Veterans Experiencing Homelessness
Housing First is an evidence-based, cost-effective approach to ending homelessness for the most vulnerable and chronically homeless individuals. The Housing First model prioritizes housing and then assists the Veteran with access to healthcare and other supports that promote stable housing and improved quality of life. The model does not try to determine who is "housing ready" or demand treatment prior to housing. Instead, treatment and other support services are wrapped around Veterans as they obtain and maintain permanent housing.
In 2011, VA tested the Housing First model at 14 HUD-VASH sites. Based on a 36-month evaluation of the Housing First Pilot Initiative, VA Homeless Program Office made an executive decision to implement Housing First nationwide in the HUD-VASH Program.
Today the HUD-VASH Program has nearly 90,000 Veterans with active HUD-VASH vouchers and collaboratively practices the Housing First model with 137 public housing authorities across the nation.
The Evidence Behind Approaches that Drive an End to Homelessness
A Case Management Guidebook: June 2018
Housing First Fact Sheet (2016)
USICH Housing First Checklist
HUD Housing First Permanent Supportive Housing Brief (2014)
Housing First The Pathways Model to end Homelessness (2010)
Housing First 101: Is it Housing Only (March 2018)
Podcast: "Housing First Initiative"
Sonya Gabrielian, MD, MPH, and Alex Young, MD, both of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy at the VA Greater Los Angeles; Stefan Kertesz, MD, MSc, Affiliate Investigator with HSR&D's Center for Mental Healthcare and Outcomes Research; and Tom O'Toole, MD, Director of the VA National Center on Homelessness among Veterans address the Housing First initiative's impact on ending Veteran homelessness.
Housing First Principles Across VA Programs (May 2016)
Employment experiences of formerly homeless adults with serious mental illness in Housing First versus treatment first supportive housing programs. Tiderington E, Henwood BF, Padgett DK, Tran Smith B.Tiderington E, et al. Psychiatr Rehabil J. 2020 Sep;43(3):253-260. doi: 10.1037/prj0000391
Housing versus treatment first for supportive housing participants with substance use disorders: A comparison of housing and public service use outcomes. Hall G, Walters S, Gould H, Lim S.Hall G, et al. Subst Abus. 2020;41(1):70-76. doi: 10.1080/08897077.2018.1449049
Is the Housing First Model Effective? Different Evidence for Different Outcomes. Tsai J. Am J Public Health. 2020 Sep;110(9):1376-1377. doi: 10.2105/AJPH.2020.305835. Am J Public Health. 2020. PMID: 32783738
Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review. Peng Y, Hahn RA, Finnie RKC, Cobb J, Williams SP, Fielding JE, Johnson RL, Montgomery AE, Schwartz AF, Muntaner C, Garrison VH, Jean-Francois B, Truman BI, Fullilove MT; Community Preventive Services Task Force.Peng Y, et al. J Public Health Manag Pract. 2020 Sep/Oct;26(5):404-411. doi: 10.1097/PHH.0000000000001219.J Public Health Manag Pract. 2020. PMID: 32732712
Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United States. Chhabra M, Spector E, Demuynck S, Wiest D, Buckley L, Shea JA. Health Soc Care Community. (2019) Sep 2. doi: 10.1111/hsc.12843. [Epub ahead of print]
The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. Kerman N, Sylvestre J, Aubry T, Distasio J. BMC Health Serv Res. 2018 Mar 20;18(1):190. doi: 10.1186/s12913-018-3028-7.
Residential Moves Among Housing First Participants. Byrne T, Henwood BF, Scriber B.
J Behav Health Serv Res. 2018 Jan;45(1):124-132. doi: 10.1007/s11414-016-9537-4. No abstract available.
Sustaining Housing First After a Successful Research Demonstration Trial: Lessons Learned in a Large Urban Center. Kumar N, Plenert E, Hwang SW, O'Campo P, Stergiopoulos V. Psychiatr Serv. 2017 Jul 1;68(7):739-742. doi: 10.1176/appi.ps.201600220. Epub 2017 Mar 1
Housing first on a large scale: Fidelity strengths and challenges in the VA's HUD-VASH program.
Kertesz SG, Austin EL, Holmes SK, DeRussy AJ, Van Deusen Lukas C, Pollio DE.Psychol Serv. 2017 May;14(2):118-128. doi: 10.1037/ser0000123.
Housing First for Adults with Problematic Substance Use. Cherner RA, Aubry T, Sylvestre J, Boyd R, Pettey D. J Dual Diagn. 2017 Jul-Sep;13(3):219-229. doi: 10.1080/15504263.2017.1319586. Epub 2017 Apr 17.
First examination of varying health outcomes of the chronically homeless according to Housing First configuration. Whittaker E, Dobbins T, Swift W, Flatau P, Burns L. Aust N Z J Public Health. 2017 Jun;41(3):306-308. doi: 10.1111/1753-6405.12631. Epub 2017 Jan 22.
Housing First and harm reduction: a rapid review and document analysis of the US and Canadian open-access literature. Watson DP, Shuman V, Kowalsky J, Golembiewski E, Brown M.Harm Reduct J. 2017 May 23;14(1):30. doi: 10.1186/s12954-017-0158-x.
Recruitment and retention of homeless individuals with mental illness in a housing first intervention study. Strehlau V, Torchalla I, Patterson M, Moniruzzaman A, Laing A, Addorisio S, Frankish J, Krausz M, Somers J. Contemp Clin Trials Commun. 2017 May 5;7:48-56. doi: 10.1016/j.conctc.2017.05.001. eCollection 2017 Sep.
A Randomized Trial Examining Housing First in Congregate and Scattered Site Formats. Somers JM, Moniruzzaman A, Patterson M, Currie L, Rezansoff SN, Palepu A, Fryer K.
PLoS One. 2017 Jan 11;12(1):e0168745. doi: 10.1371/journal.pone.0168745. eCollection 2017.
Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes. Adair CE, Kopp B, Distasio J, Hwang SW, Lavoie J, Veldhuizen S, Voronka J, Kaufman AF, Somers JM, LeBlanc SR, Cote S, Addorisio S, Matte D, Goering P. J Urban Health. 2016 Aug;93(4):682-97. doi: 10.1007/s11524-016-0062-9.
Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial. Chung TE, Gozdzik A, Palma Lazgare LI, To MJ, Aubry T, Frankish J, Hwang SW, Stergiopoulos V. Int J Geriatr Psychiatry. 2018 Jan;33(1):85-95. doi: 10.1002/gps.4682. Epub 2017 Feb 16
Further Validation of the Pathways Housing First Fidelity Scale. Goering P, Veldhuizen S, Nelson GB, Stefancic A, Tsemberis S, Adair CE, Distasio J, Aubry T, Stergiopoulos V, Streiner DL. Psychiatr Serv. 2016 Jan;67(1):111-4. doi: 10.1176/appi.ps.201400359. Epub 2015 Sep 15
Tenants with additional needs: when housing first does not solve homelessness. Volk JS, Aubry T, Goering P, Adair CE, Distasio J, Jette J, Nolin D, Stergiopoulos V, Streiner DL, Tsemberis S. J Ment Health. 2016;25(2):169-75. doi: 10.3109/09638237.2015.1101416. Epub 2015 Dec 3.
Putting Housing First: The Evidence and Impact.Goering PN, Streiner DL. Can J Psychiatry. 2015 Nov;60(11):465-6. No abstract available.
Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature. Ly A, Latimer E. Can J Psychiatry. 2015 Nov;60(11):475-87. Review
Association of housing first implementation and key outcomes among homeless persons with problematic substance use. Davidson C, Neighbors C, Hall G, Hogue A, Cho R, Kutner B, Morgenstern J. Psychiatr Serv. 2014 Nov 1;65(11):1318-24. doi: 10.1176/appi.ps.201300195. Epub 2014 Oct 31
Montgomery, A. E., Hill, L. L., Kane, V., Culhane, D. P. (2013). Housing Chronically Homeless Veterans: Evaluating the Efficacy of a Housing First Approach to HUD-VASH. Journal of Community Psychology, 41(4): 505-514. (doi: 10.1002/jcop.21554) [Epub 2013 Mar 21 - ahead of print]
Nelson, Geoffrey, Aubry, Tim, Lafrance, Adele, A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiatry, Vol 77(3), Jul 2007, 350-361
Stefancic, A., & Tsemberis, S. (2007). Housing first for long-term shelter dwellers with psychiatric disabilities in A suburban county: A four-year study of housing access and retention. Journal of Primary Prevention, 28, 265-279.
Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for
homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651-656.
Tsemberis, S., & Eisenberg, R. F. (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51(4), 487-493.
Evaluation findings from the Housing First Pilot
Multiple randomized studies document the ability of Housing First interventions to provide better residential stability and housing outcomes (Padgett, Gulcur, & Tsemberis, 2006; Stefancic & Tsemberis, 2007; Tsemberis & Eisenberg, 2000; Tsemberis, Gulcur, & Nakae, 2004) when compared to linear residential treatment approaches or treatment-as-usual conditions for persons experiencing chronic homelessness with severe mental illness. These beneficial residential stability and housing outcomes among Housing First participants did not come at the expense of increased levels of substance use compared to those in treatment-as-usual conditions (Padgett, Gulcur, & Tsemberis, 2006; Tsemberis & Eisenberg, 2000; Tsemberis, Gulcur, & Nakae, 2004), contrary to assumptions that the provision of housing without mandated sobriety would result in higher levels of participant substance abuse.
The key distinguishing feature of the Housing First approach is a commitment to offer permanent housing first to hard-to-serve homeless persons, rather than requiring a period of stabilization, sobriety, or commitment to treatment to demonstrate housing readiness. This paradigm shift of viewing chronically homeless individuals who have serious mental illness and often co-occurring substance-related disorders as "housing ready" differentiates the Housing First approach. Case managers practicing the Housing First model subscribe to the following principles:
- Treatment and supportive services are made available but are not a requirement for participation or remaining in housing.
- Assertive community outreach is used to engage and people who are homeless with mental illness and substance use problems placement in permanent housing as quickly as possible.
- A low demand approach is used to accommodate people not who cannot remain clean and sober and be fully compliant with mental health treatment to sustain the formerly homeless person in stable permanent housing.
No available resources
Executive Summary of the Housing First Model Development Initiative (A detailed review of the Safe Housing First Model Development Initiative)
Housing First: An Implementation Framework (A step by step guide for starting and managing a Housing First model using an Implementation Science Framework):
National Alliance to End Homelessness: Information on the principles of Housing First
- Ann Elizabeth Montgomery, PhD / Ann.Montgomery2@va.gov for more information about the Housing First evaluation.
- Roger Casey, PhD / Roger.Casey@va.gov or Paul Smits/ firstname.lastname@example.org for more information about the Housing First model implementation process.
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