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Housing First

Health Factors: Housing & Transit
Decision Makers: Community Development Professionals Local Government State Government Federal Government Nonprofit Leaders
Evidence Rating: Scientifically Supported
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Housing First addresses chronic homelessness by providing rapid access to permanent housing without pre-condition of treatment, along with ongoing support services such as crisis intervention, needs assessment, and case management. A form of permanent supportive housing, the program usually serves individuals who are chronically homeless and have persistent mental illness or problems with substance abuse and addiction. Clients can be placed in apartments throughout a community (Stergiopoulos 2012) or a centralized housing location with on-site support for those requiring more intensive services; clients receive housing regardless of substance use (Patterson 2013). Unlike standard rapid re-housing programs, there are no time limits for Housing First program participation (Urban-Cunningham 2015). 

Expected Beneficial Outcomes

Reduced homelessness
Reduced hospital utilization
Improved mental health
Improved well-being
Increased substance use disorder treatment

Evidence of Effectiveness

There is strong evidence that Housing First reduces homelessness (Palepu 2013, Tsemberis 2000, Gulcur 2003) and hospital utilization among individuals with persistent mental illness and problems with substance abuse and addiction (Cochrane-Stergiopoulos 2015, Fitzpatrick-Lewis 2011, Montgomery 2013, Nelson 2007).

Housing First improves housing stability for people with mental disorders (Stergiopoulos 2015, Palepu 2013, Tsemberis 2000), advances mental health and well-being (Nelson 2007, Tsemberis 2012), and increases treatment for substance abuse and addiction (Nelson 2007, Tsemberis 2000). It has also been shown to decrease utilization of psychiatric hospitals for formerly homeless individuals with mental illness (Gulcur 2003). Housing First programs can improve housing stability and decrease hospitalizations among homeless veterans (Montgomery 2013). Programs with strong case management components can improve participants’ functioning in the community (Cochrane-Stergiopoulos 2015). Program participants report significantly higher quality of life than non-participants, as well as greater safety and comfort in their new dwellings (Patterson 2013).

One study indicates that use of alcohol and other substances declines among Housing First participants (Kirst 2015), while another indicates that substance use-related outcomes do not differ significantly between participants and non-participants (Somers 2015). Additional evidence is needed to confirm the effects of program participation on substance abuse.

Strong partnerships between Housing First program staff and landlord associations can support gains in housing stability. Connecting program staff with clients of the same ethnic or racial background often results in the most successful working relationships (Stergiopoulos 2012). Using video calling to connect program participants and staff can increase program reach (Stefancic 2013).

Housing First programs decrease costs to shelters (Stergiopoulos 2015, Ly 2015) and emergency departments (Ly 2015). The rapid re-housing component of Housing First can reduce costs associated with hospitalizations and treatment for individuals with persistent mental illness and substance abuse problems (Srebnik 2013, Urban-Cunningham 2009). Early studies suggest Housing First programs generally also cost less than programs that require sobriety or treatment prior to providing housing (Gulcur 2003).

Implementation

United States

Housing First has been implemented in more than one hundred cities across the United States, Canada, Europe, and Australia (Pathways HF). Utah implements Housing First statewide and has housed over 2,000 formerly chronically homeless individuals as of 2016 (Pathways HF-UT).

Pathways to Housing, a New York-based organization from which Housing First originated, trains organizations to follow the Housing First model; Pathways to Housing agencies include Pathways Washington DC and Pathways Pennsylvania (Pathways HF, Pathways HF-DC, Pathways HF-PA).

The Mayors Challenge to End Veteran Homelessness, a partnership between the US Department of Veteran Affairs (VA) and the US Department of Housing and Urban Development (HUD), uses concepts from Housing First, rapid re-housing, and permanent supportive housing with added mental health services to serve homeless veterans (RWJF-Veteran homelessness 2014). The 100,000 Homes Campaign, a national movement to end homelessness, also uses Housing First principles in its work providing individuals, families, and veterans experiencing homelessness with homes of their own through community partnerships (100,000 Homes).

Wisconsin

The United Way of Dane County uses Housing First principles to support local families experiencing homelessness (United Way-Dane County).  

Implementation Resources

100,000 Homes - 100,000 Homes: Powered by Community Solutions. Housing First: Program manifesto, tracking progress, collect person specific data on the homeless, improve local support systems, map of program impact across the country. Accessed on August 4, 2016
MHCC-Housing First - Mental Health Commission of Canada (MHCC). Canadian Housing First Toolkit: Developed to assist other Canadian communities who are interested in adopting the Housing First approach. Accessed on August 4, 2016
NAEH-Housing First - National Alliance to End Homelessness (NAEH). Housing First: Includes checklist to implement program, how to use models, and special reports. Accessed on August 4, 2016
NAEH-Zvetina 2009 - Zvetina D, Albanese T, Spellman B, Holt E, Culhane D. Organizational change: Adopting a housing first approach. Washington, DC: National Alliance to End Homelessness (NAEH); 2009. Accessed on August 4, 2016
Pathways HF - Pathways to Housing. Housing First (HF) training, research, and partnerships. Accessed on August 5, 2016
US ICH-Housing First - United States Interagency Council on Homelessness (US ICH). Housing First: Featured tools to implement Housing First program. Accessed on February 27, 2017

Citations - Description

Patterson 2013 - Patterson M, Moniruzzaman A, Palepu A, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social Psychiatry and Psychiatric Epidemiology. 2013;48(8):1245-1259. Accessed on August 4, 2016
Stergiopoulos 2012 - Stergiopoulos V, O'Campo P, Gozdzik A, et al. Moving from rhetoric to reality: Adapting Housing First for homeless individuals with mental illness from ethno-racial groups. BMC Health Services Research. 2012;12:345. Accessed on August 4, 2016
Urban-Cunningham 2015 - Cunningham MK, Gillespie S, Anderson J. Rapid re-housing: What the research says. Washington, DC: Urban Institute; 2015. Accessed on August 4, 2016

Citations - Evidence

Cochrane-Stergiopoulos 2015 - Stergiopoulos V, Gozdzik A, Misir V, et al. Effectiveness of Housing First with intensive care management in an ethnically diverse sample of homeless adults with mental illness: A randomized controlled trial. PLOS One. 2015;10(7):e0130281. Accessed on August 4, 2016
Fitzpatrick-Lewis 2011 - Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, et al. Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health. 2011;11:638. Accessed on August 4, 2016
Gulcur 2003 - Gulcur L, Stefancic A, Shinn M, Tsemberis S, Fischer SN. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities. Journal of Community and Applied Social Psychology. 2003;13:171-186. Accessed on August 4, 2016
Kirst 2015* - Kirst M, Zerger S, Misir V, Hwang S, Stergiopoulos V. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence. 2015;5(1):24-29. Accessed on August 4, 2016
Ly 2015 - Ly A, Latimer E. Housing First impact on costs and associated cost offsets: A review of the literature. Canadian Journal of Psychiatry. 2015;60(11):475-487. Accessed on August 2, 2016
Montgomery 2013* - Montgomery AE, Hill LL, Kane V, Culhane DP. Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology. 2013;41(4):505-514. Accessed on August 4, 2016
Nelson 2007* - Nelson G, Aubry T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiarty. 2007;77(3):350-61. Accessed on August 5, 2016
Palepu 2013 - Palepu A, Patterson ML, Moniruzzaman A, Frankish CJ, Somers J. Housing First improves residential stability in homeless adults with concurrent substance dependence and mental disorders. American Journal of Public Health. 2013;103(2)e30-e36. Accessed on August 4, 2016
Patterson 2013 - Patterson M, Moniruzzaman A, Palepu A, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social Psychiatry and Psychiatric Epidemiology. 2013;48(8):1245-1259. Accessed on August 4, 2016
Somers 2015* - Somers JM, Moniruzzaman A, Palepu A. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction. 2015;110(10):1605-1614. Accessed on August 4, 2016
Srebnik 2013* - Srebnik D, Connor T, Sylla L. A pilot study of the impact of Housing First- Supported housing for intensive users of medical hospitalization and sobering services. American Journal of Public Health. 2013;103(2):316-321. Accessed on August 4, 2016
Stefancic 2013* - Stefancic A, Henwood BF, Shin SM, et al. Implementing Housing First in rural areas: Pathways Vermont. American Journal of Public Health. 2013;103(S2):S206-S209. Accessed on August 4, 2016
Stergiopoulos 2012 - Stergiopoulos V, O'Campo P, Gozdzik A, et al. Moving from rhetoric to reality: Adapting Housing First for homeless individuals with mental illness from ethno-racial groups. BMC Health Services Research. 2012;12:345. Accessed on August 4, 2016
Stergiopoulos 2015* - Stergiopoulos V, Hwang SW, Gozdzik A, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. Journal of the American Medical Association. 2015;313(9):905-915. Accessed on August 2, 2016
Tsemberis 2000* - Tsemberis S, Eisenberg RF. Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric services. 2000;51(4):487-493. Accessed on August 4, 2016
Tsemberis 2012* - Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless persons with co-occurring disorders in Washington, DC. American Journal of Public Health. 2012;102(1):13-6. Accessed on August 3, 2016
Urban-Cunningham 2009 - Cunningham M. Preventing and ending homelessness - Next steps. Metropolitan Housing and Communities Center. Washington, DC: Urban Institute; 2009. Accessed on August 4, 2016

Citations - Implementation

100,000 Homes - 100,000 Homes: Powered by Community Solutions. Housing First: Program manifesto, tracking progress, collect person specific data on the homeless, improve local support systems, map of program impact across the country. Accessed on August 4, 2016
Pathways HF - Pathways to Housing. Housing First (HF) training, research, and partnerships. Accessed on August 5, 2016
Pathways HF-DC - Pathways to Housing DC. Housing First (HF) program. Washington, DC. Accessed on August 5, 2016
Pathways HF-PA - Pathways to Housing PA. Housing First (HF) program. Pennsylvania. Accessed on August 5, 2016
Pathways HF-UT - Pathways to Housing. Housing First (HF) program in Utah. Accessed on August 5, 2016
RWJF-Veteran homelessness 2014 - Robert Wood Johnson Foundation (RWJF). RWJF Culture of Health blog: Ending veterans' homelessness by next year, including information about the Mayors Challenge and additional programs to end veteran homelessness. 2014. Accessed on August 4, 2016
United Way-Dane County - United Way of Dane County. Housing First program. Accessed on August 4, 2016

Page Last Updated

August 5, 2016

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