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Projects for Assistance in Transition from Homelessness (PATH) Triennial Process Evaluation for 2019,2020, and 2021 2

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File Title	Projects for Assistance in Transition from Homelessness (PATH) Triennial Process Evaluation for 2019,2020, and 2021 2
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Keywords	PATH Triennial Process Evaluation
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Substance Abuse and Mental Health Services Administration
Center for Behavioral Health Statistics and Quality

Projects for Assistance in
Transition from Homelessness
(PATH) Triennial Process
Evaluation 2019, 2020, and 2021

Projects for Assistance in Transition from Homelessness (PATH)
Triennial Process Evaluation 2019, 2020, 2021
Acknowledgments
This report was prepared by the Office of Evaluation, Center for Behavioral Health Statistics and
Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). Mindy Ault,
Alysaunde Grace and Shweta Palakkode were the authors. Dorrine Gross, PATH Program
Coordinator and Doug Slothouber, Chief of State and Homeless Programs Branch, Center for
Mental Health Services and Meaghan McHugh, Director, Office of Evaluation, Center for
Behavioral Health Statistics and Quality provided guidance and assistance in this evaluation.
Public Domain Notice
All material appearing in this publication is in the public domain and may be reproduced or
copied without permission from SAMHSA. Citation of the source is appreciated. However, this
publication may not be reproduced or distributed for a fee without the specific, written
authorization of the Office of Communications, SAMHSA, HHS.
Electronic Access
This publication may be downloaded from https://www.samhsa.gov/data/all-reports
Recommended Citation
Substance Abuse and Mental Health Services Administration (2024): Projects for Assistance in
Transition from Homelessness (PATH) Triennial Process Evaluation 2019, 2020, and 2021. MD:
Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services
Administration, 2024.
Originating Office
Office of Evaluation, Center for Behavioral Health Statistics and Quality, Substance Abuse and
Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857. Released 2024.
Nondiscrimination Notice
The Substance Abuse and Mental Health Services Administration (SAMHSA) complies with
applicable Federal civil rights laws and does not discriminate on the basis of race, color,
national origin, age, disability, religion, or sex (including pregnancy, sexual orientation, and
gender identity). SAMHSA does not exclude people or treat them differently because of race,
color, national origin, age, disability, religion, or sex (including pregnancy, sexual orientation,
and gender identity).
Released 2024

Table of Contents
EXECUTIVE SUMMARY.................................................................................................................................... 4
INTRODUCTION ................................................................................................................................................ 8
PATH Program ............................................................................................................................................................. 8
PATH Evaluation .......................................................................................................................................................... 9
PATH Funding Allocation and Matching Funds .............................................................................................. 9

METHODOLOGY..............................................................................................................................................10
PATH Evaluation Questions ................................................................................................................................. 10
Research Design....................................................................................................................................................... 10
Limitations……………………………………………………………………… ...........................................……………………..12

FINDINGS ...........................................................................................................................................................13
Types and Numbers of Provider Agencies Funded .................................................................................... 13
Process for Selecting PATH Provider Agencies ............................................................................................ 14
Providing Oversight and Monitoring Performance .................................................................................... 15
Providing Supports for PATH Providers .......................................................................................................... 17
Topic Areas of Technical Assistance and Training ...................................................................................... 18
Challenges………………………………………………… ............................................………………………………………….19
Number of Persons Contacted and Enrolled ................................................................................................ 22
Demographics of Persons Enrolled in PATH Services................................................................................ 23
Services Provided..................................................................................................................................................... 28
Referrals Made and Attained .............................................................................................................................. 32
How PATH Teams Identify Clients and Keep Them Engaged ................................................................. 35
Homeless Management Information System (HMIS) ................................................................................ 36
Collaboration with Continuums of Care (CoCs) ........................................................................................... 37
Involvement with Local Planning Activities ................................................................................................... 38
Collaboration with Other Organizations......................................................................................................... 38
Have Outcome and Process Goals Been Achieved? ................................................................................... 39
Considerations in Interpreting PATH Data..................................................................................................... 41
Changes in PATH Program as a Result of the COVID Pandemic ........................................................... 42

What SPCs and Provider Staff Would Like SAMHSA to Know ............................................................... 42

CONCLUSIONS ................................................................................................................................................43
RECOMMENDATIONS...................................................................................................................................44
References .........................................................................................................................................................45
Appendix A. Logic Model ............................................................................................................................47
Appendix B. Survey Instrument.................................................................................................................48
Appendix C. SPC Interview Guide ............................................................................................................67
Appendix D. Provider PATH leader interview guide .........................................................................71

EXECUTIVE SUMMARY
The Projects for Assistance in Transition from Homelessness (PATH) program was created as part
of the Stewart B. McKinney Homeless Assistance Amendments Act of 1990 (P.L. 101.645)1. The
Program is administered by the State and Homeless Programs Branch in the Division of State
and Community Systems Development of the Center for Mental Health Services (CMHS) within
the Substance Abuse and Mental Health Services Administration (SAMHSA). The PATH program
was created to provide services for individuals with serious mental illness (SMI), or co-occurring
(mental illness and substance use disorders) who are experiencing homelessness or are at
imminent risk of becoming homeless.
Section 528 of the Public Health Service Act requires that SAMHSA evaluate PATH grant
expenditures at least once every three years to ensure adherence to legislative requirements and
to provide an opportunity to recommend programmatic improvements to the PATH program.
The required evaluation questions include: Are services funded with PATH monies appropriate?
Are services well administered? Are PATH outcome and process goals achieved? This report,
prepared by the Office of Evaluation within SAMHSA’s Center for Behavioral Health Statistics
and Quality, evaluates the PATH program for grant years2 2019, 2020, and 2021.
In 2019, 2020, and 2021, funds were provided to all 50 states, the District of Columbia, Puerto
Rico, and four U.S. territories (“grantees”) to support the PATH program. PATH funds support
services such as street outreach, case management, and services not otherwise supported by
mainstream mental health programs. All grantees are required to provide a match of at least $1
for every $3 in federal funding. In 2021, a total of 435 PATH providers received grant funds.
Data in this report were collected from three sources: annual reports covering activities in 2019,
2020, and 2021; a State PATH contact (SPC) web-based survey administered in the third quarter
2023, and key-informant interviews conducted with state- and provider-level staff in two states
in the fourth quarter of FY 2023.

1 Full text of Public Law 101-645 is available at: https://www.govinfo.gov/app/details/STATUTE-104/STATUTE-104-

Pg4673
2 Grant reporting years vary by grantee; some adhere to the federal fiscal year while others use their state fiscal year
period, which does not always coincide with the federal year.

The SPC survey collected detailed information on program administration and oversight,
provision of technical assistance (TA) and training, and involvement/collaboration with local
Continuums of Care (CoCs). This report presents findings for each of the federally mandated
evaluation questions for the PATH program based on quantitative data collected from PATH
grantees, as well as findings from qualitative interviews with staff in two states.
The first evaluation question focuses on whether services funded with PATH monies are
appropriate. Data from PATH grantee annual reports suggest that over the three years, PATH
programs offered appropriate services, including outreach, case management, allowable
housing services, staff training, community mental health services, screening and diagnostic
treatment services, alcohol and drug treatment services, and supportive and supervisory services
in residential settings. Data from the annual reports indicate that an average of 64 percent of
contacted individuals with serious mental illness were enrolled in services, and 57 percent of
those enrolled received community mental health services.
The second evaluation question focuses on whether services funded through PATH were well
administered by grantees. This question was evaluated through the examination of three factors:
level of oversight of PATH providers, opportunities to improve skills, and collaboration with
community services. PATH grantees use different mechanisms to monitor grant performance.
The most common mechanism to monitor performance was through conducting site visits
(92.9%), followed by review of the U.S. Department of Housing and Urban Development’s (HUD)
Homeless Management Information System (HMIS) data (85.7%), and regularly scheduled
meetings or teleconferences (83.3%). When an issue was identified, the two most common
strategies were the provision of TA (85.7%) and training (78.6%), while over half (54.8%) of the
grantees used corrective action plans to handle concerns with providers. Regarding
collaborating with community services, the majority (85.0%) of PATH grantees reported they
participated in HUD’s CoC program.
Finally, this report examines whether the outcome and process goals for the PATH program
have been achieved. The PATH program establishes annual targets to measure performance,
and most of these targets were met or exceeded during the 2019-2021 period.

According to the annual reports, over 100,000 homeless individuals were reached each year (in
2019, roughly 127,000 individuals were reached). Each annual report demonstrated that over
58,000 of those reached were found eligible and enrolled in the program. Every individual
contacted by the program is offered referrals to appropriate local services and supports, while
those enrolled continue to receive ongoing engagement and services. Across all years,
approximately 44 percent of persons enrolled in PATH had co-occurring mental and substance
abuse disorders.
As a result of the 2020 evaluation recommendations, SAMHSA engaged in efforts to shorten the
reporting burden on grantees and began collecting qualitative data directly from SPCs and
PATH providers to understand challenges and best practices for overcoming these challenges, to
develop recommendations for the PATH program and for future programs.

Limitations, Conclusions, and Recommendations
Limitations
While the PATH program met most of its targets in this period, especially in the percentages of
enrolled homeless persons who received community health services (exceeded targets in 2019
and 2020, and met target in 2021), there were some challenges. Specifically:
•

The numbers of homeless persons contacted exceeded the target in 2019 and then fell
below the targets, by eight and 15 percent respectively, in 2020 and 2021.

•

The percentage of contacted homeless persons with SMI who became enrolled in
services did not meet targets in 2019 and 2020 but did meet the target in 2021.

It should be noted that these two years were impacted by the COVID pandemic, which
presented significant challenges for outreach work. First, cities and communities across the
nation implemented social distancing measures that affected workers’ ability to do outreach
work. At the same time, existing workforce challenges were exacerbated by pressures created by
COVID, especially for work based on direct, in-person contact with individuals whose ability to
follow risk reduction protocols was impacted by their disability.

However, the CARES Act from March 2020 provided significant funding for homeless service
providers and shelters to increase their capacity to move people off the streets.
Conclusions
•

Staff retention and extensive data requirements for PATH are the two most prevalent
issues for service provider agencies interviewed for this report.

•

More broadly, the lack of affordable housing options for PATH clients presents a hard
limit to the effectiveness of PATH services. Stable housing is a critical social determinant
of mental health (Hernández and Swope, 2019; Alegría et al, 2018), even more so for
older adults with mental illness (Chung et al, 2017). When housing options are scarce,
PATH clients are less likely to achieve housing stability and less likely to fully benefit from
mental health services.

Recommendations
•

SAMHSA should provide TA or training resources for data collection and reporting at the
provider level, including collaborating with HUD to offer support in addition to the
training provided by HMIS administrators for provider staff.

•

Consider the addition of a question to the SPC survey about whether their state or
territory would be willing to participate in qualitative data collection, either in person or
virtually.

INTRODUCTION
PATH Program
The Projects for Assistance in Transition from Homelessness (PATH) program was created as part
of the Stewart B. McKinney Homeless Assistance Amendments Act of 1990 (P.L. 101.645). The
PATH program is administered by the Division of State and Community Systems Development
within the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental
Health Services Administration (SAMHSA).3 The intent of the PATH program is to provide
supportive services not covered by mainstream mental health programs to people with serious
mental illness (SMI) who are experiencing or are at imminent risk for homelessness.
PATH is a formula grant program4 and provides funds to grantees comprising the 50 States, the
District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the
Commonwealth of the Northern Mariana Islands. Each state or territory grantee subsequently
awards funds to service provider organizations (PATH providers) located in areas with the
highest concentrations of people experiencing homelessness. All state grantees (though not U.S.
territories) are required to contribute one dollar in matching funds for every three dollars of
federal money received.5 In 2021, a total of 437 PATH providers received grant funds.
State PATH Contacts (SPCs) are staff within the grantee agencies who manage the PATH
program for their state or territory. SPCs and PATH providers report annual program data in the
SAMHSA PATH Data Exchange (PDX), which also includes data from the U.S. Department of
Housing and Urban Development’s (HUD) Homeless Management Information Systems (HMIS).
PDX data are published by SAMHSA in an annual report and are often used by SPCs to monitor

3 Projects for Assistance in Transition from Homelessness https://www.samhsa.gov/homelessness-programsresources/path
4 Formula grants are determined based on the ratio of the state’s population living in urbanized areas compared with

the total U.S. urban population. The formula for PATH is described in Section 524 of the original authorizing
legislation (Sections 521-535), found at https://www.govinfo.gov/content/pkg/STATUTE-104/pdf/STATUTE-104Pg4673.pdf
5 Perez, Rudy (2023). Homeless Encampment Sweeps May Be Draining Your City’s Budget. Housing Matters; Urban
Institute. https://housingmatters.urban.org/articles/homeless-encampment-sweeps-may-be-draining-your-citysbudget

provider agencies’ use of PATH funds. The annual report also provides an overall picture of the
activities supported by PATH.

PATH Evaluation
Section 528 of the Public Health Service Act requires that SAMHSA’s Office of the Assistant
Secretary for Mental Health and Substance Use evaluate PATH grant expenditures at least once
every three years to ensure adherence to legislative requirements and to provide an opportunity
to recommend programmatic improvements to the PATH program. This report, prepared by the
Office of Evaluation within SAMHSA’s Center for Behavioral Health Statistics and Quality,
evaluates the PATH program for calendar years 2019, 2020, and 2021.
The design for this evaluation is based on a logic model developed during early implementation
of the program. The logic model illustrates the relationship between how resources (i.e., inputs),
activities performed, and outputs from activities result in intended accomplishments (i.e.,
outcomes) through the PATH program delivery. See Appendix A for the detailed logic model
used for the triennial evaluation.

Context/
Inputs

Throughputs

Activities

Outputs

Outcomes

PATH Funding Allocation and Matching Funds
The formula for PATH program funding allocation is based on a state’s population compared
with the total U.S. population. In 2019, the total federal allotment for PATH funding for U.S.
States and territories was $61.6 million and remained level in 2020 and 2021. The PATH funding
allocation in 2019 through 2021 was higher than the funding for 2016 through 2018 (a period
where annual allotments decreased from $58 million to $57.7 million). The territories with the
smallest populations received $50,000 each from 2019 through 2021, which remained
unchanged since 2016. In 2021, the PATH funding allotments for the States and for Puerto Rico
ranged from $300,000 to $8.8 million. Thirty-two percent of these (17 States) received the
minimum allotment of $300,000.

Of note, in 2010 PATH funding was $65.1 million (U.S. Department of Health and Human
Services, 2010), an amount the program had yet to regain by 2021. As costs have continued to
rise, this equates to a net decrease in available funds over time.

METHODOLOGY
PATH Evaluation Questions
The overarching questions this evaluation addresses include the following:
Questions Mandated by Legislation:
1. Are services funded with PATH monies appropriate?
2. Are services well administered?
3. Are PATH outcome and process goals achieved? Measures include:
a. What is the number of homeless persons contacted?
b. What is the percentage of eligible contacted homeless persons with serious
mental illness who are subsequently enrolled in services?
c. What percentage of enrolled homeless persons receive community mental health
services?
Structure/Process Questions:
1. In what contexts do grantees (states/providers) operate?
2. What are the characteristics of grantee organizations(states/providers)?
3. How were programs implemented and barriers and challenges overcome?
4. What services models were provided, why and how?
5. What costs were associated with grant services and activities?
Questions to access program output/outcomes:
1.

What are the outputs and outcomes of the program?

Research Design
For this evaluation, the research team used a mixed methods approach, combining analyses of
quantitative data with the use of a qualitative data collection from two grantee States. The
addition of the qualitative data collection provided an opportunity to get a more detailed and

nuanced picture of how PATH funds are being used in two discrete locations. Data sources for
this evaluation include:
•

Annual Report Data for 2019, 2020, and 2021. Grantees are required to submit annual
reports that include information on funding, staffing, numbers of individuals
served/contacted and enrolled, client demographics, and service provision and referrals
made and attained. Data are submitted by the PATH providers via PDX, and each
grantee’s SPC approves the data submitted by their providers. The number of PATH
providers submitting data each year was 449 (2019), 436 (2020), and 435 (2021). The
submission deadline for each year was on or before the last day of the first month of the
following year (i.e., January 31, 2020, January 31, 2021, and January 31, 2022).

•

State PATH Contact (SPC) Surveys. This voluntary web-based survey collected detailed
information on program administration and oversight, provision of technical guidance
and training, HMIS data, perceptions of the appropriateness of the PATH program
design, and involvement and collaboration with HUD’s CoC program. The CoC program
is a framework that coordinates efforts across a community to address homelessness
through collaboration and funding for homeless services.6
Respondent recruitment to maximize the response rate entailed several requests for
participation made via email. Government Project Officers (GPOs) sent the initial survey
invitation emails to SPCs, highlighting the purpose and importance of the evaluation and
including a personalized link to the web-based survey. GPOs and the evaluation team
sent up to five follow-up emails to SPCs that had not yet completed the survey. From the
56 SPCs who received the survey link, 38 surveys were completed in full (68%), and 4
additional SPCs responded to at least some questions for an overall response rate of
75.0%. Survey data were collected in the third quarter of FY 2023. The survey instrument
is included in Appendix B of this report.

6 More information about HUD’s CoC program can be found at https://www.hudexchange.info/programs/coc/

•

Key informant interviews. For this report, the PATH evaluation team conducted semistructured interviews with SPCs and PATH provider staff in two states. The interviews
were conducted virtually using Microsoft Teams or Zoom, and interviewers obtained
verbal consent from each participant. Interview guides are included in Appendices C and
D.

In designing this study, the evaluation team intended to conduct in-person site visits which
would include focus groups with PATH clients from two provider agencies per state. To that end,
the evaluators developed a purposive site selection methodology for choosing grantees with
heterogeneous characteristics. The primary site selection variables included:
•

State population relative to the national median.

•

Rate of homelessness relative to the national median.

•

Level of federal PATH funding received relative to the national median.

•

Proportion of the population without health insurance relative to the national median.

The evaluation team used these criteria to establish a list of grantee states for inclusion in
qualitative data collection (with a list of alternates), and CMHS staff approved the selections.

Limitations
This evaluation has two overarching limitations that impact the findings. First, the response rate
for the 2023 SPC survey was 75% despite multiple efforts to encourage participation. A high
number of SPCs who were new in their position likely affected the response rate this year.
Newer SPCs would not have the broader understanding or historical context of the PATH
program that SPCs who have worked in that capacity for more than a few years would have,
making it more difficult for them to answer questions on the survey. Of the 42 SPCs who
responded to the survey, nearly half (47.6%) reported that they had been in their position for
fewer than two years, with 35% of these in their positions for less than one year. Several survey
invitation emails went to individuals who had left their positions as SPCs, indicating that the
evaluation team did not have a current list of SPCs. Additionally, eight of the survey responses
stopped at the consent question or only answered some of the questions. This may indicate that
the respondent did not have sufficient time in their role to be able to address the questions.

The high number of newer SPCs may have also contributed to the evaluation team’s difficulty
recruiting grantees for qualitative data collection. In designing this study, the evaluation
team intended to conduct in-person site visits which would include focus groups with PATH
clients from two provider agencies per state. However, in reaching out to recruit states for the
data collection, evaluators learned that many of the SPCs in the selected states were new in their
positions and thus less likely to know the answers to the interview questions. Additionally, many
SPCs reported that they did not have time to participate in site visits during the period of data
collection (July through August 2023).
Due to the difficulty recruiting sites, the evaluation team pivoted to “virtual” site visits in lieu of
in-person collections and decided to omit the consumer-level focus groups due to technology
limitations and concerns about the efficacy of conducting these groups online.

FINDINGS
Types and Numbers of Provider Agencies Funded
Section 522 [290cc-22] of the Public Health Service Act, as amended, requires that states and
territories only make grants to political subdivisions or to nonprofit private entities.7 Sixty
percent (60.0%) of the PATH grantees who responded to the SPC survey reported that they limit
the types of organizations that can receive PATH funds (n=42). Of the 25 PATH grantees that
placed restrictions on the types of organizations that can apply for PATH funds, the majority
(88.0%) allowed funding for community mental health centers. Fifty-six percent (56.0%) of these
grantees allowed other mental health agencies to receive funding. Less than half (40.0%)
allowed social service agencies, and less than one-third (32.0% and 28.0%, respectively) allowed
consumer-run mental health centers and other health agencies to receive PATH funding. Figure
1 describes the types of organizations that grantees indicated as eligible to apply for PATH
funds in 2023.

https://www.govinfo.gov/content/pkg/COMPS-8776/pdf/COMPS-8776.pdf

Figure 1. Types of Organizations that Apply for PATH Funds, 2023

Community mental health center

88.0%

Other mental health agency

56.0%

Social service agency

40.0%

Other

36.0%

Consumer-run mental health center
Health Care for the Homeless/other health agency

32.0%
28.0%

Other housing agency

24.0%

Shelter or other temporary housing resource

24.0%

Substance use treatment agency

24.0%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey 2023, n= 25
Notes: The grantees that did not limit the types of organizations eligible to receive PATH funds (31.0%), had missing
data (9.5%), or responded “don’t know” (n=21) were not included in this figure.
The other types of organizations that can apply for PATH funds include CoCs and county mental health providers,
other nonprofits, and public agencies.

Process for Selecting PATH Provider Agencies
Grantees used a variety of strategies to select provider agencies to deliver services, and some
used a combination of strategies. Sixty-five percent (65%) of PATH grantee SPCs reported that
they utilize a competitive procurement process to select PATH providers. In the online survey,
SPCs were asked to describe the criteria they use to distribute PATH funds to providers. They
were allowed to enter multiple responses. Less than half (45.2%) of the respondent SPCs
reported that they utilize level of need for homeless services within their state to allocate PATH
funds, and a third (33.3%) reported that they utilize a population formula to allocate PATH
funds. Nearly forty-three percent (42.9%) reported other means of allocating PATH funds. These
other means include a Request for Proposals (RFP) process, consideration of past performance,
an annual Point-in-Time count, intended use report, and consideration of the originally
approved provider proposals.

One interviewed SPC indicated that their state uses a competitive RFP process to select PATH
providers. Another SPC described using a statement of need process instead of an RFP
procurement in 2023 to “control the terms of the process a little more” by inviting specific
entities to apply for funding instead of opening the application process to the general public.
PATH leadership in that state used scoring templates, a scoring rubric, and a committee of
independent reviewers to score organizations’ applications, and the SPC noted that the state
invited all CoCs to apply, as well as several nonprofit service agencies.

Providing Oversight and Monitoring Performance
Most PATH grantees (59.5%) reported that they do not utilize an intermediary organization to
manage their PATH programs. Less than a quarter of the grantees (21.4%) reported that they
use intermediary organizations. Therefore, most PATH grantees retain the responsibility of
overseeing and monitoring the performance of PATH providers. Figure 2 displays the
distribution of strategies that PATH grantees reported using to monitor PATH provider
performance. These data suggest that grantees undertake a variety of activities to ensure that
PATH requirements are met and that the services provided are of high quality.
One SPC noted that they perform regular site monitoring check-ins and data reviews, including
reviews of spenddown on grant and contract funds. Additionally, the Internal Audits Unit within
the state’s Department of Human Services performs an in-depth review of all PATH contracts
and provider agencies every two to three years, reviewing financials, annual performance review
(APR) data, and HMIS data for errors and data integrity. One state requires a “lengthy” quarterly
report from provider agencies that identifies barriers and training needs in addition to regularly
collected data. State-level staff also conduct annual site visits and meet with provider staff who
work in “multiple overlapping roles.”
PATH grantees reported using different mechanisms to monitor performance. Grantees were
able to select all that applied, and all grantees selected at least two methods. Conducting site
visits was the most common (92.9%), followed by reviewing HMIS data (85.7%), regularly
scheduled meetings or teleconferences (83.3%), and review of financial documents or billing

(81.0%). Additional methods of monitoring include review of progress reports (71.4%),
evaluation of performance goals (52.4%), and audits (52.4%).
Figure 2. Methods for Monitoring PATH Providers, 2023

Site Visits

92.9%

Review of HMIS or Other Data

85.7%

Regularly Scheduled Meetings or Teleconferences

83.3%

Review of Financial Documents or Billing

81.0%

Review of Progress Reports

71.4%

Evaluation of Performance Goals

52.4%

Audits

52.4%

Other
0.0%

9.5%
50.0%

100.0%

Source: PATH SPC Web Survey 2023, n=42
Note: An example of other methods used for monitoring is contractors reviewing the data.

As shown in Figure 3, grantees reported using positive approaches to address concerns about
provider management or effectiveness. The two most used strategies in this regard are the
provision of TA and training (85.7% and 78.6%). Over half (54.8%) of the grantees reported using
corrective action plans to handle concerns with providers. Almost a third (31.0%) reported using
quality improvement projects to handle concerns with providers.

Figure 3. Methods for Handling Concerns with PATH Providers, 2023

Technical Assistance

85.7%

Training

78.6%

Corrective Action Plans

54.8%

Quality Improvement Projects
Don't Know

31.0%
4.8%

Other

11.9%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey 2023, n=42
Note: Data that were missing were not included in the percentage calculation.
Examples of other methods of handling concerns with PATH providers include face-to-face meetings and
participation in learning communities.

Providing Supports for PATH Providers
In addition to regular performance monitoring, sound administration also includes providing
staff with opportunities to increase skills. Most grantees (71.4%) who responded to the survey
reported that they make both TA and training available for performance enhancement; as shown
in Table 1, 88.1% reported the use of TA and 73.8% indicated the use of training. These
proportions have increased since the 2020 PATH Evaluation Report, when they were 81% and
60%, respectively.
SPCs interviewed by the evaluation team reported that they provide support to PATH provider
agencies in the following ways:
•

Encouraging peer-to-peer learning and collaboration among providers.

•

Facilitating monthly statewide PATH calls or meetings, as well as ad hoc meetings, for
provider agencies to discuss programmatic concerns and solutions.

•

Hosting an annual conference of provider agencies with an advance survey to determine
what providers want to learn about and discuss.

•

Providing regional representatives so providers have a more localized point of contact.
The SPC checks in with the regional offices to understand how PATH teams are working.

Table 1. Methods for Supporting Provider Performance, 2023
Method

Number of Grantees

Percent of Grantees

88.1%

73.8%

Provide TA to PATH
providers
Provide training to PATH
providers
Source: PATH SPC Web Survey 2023; n=47.
Note: Data that were missing were not included in the percentage calculation.

Topic Areas of Technical Assistance and Training
PATH grantees reported taking an active role in making TA and training available to PATH
providers; the top five topics are illustrated below (Figure 4). Over eighty-two percent (82.1%) of
responding PATH grantees reported providing TA/training on data reporting in 2023.
Approximately three quarters (74.4%) of the grantees reported providing TA/training on data
collection, followed by HMIS (66.7%), determining client eligibility for PATH services (61.6%), and
enrolling clients for PATH services (53.9%).

Figure 4. Topic Areas of TA or Training Provided to PATH Providers, 2023

Data Reporting

82.1%

Data Collection

74.4%

Homeless Management Information Systems

66.7%

Determining Client Eligiblity for PATH Services

61.6%

Enrolling Clients for PATH Services
0.0%

53.9%
50.0%

100.0%

Source: PATH SPC Web Survey 2023, n= 39
Notes: Data that were missing were not included in the percentage calculation.
Other topic areas included SOAR SSI/SSDI, harm reduction, substance use, program inquiries regarding eligible PATH
services, and outreach and identifying possible SMI during outreach.

Challenges
State-level Changes Affecting the PATH Program
Changing public attitudes toward homelessness in response to increasing numbers of
unsheltered people can present a challenge for PATH grantees. One grantee state passed a bill
in early 2023 mandating enforcement of ordinances prohibiting “public camping, sleeping, or
obstruction of sidewalks”.8 The bill also requires a “performance audit” by the state auditor of all
public spending on homeless programs in the state, examining “the awarding of contracts and
grants relating to homeless services and supports, the metric used to determine success of the
expenditures, and whether the metrics are met by the contractors and grantees.”9

8 Georgia Senate Bill 62. Full text is available at https://www.legis.ga.gov/legislation/63621
9 Ibid.

One SPC indicated that their state is implementing a system of nine regional hubs to carry out
data and reporting for administration of coordinated entry processes10 and has seen changes in
the delivery of services as well as an influx of TA providers as a result. The SPC noted that the
state is seeing increased numbers of people living outside, including in encampments, as well as
larger numbers of immigrants in need of housing services.

Challenges for Homeless Populations
PATH provider agency staff interviewed by the evaluation team identified a lack of affordable
housing, especially in safe locations, as a primary and urgent challenge for people experiencing
homelessness. In one state, harsh weather conditions pose a risk to health and safety for people
without homes. Staff from two provider agencies cited adverse information on criminal
background checks, especially inclusion on the sex offender registry, as a significant issue that
increases the difficulty finding affordable housing for clients, with one provider pointing out that
even an arrest or conviction from more than 20 years ago can still limit available housing
options. Additionally, in rural parts of one state, shelter and housing resources are very limited,
with some of these being privately run with entry criteria that can exclude people with SMI. The
absence of public transportation also poses a challenge to people experiencing homelessness.

Barriers to Delivering PATH Services and Approaches to Overcoming Them
SPCs indicated staff retention, extensive data requirements, and limited shelter and housing
options as major barriers to their ability to provide PATH services.
One SPC noted that consistency in staff is critical for PATH clients, and their state has focused on
increasing compensation as a means of staff retention. However, increased compensation also
results in fewer staff at the provider level, particularly as that state has seen a lack of state
investment in outreach programs overall. Service providers discussed staff attrition and difficulty
recruiting staff with the necessary skill sets for outreach work, with one provider noting that they

10 Coordinated entry is a process meant to streamline service delivery to individuals and families seeking assistance.

Intake staff use a standard, objective tool to assess a household’s vulnerability and identify their barriers to housing
and then referred to housing and services based on their needs. More information on coordinated entry is available at
https://www.hudexchange.info/homelessness-assistance/coordinated-entry/#coordinated-entry-notice

have a “small team serving a large rural area”. That organization’s approach is to consolidate the
outreach caseload, so it is shared by the entire outreach team instead of assigning individual
caseloads for each worker. The provider specified that this provides built-in succession planning
in the event of staff leaving and helps with reaching clients in a timely manner over a large
geographical area. Another SPC cited “low workforce pay” as an impediment to finding and
retaining provider staff. In addition to finding and retaining outreach staff, provider agencies
have also had difficulty hiring peer staff11 and meeting training requirements for them. In
response to this need, that state has been able to offer flexibility with training requirements and
made some changes to loosen them to help recruit peer staff.
Entering the required data for each client requires provider staff time that then cannot be spent
on outreach activities. This burden is particularly heavy for provider agencies that maintain their
own electronic medical record (EMR) systems, requiring staff to enter client data in two separate
systems. Finally, a narrow scope of shelter and housing options for PATH clients presents a
significant challenge for service providers. One SPC reported that not all shelters in the state are
“low barrier,” meaning options for individuals with SMI or substance use disorders (SUD) have an
especially difficult time accessing them—precisely the population that PATH was designed to
serve. To address these challenges, state-level PATH staff collaborate and leverage relationships
with state and local housing agencies, CoCs, and stakeholders to build a coalition for providing
services to people with SMI experiencing homelessness. In response to the problem of data
entry demands on provider staff, some PATH teams have hired administrative staff to help with
this task, allowing outreach workers to spend more time in the field.
Other Challenges for PATH Providers
Service provider staff described prioritization of services as a challenge. While services are
accessible to clients, people with SMI experiencing homelessness often have multiple and varied
needs, so staff must prioritize and manage those needs and how they can be met. One PATH
leader indicated that the approach to this is to be clear with clients about what they can offer in

11 Peer staff are individuals with lived experience with SMI and homelessness whose life experiences allow them to

provide an important perspective on service provision.

terms of services, and to ensure that “clients leave with something, which may (sometimes) be as
simple as hope and encouragement.”
Difficulty with client follow-up was also cited as a challenge for PATH providers. Clients may
move out of the area suddenly or become incarcerated without notifying their PATH team. Staff
noted that they handle this by communicating and coordinating with other service organizations
that work with the missing client to find the client and re-engage them for ongoing services.
Three other notable challenges for provider agencies include:
•

The lack of affordable housing options, especially ADA-compliant units for clients with
disabilities.

•

The absence of a state-level position against “sweeps” of homeless encampments.
Sweeps are the clearing of encampments in urban areas by police or sanitation
departments and are a common response to the high visibility of street homelessness in
cities (Perez, 2023).

•

Harsh weather conditions that force organizations to shift focus from trying to get
people into housing to making sure people experiencing homelessness are not facing
serious or fatal injuries related to extreme temperatures.

Number of Persons Contacted and Enrolled
According to the 2020 PATH Annual Report Provider Guide, the term “contact” is used to refer
to an interaction between a PATH-funded worker(s) and an individual who is potentially PATH
eligible or enrolled in PATH. A contact may occur in a street outreach setting or in a service
setting such as an emergency shelter or drop-in center. Enrollment is defined as involving a
person who has been determined to be PATH eligible and has agreed to receive services, or a
person for whom the provider has started an individual file or record (SAMHSA, 2022).
As shown in Table 2, there was a 18.1% decline in the total number of people contacted for
outreach between 2019 and 2021. The change in the number of contacts may be the result of a
decrease in the number of providers from 449 to 435. This reporting period also includes the
COVID pandemic, which is another possible factor in the decrease. Many states and
communities implemented social distancing measures, making in-person services much more

challenging to provide. The annual grantee reports also reported information on those
contacted but found to be ineligible due to not having an SMI. The number of individuals
contacted who were found to be ineligible (specifically, not found to have an SMI) also shows a
decline over the three-year period.
Table 2. Summary of Contacts, Eligibility, and Enrollment, 2019-2021
2019

2020

2021

Number contacted

126,990

115,341

103,933

Number of active enrolled

66,403

59,816

58,821

Number of outreached/contacted who were
ineligible

15,246

17,394

12,560

Source: PATH Annual Reports 2019–2021
Note: The number of providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435.

Demographics of Persons Enrolled in PATH Services
The demographic data shared below are only for individuals enrolled in services with PATH
providers in 2019 through 2021.
Age: Adults are the primary target population for the PATH program. However, since the 2018
PATH Annual Report Provider Guide, transition-age youth may be eligible if they meet the
state’s definition of serious mental illness. Table 3 displays the number and percentage of
people enrolled in the PATH program over the 3-year period. As shown in the table, each year
over 90 percent of people enrolled in PATH programs nationally were ages 18–61 (compared to
51.7 percent of the national noninstitutionalized population ages 20-59 in 2022), with the
greatest proportion (44.7%) ages 31–50 enrolled by PATH (compared to 26.0% of the general
population ages 30-49). Roughly seven to eight percent were age 62 or older (compared with
23.5% of the general population ages 60 and older) (U.S. Census, 2022).

Table 3.

PATH-Enrolled Persons by Age, 2019–2021
2019

2020

2021

Age
Number Percent Number Percent Number Percent
Less than
18

188

<1%

140

<1%

18–23

3,996

6.1%

3,261

5.5%

3,190

5.5%

24-30

9,045

13.7%

7,839

13.2%

7,114

12.2%

31-50

30,938

47.0%

28,233

47.4%

27,723

47.4%

51-61

17,120

26.0%

15174

25.5%

15,127

25.9%

4,608

7.0%

4,872

8.2%

5,193

8.9%

62 and
over
Totals

65,895

59,519

58,438

Gender: The majority of individuals enrolled by PATH programs, for each of the three years,
were men (approximately 60% each year), while women averaged 40%, and transgender or
gender-nonconforming individuals averaged less than one percent. This is comparable to the
national percentage of all homeless individuals who are men (61%), women (38%), and
transgender or gender non-conforming individuals (less than 1%) as reported in the 2022
Annual Homeless Assessment Report (De Sousa et al., 2022).
Race and Ethnicity: Table 4 includes the number and percentage of individuals enrolled in
PATH programs by reported race. In each year, over half of persons enrolled self-reported as
White, followed by Black or African American (roughly 36%). Individuals who identify as
multiracial are counted in all categories they select and thus the percentages may not be equal

to 100%. For each of the three years, 14.7% to 15.6% of participants self-reported as Hispanic
(2019=9,784; 2020=8,717; 2021=9,162).
Table 4.

PATH-Enrolled Persons by Race, 2019-2021
2019

2021

2020

Race
Number

Percent

Number

Percent

Number

Percent

38,518

58.0%

34,116

57.2%

33,886

55.9%

23,938

36.0%

21,710

36.4%

22,001

36.3%

Alaska Native

2,634

4.0%

2,598

4.4%

2,830

4.7%

Asian

650

1.0%

583

1.0%

765

1.3%

Other Pacific Islander

699

1.1%

662

1.1%

1101

1.8%

Totals

66,439

White
Black or African
American
American Indian or

Native Hawaiian or

59,669

60,583

Source: PATH Annual Reports 2019–2021
Notes: The number of providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435 The
number of people for whom race was reported as unknown: 2019=3,040, 2020=2,847, 2021=2,746.

Changing Client Populations
In 2022-23, service providers in one state noted increasing numbers of people traveling from
neighboring states, as well as an increase in the number of families with children. In another
state, provider agencies reported increases in both the homeless population overall and the
number of migrant asylum seekers among the homeless population. SPCs in both interviewed
states described efforts to reach asylum seekers and non-English speakers more broadly.

A lack of bilingual staff on PATH outreach teams and tight restrictions on eligibility of
undocumented persons for state-funded services present challenges to reaching this
population. One SPC noted that their agency is working in collaboration with community
partners to better serve the lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQ+)
population in that state. Both states provide diversity, equity, inclusion, and accessibility (DEIA)
or cultural competence trainings for PATH provider staff.

Veteran Status
The Public Health Service Act Title V mandates that PATH programs are prohibited from funding
organizations that do not have the capacity to provide adequate services to veterans.
Additionally, it mandates that states should give priority to those organizations with
demonstrated capacity to work with veterans. Across all three years, veterans constituted 5.1%
to 5.6% of all individuals enrolled in PATH programs: 2019=3,630; 2020=3,139; and 2021=2,895
(PATH Annual Report 2019-2021). The proportion of veterans enrolled is slightly lower than the
seven percent (7.0%) of all homeless individuals who were veterans as reported in the 2022
Annual Homeless Assessment Report to Congress (De Sousa et al., 2022). In the same report, it
is noted that there has been a 10 percent reduction in veterans experiencing homelessness
between 2020 and 2022. In the 2020 PATH Triennial Evaluation Report, 7-8% of clients served
were veterans. The decrease in veteran homelessness is attributed at least in part to increased
funding to the U.S. Department of Veterans Affairs (VA) for homelessness programs in the
American Rescue Plan of 2021 (HUD, 2022).

Co-Occurring Substance Use Disorders
In addition to individuals with severe mental illness, the PATH program also prioritizes those
individuals with co-occurring mental and substance use disorders. Across all years, an average of
44.3% of persons enrolled in PATH had co-occurring mental and substance use disorders.

Residence the Night Prior to Enrollment
PATH enrollees’ residence on the night prior to their enrollment is shown in Table 5. The
greatest proportion of individuals were unsheltered on the night prior to enrollment (39.9% to
49.1% across all years). This number is followed by sheltered situations (27.3% to 32.6% across

all years), then by people who had stayed in permanent housing, including staying with a friend
(15.3% to 17.3% across all years).
Table 5. PATH-Enrolled Persons by Residence Night Prior to Enrollment 2019–2021
2019

2020

2021

Residence
Number

Percent

Number

Percent

Number

Percent

25,962

39.9%

25,290

43.4%

28,334

49.1%

21,190

32.6%

18,304

31.4%

15,773

27.3%

6,622

10.2%

5,415

9.3%

4,749

8.2%

Housing

11,248

17.3%

9,287

15.9%

8,827

15.3%

Totals

65,022

Unsheltered
Situations
Sheltered
Situations
Institutionalized
Care
Permanent

58,296

57,716

Source: PATH Annual Reports 2019–2021
Notes: The number of providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435. The
number of people for whom residence was reported as unknown: 2019=1,381, 2020=1,520, 2021=1,105.
Unsheltered = Place not meant for habitation (i.e., vehicle, street, abandoned building, bus/train/
subway station/airport or anywhere outside), including non-housing service sites + emergency shelter
Sheltered = Emergency shelter + Safe Haven + Hotel or Motel (paid for without emergency shelter voucher) +
Transitional Housing for homeless persons + Interim Housing
Institutionalized care = psychiatric hospital + substance use treatment facility + hospital + jail + long-term care
facility + foster care
Permanent Housing (Subsidy) = Permanent housing for formerly homeless persons + rental by client [Veterans
Affairs Supportive Housing (VASH) subsidy] + rental by client (non-VASH subsidy) + owned by client (subsidy)
Permanent Housing (No Subsidy) = Rental by client (no subsidy) + owned by client (no subsidy)

Services Provided
As stated in the SAMHSA Notice of Funding Opportunity (NOFO), SAMHSA prioritizes certain
services for the PATH program, including street outreach, case management, and services not
supported by mainstream mental health programs. Although providers can offer and provide
the full range of PATH allowable/eligible services, PATH grantees have demonstrated a priority
for these services within their state programs. As shown in Figure 5 below, all respondents
reported that outreach services were offered within their program. PATH providers conducted
both street outreach and in-reach (97.6% and 83.3%, respectively) in their PATH programs. ‘Inreach’ is defined as contacts with clients who are already connected to their services in some
way. Additionally, community mental health services and screening and diagnostic services were
noted as being a provided service by 83.3%.
Figure 5. PATH Services Provided, 2023

Outreach Services

100.0%

Street Outreach Services

97.6%

In-reach Services

83.3%

Community Mental Health Services

83.3%

Screening and Diagnostic Treatment Services

83.3%

Habilitation and Rehabilitation Services

54.8%

Alcohol or Drug Treatment Services

57.1%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey, 2023 n=42
Note: Data that were missing or that had a response of “do not know” were not included in the percentage
calculation.

The PATH Annual Report provides data on the number and percentage of PATH enrollees
receiving each PATH-eligible service. The non-housing services are displayed in Table 6. Case
management was the most common service provided to enrolled clients (67.4% to 69.4% across
all years), followed by screening (54.0% to 58.0% across all years), community mental health

services (42.2% to 43.9% across all years), and clinical assessment (25.6% to 27.4% across all
years). Although just less than half of the clients served had a co-occurring mental illness and
substance use disorder diagnosis, only ten percent of clients received alcohol or drug treatment;
this could be due to clients already engaging in similar services, or because PATH providers are
empowering the clients to choose their own treatment goals and clients do not want referrals
for substance use treatment.
Table 6. PATH Services (Non-Housing): Number and Percentage of Enrolled Individuals
Receiving Service, 2019–2021
2019

2020

2021

Number

Percent

Number

Percent

Number

Percent

Enrolled

Persons

Receiving

Service

44,727

67.4%

41,515

69.4%

40,770

69.3%

38,508

58.0%

32,330

54.0%

32,603

55.4%

29,172

43.9%

25,907

43.3%

24,843

42.2%

Service

Case
management
services
Screening and
diagnostic
treatment
services
Community
mental health
services

2019

2020

2021

Number

Percent

Number

Percent

Number

Percent

Enrolled

Persons

Receiving

Service

16,987

25.6%

15,688

26.2%

16,091

27.4%

Reengagement 9,940

15.0%

9,041

15.1%

9,266

15.8%

Habilitation

6,739

10.1%

7,071

11.8%

9,605

16.3%

4,461

6.7%

6,049

10.1%

8,812

15.0%

6,791

10.2%

5,232

8.7%

4,813

8.2%

Service

Clinical
Assessment

and
rehabilitation
Residential
supportive
Substance use
treatment
Source: PATH Annual Reports 2019–2021, 2019 n=66,403, 2020 n= 59,816, 2021 n=58,821 Note: The number of
providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435

Table 7 displays the number and percent of enrollees receiving allowable housing services across
all years. Housing eligibility determination was the most utilized housing-related service across all
three years varying from approximately 22.2% to 24.6%.

Table 7. PATH Services (Housing): Number and Percentage of Enrolled Persons Receiving
Service, 2019–2021
2019

2020

2021

Number

Percent

Number

Percent

Number

Percent

Enrolled

Persons

Receiving

Service

14,973

22.5%

13,281

22.2%

14,700

24.6%

2,308

3.5%

2,443

4.1%

1,974

3.4%

1,934

2.9%

1,594

2.6%

1,452

2.5%

1,257

1.9%

1,059

1.8%

606

1.0%

196

<1%

134

<1%

163

<1%

Service

Housing
Eligibility
Determination
Housing
moving
assistance
Security
deposits
One-time rent
for eviction
prevention
Housing
minor
renovation

Source: PATH Annual Reports 2019–2021, 2019 n=66,403, 2020 n= 59,816, 2021 n=58,821
Note: The number of providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435

Referrals Made and Attained
Table 8 displays the number of times referrals were provided for different service types across
2019 to 2021. Approximately 43% of referrals provided across all three years were for
community mental health services. Referrals were provided for: permanent housing services
(25.9% in 2019, 22.7% in 2020, and 22.0% in 2021); temporary housing services (up to 27.8% in
2021); income assistance (approximately 16% across all years); and primary health services (up to
15.3% in 2019). The services with the fewest referrals were medical assistance (11.2% to 9.8%)
and employment assistance (8.5% down to 8.0%).
Table 8. Referrals Provided: Number and Percentage of Times Referral Type Made, 2019–
2021
2019

Number

2020

Number of
Percent

Referral

of Times

Type

Referral

of All

All

of All
Referral

Referrals
Type

Provided
Provided

Percent
of Times

Referral
Referrals

Community

Number
Percent of

Times

Type

2021

Referrals
Type

Provided
Provided

28,872

43.5%

25,443

42.5%

25,305

43.0%

17,230

25.9%

13,601

22.7%

12,966

22.0%

12,590

19.0%

12,158

20.3%

16,365

27.8%

mental
health

Permanent
housing

Temporary
housing

2019

Number

2020

Number of
Percent

Referral

of Times

Type

Referral

of All

All

of All
Referral

Referrals
Type

Provided
Provided

Percent
of Times

Referral
Referrals

Income

Number
Percent of

Times

Type

2021

Referrals
Type

Provided
Provided

10,387

15.6%

9,181

15.3%

9,858

16.8%

10,166

15.3%

8,991

15.0%

7,579

12.9%

8,835

13.3%

6,171

10.3%

6,447

11.0%

7,458

11.2%

5,876

9.8%

5,739

9.8%

Employment 5,672

8.5%

4,992

8.3%

4,712

8.0%

assistance

Primary
health
services

Substance
use
treatment

Medical
assistance

assistance

Totals

101,210

86,413

88,971

Source: PATH Annual Reports 2019–2021
Notes: The number of providers reporting data for the percentage calculation: 2019=449, 2020=436, 2021=435

Shown in Table 9 are the percentage of enrolled individuals who received a referral for each
service type and the percentages of referrals in which the service was attained for 2019 through
2021. Most individuals who received a referral did follow through with attaining the service.
In 2019, 43.5% of enrollees received a referral for community mental health, and 31.0% of
enrollees (74.3% of those who received this specific referral) attained the service.
Table 9. Referrals Provided: Percent of Enrolled Individuals Receiving a Referral and
Percent of Enrolled Individuals Attaining Referral, by Type, 2019-2021
2019

2020

2021

Percent
Percent

Percent

Percent of

Enrolled

Persons

Attaining

Receiving

the

Referral

of
of
Referral Type

Enrolled
Enrolled

Provided

Persons
Persons
Attaining
Receiving
the
Referral

Percent of

Enrolled

Persons

Receiving

Attaining

Referral

the Referral

Referral
Community

43.5%

31.0%

42.5%

31.1%

43.0%

32.0%

25.9%

11.4%

22.7%

11.0%

22.0%

10.8%

19.0%

12.2%

20.3%

13.1%

27.8%

13.0%

15.6%

10.9%

15.3%

10.4%

16.8%

12.5%

15.3%

11.6%

15.0%

10.1%

12.9%

9.4%

mental health
Permanent
housing
Temporary
housing
Income
assistance
Primary health
services

2019

2020

2021

Percent
Percent

Percent

Percent of

Enrolled

Persons

Attaining

Receiving

the

Referral

of
of
Referral Type

Enrolled
Enrolled

Provided

Persons
Persons
Attaining
Receiving
the
Referral

Percent of

Enrolled

Persons

Receiving

Attaining

Referral

the Referral

Referral
Substance use

13.3%

8.3%

10.3%

5.6%

11.0%

6.0%

11.2%

8.7%

9.8%

7.1%

9.8%

7.3%

8.5%

5.1%

8.3%

3.4%

8.0%

3.6%

treatment
Medical
assistance
Employment
assistance
Source: PATH Annual Reports 2019–2021
Notes: Number of providers with data for the percentage calculation: 2019=449, 2020=436, 2021=435; percent of
enrolled persons that completed the referral: 2019–2021, n=66,403, 2020 n= 59,816, 2021 n=58,821
Calculations: percent of enrolled persons receiving a referral = number of persons receiving a referral (assisted)/total
number of people enrolled*100. Percent of Enrolled Persons that complete/attain the referral = number of persons
attaining a referral/total number of people enrolled*100.

How PATH Teams Identify Clients and Keep Them Engaged
To identify clients, provider agency staff conduct outreach at homeless encampments, soup
kitchens, and with people living on the streets. Agencies also receive referrals through
community networks. Some agencies provide walk-in hours at their office location and receive
referrals from state agencies.
Provider staff described keeping clients engaged through consistent follow-up and
communication with a client’s care team (e.g., therapist, nurse practitioner, physician). If an
individual seems “on the fence” about accepting services, provider staff try to gauge how much

contact the person will engage with and emphasize that PATH is a voluntary program and that it
is entirely up to the individual whether to participate and for how long. One service provider
discussed the importance of “maintaining a low-barrier and non-judgmental space” for people
to “drop in and get a meal” or necessary items like clothing, tents, sleeping bags, and toiletries.

Homeless Management Information System (HMIS)
According to the current Notice of Funding Opportunity, all PATH providers should be collecting
PATH client data through HMIS or another system approved by SAMHSA that supports
interoperability with the local HMIS. Of the 42 SPCs who responded to this question on the SPC
survey, 88.1% reported all providers using HMIS, 4.8% reported at least three quarters of their
providers used HMIS, and 2.4% reported between one quarter and one half of their providers
using it. Additionally, 92.9% of grantees reported working with local HMIS administrators to
assure their PATH providers are trained in the use of HMIS. Figure 6 shows 90.5% of PATH
grantees reporting that HMIS data are used to report Annual Report/PATH data; nearly three
quarters (73.8%) of the PATH grantees use the HMIS data to monitor PATH providers. PATH
grantees also report using HMIS data to monitor PATH consumer outcomes (59.5%); monitor
PATH consumer participation in services or housing (54.8%); report to other state or federal
agencies (42.9%); and to plan for PATH services or activities (23.8%). Only two percent (2.4%)
report that they are not using HMIS data.

Figure 6. Grantees’ Use of HMIS Data, 2023

Report Annual Survey/PATH Data

90.5%

Monitor Local PATH Providers

73.8%

Monitor PATH Consumer Outcomes

59.5%

Monitor PATH Consumer Participation in Services or Housing

54.8%

Report to Other State or Federal Agencies

42.9%

Plan PATH Services or Activities
Other

23.8%
9.5%

Don't Know

2.4%

Not Yet Being Used

2.4%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey 2023 n=42
Note: Data that were missing were not included in the percentage calculation. ‘Other’ examples include utilizing the
mapping feature to communicate effectively with other outreach programs about the location and latest details for
individuals and encampment responses.

Collaboration with Continuums of Care (CoCs)
As shown in Figure 7, the majority of PATH grantees reported that they participate in the CoC
program (85.0%), and work with their local CoC to facilitate the use of HMIS for data collection
(80.5%) and to facilitate timely service coordination (78.1%). Almost all grantees reported a
requirement for providers to collaborate with CoC (87.9%).

Figure 7. PATH Grantees’ Involvement with CoCs, 2023

Grantee requires providers to collaborate with CoC

87.9%

Grantee participates in CoC program

85.0%

Grantee works with CoC to facilitate use of HMIS for PATH
data collection

80.5%

Grantee works with CoC to facilitate timely service
coordination

78.1%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey 2023 n=41
Note: Data that were missing were not included in the percentage calculation.

Involvement with Local Planning Activities
Thirty-three (33) providers reported participation in local planning activities and program
coordination although only 35 grantees report that they require their providers to participate.
Planning activities include initiatives such as coordinated entry and coordinated assessments.

Collaboration with Other Organizations
Figure 8 displays the state/territory agencies that PATH grantees reported collaborations within
the past year regarding the PATH program. In 2023: 95 percent (95.0%) of the PATH grantees
reported working with housing agencies; nearly 88 percent (87.5%) with mental health agencies;
almost 83 percent (82.5%) with substance use treatment services; 80 percent (80.0%) with health
organizations; 75 percent (75.0%) with the VA; 75 percent (75.0%) with benefits agencies; almost
73 percent (72.5%) working with the criminal justice system; 70 percent (70.0%) with
employment or vocational rehabilitation agencies; nearly 68 percent (67.5%) with transportation
agencies; and 65 percent (65.0%) with education agencies.
PATH grantees also reported collaborating with other departments or offices within their own
agency (47.5%), other agencies (32.5%), and other (12.5%).

Figure 8. State/Territory Agencies Working with PATH Grantees, 2023

Housing

95.0%

Mental Health

87.5%

Substance Use Treatment Services

82.5%

Health

80.0%

Veterans Affairs

75.0%

Benefits

75.0%

Criminal Justice System

72.5%

Employment or Vocational Rehabilitation

70.0%

Transportation

67.5%

Education

65.0%

Other Department within Grantee Agency

47.5%

Other Agency
Other

32.5%
12.5%

0.0%

50.0%

100.0%

Source: PATH SPC Web Survey 2023 n=40
Note: Data that were missing were not included in the percentage calculation.

Have Outcome and Process Goals Been Achieved?
This section provides information on the outcomes achieved by the PATH program in 2019
through 2021. Table 10 summarizes the PATH program achievements on each of three
measures for 2019 through 2021. Notably, in 2019, PATH grantees exceeded targets for
numbers of homeless persons contacted and percentage of enrolled persons who received
community mental health services. Targets for the number of homeless persons contacted and
percentage of persons with SMI who became enrolled in services were not met in 2020;
however, the targets for percentage of persons who became enrolled and percentage of
enrollees who received services were met again in 2021.
The declining numbers of homeless persons contacted, and the subsequent percentages
enrolled in FY2020 and FY2021 are likely due to two specific conditions during the COVID-19
pandemic. First, social distancing measures put in place by cities and communities starting in
March 2020 likely had an impact on outreach services being provided. Second, the CARES Act,
passed by Congress on March 25, 2020 and signed into law on March 27, 2020, appropriated $4
billion for the U.S. Department of Housing and Urban Development’s (HUD) Emergency

Solutions Grants Program “to prevent, prepare for, and respond to coronavirus, among
individuals and families who are homeless or receiving homeless assistance and to support
additional homeless assistance and homelessness prevention activities to mitigate the impacts
created by coronavirus” (U.S. Department of Housing and Urban Development, 2023). With this
increase in funding, many homeless service providers and shelters were able to expand their
capacity and provide safe shelter to people living on the street.
In 2019, the PATH program met PATH targets for two of the three measures:
▪

Number of homeless persons contacted (target exceeded – by 6%).

▪

Percentage of contacted homeless persons with SMI who became enrolled in services
(target not met – under by 4.7%).

▪

Percentage of enrolled homeless persons who received community-based mental health
services (target exceeded – by 9.5%).

In 2020, the PATH program met PATH targets for one of the three measures:
▪

Number of homeless persons contacted (target not met – under by 8%).

▪

Percentage of contacted homeless persons with SMI who became enrolled in services
(target not met – under by 5.1%).

▪

Percentage of enrolled homeless persons who received community mental health
services (target exceeded – by 1.1%).

In 2021, the PATH program met PATH targets for two of the three measures:
▪

Number of homeless persons contacted (target not met – under by 15%).

▪

Percentage of contacted homeless persons with SMI who became enrolled in services
(target met).

▪

Percentage of enrolled homeless persons who receive community mental health services
(target met).

Table 10. Performance Statistics, 2019–2021
FY2019

FY2020

FY2021

%
Target

Actual

%
Target

Actual

+/−
Numbers of
homeless
persons
contacted
(outcome)
Percentage of
contacted
homeless
persons with
SMI who
became
enrolled in
services
(outcome)
Percentage of
enrolled
homeless
persons who
received
community
mental health
services
(outcome)

120,000

126,990

+6.0%

%
Target

Actual

+/−
125,00

115,341

-8.0%

+/−
125,00

103,933

-15.0%

57.0%

52.3%

-4.7%

57.0%

51.9%

-5.1%

57.0%

56.6%

-0.4%12

55.0%

64.5%

+9.5%

64.0%

65.1%

+1.1%

64.0%

64.4%

+0.4%

Source for FY2019: https://www.samhsa.gov/sites/default/files/about_us/budget/fy-2021-samhsa-cj.pdf
Source for FY2020: https://www.samhsa.gov/sites/default/files/samhsa-fy-2023-cj.pdf
Source for FY2021: https://www.samhsa.gov/sites/default/files/samhsa-fy-2024-cj.pdf

Considerations in Interpreting PATH Data
Understanding that HMIS and APR data can only convey so much, SPCs and provider staff
discussed some considerations in interpreting that data.

12 This goal is considered met due to rounding.

SPCs in both states pointed out that counts of people contacted, enrolled, and participating in
services may not be recorded accurately in HMIS due to limited staff resources and training
issues. Service providers also noted that APR and HMIS data show whether a client obtained
housing but do not necessarily reflect improvements in quality of life or that the client may have
received other needed services or been connected to other resources for assistance.

Changes in PATH Program as a Result of the COVID Pandemic
In response to the COVID pandemic, provider agencies implemented telehealth services, which
are still offered where appropriate. Additionally, both states described an increased emphasis on
safety for outreach workers, including personal protective equipment and safety supplies, and
training from state public health department staff on best practices for working with unsheltered
homeless populations. Service providers also noted that after the worst of the pandemic,
outreach became more difficult, as many encampments had moved locations and were hard to
find.

What SPCs and Provider Staff Would Like SAMHSA to Know
Interviewers asked SPCs and provider staff what they would like SAMHSA to know in addition to
what was asked. SPCs for both states emphasized the critical need for outreach services and a
need for increased funding to meet that need with skilled outreach workers. Provider staff
added that PATH services are especially important for people in rural areas who otherwise would
not have access to mental health services. One SPC cited a need for more standardization in
processes and data requirements for PATH, suggesting that better alignment between HMIS and
CoC data requirements would make data entry less onerous for staff. Provider staff discussed
the urgent need for increasing the affordable housing stock with innovative ideas, citing tiny
houses as a possible option. One provider also pointed out that there is a gap in services for
people who are not literally homeless but unstably housed—for instance, couch surfing or
passing into and out of homelessness.

CONCLUSIONS
The PATH program continues to serve a vital purpose, particularly as communities struggle to
find solutions for increasing rates of unsheltered and chronic homelessness. SPCs and provider
agency staff interviewed for this report were eager to emphasize the crucial need in their states
for PATH services, and all of the interview participants emphasized that there is a significant
need for more resources, increased funding, and more affordable housing stock for people with
SMI who are experiencing homelessness.
•

The PATH Program met more targets in outreach, enrollment, and service provision in
this three-year period than in the previous one (2016-2018) despite some restrictions
placed on provider staff due to the COVID pandemic in 2020 and 2021.

•

The addition of a qualitative data collection for this report provided greater levels of
detail and context in findings from annual reports and the SPC survey. Although the
limited number of grantees interviewed is not large enough to extrapolate the findings
broadly, the information learned from talking with staff at the state and provider levels in
two states allowed for a more nuanced understanding of the PATH program at the
community level.

•

In both states where qualitative data were collected, SPCs and provider staff alike
reported that recruitment and retention of qualified staff came up as a major challenge
for provider agencies.

•

The burden caused by data collection and reporting was cited frequently as an
impediment to optimal service delivery, requiring a disproportionate amount of staff
time.

•

Staff at all provider agencies described the lack of affordable housing options as a severe
limitation to the effectiveness of PATH services. Without appropriate, affordable housing,
PATH providers reported having to focus their resources on survival strategies for clients
rather than being able to offer services for longer-term stability.

RECOMMENDATIONS
Based on data collected for this report through surveys and qualitative interviews with grantees,
the following are recommendations for the PATH program and for future evaluation reports.
Programmatic Recommendations
•

SAMHSA should provide TA or training resources for data collection and reporting at the
provider level, including HMIS training for provider staff.
•

A resource for training outreach staff in HMIS data reporting could explain the
data points being collected in each question and the importance of these data
for understanding client needs at both the state and national levels.

•

A webinar or easily referenced question-by-question manual would allow
provider agencies to offer consistent training to all staff, including new staff
being onboarded in light of high turnover.

•

Increased resources to grantees for recruiting and retaining skilled staff at
provider agencies would allow for more consistency and quality in the delivery of
PATH services. Workforce shortages are a particular concern in the behavioral
health field and are addressed as a priority area in SAMHSA’s 2023-2026
Strategic Plan (SAMHSA, 2023).

Evaluation Recommendation
•

Consider the addition of a question to the SPC survey about whether their state or
territory would be willing to participate in qualitative data collection, either in person or
virtually. The qualitative data collected for this report were informative and valuable but
not generalizable. Input from additional grantees input is recommended.

References
Alegría, Margarita, Amanda NeMoyer, Irene Falgàs Bagué, Ye Wang, and Kiara Alvarez (2018).
Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current
Psychiatry Reports 20(95).
Chung, Timothy E., Agnes Gozdzik, Luis I. Palma Lazgare, Matthew J. T, Tim Aubry, James
Frankish, Stephen W. Hwang, Vicky Stergiopoulos (2018). Housing First for older homeless
adults with mental illness: a subgroup analysis of the St Home/Chez Soi randomized controlled
trial. International Journal of Geriatric Psychiatry, 33(1), 85-95.
De Sousa, Tanya et al (2022). The 2022 Annual Homelessness Assessment Report (AHAR) to
Congress. U.S. Department of Housing and Urban Development.
https://www.huduser.gov/portal/sites/default/files/pdf/2022-ahar-part-1.pdf
Hernández, Diana, PhD and Carolyn B. Swope, MPH (2019). Housing as a Platform for Health and
Equity: Evidence and Future Directions. American Journal of Public Health, 109, 1363-1366.
Perez, Rudy (2023). Homeless Encampment Sweeps May Be Draining Your City’s Budget.
Housing Matters; Urban Institute. https://housingmatters.urban.org/feature/homelessencampment-sweeps-may-be-draining-your-citys-budget
SAMHSA Homeless and Housing Resource Network, (2022). PATH Annual Report Manual.
Accessed December 11, 2023 from
https://mha.ohio.gov/static/Portals/0/assets/SchoolsAndCommunities/CommunityAndHousing/
HousingResources/PATH/PATH_2020_Annual_Report_Manual_Final.pdf?ver=9r0VnijrN3PhbISSM
fiCfw%3D%3D.
Substance Abuse and Mental Health Services Administration (2023). SAMHSA’s 2023-2026
Strategic Plan. Accessed December 11, 2023 from https://www.samhsa.gov/about-us/strategicplan.

U.S. Department of Health and Human Services, 2010. Justification of Estimates for
Appropriations Committees for FY2011. Accessed January 29, 2024 from
https://www.samhsa.gov/sites/default/files/samhsa_fy11cj.pdf.
U.S. Department of Housing and Urban Development (2023). Emergency Solutions Grants –
CARES Act (ESG-CV). Accessed December 11, 2023 from
https://www.hudexchange.info/programs/esg/esg-cv/#program-requirements.
U.S. Department of Housing and Urban Development (2022). New Data Shows 11% Decline in
Veteran Homelessness Since 2020—the Biggest Drop in More than 5 Years. HUD No. 22-225.
Accessed December 18, 2023.
https://www.hud.gov/press/press_releases_media_advisories/hud_no_22_225.

Appendix A. Logic Model

Appendix B. Survey Instrument
Welcome to the
National Evaluation of SAMHSA’s Projects for Assistance in Transition from
Homelessness (PATH)
State PATH Contact (SPC)
Web Survey

Thank you for taking time to complete the National Evaluation of SAMHSA’s Projects for
Assistance in Transition from Homelessness State PATH Contact (SPC) – Web Survey. The
questions in this survey are about your knowledge of and experience with [Name of Grantee
Organization]’s PATH program.
Please click the “Continue” button below to proceed of you are affiliated with [Name of
Grantee Organization]’s PATH program. Please click here if you are not affiliated with this
program [link to terminate].
CONTINUE button

______________________________________________________________________________
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-0381. Public reporting burden for this
collection of information is estimated to average less than 1 hour per respondent, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane,
Room 15E57-A, Rockville, Maryland, 20857.

OMB No. 0930-0381
Expiration Date 4/30/2026
Consent to Participate in the National Evaluation of
Substance Abuse and Mental Health Services Administration (SAMHSA)
Projects for Assistance in Transition from Homelessness (PATH)
State PATH Contact (SPC)
Web Survey
About the Study
This interview is part of the data collection for a national evaluation of SAMHSA’s Center for
Mental Health Services (CMHS) Projects for Assistance in Transition from Homelessness (PATH)
program, to ensure that the grantee and local programs are consistent with legislative
requirements and to recommend changes to the program design and operation. The Office of
Evaluation in the Center for Behavioral Health Statistics and Quality at SAMHSA is conducting
the evaluation. These questions were approved by the Department of Health and Human
Services, SAMHSA, CMHS.
We are contacting State and Territories PATH Contacts (SPCs) to get their perspectives on their
PATH project to help SAMHSA improve the PATH program and the supports they offer to clients
and grantees. You are one of 56 SPCs who may participate in this study. The following questions
ask about your agency’s PATH program.
The SPC web survey covers background information about your agency; the services provided
by your PATH program; your PATH providers; the monitoring and oversight of the PATH
providers; the target population of clients/consumers of focus for your program and your
experience implementing your program.
Voluntary Participation and Privacy
Your participation in this survey is completely voluntary. You may refuse to answer any question
in the survey, and you may stop participating at any time.
All the information you provide in this web survey will be kept private and will not be shared
with anyone from your agency or directly with CMHS. We will not divulge your individual
responses to your employer or anyone else outside of the research team. You will be assigned a
participant ID number and your name will not appear on the web survey; the information linking
your name and agency ID will be kept—separately from this consent and your responses—in a
password-protected folder accessible only to the evaluation team.
Risks and Benefits of the Study
Participation in this interview poses little risk to you. In addition to the privacy protections
described above, we will reduce the risk of inadvertent disclosure by associating your responses
with a unique identifier and not your name.

There are no immediate benefits of participation. No incentive for participation is provided.
Information from project directors and other key staff like you will be aggregated, and the
results will help stakeholders, practitioners, policy makers, researchers, and funders learn more
about the efforts of the SAMHSA CMHS PATH program and factors contributing to their success.
Results will help inform SAMHSA and future programs about what works.
Duration
This survey will take about 1 hour of your time. This includes the time for reviewing instructions,
searching existing data sources, gathering the data needed, and completing the interview.
Questions
You are welcome to contact our office any time if you have any questions. If you have any
questions about your rights as a study participant, you may email the PDX mailbox at
[email protected] as it is monitored by the evaluation team.
By clicking on “Consent” below, you agree to participate in the study. Please select “Consent”
only if:
✔ I understand the information about the study in this consent form, and
✔ I am willing to continue to participate in the study.
☐ Consent

☐ Do not consent

☐Substance Abuse and Mental Health Services Administration (SAMHSA)
Projects for Assistance in Transition from Homelessness (PATH)
State PATH Contact (SPC)
Web Survey
Module A: Grantee and State PATH Contact (SPC) Background
Please review and verify the pre-populated information about your PATH program.
[PREFILL GRANTEE1 – GRANTEE2]
[GRANTEE1]
Grantee Organization Name: [ALLOW 200]
[GRANTEE2]
Grantee Location – City: [ALLOW 50] State: |___|___|
[GRANTEE3]
Which of the following best describes the grantee organization? Agency, Department or Division
of:
o Aging and Disabilities
o Behavioral Health
o Behavioral Health and Developmental Disabilities
o Behavioral Health and Wellness
o Health
o Health and Disparities
o Health and Family Services
o Health and Hospitals
o Health and Human Services
o Health and Mental Hygiene
o Human Services
o Human and Social Services
o Mental Health
o Mental Health and Substance Abuse/Use or Addiction
o Mental Health, Developmental Disabilities and Substance Abuse Services
o Public Health
o Public Welfare
o Social Services
o Social and Health Services
o Other (Specify):

Next we would like to ask you some questions about yourself.
[ROLE1]
Are you the State PATH Contact (SPC) for this agency’s PATH program?
o Yes [1] [GO TO ROLE2]
o No [2] [GO TO ROLE3]
o Don’t know [98]
[ROLE2]
How long have you been in this position for this agency’s PATH program?
o Less than 6 months [1]
o More than 6 months but less than 1 year [2]
o 1-2 years [3]
o 3-5 years [4]
o 6-9 years [5]
o 10+ years [6]
o Don’t know [98]
SKIP TO ROLE5
[ROLE3]
What is your role in the PATH program?
o Alternate/Secondary SPC [1]
o Supervisor of the SPC or PATH program [2]
o Other (Specify):
[3]
o Don’t know [98]
[ROLE4]
How long have you been in this role for this agency’s PATH program?
o Less than 6 months [1]
o More than 6 months but less than 1 year [2]
o 1-2 years [3]
o 3-5 years [4]
o 6-9 years [5]
o 10+ years [6]
o Don’t know [98]

MODULE B: PATH PROGRAM ADMINISTRATION AND OVERSIGHT
The next questions are about the administration of your agency’s PATH program. First, we want
to know if there are specific target populations that have been designated as high priority
populations to be served by PATH providers in your state/territory.
[POP1]
Which of the following populations have been designated as high priority populations to be
served by your agency’s PATH providers? Check all that apply.
o Persons with serious mental illness (SMI) [1]
o Persons with co-occurring SMI and substance use disorders [2]
o People who are homeless [3]
o People who are literally homeless [4]
o People who are chronically homeless [5]
o Veterans [6]
o Persons with criminal justice backgrounds (e.g., previously incarcerated,
reentry/diversion, or on probation/adjudication) [7]
o People from racial and ethnic minority groups [8]
o Youth [9]
o People who are Lesbian, gay, bisexual, or transgender individuals, questioning and allies
(LGBT/LGBTQA) [10]
o Families [11]
o Other (Specify):
[12]
o No priority populations have been designated by your state/territory [13]
o Don’t Know [98]
[SERVICES]
The next questions are in regard to the PATH services provided by your agency’s PATH program.
For each PATH allowable/eligible service, we would like to know a) whether the service is an
allowable/eligible service within your agency’s PATH program; and b) whether the service is a
priority service within your PATH program. By priority service, we mean a service that is
emphasized within your agency’s PATH program or that is a focus of your agency’s PATH
program.
[SERV1A]
Are outreach services being provided within your agency’s PATH program?

o Yes [1]
o No [2] [Go to SERV2]
o Don’t know [98] [Go to SERV2]

[SERV1B]
Do your agency’s PATH providers conduct street outreach?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV1C]
Do your agency’s PATH providers conduct in-reach?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV2]
Are screening and diagnostic treatment services being provided within your agency’s PATH
program?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV3]
Are habilitation and rehabilitation services being provided within your agency’s PATH program?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV4]
Are community mental health services being provided within your agency’s PATH program?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV5]
Are alcohol or drug treatment services being provided within your agency’s PATH program?
o Yes [1]
o No [2]
o Don’t know [98]

[SERV6]
Is staff training being provided within your agency’s PATH program? Staff training includes the
training of individuals who work in shelters, mental health clinics, substance abuse programs
and other sites where persons who are homeless require services or training in program areas
such as outreach or engagement.
o Yes [1]
o No [2]
o Don’t know [98]
[SERV7]
Are case management services being provided within your agency’s PATH program?
o
o
o

Yes [1]
No [2]
Don’t know [98]

[SERV8]
Are supportive and supervisory services in residential settings being provided within your
agency’s PATH program?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV9A]
Are making referrals for other services (e.g., primary healthcare, job training, educational
services, and housing) being provided within your agency’s PATH program?
o Yes [1]
o No [2] [Go to SERV10A]
o Don’t know [98] [Go to SERV10A]
[SERV9B]
Which services do your agency’s PATH providers make referrals for? Check all that apply.
o Primary healthcare [1]
o Job training [2]
o Educational services [3]
o Housing [4]
o Other (Specify):
[5]
o Don’t know [98]

[SERV10A]
Are the PATH allowable housing assistance services being provided within your agency’s PATH
program?
o Yes [1]
o No [2]
o Don’t know [98]
[SERV10B]
Which PATH allowable housing assistance services are provided by your PATH providers? Check
all that apply.
o Minor renovation, expansion, and repair of housing [1]
o Planning of housing [2]
o Technical assistance in applying for housing assistance [3]
o Improving the coordination of housing services [4]
o Security deposits [5]
o Costs associated with matching eligible homeless individuals with appropriate
housing situations [6]
o One-time rental payments to prevent eviction [7]
o Other (Specify):
[8]
o Don’t know [98]
[EBP1]
Does your agency promote the use of Evidence Based Practices (EBPs) by your agency’s PATH
providers? By EBPs we mean interventions that are well-defined with established fidelity criteria
and/or manuals and that have research evidence behind them.
o Yes [1] [Go to EBP2]
o No [2] [Go to SELECT1]
o Don’t know [98]
[EBP2]
How does your agency promote the use of Evidence Based Practices (EBPs) by your agency’s
PATH providers? Check all that apply.
o State/territory provides program/intervention recommendations [1]
o State/territory provides funding for specific EBPs [2]
o State/territory provides funding incentives for the implementation of EBPs [3]
o Training provided by state/territory personnel [4]
o Training funded by the state/territory and provided by outside trainers [5]
o State/territory provides training materials [7]
o State/territory provides technical assistance [8]
o State/territory arranges and/or pays for technical from program developers or other
third-party technical assistance providers [9]
o Other (Specify):
[10]
o Don’t know [98]
56

[EBP3]
Which of the following EBPs does your agency promote for use by your agency’s PATH
providers? Check all that apply.
o Assertive Community Treatment (ACT) [1]
o Cognitive Behavioral Therapy (CBT) [2]
o Critical Time Intervention (CTI) [3]
o Housing First Model [4]
o Illness Management and Recovery (IMR) [5]
o Integrated Dual Disorder Treatment (IDDT) [6]
o Intensive Case Management (ICM) [7]
o Motivational Interviewing [8]
o Motivational Enhancement Therapy (MET) [9]
o Permanent Supportive Housing [10]
o Screening and Brief Intervention (SBI) [11]
o Seeking Safety [12]
o SSI/SSDI Outreach, Access, and Recovery (SOAR) [13]
o Trauma Recovery and Empowerment Model (TREM) [14]
o Trauma-informed care [15]
o Wellness Recovery Action Plan (WRAP) [16]
o Other (Specify):
[21]
o Don’t know [98]
The next few questions are regarding the selection of your agency’s PATH providers and the
allocation of PATH funds.
[SELECT1]
How are your agency’s PATH providers selected for funding? Check all that apply.
o Prevalence of potential PATH-eligible clients in the geographic area or region [1]
o Past performance of a provider [2]
o Availability of interested and capable providers in the geographic area or region of
state/territory [3]Using a competitive procurement process [4]
o Other (Specify):
[5]
o Don’t know [98]
[ALLOCATE1]
How are PATH funds allocated to your agency’s providers? Check all that apply.
o Population formula [1]
o Level of need [2]
o Other (Specify):
[3]
o Don’t know [98]
The next few questions are about the types of organizations that receive PATH funds.

[TYPE1]
Does the state/territory limit what type of provider can receive PATH funds?
o Yes [1] [Go to TYPE2]
o No [2] (Go to INTERMEDIARY1]
o Don’t know [98]
[TYPE2]
What types of providers can apply for PATH funds? Check all that apply.
o Community mental health center [1]
o Consumer-run mental health agency [2]
o Other mental health agency [3]
o Social service agency [4]
o Shelter or other temporary housing resource [5]
o Other housing agency [6]
o Health Care for the Homeless/other health agency [7]
o Substance use treatment agency [8]
o Other (Specify):
[9]
o Don’t know [98]
The next question is regarding the use of intermediary organizations to provide PATH funds to
providers.
[INTERMEDIARY1]
Are PATH funds provided through intermediary organizations?
o Yes [1]
o No [2]
o Don’t know [98]
The next few questions are regarding the programmatic and financial oversight of your agency’s
PATH funded providers.
[OVERSIGHT1]
What are the methods utilized to monitor your agency’s PATH providers? Check all that apply.
o Site visits [1]
o Regularly scheduled meetings or teleconferences [2]
o Review of progress reports [3]
o Review of HMIS or other data [4]
o Evaluation of performance goals [5]
o Review of financial documents or billing [6]
o Audits [7]
o Other (Specify):
[8]
o Don’t know [98]

[OVERSIGHT2]
How are concerns with the performance of your agency’s PATH providers handled? Check all
that apply.
o Technical Assistance [1]
o Training [2]
o Corrective Action Plans [3]
o Quality Improvement Projects [4]
o Other (Specify):
[5]
o Don’t know [98]

MODULE C: TECHNICAL ASSISTANCE AND TRAINING
The next few questions are about the technical assistance and training that your agency’s PATH
program may have received during the past year?
[TTA1]
Has your agency’s PATH Program provided technical assistance to your agency’s PATH providers
in the past year?
o Yes [1]
o No [2]
o Don’t know [98]
[TTA2]
Has your agency’s PATH Program provided trainings to your agency’s PATH providers in the
past year?
o Yes [1]
o No [2]
o Don’t know [98]
[PROGRAMMER NOTE: If TTA1 =1 OR TTA2 = 1, GET TTA3; ELSE SKIP TO MODULE D]
[TTA3]
In what areas has your agency’s PATH program provided technical assistance or training to
PATH providers in the past year? Check all that apply.
o
o
o
o

Development of Intended Use Plans [1]
Determining client eligibility for PATH services [2]
Enrolling clients for PATH services [3]
PATH-eligible services; specify: [4]
o Evidence-Based Practices (EBPs) (general trainings or trainings on specific EBPs) [5]
o Data Collection [6]
o Data Reporting [7]
o Annual Survey Report [8]
o Homeless Management Information Systems (HMIS) [9)
o Transitioning clients out of PATH services [10]
o Other (Specify):
[11]
o Don’t Know [98]

[PROGRAMMER NOTE: If TTA5 =5, GET TTA6; ELSE SKIP TO MODULE D]
[TTA6]
Since you selected EBP in the last question, please select EBPs used by your agency’s PATH
program below. Check all that apply.
🞎 Assertive Community Treatment (ACT) [1]
🞎 Cognitive Behavioral Therapy (CBT) [2]
🞎 Critical Time Intervention (CTI) [3]
60

🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎
🞎

Housing First Model [4]
Illness Management and Recovery (IMR) [5]
Integrated Dual Disorder Treatment (IDDT) [6]
Intensive Case Management (ICM) [7]
Motivational Interviewing [8]
Motivational Enhancement Therapy (MET) [9]
Permanent Supportive Housing [10]
Screening and Brief Intervention (SBI) [11]
Seeking Safety [12]
SSI/SSDI Outreach, Access, and Recovery (SOAR) [13]
Trauma Recovery and Empowerment Model (TREM) [14]
Trauma-informed care [15]
Wellness Recovery Action Plan (WRAP) [16]
Other (Specify):
[17]
Don’t know [98]

MODULE D: HOMELESS MANAGEMENT INFORMATION SYSTEM
[HMIS1]
What percentage of your agency’s PATH providers use HUD’s Homeless Management
Information System (HMIS) for the PATH Program?
o 0-25% [1]
o 26-50% [2]
o 51-75% [3]
o 76-99% [4]
o 100% [5]
o Other (Specify):
[6]
o Don’t know [98]
[HMIS2]
Does your agency’s PATH program work with local HMIS administrators to assure that PATH
providers are trained in the use of HMIS?
o Yes [1]
o No [2]
o Don’t know [98]
[HMIS3]
How are HMIS data being used by your agency’s PATH program? Check all that apply.
o Not yet being used [1]
o To plan PATH services or activities [2]
o To monitor local PATH providers [3]
o To monitor PATH consumer participation in services or housing [4]
o To monitor PATH consumer outcomes [5]
o To report Annual Survey/PATH Data [6]
o To report to other state or federal agencies [7]
o Other (Specify):
[8]
o Don’t Know [98]

MODULE E: CONTINUUM OF CARE
The next few questions are about involvement with the HUD Continuum of Care (CoC) program.
[COC1]
Regarding participation in the HUD CoC program:
Agency
Agency’s PATH
program

Yes [1]
o
o

No [2]
o
o

Don’t Know [98]
o
o

[COC2]
Does your agency’s PATH program work with the CoCs to facilitate use of HMIS for PATH data
collection?
o Yes [1]
o No [2]
o Don’t know [98]
[COC3]
Does your agency’s PATH program work with the CoCs to facilitate timely service coordination?
o Yes [1]
o No [2]
o Don’t know [98]
[COC4]
Are your agency’s PATH providers required to collaborate with or work with their CoCs?
o Yes [1]
o No [2]
o Don’t know [98]
[COC5]
Regarding participation in other local planning activities and program coordination initiatives,
such as coordinated entry and coordinated assessments activities:

Agency
Agency’s PATH
program

Yes [1]
o
o

No [2]
o
o

Don’t Know [98]
o
o

[COC6]
Are your agency’s PATH providers required to participate in other local planning activities and
program coordination initiatives, such as coordinated entry and coordinated assessments
activities?
o Yes [1]
o No [2]
o Don’t know [98]
63

MODULE F: COLLABORATION WITH OTHER ORGANIZATIONS
Next, we want to know about your grantee’s collaboration with other state/territory agencies
and national organizations.
[COLLAB1]
First, we want to know what other state/territory agencies you have worked with in the past year
regarding your agency’s PATH program and the type of coordination. Check all that apply.
MOU/
MOA

Budget
Sharing

Contract Joint
Informal
for
Committees interactions
service
/ task forces
/workgroups

Not
Don’t
applicable Know
(e.g., is
grantee
agency)
o
o
o
o

Mental Health
o
o
o
o
o
Substance Abuse
o
o
o
o
o
Treatment Services
Health
o
o
o
o
o
Housing
o
o
o
o
o
Benefits
o
o
o
o
o
Veterans Affairs
o
o
o
o
o
Criminal Justice
o
o
o
o
o
System (includes
Corrections and
Public Safety)
Employment or
o
o
o
o
o
Vocational
Rehabilitation
Education
o
o
o
o
o
Transportation
o
o
o
o
o
Other Agency
o
o
o
o
o
Other
o
o
o
o
o
Departments/Offices
within your own
Agency or
Department
Other (please
_______________________________________________________________
specify)

o
o
o
o
o

o
o
o
o

[COLLAB2]
Please specify the topic or subject matter of coordination with each state/territory agency you
previously identified.
Agency
Mental Health
Substance Abuse
Treatment Services
Health
Housing
Benefits
Veterans Affairs
Criminal Justice System
(includes Corrections and
Public Safety)
Employment or
Vocational Rehabilitation
Education
Transportation
Other Agency
Other
Departments/Offices
within your own Agency
or Department
Other (please specify)

Topic

[COLLAB3]
Did your agency’s PATH program consult/collaborate with national-level organizations to better
serve PATH consumers in the past year?
o Yes [1] [GO TO COLLAB4]
o No [2] [GO TO CLOSE1]
o Don’t know [98]
[COLLAB4]
Please indicate which organization(s) your agency’s PATH program consulted with. Check all that
apply.
o Health Care for the Homeless [1]
o National Alliance to End Homelessness [2]
o National Coalition for the Homeless [3]
o National Center for Family Homelessness [4]
o U.S. Interagency Council on Homelessness [5]
o U.S. Department of Veterans Affairs [6]
o U.S. Department of Labor: One-Stop Career Centers [7]
65

o
o
o
o
o
o
o
o
o
o

U.S. Department of Housing and Urban Development [8]
Corporation for Supportive Housing (CSH) [9]
Technical Assistance Collaborative (TAC) [10]
National Alliance on Mental Illness (NAMI) [11]
National Association for State Mental Health Program Directors (NASMHPD) [12]
National Council of Community Behavioral Health [13]
State Association of Addiction Services (NRHA) [14]
National Rural Health Association [15]
Other (Specify)
[16]
Don’t know [98]

[CLOSE1]
Finally, please provide any additional information about the SAMHSA PATH program or your
organization that you think is important and would like to share. You will also have an
opportunity to share additional feedback if selected for a Site Visit Interview.
[ALLOW 1000]
THANK YOU VERY MUCH for participating!
Information from key stakeholders like you will help practitioners, policy makers, researchers and
funders better understand the efforts of SAMHSA PATH program, including factors contributing
to success, which we hope will improve future efforts to reduce homelessness and provide
clients the services they need.
[NEW SCREEN]
[IF GRANT ORGANIZATION NOT ACCURATE]
[TERMINATE]
We are sorry for the confusion. A team member from the National Evaluation of SAMHSA’s
PATH Program will look into the problem and get back to you.
If you have any questions or need to speak with someone about this National Evaluation of
SAMHSA’s PATH Program or the SPC web survey, please contact the evaluation team at
[email protected].

Appendix C. SPC Interview Guide
State PATH Contact (SPC) Discussion Guide
Introductions/Icebreaker: How long have you been with your agency? How long have you
worked with PATH? What brought you to PATH? What percentage of your time is spent on
PATH activities?
A. Are there important state-level changes that we should understand (for example,
changes in funding, policy, etc.) that affect your program’s implementation or
effectiveness?
B. How is the PATH program implemented in your state (what makes each state unique?
What could be done better and what is going well?)
a. How would you describe your agency’s mission and its role in the local treatment
and service system? How does the PATH program help fulfill your agency’s
mission?
b. What are your program goals for this year?
c. How are providers selected? How are they supported and managed?
d. If your agency has any other SAMHSA grants, what are they and are they related
to PATH?
e. What are the characteristics of the local treatment and service system for the
target population?
f.

What agencies do you collaborate with to provide services? These could include
other state or federal agencies and PATH providers. What is their role in the
program and in the larger treatment and service system?

g. Who are your community partners? Are there any groups that you aren’t working
with, but would like to? For examples, demographic groups from your disparity
impact statement?
h. Are there any specific populations that you are trying to reach out to?

If they have identified specific populations: Have there been challenges reaching
and involving the special populations you mentioned earlier?

What is your program doing to be culturally competent?

C. Barriers and challenges
a. How does your state conduct provider oversight? For example, review of annual
report data, site visits, record reviews, and audits.
b. How is inadequate performance by a PATH provider corrected? Examples include
not meeting contract obligations with the state, and not in compliance with PATH
requirements/statutes.
c. What are the biggest barriers/challenges faced by your program at the state or
local level) in implementing or delivering PATH services? Some examples are:
i. Identifying and enrolling the intended numbers of program clients
ii. Selecting providers
iii. Conducting provider oversight
iv. Managing data collection
v. Providing training
d. Have there been any challenges to integrating the PATH grant within your
agency? Any major gaps in treatment/services, wraparound services?
i. How is the PATH program targeting these gaps?
ii. What gaps are not being addressed?
e. Has the grant led to any innovations at your agency or your partners? For
example, are there new processes, technologies, or tracking approaches?
f.

What are some examples of successful approaches used to overcome them and
the lessons learned? (expeditors/facilitating)

g. Are there important state-level changes that we should understand (for example,
changes in funding, policy, etc.) that affect your program’s implementation or
effectiveness?

D. How do you use the PATH data?
a. What have you learned from the data? Was anything surprising?
b. Was any useful data missing?
c. For states that require progress reports: how do you use the progress report data?
d. How well does the program track client outcomes that are related to treatment,
case management and housing services? Do you feel the Annual
Report/Homeless Management Information System (HMIS) questions are useful
measures for the clients’ outcomes?
e. Are there limitations with the data for your clients and their outcomes in the
Annual Report and HMIS? In other words, what should we consider when we
interpret Annual Report/HMIS outcomes for this grantee?

E. We will now talk about the HMIS data system and using PDX for the annual reporting.
a. How does data collection and submission work within your agency? What is the
status of the HMIS implementation/migration? Are PATH funds utilized to
support HMIS implementation activities?
b. What do you (the SPC) think about the mandatory use of HMIS and submitting
annual data using a .csv upload?
c. Do you use PDX to look at the data you receive from your providers? What do
you use it for? If not, why not?
Approximately what percentage of your providers use HMIS for their PATH data?
Do any of them use the PDX system to look at their data? How are they using it?
i. For the providers that do use HMIS: what are some of the advantages of
using HMIS?
ii. What are some of the challenges or disadvantages in implementing HMIS
and PDX?
d. For the providers who are not submitting their data through HMIS: What do you
predict they will say about the mandatory use of HMIS and submitting their
annual data using a .csv upload?
69

e. How could the PDX system become more user-friendly for you and for the
providers?
F. What has changed in PATH specifically due to the pandemic?
a. What has been the impact on PATH during the pandemic? Were new processes
introduced? Have any of them been adopted as standard practice (such as
telehealth)?
G.

n/a (this section is for clients)

H. Is there anything we did not ask that we should have?
If you could tell Congress one thing about PATH and/or your community, what would it
be?

Appendix D. Provider PATH leader interview guide
PATH Service Provider Leadership Discussion Guide
A. (Icebreaker question, after introductions) What are the biggest challenges faced by the
homeless population in your state in general (such as gaps in services)? What are some
factors that make your program unique?
a. What are important state-level changes that we should understand (for example,
changes in funding, policy, etc.) that affect your program’s implementation or
effectiveness?
B. How PATH is implemented
a. How do you identify program clients? Please explain how you screen or assess
program clients.
b. How do you keep program clients engaged? What processes, tools or incentives
do you use? What are some best practices that you use or have developed?
c. How has the population that you are serving changed since submitting the last
application?
d. Which specific populations are you trying to reach out to?
i. Have there been challenges reaching and involving these special
populations?
e. What is your program doing to be culturally competent?
f.

What treatment services are provided by your program? (List all treatment
services and ask follow-up questions for each.)
i. Who (agency/staff) provides the service?

g. What specific case management/wraparound services are provided? (List all case
management/wraparound services and ask follow-up questions for each.)
i. What goals and objectives does the program have for case
management/wraparound services with respect to client outcomes?

h. How does your program track client outcomes (treatment, case management and
housing services)?
i.

Since you started receiving PATH funding, how has the process for accessing
housing changed?

How does your program integrate, housing, treatment, and wraparound services?
So far, how successful has your program been in integrating these services?

k. How and when are program clients discharged? Are services provided after
discharge?
C. Barriers/Challenges faced by your program
a. What are the biggest barriers/challenges faced by your program in implementing
or delivering PATH services? These could be at the state or local level. For
example,
i. Finding and reaching out to people in your community who would be
helped by the PATH-funded services that you offer?
ii. Getting your clients the services that they need.
iii. Bottlenecks or points in the program where clients drop out or terminate
services or housing?
iv. What is the attrition rate? Does your program have any special
procedures to address attrition?
b. What are some examples of successful approaches used to overcome the
barriers, and the lessons learned?
c. How has the grant led to innovations at your agency? For example, what new
processes, or technologies that you are now using?
D. How does your program use the PATH data?
a. What have you learned from the data? Was anything surprising?
b. For states that require progress reports: how do you use the progress report data?

c. How are the items in the Homeless Management Information System (HMIS) and
Annual Report useful measures for your client outcomes?
d. What important data missing are missing? What other outcomes do you think
that PATH should track?
e. What do you want us to know about your program that may differ from the story
the data show?
E. Does your program use the U.S. Department of Housing and Urban Development (HUD)
Homeless Management Information System (HMIS) for the PATH program?
a. [If no] What happened when you tried submitting your data to HMIS and then
uploading the .csv file?
b. [If yes] What are some of the advantages of using HMIS?
c. [If yes] What are some of the disadvantages or challenges?
d. What are some ways that the HMIS and PDX systems could be more userfriendly? Or help make you more comfortable using it?
i. Training in PDX
ii. Getting technical help when you need it (from state/grantee)
e. How often do you look at the annual reports and tables at the SAMHSA website?
How often have you run tables from the PDX website?
F. Now we’d like to talk about the impact that the COVID pandemic had on your program.
What has changed in PATH specifically because of the pandemic? What did you change
in your work processes or outreach with your clients? Which of these new processes do
you plan to continue? (Such as telehealth)?
G.

n/a (this section is for clients)

H. What did we not ask that we should have?
If you could tell Congress one thing about PATH and/or your community, what would it
be?

SAMHSA envisions that people with, affected by, or at risk for mental health and
substance use conditions receive care, achieve well-being, and thrive.
1-877-SAMHSA-7 (726-4747) | 1-800-487-4889 (TTY) | www.samhsa.gov