Housing First (long)

Housing first is an approach to housing that prioritizes moving people experiencing homelessness into independent and permanent housing as quickly as possible.

What is Housing First?

The housing first approach is usually implemented in rapid rehousing or permanent supportive housing. Programs that use a housing first approach do not refuse to house applicants because the applicant has a substance use disorder, a criminal record, or mental illness. Housing first programs provide support services to help clients stay housed, and, with the exception of regular meetings with a case manager, tenants in housing first programs are not required to use any of the supportive services the program offers. 

People use the phrase “housing first” to mean a variety of things. One way to distinguish what someone is talking about is through capitalization: if someone says Housing First (capitalized) they are likely referring to the Pathways to Housing model, while housing first (not capitalized) refers to a wider variety of low-barrier shelter models. 

Core Characteristics and Nuances of Housing First

• Housing first is an approach/philosophy. If you see the phrase “housing first program,” it probably means “a program that uses a housing first approach.”
• The Housing First philosophy is usually implemented through permanent supportive housing programs or rapid re-housing programs. 

History and origins 

• Housing First was developed in New York City in the 1990s by Dr. Sam Tsemberis and the nonprofit Pathways to Housing. 
  • Housing First was developed in reaction to costly and slow “treatment first” or “stairstep” programs. In these other programs, a person experiencing homelessness had to graduate from a series of transitional housing programs, and/or achieve sobriety, to prove themself “housing ready” before they would be housed.
• Most of the evidence for the effectiveness of housing first comes from studies of the Pathways to Housing model.
• Many programs that claim to use a Housing First approach are not totally faithful to the original Pathways to Housing model.

Pathways to Housing model (Full fidelity)

• The Pathways to Housing model centers these five principles:
  • Consumer choice: consumers (program participants) give input during the housing search process and choose which supportive services to use (except case management)
  • Separation of housing and treatment: participants get immediate access to housing without treatment or sobriety as prerequisites, and housing & treatment are provided by different staffs
  • Provide services to match needs: program provides or coordinates services
  • Recovery oriented service philosophy: ongoing, positive, hopeful, affirming support
  • Social community integration: the program supports engagement of tenants with the wider community
• Services are provided through Assertive Community Treatment (ACT), which provides a higher, more intense level of care. The ACT team includes social workers, nurses, psychiatrists, vocational and substance abuse counselors, a nurse practitioner, and a housing specialist (source).
• Tenants pay 30% of their income (usually Supplemental Security Income) toward rent (source). 
• The Pathways model is a scattered site model- staff help participants find and lease an apartment on the private market. 
  • Participants choose who, if anyone, will live with them.
• Does not evict into homelessness. If a participant needs to leave their apartment, program staff do all they can to help the participant find another apartment.
• Pathways employs a harm reduction approach. 
  • Harm reduction= a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (National Harm Reduction Coalition)

Medium to low fidelity housing first models (including HUD standard for housing first?):

• Low barrier: should not reject applicants from the program because of substance use disorder, having low/no credit, having evictions on their record, or having a criminal record.
• Offer a variety of supportive services to help a person maintain their housing (such as employment support, health care, mediation with landlords or other tenants, and others). Tenants are encouraged but not required to use these services. 
  • Services may come not in the form of ACT.
• May be implemented through a scattered site model (people in the programs lived in apartments scattered across the city), or a single-site model (people in the program live in apartments in the same building). 
  • Some scattered site models may house tenants in buildings with only affordable housing, while others may offer tenants housing in market rate mixed income housing. 
  • At single site housing first programs, services might be provided on site, or residents might travel off-site to access services