THE CASE FOR

HOUSING FIRST

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H

ousing First is a proven model for addressing homelessness that prioritizes access to permanent,

stable housing, linked with voluntary services as needed. Housing First recognizes that stable

housing is a prerequisite for effective psychiatric and substance abuse treatment and for improving

quality of life. Once stably housed, individuals are better able to take advantage of wrap-around services –

to help support housing stability, employment, and recovery. Without stable housing, attaining these goals

community functioning. This model is particularly effective among people who have been homeless

for long periods of time and have serious psychiatric disabilities, substance use disorders, and/or other

disabilities. Housing First results in higher rates of housing retention.

The Community Preventive Services Task Force (CPSTF), an independent panel of public health and

prevention experts appointed by the director of the U.S. Centers for Disease Control and Prevention (CDC),

recommends Housing First programs. The CPSTF recommendation is based on evidence from a systematic

review of 26 studies, which found that Housing First programs decrease homelessness, increase housing

stability, and improve quality of life for people experiencing homelessness. The CPSTF also found that the

economic benets exceed the intervention cost for Housing First programs; in fact, every dollar invested in

Housing First programs results in $1.44 in cost savings.

EARLY EVALUATIONS

The Pathways to Housing program, one of the early versions of Housing First, has greatly informed the eld

of homeless services. Between 2000 and 2004, there were three major studies of the Pathways model in

New York City. These initial studies found:

• A 2000 study found that after ve years, 88 percent of Pathway participants remained housed,

compared to only 47 percent of the residents in the control group.

• A 2004 study found that after 24 months, Pathways participants spent almost no time experiencing

homelessness, while participants in the city’s residential treatment program spent about a quarter of

their time experiencing homelessness on average.

• A 2004 random assignment study found that homelessness programs that eliminated barriers to

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programs where housing and services were contingent on sobriety and progress in treatment.

MAJOR EVALUATIONS

There have been four randomized controlled trials, considered the “gold standard” of research designs,

studying Housing First. These major studies found that Housing First resulted in large improvements in

housing stability.

For example, Canada conducted a signicant evaluation, encompassing ve cities – Vancouver, Winnipeg,

Toronto, Montreal, and Moncton – and over 2,000 participants, making it the world’s largest study on

Housing First. The study found:

• Housing First rapidly ends homelessness. Participants in Housing First rapidly obtained housing and

retained their housing at a much higher rate than the treatment as usual group. After two years, 62%

invested in Housing First services resulted in an average savings of $21.72.

• Housing First can improve quality of life and other outcomes. Having a place to live and the right

supports can lead to other positive outcomes beyond those provided by existing services. Housing

stability, quality of life, and community functioning outcomes were all more positive for participants in

Housing First programs.

RECENT STUDIES

Additional evaluations of Housing First have been completed in recent years. These evaluations found:

• Housing First programs reduce homelessness, increase housing stability, and improve quality of life

for people who are experiencing homelessness. Evidence from a systematic review shows Housing

First programs more effectively reduce homelessness and improve housing stability for unhoused

• Housing First can lead to better treatment outcomes. While an earlier study found no difference in

treatment outcomes between Housing First and high-barrier programs, some more recent studies

indicate that Housing First participants are more likely than others to report reduced usage of

alcohol, stimulants, and opiates. A 2015 study found that Housing First programs are more effective at

increasing outpatient service utilization, as well as outreach to and engagement of clients who are not

appropriately served by the public mental health system. Critics’ fears about increased substance use

and psychiatric symptoms have not been supported by research ndings.

• Housing First can reduce healthcare and other costs. A systematic review found that the economic

benets exceed the intervention cost for Housing First programs in the U.S., with societal cost savings

of $1.44 for every dollar invested. The economic benet due to the intervention is the combined

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reduced by nearly as much as is spent on housing. The average cost savings to the public ranges from

HUD, the U.S. Interagency Council on Homelessness (USICH), and the U.S. Department of Veterans Affairs

(VA) announced on January 26 that more than 140,000 people experiencing homelessness have been

permanently housed using the Housing First approach through “House America,” a national initiative to

address the homelessness crisis. HUD and USICH helped 105 communities permanently house more than

100,000 households experiencing homelessness and add over 40,000 deeply affordable housing units to

their development pipelines. Furthermore, the VA helped permanently house more than 40,000 veterans

experiencing homelessness in 2022, exceeding by 6.3 percent the department’s goal of housing 38,000

veterans.

The VA cites Housing First as a best practice and uses this approach in its HUD-Veterans Affairs Supportive

Housing (HUD-VASH) program. Today, the HUD-VASH Program serves nearly 90,000 veterans using the

government to Housing First, referring to the model as “a proven solution that leads to housing stability

as well as improvements in health and well-being.”

HUD emphasizes the success of Housing First in its House America initiative, and in treating the most

difcult category of homelessness:

“Permanent supportive housing models that use a Housing First approach have been proven to be

highly effective for ending homelessness, particularly for people experiencing chronic homelessness

who have higher service needs. Studies such as HUD’s “The Applicability of Housing First Models to

Homeless Persons with Serious Mental Illness” have shown that Housing First permanent supportive

housing models result in long-term housing stability, improved physical and behavioral health

outcomes, and reduced use of crisis services such as emergency departments, hospitals, and jails.”