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. Within the U.S. Department of Veterans Affairs (VA), the Housing First model is being implemented through the U.S. Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program. The program combines Housing Choice vouchers for Veterans to rent privately-owned housing, and support through VA case management services that include health care, mental health treatment, vocational assistance, and job development.
Goals & Objectives
In October 2012, VA made Housing First the official policy for the HUD-VASH program. The Center’s Model Implementation Framework (CMIF) was utilized to monitor and ensure fidelity of the initially funded sites while developing additional enhancements and guide recommendations for site expansion. Sites were selected based on their assessed potential for fully implementing all components the Housing First model. The Assertive Community Treatment (ACT) Teams funded at the Housing First model development sites were provided two initial trainings and technical assistance onsite and via semi-monthly telephone conferences.
In Fiscal Year (FY) 2014, the Center provided consultation and guidance by conducting individual visits, biweekly conference calls, and individual phone calls with those sites initially designated as Housing First Model Development Programs. Eighteen (18) sites were reviewed in 15 networks by a consultative multi-disciplinary team. A trend analysis and educational needs assessment was conducted during the first quarter of FY 2015. This assessment was used to develop educational curriculum for FY 2015.
A demonstration project that compared a Housing First program offering immediate permanent housing without requiring treatment compliance, abstinence, or housing readiness with a treatment-first program for 177 homeless Veterans found that the Housing First initiative successfully reduced time to housing placement, from 235 to 35 days; housing retention rates were significantly higher among Housing First tenants; and emergency room use declined significantly among the Housing First cohort.
Kertesz, S. G., Austin, E. L., Holmes, S. K., DeRussy, A. J., Van Deusen Lukas, C., Pollio, D. E. (2017). Housing First on a Large Scale: Fidelity Strengths and Challenges in the VA’s HUD-VASH Program. Psychological Services, 14(2): 118-128. (doi:10.1037/ser0000123)
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]
"Housing First" iLearn Training Module - January 28, 2014
"Housing First" TRAIN Video - 4290
"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.
- Listen (15:42)
For more information, get the Housing First Implementation brief.
- Ann Elizabeth Montgomery, PhD / Ann.Montgomery2@va.gov for more information about the Housing First evaluation.
- Roger Casey, PhD / Roger.Casey@va.gov for more information about the Housing First model implementation process.