- Housing first
Housing First is a relatively recent innovation in human service programs and
social policyregarding treatment of the homeless. Rather than moving homeless individuals through different "levels" of housing, known as the Continuum of Care, whereby each level moves them closer to "independent housing" (for example: from the streets to a public shelter, and from a public shelter to a shelter run by a state agency, and from there to a transitional housing program, and from there to their own apartment in the community) Housing First moves the homeless immediately from the streets or homeless shelters into their own apartments.
Pioneered by Dr.
Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine, and the organization Pathways to Housingin New York Cityin the early 1990s, Housing First is premised on the notion that housing is a basic human right, and so should not be denied to anyone, even if they are abusing alcohol or other substances. Previous and current models may require the homeless to abjure substance-abuse and seek treatment in exchange for housingFact|date=November 2007.
Housing First, when supported by the United States
Department of Housing and Urban Development, does not only provide housing. The model, used by nonprofit agencies throughout America, also provides wraparound case management services to the tenants. This case management provides stability for homeless individuals and families, which increases their success. It allows for accountability and promotes self-sufficiency. The housing provided through government supported Housing First programs is permanent and "affordable," meaning that tenants pay 30% of their income towards rent. Housing First targets individuals and families with disabilities.cite web |url= http://www.huduser.org/Publications/pdf/hsgfirst.pdf|title= The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness |publisher= HUD|date= July,2007] This housing is supported through two HUD programs. They are the Supportive HousingProgram and the Shelter Plus Care Program.cite web |url= http://www.hud.gov/offices/cpd/homeless/programs/index.cfm|title= HUD Homeless Assistance Programs |publisher= HUD|date= December 21,2007] Pathways' Housing First model has been recognized by the Substance Abuse and Mental Health Services Administration as an Evidence-based practice. cite web |url= http://www.pathwaystohousing.org/Articles/Links.html|title= National Registry of Evidence-based Programs and Practices |publisher= SAMHSA|date= November, 2007]
Housing First is currently endorsed by the United States
Interagency Council on Homelessness(USICH) as a "best practice" for governments and service-agencies to use in their fight to end homelessness in America, and is similarly endorsed by government agencies that deal with the homeless in the United KingdomFact|date=November 2007.
Housing First programs currently operate throughout the United States in cities such as
Anchorage, Alaska; New York City; Denver, Colorado; San Francisco, California; Atlanta, Georgia; Chicago, Illinois; Quincy, Massachusetts; Philadelphia, Pennsylvania; and Seattle, Washington, among many others, and are intended to be crucial aspects of communities' 10-Year Plans To End Chronic Homelessnessalso advocated by USICH.
In Massachusetts, the Home & Healthy for Good program reported some significant outcomes that were favorable especially in the area of cost savings. [ [http://www.mhsa.net/matriarch/MultiPiecePage.asp_Q_PageID_E_57 "MHSA Submits Updated Home & Healthy for Good Report to Legislature: Statewide Housing First initiative reports dramatic cost savings to Commonwealth"] - December 2007]
The Denver Housing First Collaborative, operated by the Colorado Coalition for the Homeless, provides housing through a housing first approach to more than 200 chronically homeless individuals. A 2006 cost study documented a significant reduction in the use and cost of emergency services by program participants as well as increased health status. Emergency room visits and costs were reduced by an average of 34.3 percent. Hospital inpatient costs were reduced by 66 percent. Detox visits were reduced by 82 percent. Incarceration days and costs were reduced by 76 percent. 77 percent of those entering the program continued to be housed in the program after two years.
In their 2007 Annual Report, Pathways to Housing's Dr. Tsemberis says that "Housing is the cure for homelessness. It’s that simple." [ [http://www.pathwaystohousing.org/Articles/PTHPublications/FINAL_AnnualReport_2007.pdf 2007 Annual Report] - Pathways to Housing] He has also been quoted as saying "In a perfect homeless services world, I think we'd do away with ‘transitional' services altogether. There's no need for them."McGray, Douglas, [http://www.motherjones.com/news/feature/2005/01/01_405.html "Life on the Inside"] , Mother Jones magazine, January/February 2005 Issue.] Some critics of this simple answer to such a complicated issue argue that important and necessary support services are likely missing when the homeless are so quickly housed without a proper foundation and support systems in place, resulting in some losing their homes shortly or eventually. Some newly housed former homeless say they have no idea what to do with their time, are very lonely, and can fall back into bad habits, such as substance abuse or missing regular medical and supportive appointments. There are many complications to this kind of program and these must be dealt with to make such an initiative work successfully in the middle to long term. [Abel, David, [http://www.boston.com/news/local/articles/2008/02/24/for_the_homeless_keys_to_a_home/ "For the homeless, keys to a home: Large-scale effort to keep many off street faces hurdles"] , Boston Globe, February 24, 2008.] [Bridegam, Martha, [http://www.nhi.org/online/issues/152/notsosupportive.html "When Supportive Housing Isn't"] , ShelterForce magazine, Winter 2007, National Housing Institute]
Homelessness in the United States
McKinney-Vento Homeless Assistance Act
*Graves, Florence; Sayfan, Hadar, [http://www.boston.com/news/globe/ideas/articles/2007/06/24/first_things_first/ "First things first: 'Housing first,' a radical new approach to ending chronic homelessness, is gaining ground in Boston"] ,
The Boston Globe, Sunday, June 24, 2007.
*Lyons, Julia, [http://www.endlongtermhomelessness.org/press_center/a_home_for_the.aspx "A Home for the Homeless] ", February 26, 2008,
The Salt Lake Tribune
*Nashville Business Journal, [http://boston.bizjournals.com/nashville/stories/2008/04/14/daily42.html "U.S homeless czar to meet with Mayor, Nashville officials Friday"] , Thursday, April 17, 2008.
*Greenwood R, Schaefer-McDaniel N, Winkel G, Tsemberis S. (2005) "Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness", American J Community Psychology 36(3/4):223-38.
*Pathways to Housing Inc New York. (2005), "2005 APA Gold Award: Providing housing first and recovery services for homeless adults with severe mental illness", Psychiatric Services 56:1303-5.
*Tsemberis S. (2004) "Housing first. Encyclopedia of Homelessness", Thousand Oaks, CA: Sage, V1, 277-80.
*Friedman, Donna Haig, et al., [http://www.tbf.org/UnderstandingBoston/PortalListingDetails.aspx?sec=HousingCommunityDevelopment_Housing+%26+Community+Development_Reports_Reports_2&id=5612&parentId=0 "Preventing Homelessness and Promoting Housing Stability: A Comparative Analysis"] , The Boston Foundation, June 2007.
*PBS, [http://www.pbs.org/now/shows/305/index.html "Home at Last?] , NOW series program, first aired on February 2, 2007. The topic was what will most help homeless people reenter the fabric of society and looks at the housing option.
* [http://www.ich.gov/ Interagency Council on Homelessness (USA)]
* [http://www.mhsa.net/ Massachusetts Housing and Shelter Alliance]
* [http://www.endlongtermhomelessness.org/ The Partnership to End Long Term Homelessness]
* [http://www.chapa.org/ Citizens' Housing and Planning Association]
* [http://www.nlihc.org/ National Low Income Housing Coalition]
* [http://saveourhomes.org/ National Alliance of HUD Tenants]
* [http://cchps.columbia.edu/people/tsemberis.cfm Dr. Sam Tsemberis information] - Columbia University Center for Homelessness Prevention Studies
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