Housing First
The housing first approach to resolving homelessness refers to plans, policies, and programs where people are provided housing and access to supportive services to reach their goals, without having to meet pre-conditions like sobriety.
What is Housing First?
The housing first approach to resolving homelessness is a housing justice framework that pairs housing with services. 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. Programs that are based on a housing first philosophy provide support services to help clients stay housed. 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. The goal is to support people in identifying their needs and accessing resources to meet those needs while providing them housing regardless of program participation. Housing first program participants must meet the tenancy requirements of their landlord.
People use the phrase “housing first” to mean a variety of things. Housing First can refer to the Pathways to Housing model that includes a set of specific program components (described below). It can also refer to a wider variety of supportive housing models. Program staff may describe their program as using a housing first approach, but only apply parts of the general model. This means you can’t know exactly whether a given “housing first” program achieves full fidelity without asking more. Sometimes, people use capitalization (Housing First) to refer to the Pathways to Housing model, but this is not always the case.
HUD’s largest funding for housing for people experiencing homelessness is divided into two sources of funding - permanent supportive housing and rapid rehousing funds. Each funding source requires the use of several overarching housing first principles, but does not require fidelity to the Housing First model.
Core Characteristics and Nuances of Housing First
- Housing first is both an approach/philosophy and a model. A formal housing first program includes components such as the provision of housing and supportive services for program participants. Full model fidelity is not expected in housing first 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 emerged from asking people experiencing homelessness what they needed and wanted to resolve their homelessness.
- A housing justice and empowerment model, Housing First provides housing to program participants and offers them services. Housing First emphasizes the right of all people to have access to housing regardless of the conditions of their life.
- At the time it was developed, the Housing First approach was a significant departure from “stair-step” housing programs. In treatment first or stair-step 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.
- Housing First emerged from asking people experiencing homelessness what they needed and wanted to resolve their homelessness.
- 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) have choices during the housing search process and choose which supportive services to use (except case management).
- Separation of housing and programs: participants get immediate access to housing without treatment or sobriety as prerequisites; and, housing & treatment are provided by different staffs.
- Provide services to match participant identified needs: program provides or coordinates services at direction of the client.
- Recovery oriented service philosophy: ongoing, positive, hopeful, affirming support.
- Social community integration: the program supports engagement of tenants with the wider community.
- Consumer choice: consumers (program participants) have choices during the housing search process and choose which supportive services to use (except case management).
- Housing is not free for tenants. Tenants pay 30% of their income (including 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.
- Participants choose who, if anyone, will live with them.
- The Pathways model should not evict into homelessness. If a participant needs to leave their apartment, program staff do all they can to help the participant find another place to live.
- Where appropriate, Pathways employs a harm reduction approach.
- Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (National Harm Reduction Coalition)
- Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (National Harm Reduction Coalition)
- Program participants are required to meet with a case manager, and follow tenancy rules.
Medium to low fidelity housing first models (including HUD standard for housing first?):
- Low barrier housing where applicants should not be rejected from the program because of a substance use disorder, or having low/no credit, previous evictions, or 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.
- May be implemented through a scattered site model (people in the programs live in housing scattered across a 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. Some single site housing first programs may have residents who all have similar disabilities or different disabilities.
- 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.
Relevant Perspectives
- Pathways to Housing
- More accessible (less detailed) description of original model
- More accessible (less detailed) description of original model
- Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals With Psychiatric Disabilities
- Journal article- highly detailed description of original pathways model
- Journal article- highly detailed description of original pathways model
- HUD Definition: Housing First in Permanent Supportive Housing Brief
- USICH: Housing First Checklist
- Checklist intended as a first step for providers who want to check if their housing program is using a housing First approach.
- Checklist intended as a first step for providers who want to check if their housing program is using a housing First approach.
- Community Solutions: What is Housing First?
- Comprehensive definition.
- Comprehensive definition.
- National Alliance to End Homelessness: Housing First Fact Sheet
- Brief, Q & A style definition.
Subtopics
(to be hyperlinked if this format is chosen; to be added to other formats, depending on which option is selected)
- Implementation of and guiding resources
- I&G: Assessment tools (checklists, tools intended for providers)
- USICH: Housing First Checklist: Assessing Projects and Systems for a Housing First Orientation
- Housing First: The Pathways Model to End Homelessness for People With Mental Illness and Addiction (book)
- NAEH: Understanding Housing First (video training)
- Canadian Housing First Toolkit
- THIS is Housing First for Youth. Part 1 – Program Model Guide.
- THIS is Housing First for Youth: Operations Manual.
- HUD: Housing First Assessment Tool
- I&G: Fidelity to Pathways Model
- The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users
- Table listing elements deemed important to maintaining fidelity of model
- Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals With Psychiatric Disabilities
- Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis
- Strategies to Balance Fidelity to Housing First Principles with Local Realities: Lessons from a Large Urban Centre
- The Ambiguities, Limits and Risks of Housing First from a European Perspective
- The housing first model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users
- I&G: Scattered site vs single-site (?)
- A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats
- Housing First and Single-Site Housing
- Housing First programs in congregate-site facilities: can one size fit all?
- Culturally specific care in Housing First
- Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups
- At Home in Winnipeg: Localizing Housing First as a Culturally Responsive Approach to Understanding and Addressing Urban Indigenous Homelessness
- Housing First, Cultural Competence and Ethno-Racial Communities
- Housing First in Oregon/Portland
- Examples of projects,
- Any available local studies
- Making the case for Housing First
- NLIHC: THE EVIDENCE IS CLEAR: HOUSING FIRST WORKS
- NLHIC: HOUSING FIRST: Q&A
- NAEH: Alliance Pressure Points Resource Series: Housing First Fact Sheet
- NAEH: Data Visualization: The Evidence on Housing First
- NAEH: The Truth About Housing First
- Supportive services included in Housing First?
- Racial Equity in Housing First
- Evaluating Housing First
- CSH Literature Review of Supportive Housing
- Housing retention
- Outcomes associated with HF: Housing and Health
- Fidelity to the Housing First Model and Variation in Health Service Use Within Permanent Supportive Housing
- Housing First, But What Comes Second? A Qualitative Study Of Resident, Staff And Management Perspectives On Single-Site Housing First Program Enhancement
- Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review
- Interactions with justice system
- Interactions with child welfare system and outcomes for children
- Housing First and Healthcare
- Basic definitions (use above)
- CSH: Housing First and Access to Housing
- Community Solutions: What is housing first?
- Canadian Observatory on Homelessness: Housing First
- Unsortable at this time
- How to House the Homeless (book)
- Evidence matters: Housing First and Homelessness
- Can Housing First Work for Youth?