What We Know About Housing First

written by Catherine An

August 4, 2011

Nan Roman, president and CEO of the National Alliance to End Homelessness, penned this piece on Housing First for FEANTSA (the European Federation of National Organisations Working with the Homeless) which is an umbrella of not-for-profit organisations which participate in or contribute to the fight against homelessness in Europe. What Is Housing First? Housing First is an approach that is built on the principle that a short experience of homelessness and rapid stabilization in housing are best for homeless people and most effective in ending homelessness.  Housing First places homeless people in housing quickly and then provides or links them to services as needed, rather than the more customary approach of services first, then housing. While not assuming that housing is sufficient to solve all the problems that people have, Housing First does assume that housing is a necessary platform for success in services, education, employment, and health:  in short for achieving personal and family well-being. It also has the benefit of being consumer-driven: housing is what homeless people want and seek. The Housing First approach focuses on a few critical elements.

• There is a focus on helping individuals and families access housing as quickly as possible and the housing is not time-limited (it is not shelter, transitional housing, etc.).
• While some crisis resolution and housing search services might be delivered in the process of obtaining housing, core services to promote well-being and housing stability (treatment, education, child development, etc.) are primarily delivered following housing placement.
• The nature and duration of services depend upon individual need and services are voluntary.
• Housing is not contingent on compliance with services; however consumers must typically comply with standard requirements of tenancy (paying the rent, etc.).

Housing First has most often been used to describe an approach for assisting homeless people with serious mental health and substance abuse disorders.  In this context it has been contrasted with a “housing readiness” approach in which people are required to achieve sobriety or treatment compliance as a pre-condition of receiving housing.  However, the principle of Housing First is also applicable to people with less significant or more temporary problems, such as families or individuals who are homeless for economic reasons.  Typically such people are temporarily housed in shelters or transitional housing, often at relatively high cost and for relatively long periods of time (up to two years), while they receive services that will make them “ready” for housing.  However, an increased focus on housing placement, even with relatively small amounts of housing subsidy and linkage to community-based services, is a more effective strategy with a lower cost for this population as well. What Does a Housing First Approach Entail? While there is a wide variety of program models, Housing First programs or systems typically include the following activities. Assessment and Targeting Individuals and families receive an in-depth, up-front assessment before being referred to or receiving services from a Housing First provider. This allows providers to ascertain both the needs of the consumer, and whether the available program(s) can meet those needs.   The level of assistance programs are able to provide most often shapes who a community can target for Housing First services. Evidence indicates Housing First is appropriate for most, if not all, homeless people. The combination of housing linked to services can help a wide variety of people exit homelessness more rapidly. This is supported by research that demonstrates that most formerly homeless families, including those with significant challenges, will retain housing with the provision of a long-term housing subsidy. It is also supported by evaluations of Housing First interventions with chronically homeless individuals, which have found that many who have remained outside of housing for years can retain housing with a subsidy and provision of wraparound supports. Finally, it is supported by emerging research that lower-need individuals and families who become homeless can exit homelessness rapidly and avoid repeat episodes with even small amounts of housing subsidy and linkage to community services. Permanent Housing There is substantial variation in how Housing First providers meet the housing needs of the individuals and families they serve.

• Some Housing First programs provide only minimal financial assistance, such as assistance with security deposits and application fees. Other programs are able to provide or access longer term or permanent housing subsidy.
• Some Housing First programs rely solely on apartments in the private rental market. Others master-lease apartments that they then sub-let to program participants, or purchase or develop housing themselves for sub-lease to participants.
• There are models in which the Housing First program is the legal lease holder for some initial period of time in which the individual or family is involved with the program.  When program services end, the tenant takes over the lease.  In other program models, the family or individual holds a lease with a public or private landlord from the onset.

To get people housed, Housing First programs have to help people overcome barriers to accessing permanent housing. This includes helping them to resolve outstanding credit issues, address poor tenant histories, collect needed paperwork, etc.  It also involves actively helping them identify housing by reaching out to landlords, housing management companies, public housing authorities, civic organizations, and religious congregations. To gain access to scarce housing units, Housing First programs must be responsive to the concerns of landlords, housing operators, and developers. Strategies include giving landlords 24/7 access to program staff to address tenant problems; provision of enhanced security deposits; and commitment to quickly re-locate tenants who are in violation of the lease.  Some landlords end up prioritizing Housing First tenants because of the financial and administrative benefit they realize from the partnership with Housing First organizations. All Housing First providers focus on helping individuals and families move into permanent housing as quickly as possible, based on the premise that social service needs can best be addressed after they move in to their new home. Low, Moderate or High Intensity Supportive Services The services provided to Housing First participants vary according to need.  Sometimes Housing First programs assist only with crisis intervention and re-housing, and then link the new tenants to services in the community.  On the other end of the spectrum, those tenants with more intensive and chronic problems may require long-term, housing-based services.  The goal is to provide just enough services to ensure successful tenancy and promote the economic and social well-being of individuals and families. The capacity of programs to provide supportive services following a housing placement is largely determined by, and determines, who is targeted for Housing First services. Outcome Measures Determining the effectiveness of Housing First programs relies on capturing outcome data. Among the primary outcomes that should be assessed in a Housing First program are individual or family housing outcomes. How rapidly are families being re-housed? Are individuals and families remaining housed? Do families or individuals re-enter shelter? Programs may want to capture outcomes on family or individual well-being. Programs serving families may include employment and earning outcomes and school performance of children. Programs serving chronically homeless individuals might examine increases or decreases in hospital stays, involvement with law enforcement, or engagement in employment.  Cost reduction can also be an important metric. It is also critical to examine the impact of Housing First in reducing overall homelessness in the community or city.  This can be done through regular counts of homeless people.  Another possible metric is to assess whether the average length of a homelessness episode is being reduced. Moving Forward A growing body of research documents the effectiveness of the Housing First approach when used in working with homeless people who have serious behavioral health and other disabilities. This research indicates that the approach is effective both at placing and retaining people in permanent housing and at reducing the costs associated with these individuals within the health care and judicial systems. Housing First also works for people with less intensive needs.  Recent research in the United States demonstrated the high cost of shelter and transitional housing stays for homeless individuals and families, especially relative to the cost of housing.  A significant recent U.S. investment in Rapid Re-Housing[1] (a variation on Housing First that does not typically include long term rent subsidy but rather short term infusions to quickly return households to housing) will provide much more information on the efficacy and cost of this intervention for a wider group of homeless people.  The Housing First approach, across all populations and categories of need, is clearly having an influence, and communities across the United States are beginning to re-engineer their homeless and mainstream systems to focus on the promotion of housing stability. Moving forward, we continue to embrace the Housing First approach as one that will help us end homelessness much more rapidly for individuals, families and the nation.

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[1] $1.5 billion over three years for the Homelessness Prevention and Rapid Re-Housing Program. Image courtesy of aechempati, C.P.Storm