Does Housing First Work?

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Brown et al. (2016) found that participants in a Housing First program, when compared with those who received TAU, spent less time homeless, spent less time hospitalized, and had enhanced use of needed services, including substance use treatment and mental health, medical, dental, and vision care.

It appears that when providers avoid coercive relationships with participants, use of needed services improves. This finding is in sync with research on motivational interviewing; when providers follow the client’s lead, instead of pushing or pulling the client, they help unleash the client’s internal motivation, propelling clients towards their own goals.

Somers et al. (2017) found that participants in both congregate and scattered-site Housing First programs were better able to achieve stable housing than were participants in TAU and experienced significantly greater perceived quality of life.

A Housing First program funded by the U.S. Department of Housing and Urban Development in 2007 and 2008 showed favorable results for people who had been homeless for five years or longer and were also struggling with mental health and substance use challenges (Tsemberis, Kent, & Respress, 2012).

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The Bottom Line
It can be challenging to draw definitive conclusions from research studies about the effectiveness of Housing First programs, because different programs may have different program elements, serve populations with different complex needs, and use different outcome measures. Randomly assigning consumers to different housing programs presents practical and ethical issues as well. That said, several studies show that Housing First programs have better outcomes than other housing programs. Other studies suggest that TAU and Housing First may have similar outcomes. That leaves us with an ethical decision to make. Should we favor the more humane, client-centered, nonjudgmental approach that views safe, stable, affordable housing as a human right?

It is clear that Housing First is a preferable option that embraces a coordinated system of care at the micro, mezzo, and macro practice levels.

Developing the political will and educating potential funding sources, including state, local, and federal governments, will be key to expanding Housing First programs. Addressing the systemic causes of homelessness is crucial, including subsidies to developers to expand the supply of affordable housing, rental subsidies, income support programs, expanding the economy to eradicate income disparities and ensure that full-time workers earn living wages, providing evidence-based substance use and mental health services, and ensuring universal health insurance with parity for substance use and mental health services. Homelessness affects many Americans, including veterans, immigrants, refugees, LGBTQ people, people involved in the criminal justice system, families, and many children. Homelessness and the social costs it spawns can be eliminated.

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