A More Caring Path Forward: Why Accountability Programming Matters Now
December 1, 2025
With the release of the recent HUD CoC Program Notice of Funding Opportunity (NOFO), there has been a significant knee-jerk reaction to the accountability program model. Understandably, this model was previously abandoned in favor of evidence-based practices that show higher service adoption and success rates through low-barrier models. Meeting people where they are and accepting them into services without restriction has historically increased programming acceptance and created the stability necessary for individuals to meaningfully adopt these supports.
However, the introduction of fentanyl to the American landscape and the increase in predatory behavior in and around vulnerable populations have fueled public concern about safety and contributed to a growing mischaracterization of people experiencing homelessness. What worked before is obviously not working now. As drug use rises, overdose death numbers skyrocket, and medical treatment bed supply diminishes, we must adapt our strategies to consider the need for a more structured and treatment-driven approach to saving the lives of our neighbors.
In the past, people have inappropriately associated “accountability” with punishment – law enforcement engagement, jails and prisons, or people being held against their will. In reality, accountability simply means supporting individuals in taking responsibility for their actions while providing structure around service delivery and utilization. This approach improves outcomes, reduces costs, and allows limited resources to be scaled more effectively to strengthen public health and safety across the U.S. Without this shift, we risk continuing to make only incremental progress as the crisis accelerates beyond our capacity to respond.
Through our work at Pallet and our sister company WELD, we have seen firsthand how accountability programming can transform lives. We know it can work. And we want communities to understand that accountability can be designed—and delivered—in ways that are dignified, compassionate, and deeply humane.
Why This Moment Matters So Much
HUD Point-in-Time counts over the past decade show homelessness steadily rising, with more than 750,000 people experiencing homelessness on any given night in 2024. At the same time, people who are unhoused experience significantly higher rates of substance use and substance-related emergency care than the housed population, a trend reflected across national health statistics and recent studies.
A critical distinction often gets lost in this discussion: substance use is not typically the cause of homelessness. In most cases, it begins after a person becomes homeless as a response to trauma, exposure, predatory behavior, and the daily realities of living unsheltered. Once substance use begins, these same conditions exacerbate and perpetuate it. Regardless of where the cycle begins, we are now facing unprecedented levels of behavioral health needs across the country.
As noted in the July Executive Order, these intersecting challenges have evolved into urgent public safety concerns, and people need access to effective treatment. Evidence shows that forced treatment rarely succeeds. However, interrupting dangerous behavioral cycles can create the space people need to consider alternatives, and pairing stability with accountability offers a structured path toward reintegration that supports sustainable recovery.
To date, our systems have overinvested in stabilizing housing without providing the level of services needed to disrupt the underlying cycles of homelessness, incarceration, and addiction. These cycles are deeply costly — to individuals, to families, and to entire communities.
These overlapping trends aren’t just numbers. They represent lives at risk, rising emergency system costs, and communities strained by responding to the same crises again and again. If we continue addressing these issues only episodically — an ER visit here, a shelter bed there — we will perpetuate a pattern of harm and extraordinary expense without creating lasting change.
What Accountability Programming Really Is — and What It Isn’t
Accountability programming is a structured approach within homeless-service programs that requires participants to follow specific expectations, such as engagement in case management, treatment, employment activities, or sobriety, in exchange for ongoing shelter access or housing-related services. It emphasizes personal responsibility and behavioral compliance as a condition of support.
Accountability programming is not: punitive control.
The most effective models pair clear expectations with wraparound supports — in other words, dignity plus structure.
What We’ve Seen Work: Accountability Paired with Real Support
Several lines of research show that programs that build structure and measurable reinforcement into care produce better outcomes for people with substance use disorder who are experiencing homelessness. Some examples that I have seen work:
• Behavioral incentive models such as contingency management (which provides tangible rewards for verified abstinence or engagement) consistently outperform treatment as usual for reducing substance use in clinical trials and reviews. That makes contingency management a high-value component for programs serving unhoused people with substance use disorders.
• Focused case-management interventions — especially those that are strengths-based, coordinated across agencies, and delivered with fidelity — improve housing stability and can reduce substance use over time compared with fragmented care. The literature shows solid improvements in housing outcomes when case management is well designed and resourced.
Housing First models that combine immediate access to housing and shelter with voluntary supports increase housing retention and quality of life; some randomized trials have also documented reductions in alcohol problems and improved health outcomes over time when housing is paired with supportive services. Housing and shelter plus accountability and treatment access is more effective than coercive or housing-contingent approaches alone.
Traditional Housing First models in the U.S. have prioritized housing without effective and timely offering of services – for two reasons:
- excessive cost of housing and capital expenses, which minimized or excluded funding for necessary and appropriate service models
- lack of service provider capacity in this country resulting from poor wages, unsafe environments for providers, and underinvestment in the supports needed to recruit and retain talent.
Taken together, this data points to a clear conclusion: accountability without support is unfair; support without measurable expectations is inefficient — combine both, and human outcomes improve.
Why Accountability Programming Saves Communities Money
When people repeatedly cycle through emergency departments, jails, and shelters, communities shoulder huge costs. Evidence shows that stable housing and effective treatment reduce emergency utilization, hospitalizations, and criminal-justice involvement, and that targeted accountability approaches increase engagement with services that prevent costly crises.
Investing in accountable, coordinated care therefore pays back in avoided emergency spending and better population health.
How to Do Accountability Programming the Right Way
To be ethical and effective, accountability programming should follow these principles:
- Voluntary and trauma-informed initial engagement. Make accountability a pathway people choose, with supports tailored to trauma histories. Most people will voluntarily choose programming once they have had a chance to stabilize enough to receive offered care. Non-congregate shelter with continuous access to beds, hygiene facilities, food, and basic necessities dramatically increases the likelihood of service participation and adoption.
- Low-barrier access to housing and treatment. Don’t require perfect sobriety for help; instead, meet people where they are and use incentives to shift behavior. Once someone has begun to stabilize, setting timelines for meaningful service participation is appropriate.
- Integrated teams and data sharing. Coordinated case management across housing, health, and behavioral-health systems prevents gaps that lead to relapse or return to homelessness.
- Clear, measurable goals and small, immediate incentives. Short-term wins (attending appointments, drug-free urine tests) and modest rewards increase motivation and retention.
- Peer involvement and lived-experience leadership. Peer mentors increase trust, engagement, and cultural competence in accountability systems.
The Moral and Practical Case for Compassionate Accountability
Morally: accountability programming respects dignity by treating people as partners with agency, not passive recipients of charity. Practically: it lowers downstream costs, increases housing stability, and improves health outcomes. Policymakers and funders face a choice: keep paying for the revolving-door approach of crisis response, or invest in accountable, integrated systems that help people stabilize and rejoin communities. The evidence and common decency argue for the latter.
What Communities Can Do Now
• Scale contingency management and incentives for community programs (with safeguards to prevent misuse).
• Fund low-barrier housing and shelter expansion with mandatory, funded case management and treatment access.
• Invest in integrated data systems so case managers, behavioral-health providers, and housing navigators can coordinate in real time.
• Support peer workforce development so people with lived experience can lead engagement and accountability efforts.
• Measure what matters: housing retention, treatment engagement, reduced emergency-service use, and client-reported quality of life.
A Final Word from Me
Accountability programming — thoughtfully designed, well-resourced, and grounded in evidence — is a bridge from crisis to stability. It combines human dignity with practical structure, incentivizing progress while providing the supports people need to keep going after setbacks. As homelessness and substance use trends worsen, scaling accountable, compassionate programs is not only the right moral choice — it’s the smartest investment communities can make.
Historically, we have not invested in these types of programs because of our focus on low-barrier access. While low-barrier models bring more people inside faster, the current state of affairs suggests that this model alone is not moving most people toward rehabilitation and keeps people cycling through the same systems and behaviors they are struggling to find freedom from.
Pallet’s sister non-profit, Weld Seattle, runs programs designed and led by people with lived experience. These staff taught me and their community about the importance of accountability — both personal and community-based — in sustained recovery and successful reintegration. Weld’s program models have some of the highest success and lowest recidivism in the country and, until recently, had to be privately funded because of low-barrier requirements to qualify for public funding. That restriction didn’t stop Weld from doing what they knew would work.
After almost a decade, Weld is providing housing, employment connection, digital and financial literacy, clinical services, and meaningful community to some of the most vulnerable citizens in King County. For every $1 spent on services at Weld, the social return on investment is $13.20.
Building accountability into programming, which helps people return to independence and self-sufficiency, returns them to their families, friends, and communities, breaking generational cycles of homelessness, addiction, and criminal justice involvement.
This is truly life-changing work saving lives and driving community and economic growth at the most granular level. If we can return mothers and fathers, sons and daughters, aunts and uncles, employees, and friends to a life of purpose, passion, and meaningful connection, we will be doing so much more for them and for ourselves than just housing them. We’ll be rebuilding families, networks, opportunities, and advancing our collective future.
Every life matters. Let’s prove that by changing their reality through compassionate, accountable care that not only keeps them alive, but allows them to live and thrive.
