Community-Wide Strategies for Preventing Homelessness: Recent Evidence

Ana Stefancic; Sam Tsemberis


J Prim Prev. 2007;28(3):265-279. 

In This Article

Abstract and Introduction


Housing First is an effective intervention that ends and prevents homelessness for individuals with severe mental illness and co-occurring addictions. By providing permanent, independent housing without prerequisites for sobriety and treatment, and by offering support services through consumer-driven Assertive Community Treatment teams, Housing First removes some of the major obstacles to obtaining and maintaining housing for consumers who are chronically homeless. In this study, consumers diagnosed with severe mental illness and who had the longest histories of shelter use in a suburban county were randomly assigned to either one of two Housing First programs or to a treatment-as-usual control group. Participants assigned to Housing First were placed in permanent housing at higher rates than the treatment-as-usual group and, over the course of four years, the majority of consumers placed by both Housing First agencies were able to maintain permanent, independent housing. Results also highlight that providers new to Housing First must be aware of ways in which their practices may deviate from the essential features of Housing First, particularly with respect to enrolling eligible consumers on a first-come, first-served basis and separating clinical issues from tenant or housing responsibilities. Finally, other aspects of successfully implementing a Housing First program are discussed.


Housing First is an effective housing and treatment intervention that ends and prevents homelessness for individuals with severe mental illness, co-occurring addictions, and other health problems, who have remained homeless for years (Gulcur et al. 2003; Tsemberis et al. 2004). Although this chronically homeless group constitutes only a minority of the homeless population, these individuals can account for over half of all public shelter stays (Kuhn and Culhane 1998). They also consume costly acute care services, such as emergency medical, substance use, and psychiatric care, often seeking out these services as a temporary respite from homelessness (Folsom et al. 2005; Kuno et al. 2000; McNiel and Binder 2005). By providing permanent, independent housing without prerequisites for sobriety and treatment, Housing First removes significant barriers to housing entry. By offering flexible and comprehensive consumer-driven support services that maximize housing retention, the model also prevents recurrent homelessness.

With an emphasis on funding permanent housing and support services for homeless individuals with disabling conditions, the federal Initiatives to End Chronic Homelessness, launched by the U.S. Interagency Council on Homelessness, is forging a comprehensive federal approach to end homelessness. Housing First programs are central components of these initiatives, as well as those of the more than 200 cities across the United States that have drafted ten-year plans to end chronic homelessness. This study examined the effectiveness of the Housing First approach, as implemented by two different programs in a suburban county, with regard to consumers' housing status and housing retention rates. It also considers the programs' divergent approaches to consumer selection and discharge, and their implications for consumer outcomes.


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