Practice Dilemmas, Successes, and Challenges in the Delivery of Homeless Services: Voices from the Frontline

  • Emmy TideringtonEmail author


This chapter draws upon data from a 5-year National Institute of Mental Health-funded qualitative study of homeless programs to describe how frontline providers experience the implementation and delivery of homeless services. Interviews with frontline workers and observations of practice in the field are used to elucidate common practice dilemmas, successes, and challenges from the perspective of those “on the ground.” Areas discussed include provider experiences with managing risk and recovery in their work with service users who have active addiction and psychiatric issues, approaches for working with and around limited resources and policy constraints, implementation strategies for the delivery of harm reduction and “treatment first” program orientations, and how providers work to honor consumer choice and self-determination within the confines of program rules.


Frontline practice Service delivery Homeless services Frontline providers Housing first “Treatment first” Practice dilemmas Service provision Intimacy Working relationship Direct services Being in personal space Reading the surroundings Negotiating frontline roles Privacy Transitional housing Shelter programs Program rules Managing risk Crisis intervention Social relationships in homeless services Loneliness and isolation Exploitation Right to self-determination Supervision, use of Control, exercising Control, relinquishing Liability Client-centered practice Consumer-driven services Harm reduction Sobriety Treatment mandates Stress Self-care Services funding Documentation Burnout Compassion fatigue Secondary traumatic stress Organizational culture Hope 

Supplementary material

441379_1_En_18_MOESM1_ESM.docx (26 kb)
(DOCX 25 kb)


  1. Baker, C. K., Billhardt, K. A., Warren, J., Rollins, C., & Glass, N. E. (2010). Domestic violence, housing instability, and homelessness: A review of housing policies and program practices for meeting the needs of survivors. Aggression and Violent Behavior, 15(6), 430–439.CrossRefGoogle Scholar
  2. Barrow, S. M., Herman, D. B., Cordova, P., & Struening, E. L. (1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89(4), 529–534.CrossRefGoogle Scholar
  3. Barrow, S., McMullin, L., Tripp, J., & Tsemberis, S. (2007). Consumer integration and self-determination in homelessness research, policy, planning, and services. Washington, D.C: Paper presented at the 2007 National Homelessness Conference.Google Scholar
  4. Bride, B. E. (2007). Prevalence of secondary traumatic stress among social workers. Social Work, 52(1), 63–70.CrossRefGoogle Scholar
  5. Corrigan, P. W. (2011). The dignity to fail. Psychiatric Services, 62(3), 241–241.CrossRefGoogle Scholar
  6. Gillis, L., Dickerson, G., & Hanson, J. (2010). Recovery and homeless services: New directions for the field. Open Health Services and Policy Journal, 3, 71–79.CrossRefGoogle Scholar
  7. Henwood, B. F., Padgett, D. K., & Tiderington, E. (2014). Provider views of harm reduction versus abstinence policies within homeless services for dually diagnosed adults. The Journal of Behavioral Health Services and Research, 41(1), 80–89.CrossRefGoogle Scholar
  8. Howell, A. M. (2012). Working in the trenches: Compassion fatigue and job satisfaction among workers who serve homeless clients [Master of Social Work Clinical Research Paper 116]. St. Catherine’s University. Accessed 27 July 2018.
  9. Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164(2), 229–233.Google Scholar
  10. Lakeman, R. (2011). How homeless sector workers deal with the death of service users: A grounded theory study. Death Studies, 35(10), 925–948.CrossRefGoogle Scholar
  11. Longhofer, J., Kubek, P. M., & Floersch, J. (2010). On being and having a case manager: A relational approach to recovery in mental health. New York: Columbia University Press.Google Scholar
  12. Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive Behaviors, 21, 779–788.CrossRefGoogle Scholar
  13. Mullen, J., & Leginski, W. (2010). Building the capacity of the homeless service workforce. Open Health Services and Policy Journal, 3, 101–110.CrossRefGoogle Scholar
  14. Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue. Best Practices in Mental Health, 6(2), 57–68.Google Scholar
  15. Olivet, J., McGraw, S., Grandin, M., & Bassuk, E. (2010). Staffing challenges and strategies for organizations serving individuals who have experienced chronic homelessness. The Journal of Behavioral Health Services and Research, 37(2), 226–238.CrossRefGoogle Scholar
  16. Pauly, B. B., Reist, D., Belle-Isle, L., & Schactman, C. (2013). Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy, 24(4), 284–290.CrossRefGoogle Scholar
  17. Sheedy, C. K., & Whitter M. (2009). Guiding principles and elements of recovery-oriented systems of care: What do we know from the research? [HHS Publication No. (SMA) 09–4439]. Rockville: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration.Google Scholar
  18. Siegel, C. E., Samuels, J., Tang, D., Berg, I., Jones, K., & Hopper, K. (2006). Tenant outcomes in supported housing and community residences in New York City. Psychiatric Services, 57, 982–991.CrossRefGoogle Scholar
  19. Stefancic, A. (2014). “If I stay by myself, I feel safer”: Dilemmas of social connectedness among persons with psychiatric disabilities in Housing First. Columbia University Academic Commons. Accessed 27 July 2018.
  20. Tiderington, E. (2018). The apartment is for you, it’s not for anyone else: Managing social recovery and risk on the frontlines of single-adult supportive housing. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 152–162.CrossRefGoogle Scholar
  21. Tiderington, E., Stanhope, V., & Henwood, B. F. (2013). A qualitative analysis of case managers' use of harm reduction in practice. Journal of Substance Abuse Treatment, 44(1), 71–77.CrossRefGoogle Scholar
  22. Tiderington, E., Stanhope, V., & Padgett, D. K. (in press). “How do we force six visits on a consumer?”: Frontline dilemmas and strategies for person-centered care under Medicaid fee-for-service. American Journal of Psychiatric Rehabilitation.Google Scholar
  23. Tsai, J., Mares, A. S., & Rosenheck, R. A. (2012). Does housing chronically homeless adults lead to social integration? Psychiatric Services, 63(5), 427–434.CrossRefGoogle Scholar
  24. Waegemakers Schiff, J. (2016). Burnout and PTSD in workers in the homeless sector in Calgary. Calgary Homeless Foundation. Accessed 27 July 2018.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Rutgers, The State University of New JerseyNew BrunswickUSA

Personalised recommendations