:
1. Workers and self-employed persons enjoy equal treatment to national workers in regard to social benefit eligibility.
2. For jobseekers, access to social benefits on equal terms to national workers is conditional on having previously worked between 6 and 12 months in the host member state. Additionally, for jobseekers who have not previously worked in the host member state, their eligibility for social benefits is dependent on their ties with the national labour market. If eligible, the social benefits they might benefit from directly target labour market integration; eligibility for broader social benefits varies throughout countries and contexts (Blauberger and Schmidt, 2014[35]).
3. For economically inactive EU citizens, such as pensioners, long-term unemployed persons, tourists or students, access to social benefits changes over time, along three phases (Costamagna, Montaldo and Romanelli, 2022[36]):
a. For the first 90 days of residence in the host country, economically inactive EU citizens have partial access to social assistance.
b. For EU mobile citizens residing up to five years in a host Member State, their access to social assistance (and that of their family) is dependent on whether they meet the requirements stipulated in Article 7 of the Directive 2004/38/EC of the European Parliament and of the Council of 29 April 2004.
c. EU mobile citizens that have continuously and legally resided for more than five years in a host Member State and have obtained a permanent residence permit are entitled to the same access to social benefits as nationals.
Note: As established by the Court of Justice of the European Union, social benefits can be defined as “the advantages which…, whether or not linked to a contract of employment, are generally granted to national workers primarily because of their objective status as workers or by virtue of the mere fact of their residence on the national territory and the extension of which to workers who are nationals of other Member States therefore seems suitable to facilitate their mobility within the Community” (EUR-lex, 1979[37]).
In Denmark, the Kirkens Korshær organisation supports the social integration of EU mobile citizens experiencing homelessness who hold a residence permit in another EU country through the ESF+ funded Kompasset (Kirkens Korshær, 2024[38]). Since EU mobile citizens are not entitled to access public services in Denmark, Kirkens Korshær offers guidance on their rights and supports them in job searching, provided they have authorisation to work in Denmark. Staff and volunteers assist beneficiaries in a variety of European languages, including English, Romanian, Polish, Spanish and Greek.
In Austria, the neunerhaus Health Center provides free, low-threshold medical care services to individuals experiencing homelessness and those without medical insurance, including EU mobile citizens. The interdisciplinary centre includes a general practice, a dental clinic, social work counselling, peer work, nursing services, and a mental health practice (neunerhaus, 2024[39]). Additionally, video interpretation provides translation support in over 40 languages (Haj Ahmad and Busch-Geertsema, 2024[33]).
In the United States, the city of New York issues a municipal identification card, IDNYC, accessible for people aged 10 years or older. The IDNYC card is available to applicants regardless of their immigration status and ensures access to various services, including cash assistance, health benefits, employment identity, and affordable housing (ACCESS NY, 2024[40]). To request this card, applicants must provide proof of residence, which can be issued by a shelter if the applicant is experiencing homelessness.
How can low-barrier services supplement, or be incorporated within, existing mainstream services?
Whether people experiencing homelessness are best served through mainstream services or specialised services targeting people experiencing homelessness depends on different factors and specific country contexts. What is important, however, is to establish a strong connection between low-threshold street medicine and mainstream services (e.g. through referrals), to ensure that more complex health needs are met (Enich, Tiderington and Ure, 2022[41]). By avoiding downstream emergency department and hospital utilisation, low-threshold support can also contribute to saving costs overall (Basu et al., 2011[42]).
Integrating public services across sectors, in particular between medical/health providers and other social services, is also important to ensure people experiencing homelessness receive a range of tailored supports (Adams and Hakonarson, 2024[43]; OECD, 2023[31]). Integrated public services are particularly valuable for people experiencing homelessness with complex needs, who often require specialised support from several services providers and/or agencies (OECD, 2015[44]).
Eliminating administrative barriers through data partnerships and other innovative solutions to ensure access to health and social services
Creating a framework for integrated social and health service delivery is important for ensuring that people experiencing homelessness have access to tailored support. Studies in the United States have found that data partnerships between multiple service providers (e.g. healthcare providers, permanent supportive housing providers food banks, etc.) lead to higher co‑ordination and better social and health outcomes for beneficiaries (Angelov and Buck, 2023[45]; Schick et al., 2019[46]).
In many OECD countries, it is difficult for people experiencing homelessness to apply for or receive benefits without a mailing address. In the Netherlands, individuals legally residing in the country are registered in the Municipal Personal Records Database (GBA). If a permanent home address is missing, a postal address can be requested. Plus, if both a permanent home address and a postal address are missing, municipalities have the legal obligation to register the individual with a postal address of a town hall or an institution with which the municipality collaborates. Since municipalities in the Netherlands often require to be registered as a resident to receive certain local services, this allows people experiencing homelessness to qualify for emergency shelters and other services in the locality in which they are living (FEANTSA, 2020[47]; Evangelista, 2013[48]).
Supporting people experiencing homelessness through mobile medical support
Mobile medical support provides low-barrier and easy to access health and social services to address the unique needs and circumstances of people living rough. In California (the United States), a recent rise in homelessness has fuelled rapid growth in community mobile medical support programmes. The state’s Department Health Care Services (DHCS) provides reimbursements for care in over 25 recognised programmes. The services are often delivered by medical students and community health workers. In California, the programme is an important form of medical support for people of colour; 25% of the patients identify as African-American and 23% identify as Hispanic (Feldman, 2023[49]).
In Brazil, the Consultório na Rua programme provides primary healthcare services to people experiencing homelessness through street clinics. Intervention teams are made up of a variety of specialists, ranging from nurses and dental surgeons to social workers and therapists (Ministry of Health, 2024[50]). The assistance provided is tailored to patients’ needs and includes support for substance use disorders, mental health conditions, as well as dental and vision problems. An independent academic evaluation in the city of São Paulo found that the programme operates to 75% of its expected capacity, lagging in providing care for people experiencing homelessness who engage in substance use (Borysow, Oda and Furtado, 2023[51]).
In the United Kingdom, the Groundswell charity manages the Homeless Health Peer Advocacy (HHPA) program. Although not a mobile clinic, this programme helps people experiencing homelessness access physical and mental health services by assisting them with attending appointments and navigating the healthcare system (Groundswell, 2024[52]). Moreover, the support is provided by people experiencing homelessness. “Link workers” are non-clinical staff who work within or alongside general practitioners to help patients access services for needs such as mental health, housing, loneliness, and benefits, often employed by a group of general practitioners or community organisations working on behalf of the National Health Service (NHS). As of December 2023, there are approximately 3 200 social prescribers in England, supported by NHS England’s Social Prescribing Network and an online collaboration platform for practitioners (Nuffield Trust, 2024[53]).
Improving health outcomes and providing an entry point to services through Overdose Prevention Centres
Substance use disorders (such as of opioids) can both contribute to homelessness and be a consequence of it (Yoo et al., 2022[54]). Individuals experiencing homelessness with substance use disorders face a heightened risk of fatal and non-fatal overdoses and frequently encounter challenges in accessing treatment (Milaney et al., 2021[55]; McLaughlin et al., 2021[56]; Fine et al., 2022[57]). Overdose Prevention Centres (OPCs) have emerged as effective interventions to address this issue, also because they reach vulnerable populations, including those not served by traditional services (Shorter et al., 2023[58]; Magwood et al., 2020[59]; Bardwell et al., 2017[60]). OPCs provide people who use drugs with clean needles and syringes, to inject drugs in a clean, indoor, clinical facility out of public view where they are free of harassment, and access to emergency services. Carefully designed low-barrier services such as OPCs can also function as an entry point to a variety of services, including primary care, hospital treatment and drug therapy, especially for the most vulnerable populations (Shorter et al., 2023[58]). OPCs currently operate in approximately 15 OECD countries, including Australia, Canada, Mexico, and a range of European countries. In addition to OPCs, mobile treatment units, such as methadone units, can offer individuals with opioid use disorder delocalised comprehensive and specialised care (Gibbons et al., 2024[62]; Chatterjee et al., 2024[63]).
The Netherlands was an early pioneer of OPCs since the height of its heroin crisis in the 1980s. The Dutch Harm Reduction Network (HRN) monitors services for people with substance use disorders. OPCs are now operating in approximately 21 communities and serving 5 to 30 clients daily. The facilities do not systematically record the number of users who visit and consume drugs to protect privacy, but employees report an increase in younger patients experiencing homelessness with or without migration background under the age of 35 who often have mild disabilities (Singer, 2023[64]), (van der Gouwe, 2022[65]).
The needs of people with opioid use disorders are better addressed through integrated health services, including psychosocial interventions and screening for other infectious diseases (OECD, 2019[66]). In Greece, alcohol and drug-use disorders make up a significant part of the country’s mental health burden and progressive reforms have been shifting provision away from institutionalised care to the delivery of community-based services. The National Action Plan for Public Health 2021‑25 and National Action Plan for Mental Health 2021‑30 promote investment in integrated, recovery-oriented, community-based centres that decrease stigma and social exclusion (OECD/European Observatory on Health Systems and Policies, 2021[67]). The city of Athens, in partnership with the Partnership for Health Cities global network, implemented an intervention focused on its unhoused population with opioid use disorders. The intervention provides housing, therapeutic services, healthcare, counselling, legal support, and programmes for the social reintegration of people experiencing homelessness who inject drugs (Vital Strategies, 2020[68]).
Facilitating access to mental health support for people experiencing homelessness
Homelessness has been shown to have an enduring impact on mental health of young people (Russell et al., 2020[69]). This underscores the importance of providing early access to mental health support for people experiencing homelessness, which is correlated with positive mental health outcomes (Dixon et al., 2011[70]).
In 2023, over 14% of Australia’s specialist homelessness services (SHS) clients were single young people, of whom almost 50% had mental health conditions, and 73% were not enrolled in education or formal training. More than half of the clients with a current mental health condition also experienced another type of vulnerability, which highlights the value of an integrated service response (Australian Institute of Health and Welfare, 2024[71]). The Reconnect Program is the Australian Government’s long standing youth homelessness prevention initiative that serves as an early intervention and prevention programme for young people aged 12 to 18 years (or 12 to 21 years in the case of newly arrived youth) who are experiencing or at risk of homelessness, and their families. Reconnect services work to prevent homelessness through the provision of counselling, group work, mediation, and practical support to the whole family. Reconnect providers also purchase other services to meet the individual needs of clients, such as specialised mental health services. In 2024, an independent review of the Reconnect Program was conducted on behalf of the Australian Government Department of Social Services to investigate the appropriateness, effectiveness, and efficiency of the programme. The review highlighted the importance of the Reconnect Program to children and young people, their families, and their communities. The review findings are currently being considered to determine next steps (Department of Social Services, 2024[72]). Building on the success of this project, Canada’s Reconnect project provides a community-driven early intervention programme aimed at supporting young people aged 13‑24 who are at risk of, or have recently entered, homelessness (Homeless Hub, 2024[73]).
In Ireland, the NGO Simon Community provides counselling services and psychotherapeutic support to people experiencing homelessness. This support is provided one‑on-one and can take the form of motivational interviewing, cognitive behavioural therapy, or behaviour focused therapy, among others (Dublin Simon Community, 2024[74]).
What opportunities exist to facilitate access to job training and job opportunities for people who are able to work?
Expanding employment and training opportunities as one aspect of services for people experiencing homelessness can also facilitate a sustainable transition out of homelessness, for those who are able to take up employment (Axe, Childs and Manion, 2020[75]). Despite the willingness to work expressed by many individuals experiencing homelessness, they face numerous barriers in accessing and maintaining formal employment, including difficulties in providing contact information, stigma in disclosing homelessness to employers, and various personal challenges such as health issues and criminal records (Marshall et al., 2022[76]; Tiderington et al., 2020[77]). Tailored employment programmes may benefit individuals experiencing and/or exiting homelessness, especially those previously integrated into the labour market. However, outcomes vary: merely securing employment may not guarantee stable employment (Barton et al., 2021[78]; Bretherton and Pleace, 2019[79]). There is a need to strengthen the evidence base to understand the most effective employment-related interventions for this particular population, to assess which types of employment support can be most effective in different contexts (for further discussion, see (Newton et al., 2020[80]) and (Card, Kluve and Weber, 2017[81])).
Reducing barriers to employment through training and sustained support
In France, the Accompagnement global programme supports jobseekers facing barriers to enter the labour market. The programme connects jobseekers registered in the French Public Employment Services (PES) with a PES caseworker and a social worker to provides holistic support in finding employment opportunities. The PES caseworker provides beneficiaries with professional assistance to identify and overcome obstacles hampering labour market entry; the social worker assists beneficiaries with social issues, including housing and financial hardship. As of 2018, roughly 85% of beneficiaries were satisfied with the programme and the probability of finding stable employment within six months of entering the programme was 27%.
In Austria, people experiencing homelessness can be supported by non-profit Social Economic Enterprises that offer sheltered, market-based workplaces for vulnerable groups and partner with private actors to facilitate the transition of participants to the primary labour market (OECD, 2021[82]).
In England and Wales (the United Kingdom), people experiencing or at risk of experiencing homelessness qualify for the Work and Health Programme. Launched in 2018, the programme provides intensive, tailored support though health and social care providers, professional contacts, and other local services to help people experiencing or at risk of experiencing homelessness transition into work. Beneficiaries of the programme are referred by jobcentres to work with public, private or voluntary organisations, known as providers, to help overcome barriers to work. Providers receive financial incentives, including funding for initial service delivery, and outcome related payments when the beneficiary finds stable employment. Providers support beneficiaries for up to 21 months (Department for Work and Pensions, 2024[83]).
In Japan, the Ministry of Health, Labour, and Welfare has an open call for businesses to participate in an employment programme designed to support the labour market integration of people experiencing homelessness (Ministry of Health, Labour, and Welfare, 2024[84]). The programme targets four regions in the country and seeks to provide people experiencing homelessness, or at risk of homelessness, with counselling and support to find employment. This includes personalised advice and seminars, as well as temporary work experience in specific businesses.
In Seoul (Korea), the Homeless Job Support Centre provides people experiencing homelessness with counselling services to support their entry into the labour market. Support is provided in two ways: first, the centre offers pre‑employment training services by providing access to employment programmes and collaborating with educational institutions. Second, the centre provides tailored, personalised support to help beneficiaries obtain relevant certifications, stay informed about job listing, connect with their desired occupations, and prepare for interviews (Seoul Homeless Support Center, 2024[85]).
In March 2022, the European Commission activated a Temporary Protection Directive for Ukrainian refugees to give immediate asylum protection (European Commission, 2024[86]). This programme gives Ukrainian refugees automatic access to employment and accommodation, along with other forms of social welfare, education, and medical care. Access to employment is specifically facilitated by removing the authorisation to work requirement (i.e., Ukrainian refugees do not need to apply for a work permit), and the provision of vocational training, language courses, and career counselling. Over 5 million refugees have benefited from this programme, with many planning to return to Ukraine and others transitioning to longer-term residency in Europe (Aida Asylum Database Information, 2023[87]).
There is considerable diversity in the level and type of support needs of people experiencing or at risk of homelessness: some individuals do not require support beyond housing assistance, while others have multiple and/or complex needs, and may require different forms of health, social and employment support. At the individual level, a first critical step is to conduct a timely needs assessment. More broadly, however, ensuring access to services – including by providing a range of low-barrier supports and removing bottlenecks to service provision – is a fundamental component of an inclusive policy approach. Co‑ordinating existing services, as well as co-locating different types of support in a single site (or in close proximity) have also proven to be effective in different contexts.
Building on the operational issues and good practices described above, the following recommendations can help policy makers and practitioners improve the provision of low-barrier, tailored wraparound services for people who need them:
Carry out a timely needs assessment to identify individual needs and circumstances of people experiencing or at risk of homelessness (including people leaving institutional care), and ensure that individuals with high-service needs receive the support they need.
Eliminate administrative, logistical, and social hurdles to accessing services, including through trainings to mainstream service providers.
Co‑ordinate and, where possible, co-locate, health and social services to facilitate targeted treatment and care to meet individuals’ needs that extend beyond housing.
Facilitate access to low-barrier medical services, including Overdose Prevention Centres, street medicine, and mental health support.
Strengthen access to employment opportunities for people who are able to work through training and sustained support.
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