Pathways' Housing First Program

Placement on the Continuum of Evidence Effective-Quasi Download icon Download PDF
Target Population: 
Adults, Veterans
Sector: 
Community-Based
Topic: 
Alcohol/Drugs/Tobacco, Antisocial Behavior, Behavioral Problems, Case Management, Depression, Employment, Suicide
Military Sector: 
Veterans Affairs
Target Audience 

This program is for individuals who are homeless and who have complex needs, such as severe psychiatric disabilities and/or substance use disorders.

Summary 

The Pathways' Housing First Program is designed to immediately supply 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.

Evidence 

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 compared to control groups, showed a faster decrease in homelessness over time as compared to control groups, or spent more days in their own home as compared to control groups.  There were positive results for several other outcomes.  One trial found a significant reduction in convicted offenses as compared to a control group.  Another study found significant decreases in suicidal ideation and intent from baseline to a 2-year follow-up.  However, across all studies, there was no effect or mixed effects on secondary outcomes including drug or alcohol abuse, psychiatric symptoms, quality of life, community functioning, employment, or satisfaction with housing.

Components 

The Pathways' Housing First Program 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, who can be at greater risk for victimization.  There are five key principles to the Housing First model, which is the foundation for all Housing First programs:

  • Immediate access to housing with no housing readiness conditions - Provide housing regardless of mental health condition or substance use behaviors.
  • Consumer choice and self-determination - Promote self-sustainability and provide a supported learning environment in which participants are able to make productive changes in their lives.
  • Recovery orientation - Allow participants to define their own recovery goals and work at their own pace.
  • Individualized and person-driven supports - Provide support services that fit the individual.
  • Social and community integration - Help participants build community connections, provide education about Housing First to communities, and dispel negative stereotypes about homelessness.  

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.  Tenants are given a choice of available apartments and decide if they want a roommate.  If apartments are not available, tenants are housed in hotels or YMCA locations until housing is obtained.  Program staff use an assertive community treatment (ACT) team format to provide social and health-related services and resources.

Previous Use 

Initiated in 1992, the Housing First model has been implemented across the United States and internationally.  The program has also been implemented and evaluated among homeless Veterans.

Training 

Optional on-site training is available, and costs vary depending on site needs.  Technical assistance, follow-up training, and fidelity visits are also available.  For additional training and cost information, please contact Pathways using details in the Contact section.  

Considerations 

Considerations for implementing this program include recruiting outreach staff, creating relationships with shelters, engaging assertive community treatment (ACT) staff to implement treatment, coordinating available housing units, obtaining apartment building administration buy-in and consent to house individuals receiving Pathways' Housing First Program 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

Implementation 

If you are interested in implementing Pathways' Housing First Program, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Time 

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.  

Cost 

Implementation materials can be purchased online www.hazelden.org/OA_HTML/ibeCCtpItmDspRte.jsp?item=385155&sitex=10020:22372:US  The manual and DVD set is $189; the manual is available separately for $49.95.  A set of 10 manuals and 1 DVD costs $499.  Other costs will vary and could be extensive depending on housing used and 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.  

Evaluation Plan 

To move the Pathways' Housing First Program to the Effective category on the Clearinghouse Continuum of Evidence, at least one external evaluation must be conducted that demonstrates sustained, positive outcomes. This study must be conducted independently of the program developer.

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 

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact Pathways' National by email info@pathwayshousingfirst.org or visit www.pathwayshousingfirst.org/

References
References - Used For Placement 

Aubry, T., Goering, P., Veldhuizen, S., Adair, C. E., Bourque, J., Distasio, J., ... Tsemberis, S. (2015). A multiple-city RCT of Housing First with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services, 67, 275-281.

Aubry, T., Tsemberis, S., Adair, C. E., Veldhuizen, S., Streiner, D., Latimer, E., ... Hume, C. (2015). One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatric Services, 66, 463-469.

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, 384-390.

Chung, T. E., Gozdzik, A., Palma Lazgare, L. I., To, M. J., Aubry, T., Frankish, J., ... Stergiopoulos, V. (2017). 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. doi:http://dx.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 and Life-Threatening Behavior, 46, 655-663.

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, 223-238.

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. Journal of Community and Applied Social Psychology, 13, 171-186. doi: 10.1002/casp.723

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, 24-29.

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, 505-514.

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, 74-83.

Patterson, M. L., Moniruzzaman, A., & Somers, J. M. (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, 604-611.

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, 603-609.

Russolillo, A., Patterson, M., McCandless, L., Moniruzzaman, A., & Somers, J. (2014). Emergency department utilization among formerly homeless adults with mental disorders after one year of Housing First interventions: A randomized controlled trial. International Journal of Housing Policy, 14, 79-97.

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, 1605-1614.

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, e72946. doi: 10.1371/journal.pone.0072946

Stergiopoulos, V., Hwang, S. W., Gozdzik, A., Nisenbaum, R., Latimer, E., Rabouin, D., ... Katz, L. Y. (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. Journal of the American Medical Association, 313, 905-915.

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 , 219-232. doi: 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, 225-241.

Tsemberis, S., & Eisenberg, R. F. (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51, 487-493.

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, 651-656.

*Resources and associated costs reflect those identified at the time of fact sheet publication.