Housing First

Housing First is a policy that offers permanent housing as quickly as possible to homeless people, and other supportive services afterward. Begun in 1988 to address the needs of homeless families with children in Los Angeles, California, Housing First was popularized in the following decades and became government policy in the United States and various other countries.
Housing First is an alternative to a system of emergency shelter/transitional housing progressions. Rather than moving homeless individuals through different "levels" of housing, whereby each level moves them closer to "independent housing" (for example: from the streets to a public shelter, and from a public shelter to a transitional housing program, and from there to their own apartment in the community), Housing First moves the homeless individual or household immediately from the streets or homeless shelters into their own accommodation.
Housing First approaches are based on the concept that a homeless individual or household's first and primary need is to obtain stable housing, and that other issues that may affect the household can and should be addressed once housing is obtained. In contrast, many other programs operate from a model of "housing readiness" — that is, that an individual or household must address other issues that may have led to the episode of homelessness prior to entering housing.
General principles.
Housing First is an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness.
History and evolution.
In the late 19th Century, Don Bosco pioneered both the concept that would later become known as Housing First in Italy as well as pioneering the concept that would provide Dorothy Day the basis for her Catholic Worker Movement House of Hospitality founded in 1933. Bosco himself was inspired by and created a need society based on the teachings of St. Francis de Sales a 16th and 17th Century clergyman who was also at the forefront of early movements insisting that basic needs of the people be met first without going through a lot of or needing to comply with various rules and regulations prior to service receipt.
The next big event in the history of the movement was the Diggers of San Francisco which operated between March 1966 and September 1968. During those years, many soon-to-be-famous political activists led by example and championed this and other similar causes. Their heyday was celebrated at the Summer of Love.
The funeral commemorating the end on October 6, 1967 was designed to inspire people to stay where they were and bring the ideology behind and changes effected by the event to their own locales. Diggers and their Greenwich Village equivalents such as Abbie Hoffman lasted with their Central Park Be-Ins for another year or so before being re-absorbed back into society as people went off into agrarian/back to the earth movements, pursued their educations or embarked on their conventional careers.
By the mid-`70s, the problem had gotten critical, especially on the East Coast in our Nation's Capital. Activist Mitch Snyder would join the Community for Creative Non Violence in 1974 and proceed to become its' driving force, leading to numerous improvements for assisting the chronically homeless which were further improved in the late 80s and early 90s.
In 1992 Dr. Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine, founded Pathways to Housing in New York City. Housing First for the chronically homeless is premised on the notion that housing is a basic human right, and so should not be denied to anyone, even if they are abusing alcohol or other substances. The Housing First model, thus, is philosophically in contrast to models that require the homeless to abjure substance-abuse and seek treatment in exchange for housing.
Housing First, when supported by the United States Department of Housing and Urban Development, does not only provide housing. The model, used by nonprofit agencies throughout America, also provides wraparound case management services to the tenants. This case management provides stability for homeless individuals, which increases their success. It allows for accountability and promotes self-sufficiency. The housing provided through government supported Housing First programs is permanent and "affordable," meaning that tenants pay 30% of their income towards rent. Housing First, as pioneered by Pathways to Housing, targets individuals with disabilities. This housing is supported through two HUD programs. They are the Supportive Housing Program and the Shelter Plus Care Program.
The Housing First Model is executed through either a scattered-site or project-based implementation. A scattered-site Housing First program is a model in which residents are offered the opportunity of being housed in individual housing units throughout a community. This model integrates participants in a community as opposed to assembling multiple or all participants in one project or location. In a project-based Housing First implementation, residents are offered units within a single housing project or site. This model congregates multiple or all participants in one locality. In both the scattered-site and project-based Housing First programs, residents are given access to a wide variety of supportive health and rehabilitation services which they have the option, although not mandatory, to participate in and receive treatment.
Housing First is currently endorsed by the United States Interagency Council on Homelessness (USICH) as a "best practice" for governments and service-agencies to use in their fight to end chronic homelessness in America.
Housing First programs currently operate throughout the United States in cities such as New Orleans, Louisiana; Plattsburgh, New York; San Diego, California; Anchorage, Alaska; Salisbury, Maryland; Minneapolis, Minnesota; New York City; District of Columbia; Denver, Colorado; San Francisco, California; Atlanta, Georgia; Chicago, Illinois; Portland, Maine; Quincy, Massachusetts; Philadelphia, Pennsylvania; Salt Lake City, Utah; Seattle, Washington; Los Angeles; Austin, Texas; and Cleveland, Ohio
Evidence and outcome.
One research in Seattle, Washington found that providing housing and support services for homeless alcoholics costs taxpayers less than leaving them on the street, where taxpayer money goes towards police and emergency health care. Results of which appeared in the Journal of the American Medical Association April, 2009. This first US controlled assessment of the effectiveness of Housing First specifically targeting chronically homeless alcoholics showed that the program saved taxpayers more than $4 million over the first year of operation. During the first six months, even after considering the cost of administering the housing, 95 residents in a Housing First program in downtown Seattle, the study reported an average cost-savings of 53 percent—nearly US$2,500 per month per person in health and social services, compared to the per month costs of a wait-list control group of 39 homeless people. Further, stable housing also results in reduced drinking among homeless alcoholics.
In Utah, there has been "a 72 percent decrease overall since enacting the plan in 2005" according to the Utah Division of Housing and Community Development. There has been some success with Utah's housing first plan
In August 2007, the US Department of Housing and Urban Development reported that the number of chronically homeless individuals living on the streets or in shelters dropped by an unprecedented 30 percent, from 175,914 people in 2005 to 123,833 in 2007. This was credited in part to the "housing first" approach; Congress in 1999 directed that HUD spend 30% of its funding on the method.
In September 2010, it was reported that the Housing First Initiative had significantly reduced the chronic homeless single person population in Boston, Massachusetts, although homeless families were still increasing in number. Some shelters were reducing the number of beds due to lowered numbers of homeless, and some emergency shelter facilities were closing, especially the emergency Boston Night Center. By 2015, Boston Mayor Marty Walsh had announced a 3-year plan to end chronic homelessness, focusing on coordinating efforts among public agencies and nonprofit organizations providing services to homeless men and women.
In 2013, the estimated national public cost of chronic homelessness was between $3.7 and $4.7 billion according to the United States Interagency Council on Homelessness (USICH). Through Housing First programs, chronically homeless individuals are using fewer hospital resources, spending less time in costly incarceration and requiring fewer emergency room visits. A research study at University of Northern Carolina also reported that a housing project for the chronically homeless called Moore Place had saved the county $2.4 million.
The implementation of Housing First philosophy when working with homeless families and young adults has been shown to increase clients' enrollment in public assistance benefits, decrease involvement in the child welfare system, and have very few returning to homelessness.
When comparing the effects of Housing First on older and younger homeless adults, older homeless adults have shown significantly higher rates of improvement in areas like mental component summary scores, condition specific quality of life, mental health symptom severity, and percentage of days stably housed.
When comparing the effects of Housing First on homeless adults with lower or borderline intellectual functioning to homeless adults with normal intellectual functioning it has been shown that there is no significant difference.
Post–2007 U.S. policy and legislation.
The United States Congress appropriated $25 million in the McKinney-Vento Homeless Assistance Grants for 2008 to show the effectiveness of Rapid Re-Housing programs in reducing family homelessness.
In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, part of which addressed homelessness prevention, allocating $1.5 billion for a Homeless Prevention Fund. The funding for it was called the "Homelessness Prevention and Rapid Re-Housing Program" (HPRP), and was distributed using the formula for the Emergency Shelter Grants (ESG) program.
On May 20, 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUD's Homeless Assistance programs. It was part of the Helping Families Save Their Homes Act of 2009. The HEARTH act allows for the prevention of homelessness, rapid re-housing, consolidation of housing programs, and new homeless categories. In the eighteen months after the bill's signing, HUD must make regulations implementing this new McKinney program.
On June 11, 2014, the 100,000 Homes Campaign in the United States, launched in 2010 to "help communities around the country place 100,000 chronically homeless people into permanent supportive housing", announced that it reached its four-year goal of housing 100,000 chronically homeless people nearly two months before its July 29 deadline.
New York Times journalist David Bornstein summarized key elements of the 100,000 Homes Campaign that campaign leaders attribute to its success. This included learning individual homeless people's "name and need" by mobilizing volunteers to go very early in the morning to check on them, establishing a "vulnerability index" so they could prioritize certain homeless people and "bring housing advocates and agency representatives together to streamline the placement processes, and share ideas about how to cut through red tape."
Outside the United States.
Australia.
Some housing projects have been shown to produce similar results to the US Housing First model in terms of strong housing outcomes and reductions in intensity and frequency of service use relative to pre-intervention levels.
Canada.
In its Economic Action Plan 2013, the Federal Government of Canada proposed $119 million annually from March 2014 until March 2019—with $600 million in new funding—to renew its Homelessness Partnering Strategy (HPS). In dealing with homelessness in Canada, the focus is on the Housing First model. Thus, private or public organizations across Canada are eligible to receive HPS subsidies to implement Housing First programs. In 2008, the Federal Government of Canada funded a five-year demonstration program, the "At Home/Chez Soi project", aimed at providing evidence about what services and systems best help people experiencing serious mental illness and homelessness. Launched in November 2009 and ending in March 2013, the "At Home/Chez Soi project" was actively addressing the housing need by offering Housing First programs to people with mental illness who were experiencing homelessness in five cities: Vancouver, Winnipeg, Toronto, Montréal and Moncton. In total, "At Home/Chez Soi" has provided more than 1,000 Canadians with housing.
Fortune reported that the Housing First approach resulted in a 66 percent decline in days hospitalized (from one year prior to intake compared to one year in the program), a 38 percent decline in times in emergency room, a 41 percent decline in EMS events, a 79 percent decline in days in jail and a 30 percent decline in police interactions. Sue Fortune, Director of Alex Pathways to Housing in Calgary in her 2013 presentation entitled "Canadian Adaptations using Housing First: A Canadian Perspective" argued that less than 1% of existing clients return to shelters or rough sleeping; clients spend 76% fewer days in jail; clients have 35% decline in police interactions.
Pathways to Housing Canada describes the Housing First as a "client-driven strategy that provides immediate access to an apartment without requiring initial participation in psychiatric treatment or treatment for sobriety."
Following the development of several Housing First programs through the Home/Chez Soi research project, an initiative to provide Housing First training and technical assistance was created and has been shown to be useful in developing high fidelity programs.
Czech Republic.
In Czech Republic the first pilot Housing First project started in May 2016. 50 families were taken into municipal flats in Brno. NGO IQ Roma Servis supported them for next two years. More than 80% of the families were able to sustain in the flats. This project won SozialMarie - international prize for the best social innovation project.
In 2017 another project started in Brno. This time the target people group was long term homeless singles and the project is run by the municipality. The program supports 65 tenants in municipal flats.
In 2019 Czech government and EU supported 13 new Housing First projects across the country by European Social Fund.
Denmark.
In Denmark, Housing First is embedded in the national Homeless Strategy as the overall strategy. However, it has been shown that this intervention strategy is serving only a small number of people recorded to be homeless which is most likely due to barriers like shortage of affordable housing.
Finland.
See article: Homelessness in Finland
In 2007 the centre-right government of Matti Vanhanen began a special program of "four wise men" to eliminate homelessness in Finland by 2015.
The programme to reduce long-term homelessness targets just some homeless people. Assessed on the basis of social, health and financial circumstances, this is the hard core of homelessness. The programme to reduce long-term homelessness focuses on the 10 biggest urban growth centres, where most of the homeless are to be found. The main priority, however, is the Helsinki Metropolitan Area, and especially Helsinki itself, where long-term homelessness is concentrated.
The programme is structured around the "housing first" principle. Solutions to social and health problems cannot be a condition for organising accommodation: on the contrary, accommodation is a requirement which also allows other problems of people who have been homeless to be solved. Having somewhere to live makes it possible to strengthen life management skills and is conducive to purposeful activity.
Because of all the reasons there are for long-term homelessness, if it is to be cut there need to be simultaneous measures at different levels, i.e. universal housing and social policy measures, the prevention of homelessness and targeted action to reduce long-term homelessness.
The programme's objectives are:
France.
The French government launched a Housing First-like program in France in 2010 in 4 major cities - Toulouse, Marseille, Lille and Paris - called "Un chez-Soi d'abord". It follows the same principles as the Canadian and US programs: it is focused on homeless people with mental illness or addicted to drugs or alcohol. The plan is on a three-year basis for each individual, living in accommodation provided by an NGO.
Clients are given any needed help with social issues and medical care. The first houses have been working in three cities since 2011 and a hundred apartments have been planned in Paris starting in May 2012.
Several NGOs are involved in this trial. They provide rental management and social support for tenants.
Those NGOs are linked with scientists investigating the results of the experiment and serve as a relay for information and status reports on the targeted public. The lead team of "Un chez-soi d'abord" is expecting results to be published around 2017.
Japan.
Though homeless support groups like non-profit organization , , Médecins du Monde Japan have requested Housing First, Japanese government does not have a Housing First program yet. Traditionally, the government offers public housing (so-called Koei-jutaku) for low-income people by public housing law, run by local government. Rent fees are adjusted according to household income. Because applicants must be selected by lottery, low-income people are not guaranteed to be chosen to live in the housing, although they have an advantage. There are a couple of Housing First-like programs. Some renovate discarded or empty homes and they rent the rooms to single mothers with financial and occupational support.
United Kingdom.
In 2017, the U.K. government announced plans for a Housing First pilot programme in the West Midlands, Liverpool, and Manchester, along with funding of £28m. This followed publication of a report entitled "Housing First" by the Centre for Social Justice which cited the results from the Finnish application of Housing First.
Miscellaneous.
As part of the H2020 research project "HOME_EU: Reversing Homelessness in Europe" by the European Commission, approximately 5600 surveys have been conducted between March and December 2017 in France, Ireland, Italy, the Netherlands, Portugal, Spain, Poland, and Sweden in order to understand people's knowledge, attitudes, and practices about homelessness and how much support the general public has in regards to Housing First as a solution for homelessness in Europe.
Criticism of Housing First.
Limits of evidence based policy.
On July 31, 2011, Prof. Victoria Stanhope, Ph.D., of New York University School of Social Work and Prof. Kerry Dunn, J.D., Ph.D., of University of New England School of Social Work, published “The curious case of Housing First; The limits of evidence-based policy” in the International Journal of Law and Psychiatry. Drs. Stanhope and Dunn gave an overview of evidence-based policy and presented “critiques based on its reliance on positivist methods and technical approach to policy making. Using these critiques as a framework, the paper discusse[d] the case of Housing First, a policy adopted by the Bush Administration in order to address the problem of chronic homelessness.” According to Drs. Stanhope and Dunn, the Housing First “is an example of research-driven policy making but also resulted in a progressive policy being promoted by a conservative administration. In discussing the case, the paper elaborates on the relationship between evidence and policy, arguing that evidence-based policy fails to integrate evidence and values into policy deliberations. The paper concludes with alternative models of policy decision-making and their implications for research.”
Housing First has been criticized on its failure to address broader service outcomes, namely substance abuse (in one case, it was argued that the only reason substance abuse outcomes were no worse was that the residents were not severely addicted). These criticisms have been rebutted on the grounds that Housing First is a program to end homelessness not to reduce substance abuse, though more recent research indicates it is more effective than traditional approaches in this regard as well. This exchange highlights the way in which the selection of outcomes sets both the terms of the debate and the parameters of “what works.” Embedded in that mantra are a priori decisions about what constitutes working and for whom; in this case it was stable housing for the chronic homeless.
According to Stanhope, Housing First “asserts a right to housing. Such a material right is an anathema to neoliberal ideology and challenges deeply held beliefs that have shaped US welfare from its inception: That no one has a right to a government benefit unless they have proved themselves to be deserving or worthy (e.g., "TANF"), or have earned it (e.g., social insurance).”
In a rapid review and document analysis of Housing First scholarly literature in the U.S. and Canada, it has been shown that these literature are severely lacking in the implementation and explicit mention of Harm Reduction.
Exceptions to Housing First.
Emergency response.
Hotels.
Hotels have historically been used to house the homeless population temporarily while further accommodations are made. For example, the Cecil Hotel in Los Angeles, CA had intentions of converting upwards of 400 units of housing for the local residents before the project was shut down due to a greater interest in gentrification of the surrounding region. This surrounding region, now known as Skid Row, is now notoriously known for hosting one of the largest populations of homeless individuals in the United States. Given their ability to house a large number of individuals in a minimal amount of space, hotels have become a recent point of interest with regards to transitional and emergency housing for sudden circumstances such as COVID-19 and other natural disasters. In support of using hotels for the COVID-19 crisis, the Federal Emergency Relief Administration (FEMA) announced that their Public Assistance Program Category B is able to reimburse 75 percent of the expenses endured from obtaining temporary housing and shelter. This program specifically targets those sheltering in hotels as FEMA already stated that they have pre-established relationships with certain states in order to fund hotel shelter-in-place programs.
Hotels have also become relevant in the conversation of Housing First as they have been used increasingly as a response to the global pandemic. Though they fail to move the unhoused directly to long-term shelter such as apartments or other affordable housing units, hotels have proven to be critical to the stabilization of large homeless communities in density populated cities such as New York and San Francisco. Organizations like Hotels not Hospitals (HnH) in San Francisco have utilized hotels as a "first-step" towards long-term housing as COVID-19 became especially concerning within the unhoused community. Given the spontaneity of the global pandemic, this NGO leaned on hotels to quickly house the vulnerable unhoused community while apartment living situations were curated. At the start of the pandemic, this organization immediately began funneling in as many at-risk unhoused individuals as they could into willing hotels.
HnH fits into the framework of Housing First as they operate without overwhelming prospective occupants with several tedious questions. They have attempted to lower the barrier of entry to long-term housing for local, unhoused San Franciscans by moving as many unhoused individuals into, more recently, apartments. By utilizing an emergency response alteration the Housing First framework, they've been able to protect the vulnerable from enduring a global pandemic without necessary, fundamental support and resources such as PPE and health guidance. Though hotels are not a permanent solution, they have helped non-state actors immediately respond while simultaneously working out long-term solutions amidst sudden, dangerous circumstances like COVID-19.