The decision to leave an abusive relationship can be one of the most awful to make, and when children are involved, the difficulty in doing so is magnified. Whether to stay in a situation that has already resulted in physical or emotional pain—or both—or leave without anywhere to go is a Morton’s Fork: Neither option is a healthy solution. The reality is the majority of women experiencing homelessness in the United States today have experienced domestic violence, although an exact figure is difficult to pinpoint. (Men also experience domestic violence, but their numbers are far smaller.) Yet, as with any demographic, there’s no one-size-fits-all response. “There’s a lot of interest in looking at survivor-driven choices for housing options,” says Marylouise Kelley, PhD, director of the Family Violence Prevention & Services Program in the Family and Youth Services Bureau at the Department of Health and Human Services (HHS). “They present a new opportunity that, along with shelter, can be options for victims of domestic violence who need something different.” Sometimes what’s most helpful might be as simple as paying a nurse’s licensing fee so she doesn’t lose her job, changing the locks in her apartment, or providing the money for her to take a bus across town to get to work or school. “If what she needs is to stay in her own home, and some legal advocacy to help her get a protection order would be helpful, that’s what she gets,” says Kelley, who is also co-chair of the domestic violence subgroup of the United States Interagency Council on Homelessness (USICH) Interagency Working Group to End Family Homelessness. Pilot Projects Show Promise But for those women who don’t have a place to call home, the Housing First model has recently been tested and found beneficial. The Domestic Violence Housing First (DVHF) pilot, a Bill & Melinda Gates Foundation-funded program in Washington state, proved successful in eliminating housing as a reason for survivors to stay in abusive relationships. By following the standard Housing First approach of getting survivors stably housed before focusing on the supports each one needed, DVHF found that 96% of its participants, who came from diverse populations—46 different languages were spoken in survivors’ homes and 67% of them lived in rural communities—were still housed 18 months after entering the program. But given the universal domestic violence component, unlike traditional Housing First, whose main goal is securing permanent housing as quickly as possible, the pilot’s priorities were the safety, self-determination, and healing from trauma of the survivors and their children. “The idea of Housing First is you begin by asking the survivor what they need and what they want,” says Kelley. So while one woman may need safe housing in a shelter, with an onsite support system, that’s where she’ll go, while someone who feels ready to be on her own with ongoing support from outside might be housed in an apartment complex with a landlord who understands the situation and can be alerted to the inherent risks. Kelley says there are endless options, and the choice depends on what the survivor needs for her own safety. Other states are working on or already have functioning similar programs—Kelley says Volunteers of America Oregon’s Home Free is another domestic violence–focused housing innovation based on Housing First that’s been in use for several years and has been named a National Alliance to End Homelessness best practice. But because the DVHF program requires flexible funding, its adoption might prove challenging for some states. Jasmine Hayes, policy director at USICH, says communities have to look at needs locally as they implement coordinated entry systems as part of requirements for the Department of Housing and Urban Development (HUD) Continuum of Care Program. “Everyone is trying to figure out about information sharing and confidentiality while still ensuring that those families have equal access to the resources that are available through coordinated entry without compromising their safety,” says Hayes. Domestic violence necessitates a new level of rapid intervention, and the Washington program’s emphasis on the importance of immediate connection to services resulted in the flexible use of funding to support families, which in turn equaled the most positive outcomes. Training Furthers Progress Kelley’s subcommittee co-chair, Rosie Hidalgo, deputy director for policy of the Office on Violence Against Women at the Department of Justice (DOJ), says that through listening sessions and meetings, the group has recognized a need to provide better training and technical assistance to those in the field. That means those in homeless services may need to be trained in safety and confidentiality, and how to best meet the needs of survivors of domestic violence, which often translates to transitional housing that provides services and support, whereas domestic violence advocates must better understand the issues around continuums of care, coordinated entry, and Homeless Management Information System (HMIS) software. Kelley notes that the development of some models by domestic violence advocates who fully understand the safety issues means they’re generally being addressed even as housing options are being considered. “They’re being very careful in the selection of the apartments and the landlords,” she says. “They’re doing training about domestic violence and how you stay safe, and they’re providing wraparound services and advocacy for the victims in these apartments or off-site houses. So they’re not just saying, ‘We’ll pay your rent. See ya. Good luck.’ People are having to learn the skills for doing this work differently, and that’s what these pilots have been helpful for.” Learn more about Housing First at the Alliance to End Homelessness. Access a detailed evaluation of the Domestic Violence Housing First program at USICH. This article was originally published to highlight the July 2015 theme of Women’s Behavioral Health Conditions. Access more behavioral health and homelessness resources.