Topic: Alcohol/Drugs/Tobacco, Antisocial Behavior, Employment
Target Population: Adults, Veterans
Sector: Community-Based
Military Sector: Veterans Affairs
This program is for individuals who are homeless and who have complex needs, such as severe psychiatric disabilities and/or substance use disorders.
Pathways' Housing First is designed to supply immediate housing for individuals who are homeless and then introduce participants to supportive services that could address mental and physical health issues, substance use problems, and employment concerns.
Several internal and external randomized controlled and quasi-experimental trials of this program found significant and sustained results for outcomes of housing stability and homelessness. Participants spent significantly less time homeless, experienced a faster decrease in homelessness over time, or spent more days in their own home as compared to control groups. However, across all studies, there were no effects or mixed effects on other outcomes including drug or alcohol abuse, psychiatric symptoms, quality of life, community functioning, employment, incarceration, suicidal ideation, or satisfaction with housing. Results of an uncontrolled study among homeless veterans in Canada indicated reductions in homelessness and an overall decrease in health service utilization, including telephone appointments, service provider and drop-in center visits, crisis service phone calls, ambulance rides, and emergency room visits. There was no change in quality of life.
Pathways' Housing First provides an alternative approach to homelessness by first offering participants housing and, then, support services. The program seeks to house individuals who have trouble maintaining housing under traditional treatment programs, and it prioritizes elderly or female individuals. There are five key principles to the Housing First model, which is the foundation for all Housing First programs:
All Housing First programs follow these principles; however, individual programs can be modified to focus on specific locations or populations. Outreach teams on the street and shelter staff distribute program information and approach possible participants. Staff locate housing for individuals upon admission, help in lease execution, facilitate apartment furnishing, and assist with moving. If apartments are not available, tenants are housed in hotels or YMCA locations until housing is obtained.
Initiated in 1992, the Housing First model has been implemented across the United States and internationally. This program has also been implemented and evaluated among homeless veterans.
This program is facilitated by agency or community volunteers and treatment staff. Optional training is available and consists of an initial consultation, on-site training, community regional training, webinars, ongoing teleconferences, and fidelity visits. Costs vary depending on site needs. Please visit https://www.pathwayshousingfirst.org/training, or use details in the Contact section to learn more.
Considerations for implementing this program include recruiting facilitators and outreach staff, creating relationships with shelters, engaging assertive community treatment staff to implement treatment, coordinating available housing units, obtaining apartment building administration buy-in and consent to house individuals receiving Pathways' Housing First support, understanding this program could be expensive to facilitate and some tenants may not have stable incomes, and realizing funds will need to be acquired.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing Pathways' Housing First, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
This program provides ongoing support for an undetermined length of time, and the treatment team works with participants through periods of housing loss, hospitalization, or incarceration. If an individual refuses formal services, a treatment team member meets with that individual four to six times per month to check on him or her and monitor his or her safety and well-being.
Implementation materials can be purchased online https://www.hazelden.org/store/item/385155. The manual and DVD set is $235. Other costs will vary and could be extensive depending on housing used and the amount of time support is needed. The developer provided a cost estimation of $1.6 to $2 million to house 40 people. Approximately half of that cost goes to rent stipend, and the other half is for a service support team.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals.
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact the Pathways Housing First Institute by mail Business Office, 1028 2nd Street, Ste. 22, Santa Monica, CA 90403-3629, or visit https://www.pathwayshousingfirst.org/
https://www.pathwayshousingfirst.org/, https://www.endhomelessness.org/pages/housing_first, https://www.hazelden.org/store/item/385155, and Tsemberis and Eisenberg (2000).
Aquin, J. P., Roos, L. E., Distasio, J., Katz, L. Y., Bourque, J., Bolton, J. M., … Sareen, J. (2017). Effect of Housing First on suicidal behaviour: A randomised controlled trial of homeless adults with mental disorders. The Canadian Journal of Psychiatry / La Revue Canadienne De Psychiatrie, 62(7), 473-481.
Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., … Tsemberis, S. (2016). A multiple-city RCT of Housing First with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67(3), 275-281. https://doi.org/10.1176/appi.ps.201400587
Aubry, T., Tsemberis, S., Adair, C. E., Veldhuizen, S., Streiner, D., Latimer, E., … Goering, P. (2015). One-year outcomes of a randomized controlled trial of Housing First with ACT in five Canadian cities. Psychiatric Services, 66(5), 463-469. https://doi.org/10.1176/appi.ps.201400167
Brown, M. M., Jason, L. A., Malone, D. K., Srebnik, D., & Sylla, L. (2016). Housing First as an effective model for community stabilization among vulnerable individuals with chronic and nonchronic homelessness histories. Journal of Community Psychology, 44(3), 384-390. https://doi.org/10.1002/jcop.21763
Cherner, R. A., Aubry, T., Sylvestre, J., Boyd, R., & Pettey, D. (2017). Housing First for adults with problematic substance use. Journal of Dual Diagnosis, 13(3), 219-229. https://doi.org/10.1080/15504263.2017.1319586
Chung, T. E., Gozdzik, A., Palma Lazgare, L. I., To, M. J., Aubry, T., Frankish, J., … Stergiopoulos, V. (2018). Housing First for older homeless adults with mental illness: A subgroup analysis of the At Home/Chez Soi randomized controlled trial. International Journal of Geriatric Psychiatry, 33(1), 85-95. https://doi.org/10.1002/gps.4682
Collins, S. E., Taylor, E. M., King, V. L., Hatsukami, A. S., Jones, M. B., Lee, C., … Nelson, L. A. (2016). Suicidality among chronically homeless people with alcohol problems attenuates following exposure to Housing First. Suicide & Life-Threatening Behavior, 46(6), 655-663. https://doi.org/10.1111/sltb.12250
Ferreiro, I. C., Cuadra, M. A. R., Serqueda, F. A., & Abad, J. M. H. (2022). Impact of Housing First on psychiatric symptoms, substance use, and everyday life skills among people experiencing homelessness. Journal of Psychosocial Nursing and Mental Health Services, 1-10. https://doi.org/10.3928/02793695-20220316-01
Greenwood, R. M., Schaefer-McDaniel, N. J., Winkel, G., & Tsemberis, S. J. (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology, 36(3), 223-238. https://doi.org/10.1007/s10464-005-8617-z
Gulcur, L., Stefancic, A., Shinn, M., Tsemberis, S., & Fischer, S. N. (2003). Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and Housing First programmes: Homelessness: Integrating international perspectives. Journal of Community & Applied Social Psychology, 13(2), 171-186
Kerman, N., Aubry, T., Adair, C. E., Distasio, J., Latimer, E., Somers, J., & Stergiopoulos, V. (2020). Effectiveness of Housing First for homeless adults with mental illness who frequently use emergency departments in a multisite randomized controlled trial. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-020-01008-3
Kerman, N., Sylvestre, J., Aubry, T., & Distasio, J. (2018). The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of Housing First. BMC Health Services Research, 18(1), 190-190. https://doi.org/10.1186/s12913-018-3028-7
Kirst, M., Friesdorf, R., Ta, M., Amiri, A., Hwang, S. W., Stergiopoulos, V., & O'Campo, P. (2020). Patterns and effects of social integration on housing stability, mental health and substance use outcomes among participants in a randomized controlled Housing First trial. Social Science & Medicine, 265, 113481-113481. https://doi.org/10.1016/j.socscimed.2020.113481
Kirst, M., Zerger, S., Misir, V., Hwang, S., & Stergiopoulos, V. (2015). The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence, 146(1), 24-29. https://doi.org/10.1016/j.drugalcdep.2014.10.019
Loubière, S., Lemoine, C., Boucekine, M., Boyer, L., Girard, V., Tinland, A., … French Housing First Study Group. (2022). Housing First for homeless people with severe mental illness: Extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d'Abord trial. Epidemiology and Psychiatric Sciences, 31, e14-e14. https://doi.org/10.1017/S2045796022000026
Luong, L., Lachaud, J., Kouyoumdjian, F. G., Hwang, S. W., & Mejia-Lancheros, C. (2020). The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada. Canadian Journal of Public Health, 112(2), 270-279. https://doi.org/10.17269/s41997-020-00433-z
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. https://doi.org/10.1002/jcop.21554
Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74-83. https://doi.org/10.1177/1049731505282593
Patterson, M. L., Moniruzzaman, A., & Somers, J. M. (2013;2014;). Community participation and belonging among formerly homeless adults with mental illness after 12 months of Housing First in Vancouver, British Columbia: A randomized controlled trial. Community Mental Health Journal, 50(5), 604-611. https://doi.org/10.1007/s10597-013-9672-9
Poremski, D., Stergiopoulos, V., Braithwaite, E., Distasio, J., Nisenbaum, R., & Latimer, E. (2016). Effects of Housing First on employment and income of homeless individuals: Results of a randomized trial. Psychiatric Services, 67(6), 603-609. https://doi.org/10.1176/appi.ps.201500002
Russolillo, A., Patterson, M., McCandless, L., Moniruzzaman, A., & Somers, J. (2014). Emergency department utilisation among formerly homeless adults with mental disorders after one year of Housing First interventions: A randomised controlled trial. European Journal of Housing Policy, 14(1), 79-97. https://doi.org/10.1080/14616718.2014.884881
Somers, J. M., Moniruzzaman, A., & Palepu, A. (2015). Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction, 110(10), 1605-1614. https://doi.org/10.1111/add.13011
Somers, J. M., Moniruzzaman, A., Patterson, M., Currie, L., Rezansoff, S. N., Palepu, A., & Fryer, K. (2017). A randomized trial examining Housing First in congregate and scattered site formats. PloS One, 12(1), e0168745-e0168745. https://doi.org/10.1371/journal.pone.0168745
Somers, J. M., Rezansoff, S. N., Moniruzzaman, A., Palepu, A., & Patterson, M. (2013). Housing First reduces re-offending among formerly homeless adults with mental disorders: Results of a randomized controlled trial. PloS One, 8(9), e72946-e72946. https://doi.org/10.1371/journal.pone.0072946
Stergiopoulos, V., Hwang, S. W., Gozdzik, A., Nisenbaum, R., Latimer, E., Rabouin, D., … At Home/Chez Soi Investigators. (2015). Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA: The Journal of the American Medical Association, 313(9), 905-915. https://doi.org/10.1001/jama.2015.1163
Tsai, J., Mares, A. S., & Rosenheck, R. A. (2010). A multi-site comparison of supported housing for chronically homeless adults: "Housing First" versus "residential treatment first". Psychological Services, 7(4), 219-232. https://doi.org/10.1037/a0020460
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.
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. https://doi.org/10.1176/appi.ps.51.4.487
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. https://doi.org/10.2105/AJPH.94.4.651
