Housing First

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Date last updated

Housing First programs address chronic homelessness by providing rapid access to permanent housing, without a pre-condition of treatment, along with ongoing support services such as crisis intervention, needs assessment, and case management. A form of permanent supportive housing, the program usually serves individuals who are chronically homeless and have persistent mental illness or problems with substance abuse and addiction. Clients can be placed in apartments throughout a community1 or a centralized housing location with on-site support for those requiring more intensive services; clients receive housing regardless of substance use2. Unlike standard rapid re-housing programs, there are no time limits for Housing First program participation3

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced homelessness

  • Increased housing stability

  • Reduced hospital utilization

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Improved mental health

  • Improved well-being

  • Increased substance use disorder treatment

What does the research say about effectiveness?

There is strong evidence that Housing First programs reduce homelessness4, 5, 6, 7, increase housing stability4, 5, 7, 8, 9, 10, 11, and reduce hospital utilization 11, 12, 13, 14.

Housing First programs improve housing stability for people with mental disorders5, 7, 10, including homeless youth9, particularly when programs include strong case management4. Programs can also increase housing stability for veterans11, chronically homeless individuals15, and survivors of domestic violence and their families16. Housing First programs reduce hospital utilization among veterans11 and individuals with persistent mental illness or problems with substance abuse and addiction12, 13, 14, and decrease utilization of psychiatric hospitals for formerly homeless individuals with mental illness6.

Housing First programs can improve mental health and well-being for participants14, 17, and may also increase treatment for substance abuse and addiction7, 14. Programs with strong case management components can improve participants’ functioning in the community12. Program participants report significantly higher quality of life than non-participants, as well as greater safety and comfort in their new dwellings2.

An Alaska-based study of a Housing First program for chronically homeless individuals indicates such programs can reduce homelessness, improve physical and mental health, and increase social engagement among participants15. Programs for domestic violence survivors and their families appear to increase housing stability, safety, and well-being; participants often do not require substantial financial assistance at program completion16.

Housing First programs may reduce substance misuse and severe alcohol problems8, 18; however, in some instances substance use-related outcomes do not differ significantly between participants and non-participants19. Additional evidence is needed to confirm the effects of program participation on substance abuse8.

Strong partnerships between Housing First program staff and landlord associations can support gains in housing stability. Connecting program staff with clients of the same ethnic or racial background often results in the most successful working relationships1. Using video calling to connect program participants and staff can increase program reach20. Programs which encourage community integration and supportive social networks can contribute to long-term housing stability8.

Housing First programs decrease costs to shelters10, 21 and emergency departments21. The rapid re-housing component of Housing First can reduce costs associated with hospitalizations and treatment for individuals with persistent mental illness and substance abuse problems22, 23. Early studies suggest Housing First programs generally also cost less than programs that require sobriety or treatment prior to providing housing6.

How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples

Housing First programs have been implemented in more than 100 cities across the United States, Canada, Europe, and Australia24. Pathways to Housing, the New York-based organization from which Housing First originated, trains organizations to follow the Housing First model; Pathways to Housing agencies include Pathways Washington, D.C. and Pathways Pennsylvania24, 25, 26.

The Washington State Coalition Against Domestic Violence’s Domestic Violence Housing First program is an example of an organization that focuses on survivors of domestic violence and their families27.

There are many veteran-specific programs which use Housing First principles. The HUD-VA Supported Housing (HUD-VASH) program, a supportive housing program for homeless veterans with psychiatric or substance abuse disorders, includes rental assistance vouchers from the U.S. Department of Housing and Urban Development (U.S. HUD) combined with case management and clinical services provided by the U.S. Department of Veteran Affairs (VA); 93,000 vouchers have been awarded and approximately 150,000 homeless veterans have been served by HUD-VASH since 200828, 29. The Mayors Challenge to End Veteran Homelessness, an additional partnership between the VA and U.S. HUD, uses concepts from Housing First, rapid re-housing, and permanent supportive housing with added mental health services30. The Built for Zero Collaborative, a national movement to end chronic and veteran homelessness, also uses Housing First principles; 96,000 people have gained housing in participating communities since January 2015, including 65,000 veterans31.

Implementation Resources

Homeless Hub-HF - Homeless Hub. Accommodations and supports: Housing First (HF). Canadian Observatory on Homelessness.

Safe Housing Partnerships - Safe Housing Partnerships. Rapid re-housing, housing first, housing tax credits, and other affordable housing approaches. Domestic Violence and Housing Technical Assistance Consortium: a collaboration of the Administration for Children and Families, U.S. Department of Health and Human Services; the Office on Violence Against Women and the Office for Victims of Crime, U.S. Department of Justice; and the Office of Special Needs Assistance Programs, U.S. Department of Housing and Urban Development.

MHCC-Housing First - Mental Health Commission of Canada (MHCC). Canadian Housing First Toolkit: Developed to assist other Canadian communities who are interested in adopting the Housing First approach.

US ICH-Housing First - United States Interagency Council on Homelessness (U.S. ICH). Housing First: Featured tools to implement Housing First program.

NAEH-Housing First - National Alliance to End Homelessness (NAEH). Housing First: Includes checklist to implement program, how to use models, and special reports.

Built for Zero - Community Solutions. Built for Zero: a national change effort to end veteran and chronic homelessness.

Pathways HF - Pathways Housing First. Training and consulting for the Housing First model.


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1 Stergiopoulos 2012 - Stergiopoulos V, O'Campo P, Gozdzik A, et al. Moving from rhetoric to reality: Adapting Housing First for homeless individuals with mental illness from ethno-racial groups. BMC Health Services Research. 2012;12:345.

2 Patterson 2013 - Patterson M, Moniruzzaman A, Palepu A, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social Psychiatry and Psychiatric Epidemiology. 2013;48(8):1245-1259.

3 Urban-Cunningham 2015 - Cunningham MK, Gillespie S, Anderson J. Rapid re-housing: What the research says. Washington, D.C.: Urban Institute; 2015.

4 Campbell-Munthe-Kaas 2018 - Munthe-Kaas HM, Berg RC, Blaasvaer N. Effectiveness of interventions to reduce homelessness: A systematic review and meta-analysis. Campbell Systematic Reviews. 2018:1-284.

5 Palepu 2013 - Palepu A, Patterson ML, Moniruzzaman A, Frankish CJ, Somers J. Housing First improves residential stability in homeless adults with concurrent substance dependence and mental disorders. American Journal of Public Health. 2013;103(2)e30-e36.

6 Gulcur 2003 - Gulcur L, Stefancic A, Shinn M, Tsemberis S, Fischer SN. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities. Journal of Community and Applied Social Psychology. 2003;13:171-186.

7 Tsemberis 2000 - Tsemberis S, Eisenberg RF. Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric services. 2000;51(4):487-493.

8 Boland 2018a - Boland L, Slade A, Yarwood R, Bannigan K. Determinants of tenancy sustainment following homelessness: A systematic review. American Journal of Public Health. 2018;108(11):e1-e8

9 Kozloff 2016 - Kozloff N, Adair CE, Palma Lazgare Li, et al. “Housing First” for homeless youth with mental illness. Pediatrics. 2016;138(4):1-12.

10 Stergiopoulos 2015 - Stergiopoulos V, Hwang SW, Gozdzik A, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. Journal of the American Medical Association. 2015;313(9):905-915.

11 Montgomery 2013 - Montgomery AE, Hill LL, Kane V, Culhane DP. Housing chronically homeless veterans: Evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology. 2013;41(4):505-514.

12 Cochrane-Stergiopoulos 2015 - Stergiopoulos V, Gozdzik A, Misir V, et al. Effectiveness of Housing First with intensive care management in an ethnically diverse sample of homeless adults with mental illness: A randomized controlled trial. PLOS One. 2015;10(7):e0130281.

13 Fitzpatrick-Lewis 2011 - Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, et al. Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health. 2011;11:638.

14 Nelson 2007 - Nelson G, Aubry T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. American Journal of Orthopsychiarty. 2007;77(3):350-61.

15 Driscoll 2018 - Driscoll DL, Johnston JM, Chapman C, et al. Changes in the health status of newly housed chronically homeless: the Alaska Housing First program evaluation. Journal of Social Distress and the Homeless. 2018;27(1):34-43.

16 Mbilinyi 2015 - Mbilinyi L. The Washington State Domestic Violence Housing First Program: Cohort 2 agencies final evaluation report, September 2011 – September 2014. Washington State Coalition Against Domestic Violence. The Bill & Melinda Gates Foundation; 2015.

17 Tsemberis 2012 - Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless persons with co-occurring disorders in Washington, D.C. American Journal of Public Health. 2012;102(1):13-6.

18 Kirst 2015 - Kirst M, Zerger S, Misir V, Hwang S, Stergiopoulos V. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence. 2015;5(1):24-29.

19 Somers 2015 - Somers JM, Moniruzzaman A, Palepu A. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction. 2015;110(10):1605-1614.

20 Stefancic 2013 - Stefancic A, Henwood BF, Shin SM, et al. Implementing Housing First in rural areas: Pathways Vermont. American Journal of Public Health. 2013;103(S2):S206-S209.

21 Ly 2015 - Ly A, Latimer E. Housing First impact on costs and associated cost offsets: A review of the literature. Canadian Journal of Psychiatry. 2015;60(11):475-487.

22 Srebnik 2013 - Srebnik D, Connor T, Sylla L. A pilot study of the impact of Housing First- Supported housing for intensive users of medical hospitalization and sobering services. American Journal of Public Health. 2013;103(2):316-321.

23 Urban-Cunningham 2009 - Cunningham M. Preventing and ending homelessness - Next steps. Metropolitan Housing and Communities Center. Washington, D.C.: Urban Institute; 2009.

24 Pathways HF - Pathways Housing First. Training and consulting for the Housing First model.

25 Pathways HF-DC - Pathways to Housing DC. Housing First (HF) program. Washington, D.C.

26 Pathways HF-PA - Pathways to Housing PA. Housing First (HF) program. Pennsylvania.

27 WSCADV-Housing First toolkit - Washington State Coalition Against Domestic Violence (WSCADV). Domestic violence Housing First toolkit.

28 US HUD-VASH - U.S. Department of Housing and Urban Development (U.S. HUD). Veterans Affairs Supportive Housing (VASH): HUD-VASH Vouchers.

29 HUD-VASH 2018 - U.S. Department of Housing and Urban Development (U.S. HUD). HUD and VA announce additional support to help homeless veterans find permanent homes: Second round of HUD-VASH vouchers to provide housing for veterans and their families. HUD Public Affairs, press release; December 11, 2018.

30 US ICH-Veteran homelessness - United States Interagency Council on Homelessness (U.S. ICH). Mayors challenge to end veteran homelessness: Criteria and benchmarks for ending veteran homelessness.

31 Built for Zero - Community Solutions. Built for Zero: a national change effort to end veteran and chronic homelessness.