Additional Housing Programs: Housing First

By Kim Johnson, Policy Analyst, NLIHC Evidence Supporting Housing First wo decades of research and evaluation Research shows that Housing First rapidly ends support the efficacy of Housing First as a homelessness, is cost-effective, and improves means of ending homelessness, including quality of life and community functioning. This Tfor chronically homeless individuals (people with model was first developed for people with serious severe disabilities, including mental illness or psychiatric or substance use disorders who had substance use disorders, who have been homeless been homeless for long periods of time and for a long time). Housing First prioritizes access to was later extended to all homeless populations. safe, stable, accessible housing with services when Housing First has been credited with helping needed to ensure long-term housing stability reduce chronic homelessness by 20% since 2007 and effective treatment for underlying health and veteran homelessness by 50% since 2009. conditions, including substance use and mental Key to the success of Housing First is its health disorders. emphasis on low-barrier access to permanent, stable housing with supportive services when PROGRAM SUMMARY needed. Access to Housing First programs Housing First is a whole-systems model for is not contingent upon minimum income addressing homelessness that prioritizes access requirements, sobriety, criminal history, to permanent, stable housing with services when successful completion of a treatment program, needed. Housing First recognizes that stable or participation in supportive services; rather, housing is a prerequisite for effective psychiatric Housing First recognizes that stable, supportive, and substance abuse treatment, for stable accessible housing is fundamental to being able employment, and for improving quality of life. to effectively utilize wrap-around services. The Once stably housed, individuals are better able model eschews a “one-size-fits-all” approach to take advantage of wrap-around services that to addressing homelessness and instead pairs help support stability, employment, and recovery people and families with the level of financial – goals that are difficult to attain without stable assistance and supportive services necessary to housing. achieve long-term housing stability. Rapid re-housing (RRH) and permanent A random assignment study found that supportive housing (PSH) can both utilize the homelessness programs utilizing low-barrier Housing First model. In RRH, individuals and access to housing and services were more families experiencing homelessness receive successful in reducing homelessness than assistance identifying, leasing, and moving programs where housing and services were into new housing quickly and are connected contingent upon sobriety. When individuals were to supportive services if needed. Similarly, provided access to stable, affordable housing and PSH provides longer-term housing assistance given autonomy in deciding whether and when and voluntary supportive services, including to use services, 79% remained stably housed health care, employment, and treatment at the end of six months, compared to 27% of services, to ensure people experiencing chronic individuals in the control group. homelessness can attain long-term housing In addition to greater housing retention, stability. Housing First has shown success in reducing drug use among chronically homeless people with a history of substance use, more effectively

7–56 2021 ADVOCATES’ GUIDE increasing outpatient service utilization, and USICH Director Robert Marbut, appointed under increasing outreach to and engagement of the Trump Administration, frequently used clients not appropriately served by the public misleading and inaccurate data to falsely claim mental health system. Housing First has also that homelessness has increased as a result of been shown to decrease costs among chronically the widespread adoption of Housing First. Marbut homeless individuals utilizing emergency inflated the number of people experiencing medical services. Housing First provides a vital homelessness by including individuals in RRH option to the many people who are not able to and PSH programs in his homelessness count maintain perfect treatment immediately after – individuals living in their own apartments or exiting homelessness and ensures they will not houses and who are, by definition, not homeless. be relegated to long-term homelessness. He also falsely claimed that Housing First does not provide supportive services when needed and Attempts to Undermine Housing First drawn false conclusions about the underlying Despite its proven success and bipartisan causes of homelessness to support his misguided support in Congress, during its tenure the Trump policies. Administration sought to replace Housing Rather than Housing First, Marbut advocated for First models with programs that would deny an approach that would make it more difficult people and families experiencing homelessness for homeless families and chronically homeless stable housing if they were unable to maintain individuals to obtain safe, stable housing. While treatment or attain perfect sobriety. This shift in Marbut touted his approach as “treatment first,” policy not only ignored the decades of research in reality, high-barrier programs that mandate attesting to the validity of Housing First, but failed perfect sobriety or treatment as a prerequisite to to address the underlying, systemic causes of housing are not nearly as successful at ensuring homelessness and housing instability. long-term housing stability. A metanalysis Under past Republican and Democratic of existing research found that 65-85% of Administrations, HUD and the U.S. Interagency individuals participating in Housing First Council on Homelessness (USICH) have endorsed programs remained housed in the two years Housing First as a best practice to ending after entering the program, compared to just homelessness and the model has enjoyed 23-39% of individuals in programs emphasizing bipartisan support from congressional leaders. “treatment first.” Even USICH’s own documents First incorporated into federal recommendations support the efficacy of Housing First programs, under the George W. Bush Administration, finding that pairing Housing First with supportive Housing First was credited with reducing services when needed results in housing homelessness by 30% between 2005 and 2007. retention rates between 75-85% for individuals During the Great Recession, implementation of and 80-90% for families. RRH under the Obama Administration helped Available research on the efficacy of “treatment an estimated 700,000 people at-risk of or first” approaches to ending homelessness did experiencing homelessness find stable housing. not yield promising results. One 2004 study Rather than building on these successes, the concluded “there is no empirical support for the Trump Administration rejected decades of practice of requiring individuals to participate in research, learning, and bipartisan support for psychiatric treatment or attain sobriety before Housing First to focus instead on returning being housed.” Studies have also suggested that to failed “behavioral modification” strategies. requiring “perfect abstinence” as a prerequisite Trump Administration officials made several for housing can actually hinder participants in false claims about Housing First, relying on achieving long-term housing stability, recovery, manipulated data and misrepresented research and employment. to make its case.

NATIONAL LOW INCOME HOUSING COALITION 7–57 Housing First, Homelessness, and COVID with developing a strategy to make housing a right for all people. Housing First’s foundational Access to safe, stable, accessible, and affordable tenet of providing people experiencing or on housing is a key determinant of health, and the verge of homelessness low-barrier access to this connection has never been more apparent affordable housing and supportive services when than during the ongoing coronavirus pandemic. needed is central to realizing this goal. Indeed, Policies that would actively deny people President Biden has pledged to ensure the experiencing homelessness or housing instability federal government “commits to a ‘Housing First’ access to housing, including Marbut’s proposed approach to ending homelessness,” including by “treatment first” approach, risk furthering the conducting a comprehensive review of federal spread of coronavirus, prolonging the pandemic, housing policies to ensure they incentivize a and exposing already marginalized people to Housing First approach. irreparable harm. Adequately adopting a Housing First approach The Centers for Disease Control and Prevention to ending homelessness requires a major (CDC) announced a federal moratorium on investment in developing homes affordable to evictions for nonpayment of rent, citing the the lowest-income people, including through “historic threat to public health” posed by programs like the Housing Trust Fund. The the virus and noting “eviction moratoria… private sector cannot, on its own, build or can be an effective public health measure maintain homes at a price extremely low-income utilized to prevent the spread of communicable people can afford, making it necessary for the disease.” The CDC further states that “housing federal government to play a leading role in the stability helps protect public health because construction and maintenance of these homes. homelessness increases the likelihood of Congress must also preserve our nation’s existing individuals moving into congregate settings, such affordable housing infrastructure, including as homeless shelters, which then puts individuals public housing, rather than allowing homes to fall at higher risk to COVID-19.” into disrepair. People experiencing homelessness who contract A major expansion in rental assistance through coronavirus are twice as likely to be hospitalized, the Housing Choice Vouchers program would two to four times as likely to require critical care, help bridge the growing gap between wages and two to three times as likely to die from the and housing costs, keep people stably housed, illness as the general population. People who and ensure people experiencing homelessness are homeless are more susceptible to severe can find safe, affordable housing. With greater complications from the virus due to a higher investments in this program, low-income prevalence of underlying health conditions and households would be able to keep more of their the inability to engage in preventative measures income for other essentials like food, medical recommended by the CDC, including social care, education, and transportation, and would distancing, regular handwashing, and avoiding be able to save money for larger investments, like high-touch surfaces. The greater risk of severe a down payment on a home or a child’s college illness and death for people experiencing savings account. homelessness who contract coronavirus makes ensuring low-barrier access to safe, stable, It is imperative to invest in culturally responsive accessible housing both a moral imperative and a homeless assistance systems as well, so that public health necessity. people who slip into homelessness can be quickly identified, moved into safe, immediate shelter, FORECAST FOR 2021 and engaged in Housing First programs with During his campaign, President Biden supportive services if needed. In order to begin committed to pursuing a “comprehensive addressing the longstanding racial inequities approach to ending homelessness,” starting in housing, it is also vital to target resources

7–58 2021 ADVOCATES’ GUIDE to historically marginalized communities. Targeting resources to those with the greatest need would increase the impact of investments and help build up communities that have faced generations of disinvestment.

What to say to Legislators Having a safe, stable, affordable place to live and the right supports can lead to positive outcomes beyond those provided by services alone. Over two decades of research prove that housing stability, quality of life, and community functioning are consistently higher among participants in Housing First programs. Moving away from evidence-based approaches to addressing homelessness, as the Trump Administration proposed, would deny individuals and families in need of safe, decent, affordable and accessible homes. Requiring treatment or sobriety as a prerequisite to receiving stable housing does not solve homelessness – rather, it can make solving homelessness more difficult by demanding people overcome the challenges of substance abuse or mental illness without the stability and safety of a home. “Treatment first” ignores the systemic issues that allow people to live unhoused and ensures there will always be people who are homeless. Congress and the Biden Administration should work together to increase investments in decent, safe, affordable, and accessible rental homes for people with the lowest incomes; work to actively undo the generations of racist policies that have disproportionately exposed Black and Native people to housing instability and homelessness; and continue to pursue Housing First as a proven solution to homelessness.

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