Policy Analysis of the Housing First
Model
Tina Rogoski
California State University, Long Beach
May 2012
Housing First
• Provides immediate access to housing with an intensive case management
team providing a multitude of services
• Aimed for the chronically homeless who often have mental health and
substance abuse concerns as well as major chronic medical conditions
• In stark contrast to the traditional approach that had been used thus far
• Based on the belief that housing is a basic human right
• Regards housing and treatment as separate domains
• Respects harm reduction and consumer choice
Main Goals: -To help the homeless maintain and manage independent
apartments while providing services to enhance one’s quality of life
-To promote positive impacts on mental health, substance use, and
medical health
-To reduce ER visits, hospitalizations, and use of other crisis services such
as police and ambulances
Pearson, Montgomery, & Locke, (2009); Kertesz et al., (2009); Tsemberis, (1999); Corporation for Supportive Housing, (2006)
Social Work Relevance
• Social workers are committed to ensuring that the needs are
met for populations that experience marginalization and
oppression and the chronically homeless are an especially
vulnerable and at risk population
• Many have little to no income, high rates of behavioral health
conditions, mental health, chronic medical conditions,
substance abuse, lack access to appropriate health care, are
exposed to high levels of trauma and violence, and frequent
ERs, hospitals, and jails
• It is essential that social workers promote core values such as
social justice and worth and dignity of the person in order to
help enhance one’s quality of life
• Providing housing does just that as once one has a roof over
one’s head it is much easier to see improvements in most
other areas of life
NASW, (2010); The United States Interagency Council on Homelessness, (2010); Pearson et al., (2009)
Literature
• Settlement housing movement during the late 19th century reflected a
dual responsibility to social service & reform
• Then reformists created a large scale government supported housing
rental program aimed at helping those living in poverty called public
housing
• Section 8 Housing was created in 1974 and promoted by Congress as a
way to establish economically and racially integrated neighborhoods
across the U.S.
• Deinstitutionalization beginning in the 1960s and economic downturn
furthered the growth of homelessness
• McKinney-Vento Act of 1987 established federally recognized services for
the homeless for the first time including emergency relief provisions for
shelter, food, mobile health care, and transitional housing
• The traditional housing approach has been the main method of combating
homelessness involving a linear design of having to complete a succession
of programs while also managing sobriety and taking psychiatric
medication
Koerin, (2003); Schill & Wachter, (1995); Beck, (1996); Nelson, (2010); National Coalition for the
Homeless, (2006); Kertesz et al., (2009)
Methods
• A secondary review of existing literature including data
sources such as California State University, Long Beach
library resources, special government sections, public
agency documents, and government agency documents
• Theoretical framework used is Gil’s (1976) policy analysis
focusing on 4 main sections of:
-Issues dealt with by the policy
-Objectives, value premises, theoretical positions, target
segments, and substantive effects
-Implications of the policy causing changes among
distribution of rights and quality of life
-Interactions of the policy with forces affecting social
evolution
Policy Analysis
• Housing First is in stark contrast to the theories underlying the
traditional housing approach and is instead defined by the
recovery model, self-determination, harm reduction, and
collaboration
• Its main objective is to provide optimal services to the
chronically homeless by finding independent housing without
the requirements of psychiatric treatment or sobriety
• Essential values are that everyone has the right to housing,
individual choice over one’s life decisions, and empowerment
• Individuals are provided immediate access to a broad range of
supportive services by an assertive community treatment
team working to meet the individual where they are at
Padgett et al., (2011); Johnsen & Teixeira (2010); Tsemberis, (1999)
Long Range Effects:
-Maintained higher housing-retention rates
-Fewer days incarcerated
-Positive impacts on health, mental illness, and substance use
-Decreased use of ER and hospitals
-Increased use of preventative health care
-Cost effectiveness due to this decrease in utilization of expensive crisis
oriented systems
Supporters:
-Housing First has gained momentum across the country with support from
the federal government, media, policymakers, and homeless advocates
-Discussed positively in major print, including national newspapers,
magazines, broadcast media, and scientific scholarly articles
-Foreign countries, such as the United Kingdom, Belgium, Norway, and
Denmark, have implemented numerous similar projects to see if they can
achieve the same positive effects as have been reached in the U.S.
Tsemberis (1999); Kertesz et al. (2009); Atherton & Nicholls (2008)
•
•
•
•
•
Strengths
Many studies reported substantial evidence to support
positive outcomes of the Housing First model
Many attribute the decrease in the chronically homeless
population to the rise of this model across the country
Showcases that program philosophies centered in choice and
empowerment over restrictions and compliance warrant
attention as not only effective but also humane
Challenges
Housing First is still a relatively recent intervention so even
though most of its early appraisals have led to positive
findings it is important to recognize that long-term effects
have yet to be fully determined due to its recent
implementation.
Much of the current literature is also written by supporters
and advocates where it is essential to recognize that research
completed by supports can tend to lean in the direction of
positive outcomes
References
Atherton, I., & Nicholls, C.M. (2008). ‘Housing First’ as a means of addressing multiple needs and
homelessness. European Journal of Homelessness, 2, 289-303.
Beck, P. (1996).Fighting Section 8 discrimination: The Fair Housing Act’s new frontier. Harvard Civil Rights-Civil
Liberties Law Review, 31, 155-186.
Corporation for Supportive Housing.(2006). Guidebook on developing permanent supportive housing for
homeless veterans. New York, NY: Author.
Kertesz, S.G., Crouch, K., Milby, J.B., Cusimano, R.E., & Schumacher, J.E. (2009). Housing first for homeless
persons with active addiction: Are we overreaching? The Milbank Quarterly, 87(2), 495-534.
Koerin, B. (2003). The settlement house tradition: Current trends and future concerns. Journal of Sociology and
Social Welfare, 3(2), 53-68.
Johnsen, S., &Teixeira, L. (2010).Staircases, elevators and cycles of change: ‘Housing First’ and other
housingmodels for homeless people with complex support needs. London, UK:Crisis.
National Association of Social Workers.(2011). National Association of Social Workers. Retrieved from
http://www.socialworkers.org/
National Coalition for the Homeless.(2006). McKinney-Vento Act. Washington, DC: Author.
Nelson, G. (2010). Housing for people with serious mental illness: approaches, evidence, and transformative
change. Journal of Sociology & Social Welfare, 37(4), 123- 146.
Padgett, D.K., Stanhope, V., Henwood, B.F., & Stefancic, A. (2011). Substance use outcomes among homeless
clients with serious mental illness: Comparing housing first with treatment first programs. Community
Mental Health Journal, 47, 227- 232.
Pearson, C., Montgomery, A.E., & Locke, G. (2009).Housing stability among homeless individuals with serious
mental illness participating in housing first programs. Journal of Community Psychology,37(3), 404-417.
Schill, M.H., &Wachter, S.M. (1995). The spatial bias of federal housing law and policy: Concentrated poverty in
urban America. The University of Pennsylvania Law Review,143(5), 1285-1342.
Tsemberis, S. (1999). From streets to homes: An innovative approach to supported housing for homeless adults
with psychiatric disabilities. Journal of Community Psychology, 27(2), 225-241.
The United States Interagency Council on Homelessness. (2010). Opening doors: Federal strategic plan to
prevent and end homelessness. Washington, D.C: Author.