“Current rates of homelessness in New York City are the highest ever documented.1 A small percentage of this population remains chronically homeless, either living on the streets or other public places or intermittently using emergency rooms, shelters, jails, and other short-term services, but never successfully ending their homelessness.2 Members of this chronically homeless group typically have a history of mental illness,3 compounded by substance use disorders.4,5,6 Although much is known about the chronically homeless, these individuals continue to elude existing program efforts.