Housing First

Housing First is just one example of a program that can contribute to ending people’s homelessness.

Housing First

‘Housing First’ as a model for assisting chronically homeless people is a relatively simple concept. It requires a suitable and affordable house or unit and, for most formerly homeless people, the provision of ongoing support to help ensure they sustain their tenancy. This is not a difficult service model to grasp.

There are numerous examples of the ‘Housing First’ model. These include Common Ground in New York, through its ‘Streets to Home’ Program; Pathways to Housing, also in New York; the Streets to Homes program being implemented by Toronto City Council in Canada and Ecuhome, a service also based in Toronto, Canada.

‘Housing First’ is based on a number of elements. These include:

People do not have to be assessed as ‘housing ready’
This is a criterion that is regularly used in other service models and requires homeless people to first transition through a support service or transitional housing option and/or to undertake independent living skills training and assessment. The key reason being that people not be ‘set-up’ to fail in their tenancies. Whilst this is a valuable objective (it is essential that we not set people up to fail), it may not be substantiated by evidence.

Housing is provided as quickly as possible
Offers of housing to move from chronic homelessness on the street are provided as soon as possible after someone agrees that they want to move into housing.

People are provided with adequate and appropriate support services in their home
Whatever level of ongoing support needed, is provided. In the model used by Pathways to Housing in NYC, this is termed assertive community treatment.

People with alcohol or other drug addictions can access housing
Many other program models that may require a transitional period in a congregate care environment may also require a period (or longer) of abstinence from alcohol and/or other drugs. Most Housing First models do not require this and people will be able to access housing regardless of their substance use issues. However, this does not mean that their substance use will be ignored over the longer term. In the first instance there will be support to try to manage it better and over the longer term, support to understand it, reduce or even to cease it. There is some evidence accumulating that once people are in a stable housing situation they are in a better position to try and tackle their addictions.

“Housing First is an effective intervention that ends and prevents homelessness for individuals with severe mental illness and co-occurring addictions. By providing permanent, independent housing without prerequisites for sobriety and treatment, and by offering support services through consumer-driven Assertive Community Treatment teams, Housing First removes some of the major obstacles to obtaining and maintaining housing for consumers who are chronically homeless”. [1]  Stefancic, Tsemberis et al.

Separate the behaviour from the diagnoses
Common Ground as an example of a service that provides Housing First makes it clear that they do not ask anything more of their lease holder tenants than any other landlord asks. No other private landlord would feel they could ask if someone is drinking in their apartment or not taking their prescribed medication. However, as Rosanne Haggerty states, “But we’re very strict about behaviour. If someone behaves badly we get on it very quickly, figuring out what needs to be changed. We have few rules but we enforce them vigorously.” [2]

Separate the management of the housing from the support
Most organisations who provide Housing First try to make a separation between the management of the tenancy and the support of the client. Common Ground does this, using a different agency (CUCS) to provide support to people in Common Ground buildings.

Click here to read the article Evidence for Housing First by Felicity Reynolds, published in Parity Magazine, 2009.

For further information about the Housing First approach, watch "Housing First for Homelessness" from CBS.

Footnotes:

1. Stefancic, Tsemberis et al.

2. Vitullo-Martin, J; Homeless in America, The Wall Street Journal, January 18 2007. Quote cited in article by Rosanne Haggerty, Common Ground President.