Effective treatment planning is optimal when consumers’ perceived needs align with their providers’ assessments of those needs, which can facilitate collaborative partnerships and recovery-oriented services. This study compares consumers’ and case managers’ perceptions of consumer needs for adult clients in programs serving homeless adults with serious mental illness that use either a Housing First or non-Housing First (i.e., traditional) approach. Descriptive statistics were calculated based on a 20-item needs assessment checklist. The alternative chance-correlated coefficient (AC1) was used to assess level of overall agreement between individual consumer–case manager dyads while controlling for chance. Results of analyses with 72 consumer–case manager dyads show that although there was high agreement on the need for housing, case managers assessed greater needs in the clinical and social domains whereas consumers reported greater needs in the vocational and independent living domains, which did not differ between the Housing First and non-Housing First programs. Case managers and the consumers they serve show concordance in some areas of needs assessment; however, the areas of disagreement in perceived need may impede engagement and the delivery of recovery-oriented services, particularly when working with individuals experiencing multiple and sometimes competing needs such as homeless adults with serious mental illness.