Posted by Fadumo Abdi, Self-Sufficiency Research Clearinghouse Staff

Housing First is a consumer-driven approach to addressing homelessness that centers on providing homeless people with housing quickly and then providing additional support services as needed. This immediate focus on helping individuals and families access and sustain permanent housing solutions is what differentiates the approach from other homelessness strategies. The primary focus on securing stable and permanent housing first is consistent with what individuals and families experiencing homelessness want to achieve when they initially seek services.

Programs modeled from the Housing First approach share critical elements, including:

• A focus on helping individuals and families access permanent rental housing as quickly as possible;
• A variety of supportive services are delivered to promote housing stability and individual well-being on an as-needed and entirely voluntary basis; and
• A standard lease agreement to housing – as opposed to mandated services compliance.

For example, Pathways to Housing, the first Housing First program of its kind, was designed to end homelessness and support recovery for individuals with severe psychiatric disabilities and co-occurring substance use disorders by emphasizing consumer choice, psychiatric rehabilitation, and harm reduction. The program addresses homeless individuals’ needs from a consumer perspective which encourages consumers to define their own needs and set clear recovery goals coupled with intensive case management services to provide access to identified services without prerequisites for psychiatric treatment or sobriety. The consumer-centered approach highlighted in Pathways to Housing and other Housing First models is in contrast to other housing assistance models that condition the provision of housing based on participation and compliance with behavioral health, substance treatment, and/or work training program requirements. Other target populations served through the Housing First approach have included homeless families who are experiencing persistent poverty, unemployment, child welfare involvement, or domestic violence.

Unlike its predecessors, Housing First assumes stable housing must be established before an individual can begin to work toward improving their mental health, financial stability, and self-sufficiency. Research has found that by providing homeless people with immediate housing without prerequisites of participation in treatment services, they were more likely to stay housed for longer and less likely to return to homelessness. Similarly, giving clients the choice of which supportive services they need has also been found to result in reduced psychiatric symptoms and substance use among participants.

Consistent with the consumer choice perspective that underscores the Housing First approach, there is some variability in the supportive services programming offered to clients even when focusing on the same sub-population. For example, a 12-month evaluation of three programs using Housing First approach to serve homeless individuals with mental illnesses found that clients of all three programs demonstrated positive outcomes relative to sustained housing, increased earnings, and improved symptoms, but varied in terms of housing tenure and support services offered. Programs outlined in the study utilized several successful strategies for the delivery of services including housing-based case managers or daily home visits by coordinators available on a 24/7 basis. Housing inventory also varied by program with some scattering properties among available private apartments and housing facilities stock while other programs solely own properties used for program participants. The ways in which the three programs implemented the Housing First model presented unique success and challenges. For example, the program which owns the housing units is able to provide more client supervision, but this can limit client integration into the broader community. Although each program took different approaches to implementation, each ultimately achieved positive outcomes for the individuals served.

As more research is conducted on the effects of the Housing First approach, findings suggest programs that adhere to the Housing First’s core elements of unconditional, immediate housing and choice of services demonstrate positive outcomes. With a growing recognition of the Housing First approach some practitioners have begun to describe it as a whole-system orientation and response to the problem of homelessness. This holistic orientation is influencing how communities across the country respond to the persistent challenges posed by homelessness particularly among those with complex needs. For example, The U.S. Department of Health and Human Services has funded a study to assess the effects of five programs using the Housing First model for high need families. The evaluation targets families in the child welfare system struggling with substance use, mental health issues, and unstable housing. Through the study, the program hopes to determine its ability to provide trauma-informed care, develop working relationships with local housing agencies, and capacity to connect families to community resources. Continued research and practice evidence will serve as helpful resource guides and implementation toolkits for the future as more communities implement a Housing First approach to address the myriad challenges of homeless individuals and families with the greatest needs.

Learn more about the Housing First model in the SSRC Library:

• Supportive housing for high-need families in the child welfare system. This brief describes the purpose and design of five program sites that use the Housing First model to implement supportive housing services for high need families.
• The applicability of housing first models to homeless persons with serious mental illness. This evaluation compares the outcomes of three programs that implemented the housing first model serving individuals with mental health illness and substance use addiction.
• Permanent supportive housing: Assessing the evidence. This article is a comprehensive literature review evaluating how effective the housing first model is for individuals with mental health illnesses and substance use addiction.
• The SHIFT study: Final report. This study examines the outcomes of supportive housing programs promoting self-sufficiency among families in four communities in New York.

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