Policy Analysis of the Housing First Model

Tina RogoskiCalifornia State University, Long Beach

May 2012

Housing First• Provides immediate access to housing with an intensive case management team

providing a multitude of services • Aimed for the chronically homeless who often have mental health and substance

abuse concerns as well as major chronic medical conditions• In stark contrast to the traditional approach that had been used thus far• Based on the belief that housing is a basic human right • Regards housing and treatment as separate domains• Respects harm reduction and consumer choice

Main Goals: -To help the homeless maintain and manage independent apartments while providing services to enhance one’s quality of life-To promote positive impacts on mental health, substance use, and medical health-To reduce ER visits, hospitalizations, and use of other crisis services such as police and ambulances

Pearson, Montgomery, & Locke, (2009); Kertesz et al., (2009); Tsemberis, (1999); Corporation for Supportive Housing, (2006)

Social Work Relevance

• Social workers are committed to ensuring that the needs are met for populations that experience marginalization and oppression and the chronically homeless are an especially vulnerable and at risk population

• Many have little to no income, high rates of behavioral health conditions, mental health, chronic medical conditions, substance abuse, lack access to appropriate health care, are exposed to high levels of trauma and violence, and frequent ERs, hospitals, and jails

• It is essential that social workers promote core values such as social justice and worth and dignity of the person in order to help enhance one’s quality of life

• Providing housing does just that as once one has a roof over one’s head it is much easier to see improvements in most other areas of life

NASW, (2010); The United States Interagency Council on Homelessness, (2010); Pearson et al., (2009)

Literature• Settlement housing movement during the late 19th century reflected a dual

responsibility to social service & reform• Then reformists created a large scale government supported housing rental

program aimed at helping those living in poverty called public housing• Section 8 Housing was created in 1974 and promoted by Congress as a way to

establish economically and racially integrated neighborhoods across the U.S. • Deinstitutionalization beginning in the 1960s and economic downturn

furthered the growth of homelessness• McKinney-Vento Act of 1987 established federally recognized services for the

homeless for the first time including emergency relief provisions for shelter, food, mobile health care, and transitional housing

• The traditional housing approach has been the main method of combating homelessness involving a linear design of having to complete a succession of programs while also managing sobriety and taking psychiatric medication

Koerin, (2003); Schill & Wachter, (1995); Beck, (1996); Nelson, (2010); National Coalition for the Homeless, (2006); Kertesz et al., (2009)

Methods• A secondary review of existing literature including data sources

such as California State University, Long Beach library resources, special government sections, public agency documents, and government agency documents

• Theoretical framework used is Gil’s (1976) policy analysis focusing on 4 main sections of:-Issues dealt with by the policy-Objectives, value premises, theoretical positions, target segments, and substantive effects

-Implications of the policy causing changes among distribution of rights and quality of life

-Interactions of the policy with forces affecting social evolution

Policy Analysis • Housing First is in stark contrast to the theories underlying the

traditional housing approach and is instead defined by the recovery model, self-determination, harm reduction, and collaboration

• Its main objective is to provide optimal services to the chronically homeless by finding independent housing without the requirements of psychiatric treatment or sobriety

• Essential values are that everyone has the right to housing, individual choice over one’s life decisions, and empowerment

• Individuals are provided immediate access to a broad range of supportive services by an assertive community treatment team working to meet the individual where they are at

Padgett et al., (2011); Johnsen & Teixeira (2010); Tsemberis, (1999)

Long Range Effects: -Maintained higher housing-retention rates-Fewer days incarcerated-Positive impacts on health, mental illness, and substance use-Decreased use of ER and hospitals-Increased use of preventative health care-Cost effectiveness due to this decrease in utilization of expensive crisis oriented

systemsSupporters:-Housing First has gained momentum across the country with support from the

federal government, media, policymakers, and homeless advocates-Discussed positively in major print, including national newspapers, magazines,

broadcast media, and scientific scholarly articles -Foreign countries, such as the United Kingdom, Belgium, Norway, and Denmark,

have implemented numerous similar projects to see if they can achieve the same positive effects as have been reached in the U.S.

Tsemberis (1999); Kertesz et al. (2009); Atherton & Nicholls (2008)

Strengths • Many studies reported substantial evidence to support positive

outcomes of the Housing First model• Many attribute the decrease in the chronically homeless population

to the rise of this model across the country• Showcases that program philosophies centered in choice and

empowerment over restrictions and compliance warrant attention as not only effective but also humane

Challenges• Housing First is still a relatively recent intervention so even though

most of its early appraisals have led to positive findings it is important to recognize that long-term effects have yet to be fully determined due to its recent implementation.

• Much of the current literature is also written by supporters and advocates where it is essential to recognize that research completed by supports can tend to lean in the direction of positive outcomes

References Atherton, I., & Nicholls, C.M. (2008). ‘Housing First’ as a means of addressing multiple needs and homelessness.

European Journal of Homelessness, 2, 289-303.Beck, P. (1996).Fighting Section 8 discrimination: The Fair Housing Act’s new frontier. Harvard Civil Rights-Civil

Liberties Law Review, 31, 155-186. Corporation for Supportive Housing.(2006). Guidebook on developing permanent supportive housing for homeless

veterans. New York, NY: Author.Kertesz, S.G., Crouch, K., Milby, J.B., Cusimano, R.E., & Schumacher, J.E. (2009). Housing first for homeless persons

with active addiction: Are we overreaching? The Milbank Quarterly, 87(2), 495-534.Koerin, B. (2003). The settlement house tradition: Current trends and future concerns. Journal of Sociology and

Social Welfare, 3(2), 53-68.Johnsen, S., &Teixeira, L. (2010).Staircases, elevators and cycles of change: ‘Housing First’ and other housingmodels

for homeless people with complex support needs. London, UK:Crisis.National Association of Social Workers.(2011). National Association of Social Workers. Retrieved from

http://www.socialworkers.org/National Coalition for the Homeless.(2006). McKinney-Vento Act. Washington, DC: Author.Nelson, G. (2010). Housing for people with serious mental illness: approaches, evidence, and transformative

change. Journal of Sociology & Social Welfare, 37(4), 123- 146.Padgett, D.K., Stanhope, V., Henwood, B.F., & Stefancic, A. (2011). Substance use outcomes among homeless clients

with serious mental illness: Comparing housing first with treatment first programs. Community Mental Health Journal, 47, 227- 232.

Pearson, C., Montgomery, A.E., & Locke, G. (2009).Housing stability among homeless individuals with serious mental illness participating in housing first programs. Journal of Community Psychology,37(3), 404-417.

Schill, M.H., &Wachter, S.M. (1995). The spatial bias of federal housing law and policy: Concentrated poverty in urban America. The University of Pennsylvania Law Review,143(5), 1285-1342.

Tsemberis, S. (1999). From streets to homes: An innovative approach to supported housing for homeless adults with psychiatric disabilities. Journal of Community Psychology, 27(2), 225-241.

The United States Interagency Council on Homelessness. (2010). Opening doors: Federal strategic plan to prevent and end homelessness. Washington, D.C: Author.