Housing first. Support always.

Housing First is an evidence-informed approach that treats housing as the foundation for recovery and stability, not as a reward someone must earn after completing treatment, reaching sobriety, or proving “readiness.”

What housing first means:

Housing without preconditions

People are not required to demonstrate sobriety, treatment participation, compliance, or other milestones before they can access permanent housing.

Choice and dignity

People have a meaningful voice in where they live, what support they receive, and the goals they pursue.

Individualized support

Services remain essential. They should be voluntary, responsive, and tailored to what each person needs to keep housing and build stability.

A focus on long-term stability

Success is more than moving into an apartment. It means reducing barriers and coordinating support so people can remain housed.

Housing First does not mean housing only.

Housing provides the platform. Healthcare, behavioral health services, income support, transportation, relationships, and case management can help turn that platform into lasting stability.

The evidence is overwhelming.

Housing First Research Review Annotated Bibliography

Collins, S. E., Malone, D. K., & Clifasefi, S. L. (2013). Housing retention in single-site Housing First for chronically homeless individuals with severe alcohol problems. American Journal of Public Health, 103(Suppl. 2), S269–S274. https://doi.org/10.2105/AJPH.2013.301312

Collins, Malone, and Clifasefi examine whether individuals experiencing chronic homelessness and severe alcohol problems can maintain housing within a low-barrier, single-site Housing First program. The Seattle-based study followed 111 participants for two years. Only 23% of participants returned to homelessness during the follow-up period, meaning approximately 77% remained housed. Notably, commonly assumed risk factors—including alcohol and other drug use, psychiatric symptoms, illness burden, and previous homelessness—did not predict a return to homelessness. Participants who were actively drinking were actually more likely to remain in the Housing First program than nondrinkers. These findings challenge the assumption that sobriety or abstinence must precede stable housing for people with severe alcohol-use problems. The study provides particularly relevant evidence for the harm-reduction component of Housing First and demonstrates that housing retention is possible even among individuals with substantial substance-use challenges. However, the study was part of a larger nonrandomized controlled trial and focused specifically on housing retention rather than demonstrating causal effects across broader health or social outcomes. Nevertheless, its findings provide valuable U.S.-based evidence that Housing First can successfully accommodate people with severe alcohol problems without making abstinence a condition of housing.

Martinez, T. E., & Burt, M. R. (2006). Impact of permanent supportive housing on the use of acute care health services by homeless adults. Psychiatric Services, 57(7), 992–999. https://doi.org/10.1176/ps.2006.57.7.992

Martinez and Burt examine whether permanent supportive housing affects the use of acute health-care services among adults experiencing chronic homelessness in the United States. The study is particularly relevant to Housing First because permanent supportive housing combines stable housing with voluntary supportive services rather than requiring individuals to complete treatment before obtaining housing. The researchers found substantial reductions in emergency-department and inpatient hospital utilization following placement in permanent supportive housing. Emergency-department use declined both in the proportion of participants using emergency services and in the average number of visits, while hospital admissions also decreased. These findings suggest that providing stable supportive housing may improve continuity of care and reduce reliance on expensive acute-care services. The study therefore expands the case for Housing First beyond housing stability by demonstrating potential benefits for health-service utilization and public-sector costs. However, the study does not provide the same level of causal evidence as a randomized controlled trial, so reductions in health-care utilization cannot be attributed exclusively to the housing intervention. Nevertheless, it provides important U.S.-based evidence that permanent supportive housing may have meaningful effects on health-care utilization among people experiencing chronic homelessness.

O’Campo, P., Stergiopoulos, V., Deering, K., & others. (2022). Health and social outcomes in the Housing First model: Testing the theory of change. EClinicalMedicine, 47, 101387. https://doi.org/10.1016/j.eclinm.2022.101387

This article examines how the Housing First model affects health and social outcomes among people experiencing homelessness. Using data from the At Home/Chez Soi randomized controlled trial in Canada, the researchers investigate the pathways through which Housing First may lead to improvements in quality of life, recovery, and crisis-related outcomes. The study found that connections to health and social services, improvements in health, and increased social connectedness were important factors associated with improved quality of life and recovery over time. The authors conclude that stable housing is an important foundation, but that additional health and social supports contribute to longer-term improvements in well-being. The study is particularly useful for understanding not only whether Housing First is effective, but also the mechanisms that may explain its effects. A strength of the article is its use of longitudinal data from a large randomized trial; however, the proposed pathways were less successful in explaining crisis-related events and service use. This source would be useful for research on homelessness, supportive housing, Housing First programs, and interventions designed to improve health and social outcomes among people experiencing homelessness.

Peng, Y., Hahn, R. A., Finnie, R. K. C., Cobb, J., Williams, S. P., Fielding, J. E., Johnson, R. L., Montgomery, A. E., Schwartz, A., Muntaner, C., Garrison, V. H., Jean-Francois, B., Truman, B. I., Fullilove, M. T., & Community Preventive Services Task Force. (2020). Permanent supportive housing with Housing First to reduce homelessness and promote health among homeless populations with disability: A Community Guide systematic review. Journal of Public Health Management and Practice, 26(5), 404–411. https://doi.org/10.1097/PHH.0000000000001219

This systematic review examines the effectiveness of the Housing First approach compared with Treatment First or treatment as usual for people experiencing homelessness who have disabilities. The authors reviewed 26 studies involving 17,182 participants in the United States and Canada. Their findings indicate that Housing First substantially reduced homelessness and improved housing stability. The review also found improvements in quality of life, community integration, and certain health-care outcomes, although effects on physical and mental health were generally limited or mixed. The authors conclude that providing permanent housing without requiring individuals to first complete treatment or achieve sobriety is more effective at promoting housing stability and reducing homelessness. This source is particularly useful for research on homelessness, public health, housing policy, and social determinants of health because it synthesizes evidence from numerous studies rather than relying on a single intervention or population. A limitation is that the included research was conducted primarily in urban settings in the United States and Canada, so the findings may not apply equally to rural communities or other countries.

Tsai, J., Mares, A. S., & Rosenheck, R. A. (2010). A multisite comparison of supported housing for chronically homeless adults: “Housing First” versus “residential treatment first.” Psychological Services, 7(4), 219–232. https://doi.org/10.1037/a0020460

Tsai, Mares, and Rosenheck compare Housing First with a treatment-first approach using data from a national, multisite U.S. housing initiative. The study included 709 chronically homeless adults and followed participants for two years, comparing individuals who entered independent housing directly with those who received residential treatment or transitional housing before moving into independent housing. Participants who received immediate independent housing spent more days in their own housing, experienced fewer days of incarceration, and reported greater choice regarding treatment. The researchers did not find clinical or community-adjustment advantages associated with receiving residential treatment before independent housing, although the treatment-first group incurred higher substance-abuse service costs. These findings provide support for the Housing First principle that people do not necessarily need to become “housing ready” through transitional treatment before moving into independent housing. A major strength is the multisite U.S. sample, which increases the relevance of the findings to different communities. However, the study was observational rather than randomized, and the authors appropriately caution that randomized trials are needed to establish causation. Despite this limitation, the study provides important comparative evidence that treatment-first approaches do not necessarily produce better housing or clinical outcomes than immediate access to independent housing.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656. https://doi.org/10.2105/AJPH.94.4.651

This study is one of the foundational evaluations of the Housing First model in the United States. Conducted in New York City, the researchers randomly assigned 225 adults experiencing homelessness and living with mental illness and substance-use disorders to either immediate access to independent housing through Housing First or a comparison condition in which housing was contingent on treatment participation and sobriety. Participants were followed for 24 months. The Housing First group obtained housing more quickly, remained stably housed for longer, and reported greater perceived choice than participants in the comparison condition. Importantly, Housing First participants did not experience worse substance use or psychiatric outcomes despite not being required to achieve sobriety before obtaining housing. The findings provide strong support for the central Housing First principles of immediate access to permanent housing, consumer choice, and harm reduction. Because the study used random assignment and directly compared Housing First with a treatment-first approach, it provides particularly strong evidence that requiring treatment or sobriety before housing is not necessary for successful housing retention among this population. This article is especially valuable as foundational evidence for the effectiveness and underlying philosophy of Housing First.

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