'Housing First' Model Making Inroads on Homelessness

By Haskins, Julia | The Nation's Health, February-March 2018 | Go to article overview

'Housing First' Model Making Inroads on Homelessness


Haskins, Julia, The Nation's Health


PEOPLE WHO ARE HOMELESS in the Arlington, Virginia, area can turn to the Homeless Services Center at the Arlington Street People's Assistance Network for the health and support services that they cannot easily access. Medical care, food, shelter, counseling and job training are all available to people who need assistance.

Such wraparound services are vital to people who are homeless, but the "housing first" model is at the heart of the organization's mission.

Housing first is based on the premise that housing is necessary for health, security and wellness, and that people need not meet a long list of prerequisites to access permanent housing. While some programs require people to enter treatment programs for addiction or mental health or be employed before they are housed, housing first posits that with the right services and support, such issues can be better addressed after housing is secured.

"If you really want to end homelessness, you have to embrace housing first," Kathleen Sibert, MBA, president and CEO of the Arlington Street People's Assistance Network, told The Nation's Health.

Once "you get someone into housing ... you can work on all the other issues, whether it's mental health, whether it's substance abuse, whether it's not being able to hold onto a job," she said.

Homelessness in the U.S. has increased for the first time in seven years, according to the 2017 Annual Homeless Assessment Report to Congress, which is produced by the U.S. Department of Housing and Urban Development. On a single night in 2017, almost 554,000 people were homeless, a 0.7 percent increase from the year before. The report also noted an uptick in the number of people who were homeless and unsheltered.

With rates of homelessness going up, the housing first model has gained momentum among public health and homelessness advocates as a solution to the crisis. Implementing a housing first system orientation and response is one of the 10 strategies established by the U.S. Interagency Council on Homelessness to end chronic homelessness and was also included in Opening Doors, the council's federal strategic plan to prevent and end homelessness that was first released in 2002.

Housing first is not a panacea for people who are homeless, but the practice can lead to improved health outcomes. As a social determinant of health, housing allows people to achieve stability in various aspects of their lives.

"The solution to homelessness is essentially housing," Nan Roman, MA, president and CEO of the National Alliance to End Homelessness, told The Nation's Health. "It's not that (people who are homeless) don't have other needs, but if they're housed, they're not homeless."

Being housed does alleviate many problems that are exacerbated by homelessness, Roman said. Exposure to environmental elements can lead to adverse health effects, as demonstrated by the hepatitis A outbreak in San Diego County last year. The outbreak, which resulted in 20 deaths, mostly affected people in the county who were homeless as well as people who were using illicit drugs. The local public health emergency spurred city officials to find more temporary housing for people who were homeless to control the outbreak and underscored the need to provide housing to people most susceptible to illness. Common health issues affecting people who are homeless include mental health problems, substance misuse problems, bronchitis and pneumonia, complications from outdoor exposure and wound and skin problems, according to the National Institutes of Health.

At APHA's 2017 Annual Meeting and Expo in Atlanta, the Association adopted a new policy statement on homelessness that endorses the housing first model and low-barrier housing.

APHA's first policy statement on homelessness in two decades encapsulates a growing body of evidence that providing housing to people, regardless of their employment status, mental health or sobriety, is effective. …

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