Abstract
This mixed-methods study addresses transitions out of homelessness associated with medical and substance abuse service use for a unique cohort of 174 chronically homeless street dwellers at risk of death. Multi-nominal and survival analyses indicate that high-risk women, white street dwellers, older individuals, and those with health insurance coverage had greater odds of leaving the streets. Thouh high-risk street dwellers used health services extensively, medical and substance abuse treatments did not impact positive housing outcomes, except for extended stays at homeless respite care. Policy implications include the need for increasing affordable housing options and integrating housing services into any type of health services for chronically homeless street dwellers.