Housing First

Housing First, also known as "rapid re-housing", is a relatively recent innovation in human service programs and social policy regarding treatment of the homeless and is an alternative to a system of emergency shelter/transitional housing progressions. Rather than moving homeless individuals through different "levels" of housing, known as the Continuum of Care, 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 apartments.

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

Pioneered by Dr. Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine, and the organization Pathways to Housing in New York City in the early 1990s, 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. Pathways' Housing First model has been recognized by the Substance Abuse and Mental Health Services Administration as an Evidence-based practice.

Principles of Housing First are: 1) Move people into housing directly from streets and shelters without preconditions of treatment acceptance or compliance; 2) The provider is obligated to bring robust support services to the housing. These services are predicated on assertive engagement, not coercion; 3) Continued tenancy is not dependent on participation in services; 4) Units targeted to most disabled and vulnerable homeless members of the community; 5) Embraces harm-reduction approach to addictions rather than mandating abstinence. At the same time, the provider must be prepared to support resident commitments to recovery; 6) Residents must have leases and tenant protections under the law; 7) Can be implemented as either a project-based or scattered site model.

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 Plattsburgh, New York; Anchorage, Alaska; Minneapolis, Minnesota; New York City; District of Columbia; Denver, Colorado; San Francisco, California; Atlanta, Georgia; Chicago, Illinois; Quincy, Massachusetts; Philadelphia, Pennsylvania; Salt Lake City, Utah; Seattle, Washington, and Cleveland, Ohio among many others, and are intended to be crucial aspects of communities' so-called 10-Year Plans To End Chronic Homelessness also advocated by USICH.

Evidence and outcomes

In Massachusetts, the Home & Healthy for Good program reported some significant outcomes that were favorable especially in the area of cost savings.

The Denver Housing First Collaborative, operated by the Colorado Coalition for the Homeless, provides housing through a Housing First approach to more than 200 chronically homeless individuals. A 2006 cost study documented a significant reduction in the use and cost of emergency services by program participants as well as increased health status. Emergency room visits and costs were reduced by an average of 34.3 percent. Hospital inpatient costs were reduced by 66 percent. Detox visits were reduced by 82 percent. Incarceration days and costs were reduced by 76 percent. 77 percent of those entering the program continued to be housed in the program after two years. See Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report.

Researchers in Seattle Washington, partnering with the Downtown Emergency Service Center, 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 the study funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation 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 dollars 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, a decrease of 42 percent in chronic homelessness from 2009 to 2010 "can be attributed to the State’s Housing First Initiative," according to the Utah Division of Housing and Community Development.

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.

Recent US 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.

In late 2009, some homeless advocacy organizations, such as the National Coalition for the Homeless, reported and published perceived problems with the HEARTH Act of 2009 as a HUD McKinney-Vento Reauthorization bill, especially with regard to privacy, definitional ineligibilty, community roles, and restrictions on eligibile activities.

On June 22, 2010, the United States Interagency Council on Homelessness presented Opening Doors: Federal Strategic Plan to Prevent and End Homelessness to the Obama Administration and Congress. This is the nation's first comprehensive strategy as mandated by the HEARTH Act and includes Housing First as a best practice for reaching the goal of ending chronic homelessness by 2015.

Application to family homelessness

The Housing First methodology is also being adapted to decreasing the larger segment of the homeless population, family homelessness, such as in the Los Angeles based program Housing First for Homeless Families which had been established in 1988. Dennis Culhane, University of Pennsylvania homelessness researcher, states: “There’s a lot of policy innovation going on around family homelessness, and it’s borrowing a page from the chronic handbook — the focus is on permanent housing and housing-first strategies.”

Applications of Housing First -policy outside the US

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 also 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:

• To halve long-term homelessness by 2011
• To eliminate homelessness entirely by 2015
• More effective measures to prevent homelessness

See also

• Homelessness in the United States
• McKinney-Vento Homeless Assistance Act

Bibliography

• Graves, Florence; Sayfan, Hadar, "First things first: 'Housing first,' a radical new approach to ending chronic homelessness, is gaining ground in Boston", The Boston Globe, Sunday, June 24, 2007.
• Lyons, Julia, "A Home for the Homeless", February 26, 2008, The Salt Lake Tribune
• Nashville Business Journal, "U.S homeless czar to meet with Mayor, Nashville officials Friday", Thursday, April 17, 2008.
• Greenwood R, Schaefer-McDaniel N, Winkel G, Tsemberis S. (2005) "Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness", American J Community Psychology 36(3/4):223-38.
• Pathways to Housing Inc New York. (2005), "2005 APA Gold Award: Providing housing first and recovery services for homeless adults with severe mental illness", Psychiatric Services 56:1303-5.
• Tsemberis, Sam; Eisenberg, Ronda R. (2000). "Pathways to Housing: Supported Housing for Street-Dwelling Homeless Individuals with Psychiatric Disabilities". Psychiatric Services 51 (4): 487–93. doi:10.1176/appi.ps.51.4.487. PMID 10737824. 
• Tsemberis S. (2004) "'Housing first' Approach" article in "Encyclopedia of Homelessness", Thousand Oaks, CA: Sage, V1, pp. 277–80.
• Tsemberis, Sam; Gulcur, Leyla; Nakae, Maria (2004). "Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis". American Journal of Public Health 94 (4): 651–56. doi:10.2105/AJPH.94.4.651. 
• Tsemberis, Sam; Stefancic, Ana (2007). "Housing First for Long-Term Shelter Dwellers in a Suburban County: Traditional Housing and Treatment Services". The Journal of Primary Prevention 28 (3): 265–279. http://www.medscape.com/viewarticle/561611_2. 

Further reading

• "Editorial: Doubled demand for housing over shelters, hotels", Spare Change News, Boston, Fri, December 2, 2011
• Bassuk, Ellen L.; Geller, Stephanie (2006). "The Role of Housing and Services in Ending Family Homelessness". Housing Policy Debate 17 (4): 781–806. doi:10.1080/10511482.2006.9521590. http://www.mi.vt.edu/data/files/hpd%2017(4)/roleofhousingandservices.pdf. 
• Benner, Tom, "Mass. Wants New Emphasis on Housing over Shelters", Spare Change News, Boston, July 15, 2011 (part 1 of 3)
• Benner, Tom, "New Homeless Policy", Spare Change News, July 29, 2011 (part 2 of 3)
• Benner, Tom, "An Exclusive Interview with Lt. Gov. Tim Murray on the State's New Housing First Policy", Spare Change News, August 12, 2011 (part 3 of 3)
• Bornstein, David, "A Plan to Make Homelessness History", The New York Times, December 20, 2010.
• Burt, Martha; et al., Helping America's homeless: emergency shelter or affordable housing?, Washington DC : Urban Institute Press, 1st edition, April 2001. ISBN 978-0-87766-701-8
• Center for the Study of Social Policy, "Affordable Housing as a Platform for Improving Family Well-Being: Federal Funding and Policy Opportunities", Financing Community Change Brief, June 2011, Washington D.C.
• Friedman, Donna Haig, et al., "Preventing Homelessness and Promoting Housing Stability: A Comparative Analysis", The Boston Foundation, June 2007.
• Karash, Robert L., "Housing Lost, Housing Regained, Housing Kept", Spare Change News, Boston, February 25, 2010.
• McCarroll, Christina, "Pathways to housing the homeless", The Christian Science Monitor, May 1, 2002
• Notkin, Susan; et al., "Families on the Move: Breaking the Cycle of Homelessness", Edna McConnell Clark Foundation, New York, NY, 1996.
• O’Flaherty, Brendan, "Making room : the economics of homelessness", Cambridge, Mass. : Harvard University Press, 1996. ISBN 0674543424
• Putnam, Kristen M., "Homelessness: Key Findings and Grantmaking Strategies", June 2002, Charles and Helen Schwab Foundation and Putnam Community Investment Consulting.
• Quigley, John M.; Raphael, Steven, "The Economics of Homelessness: The Evidence from North America", European Journal of Housing Policy 1(3), 2001, 323–336
• Roberts, Kevin, "Expert: ‘Even if shelters were better, they’re still not solving the problem'", Street News Service, Fri, December 2, 2011. Originally published in One Step Away street newspaper, Philadelphia, Pennsylvania
• Roncarati, Jill, "Homeless, housed, and homeless again", Journal of the American Academy of Physician's Assistants, June 2008.
• Tull, Tanya, "The 'Housing First' Approach for families Affected by Substance Abuse", The Source, v.13. n.1, Spring 2004, The National Abandoned Infants Assistance Resource Center

Media

• PBS, "Home at Last?, NOW series program, first aired on February 2, 2007. The topic was what will most help homeless people reenter the fabric of society and looks at the housing option.

External links

• Interagency Council on Homelessness (USA)
• Massachusetts Housing and Shelter Alliance
• The Partnership to End Long Term Homelessness
• Citizens' Housing and Planning Association
• National Low Income Housing Coalition
• National Alliance of HUD Tenants
• Dr. Sam Tsemberis information — Columbia University Center for Homelessness Prevention Studies (CHPS)
• Downtown Emergency Service Center, Seattle — Housing First programs
• The Philadelphia Committee to End Homelessness
• Housing First - Transitional Housing for Individuals and Families