Housing First: wheres the evidence?
Written by Jeanette Waegemakers Schiff and John Rook (University of Calgary), 2012.
Given the increasing use of Housing First as a public policy strategy to eradicate homelessness, the authors of this study outline current and emerging evidence of Housing Firsts effectiveness. The focus of the report is to catalogue and categorize literature pertaining to Housing First, rather than summarize the findings of the literature. The report concludes that a gap exists in academic research regarding the effectiveness of Housing First, especially in a Canadian context.
The report was developed through an academic literature review focused on the three longest standing examples of Housing First in existence today: Houselink (1977, Toronto); Beyond Shelter (1988, Los Angeles); and Pathways to Housing (1992, New York City).
The report excludes non-academic sources of information, and is critical of the tendency of available academic literature to emphasize qualitative evidence, as opposed to quantitative.
The report describes Housing First as an approach to combating homelessness that offers homeless individuals with housing, followed by services that address factors that often lead to homelessness such as mental illness and substance addictions.
All three models used in the study have undergone some form of evaluation, but only one (Pathways) has undergone a large multi-year research study, which the authors consider to be a gold standard for this kind of intervention.
There is limited information available about the suitability of Housing First as a strategy to reduce homelessness in Canada. Specifically, more information is needed regarding its effectiveness with sub-sets of the homeless population, such as Aboriginal groups, families, youth, seniors, immigrants and refugees.
While preliminary work has been completed in Australia and Europe to assess the suitability of a Housing First approach in those jurisdictions, most of the research published focuses on Housing First projects in the United States.
The models included in the study exhibit a consistent set of underlying principles in their approaches:
There is no pre-requisite for clients to demonstrate housing readiness.
The housing type and location is chosen by the individual being housed, to the extent available and affordable.
Support services are made available, but are not mandatory.
Abstinence from substance use is not required.
Stabilization and return to the community is valued. Many Housing First models employ residents to support community reintegration.
Housing First is considered a leading practice in addressing and eradicating homelessness, in spite of a lack of respected academic literature in support of this approach. However, the study authors note that practitioners and program managers report positive results and decreased costs when a Housing First model is compared with treatment-based approaches.
The authors of the study conclude literature shows that Housing First is an effective approach in housing and maintain housing for single adults with mental illness and substance use issues in urban locations where there is ample rental housing stock (Waegemakers Schiff & Rook, 2012, p.17-18). There is a gap in available information regarding sub-sets of the homeless population, although a current study being conducted by the Mental Health Commission of Canada called At Home/Chez Soi is expected to address some of these issues.
Reviewed by Esther Steeves