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This paper investigates a taken-for-granted institutional form, shelters for unhoused New Yorkers, through the neo-institutional lens of institutional inertia and critical case study methodology. It focuses on the external shock of COVID-19, NYC's use of unoccupied hotels for social distancing, and the return to shelters when COVID waned. For guidance, we examine other instances of interrupted institutional inertia following shocks. Using Lewin's force field analysis, we explore why changes to some institutional forms amidst COVID persisted while novel approaches to shelter dissipated. We conclude that directly involving unhoused people in the design and implementation of homeless services may improve outcomes. Human service professionals share a body of knowledge and assumptions – a kind of echo chamber that amplifies and confirms beliefs. It is important to look beyond traditional and familiar models of service delivery to find alternative ideas and approaches that may be effective. Returning to Kurt Lewin's concept of force fields provides opportunities to think effectively and holistically about how to modify or change services, policies, and organizations. People served by human services – those with lived experiences – possess unique expertise that can inform organizational decisions and planning in new and helpful ways. As practitioners, we need to find ways to be more inclusive of the perspectives and ideas of those our programs serve through participatory methods of planning, decision making, and evaluation. [ABSTRACT FROM AUTHOR]

The scale of homelessness in the United States is a product of systematic political and economic restructuring. Austerity politics thrive in an environment that obscures these historical realities. Examining the devolution of homeless services not only illuminates the myriad paradoxes embedded in fiscal conservativism–it also provides a blueprint for reform. COVID-19 has only accentuated inequality and stirred social unrest. Nevertheless, these forces have failed to overturn entrenched power structures. As a necessity for sustaining life, a means of accumulating wealth, and inroads to social capital, housing is key to creating a more equitable post-COVID world. [ABSTRACT FROM AUTHOR]

Individuals experiencing chronic homelessness are highly marginalized and frequently access acute healthcare services. This program evaluation used secondary data collected from adults experiencing chronic homelessness (n=133) who participated in a Housing First program offering in-home behavioral health services within a large Midwestern city. Participant demographics (e.g., gender, race, age) and data on health factors (e.g., substance misuse and mental health symptoms, and ER visits and inpatient hospitalizations) were collected at program enrollment and at 6-month and 12-month follow-ups. High proportions of missing data led the evaluators to exclude 12-month follow-up and in-home behavioral health data from the analyses. Neither inpatient nights nor ER visits changed significantly between enrollment and 6-months. Males were disproportionately hospitalized throughout the study, suggesting a need for gender-targeted services. Higher rates of hospitalization among African Americans at enrollment subsided by follow-up. Future evaluation should examine if in-home behavioral health services reduced racial health disparities. Acute care use was low overall, likely because of the stabilizing impact of housing. Data limitations suggest a need for more robust study designs to identify causal factors and to enrich our understanding of the role of behavioral health intervention within the Housing First paradigm. Results underscore the importance of using empirically-supported assessment tools to evaluate consumers' individualized needs and responsively allocate supportive services. [ABSTRACT FROM AUTHOR]