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Housing First

Housing First is a policy that offers unconditional, permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was first discussed in the 1990s, and in the following decades became government policy in certain locations within the Western world.[1] There is a substantial base of evidence showing that Housing First is both an effective solution to homelessness and a form of cost savings, as it also reduces the use of public services like hospitals, jails, and emergency shelters.[2] Cities like Helsinki and Vienna in Europe have seen dramatic reductions in homelessness due to the adaptation of Housing First policies,[3][4] as have the North American cities Columbus, Ohio, Salt Lake City, Utah, and Medicine Hat, Alberta.[5][6][7][8][9][10]

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 or house 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.


The Housing First strategy is a comprehensive solution incorporating support for homeless people in all aspects of their personal and social life. It does not intend to provide housing for the people in need and forget about them.[11][12][13][14] The Housing First philosophy is a paradigm shift, where quick provision of stable accommodations is a precondition for any other treatment to reduce homelessness. Meanwhile, this approach relies on layers of collaborative support networks that promote stability and eliminate factors that cause or prolong homelessness. The support system addresses issues such as healthcare, education, family, children, employment, and social welfare.[15][16]

General principles[edit]

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.[17]

Definition[edit]

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.[24]


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.[25] This housing is supported through two HUD programs. They are the Supportive Housing Program and the Shelter Plus Care Program.[26]

Execution[edit]

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.[27][28] This model integrates participants in a community as opposed to assembling multiple or all participants in one project or location.[29] 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.[30] 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.[25]


Weekly staff visits as well as a normal lease agreement are also a part of the program. Consumers have to pay 30 percent of their income every month as rent.[31] Rather than have a homeless person remain in an emergency homeless shelter, it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications that must be dealt with to make such an initiative work successfully in the middle to long term.[32][33]

Evidence and outcome[edit]

Australia[edit]

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.[34]

Canada[edit]

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.[35] 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.[36]


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.[37] 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.[37]


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."[37]


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.[38]


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.[39]

Czech Republic[edit]

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.[40]


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.[41]


In 2019 Czech government and EU supported 13 new Housing First projects across the country by European Social Fund.[42]

Denmark[edit]

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.[43]

Criticism of Housing First[edit]

Limits of evidence based policy[edit]

In 2011, Professor Victoria Stanhope of New York University School of Social Work and Professor Kerry Dunn of University of New England School of Social Work, writing in the International Journal of Law and Psychiatry,[27] gave a critical overview of evidence-based policy, based on its reliance on positivist methods and technical approach to policy making, which used the Bush Administration's Housing First policy as a case study. According to Stanhope and Dunn, Housing First is "an example of research-driven policy making but also resulted in a progressive policy being promoted by a conservative administration". The paper argues that evidence-based policy fails to integrate evidence and values into policy deliberations, and concludes with alternative models of policy decision-making and their implications for research."[27]


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).[79] 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.[80] 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.[27]


According to Stanhope, Housing First "is an anathema to neoliberal ideology" because it asserts a fundamental right to housing and therefore "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).”[27][81] Stanhope argues that the dissonance between the fundamental right to housing that Housing First entails and neoliberal ideology has not been considered during policymaking, especially because of the focus on the empirical outcomes of Housing First.[27]


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.[82]

Exceptions to Housing First[edit]

Emergency response[edit]

Hotels have historically been used to house the homeless population temporarily while further accommodations are made.[83]

Homelessness in the United States

McKinney-Vento Homeless Assistance Act

a Canadian program inspired by Housing First[84]

At Home

Graves, Florence; Sayfan, Hadar, , The Boston Globe, Sunday, June 24, 2007.

"First things first: 'Housing first,' a radical new approach to ending chronic homelessness, is gaining ground in Boston"

Lyons, Julia, ", February 26, 2008, The Salt Lake Tribune

"A Home for the Homeless

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 Journal of Community Psychology. 36 (3/4): 223–38.  10.1.1.468.1280. doi:10.1007/s10464-005-8617-z. PMID 16389497. S2CID 26632429.

CiteSeerX

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 (10): 1303–5. :10.1176/appi.ps.56.10.1303. PMID 16215200.{{cite journal}}: CS1 maint: multiple names: authors list (link)

doi

Nashville Business Journal, Thursday, April 17, 2008.

"U.S homeless czar to meet with Mayor, Nashville officials Friday"

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. :10.1176/appi.ps.51.4.487. PMID 10737824.

doi

Tsemberis S. (2004) "'Housing first' Approach" article in , Thousand Oaks, CA: Sage, V1, pp. 277–80.

"Encyclopedia of Homelessness"

Tsemberis, Sam; Gulcur, Leyla; Nakae, Maria (2004). . American Journal of Public Health. 94 (4): 651–56. CiteSeerX 10.1.1.526.8215. doi:10.2105/AJPH.94.4.651. PMC 1448313. PMID 15054020.

"Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals with a Dual Diagnosis"

Tsemberis, Sam; Stefancic, Ana (2007). . The Journal of Primary Prevention. 28 (3): 265–279. doi:10.1007/s10935-007-0093-9. PMID 17592778.

"Housing First for Long-Term Shelter Dwellers in a Suburban County: Traditional Housing and Treatment Services"

. Canadian Broadcasting Corporation (CBC). Published 24 January 2020.

Housing is a human right: How Finland is eradicating homelessness

. AcademyHealth. July 18, 2016.

"Rapid Evidence Review: What Housing-related Services and Supports Improve Health Outcomes among Chronically Homeless Individuals?"

Bassuk, Ellen L.; Geller, Stephanie (January 2006). "The role of housing and services in ending family homelessness". Housing Policy Debate. 17 (4): 781–806. :10.1080/10511482.2006.9521590. S2CID 153559785.

doi

Burt, Martha; et al., , Washington DC : Urban Institute Press, 1st edition, April 2001. ISBN 978-0-87766-701-8

Helping America's homeless: emergency shelter or affordable housing?

McCarroll, Christina, , The Christian Science Monitor, May 1, 2002

"Pathways to housing the homeless"

Notkin, Susan; et al., "Families on the Move: Breaking the Cycle of Homelessness", , New York, NY, 1996.

Edna McConnell Clark Foundation

O'Flaherty, Brendan, , Cambridge, Mass. : Harvard University Press, 1996. ISBN 0-674-54342-4

"Making room : the economics of homelessness"

Quigley, John M.; Raphael, Steven (2 December 2010). . European Journal of Housing Policy. 1 (3): 323–336. doi:10.1080/14616710110091525. S2CID 154789471.

"The economics of homelessness: The evidence from North America"

Roncarati, Jill, , Journal of the American Academy of Physician's Assistants, June 2008.

"Homeless, housed, and homeless again"

Tull, Tanya (Spring 2004). (PDF). The Source. 13 (1). The National Abandoned Infants Assistance Resource Center.

"The 'Housing First' Approach for families Affected by Substance Abuse"

"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.

PBS