Housing First

Housing First prioritizes quickly providing permanent housing to individuals and families experiencing homelessness, and doing so with minimum preconditions or barriers.  The Housing First approach to homelessness assistance was originally developed as a program philosophy and model for permanent supportive housing (PSH) for people with behavioral health issues who had chronic patterns of homelessness. This model of Housing First, and the literature examining it, focus on an approach to PSH that places people in stable, permanent housing with a standard lease agreement and rights of tenancy, and without preconditions such as sobriety or willingness to accept services, although intensive but optional services are available to them.

Studies measuring the outcomes of this Housing First approach to PSH have concluded that it succeeds in helping people retain stable housing. Although living in stable housing does not necessarily lead to resolution of all of the residents’ health issues,[1] it can provide a foundation for recovery and reduce the use of emergency rooms and other costly medical services.[2]

Over time, the guiding principles of Housing First have been promoted for other populations and housing approaches, such as Rapid Re-Housing (RRH). These principles include:

  • A focus on helping individuals and families access and sustain permanent rental housing as quickly as possible
  • Tenancy based upon the provisions of a standard lease agreement, and not on service participation or compliance
  • A variety of services available to promote housing stability and individual well-being on an as-needed and entirely voluntary basis[3]

[1] Padgett, Deborah K., Victoria Stanhope, Ben F. Henwood, and Ana Stefancic. Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: Comparing Housing First with Treatment First Programs. Community Ment Health J. 2011 Apr; 47(2): 227-232, which finds that homeless adults with serious mental illness who are enrolled in a Housing First approach have significantly lower rates of substance use and substance abuse treatment utilization than their peers in a Treatment First approach. Earlier research by Padgett and colleagues finds a less clear recovery trajectory; see, for example, Henwood, Benjamin F., Deborah K. Padgett, Bikki Tran Smith, and Emmy Tiderington. Substance Abuse Recovery after Experiencing Homelessness and Mental Illness: Case Studies of Change Over Time. J Dual Diagn. 2012 Jan 1; 8(3): 238-246.

[2]Larimer, Mary E. et al., Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems. JAMA. 2009 April 1; 301(13): 1349-1357; Mackelprang, Jessica L., Susan E. Collins, and Seema L. Clifasefi. Housing First is Associated with Reduced Use of Emergency Medical Services. Prehosp Emerg Care. 2014 Oct-Dec; 18(4): 476-482.

[3]Housing First” website. National Alliance to End Homelessness.