06/05/2014 - Housing First: How Evidence Drives Solutions to Homelessness

By Eric Grumdahl, USICH Policy Director

Evidence plays a central role in shaping Federal policy. Through the implementation of Opening Doors: Federal Strategic Plan to Prevent and End Homelessness, evidence has transformed Federal homelessness programs. This is particularly the case for Veteran Affairs programs. Our progress—a 24 percent reduction in Veteran homelessness in three years—is directly tied to the commitment to apply evidenced-based practices to end homelessness, particularly Housing First, permanent supportive housing, and rapid re-housing.

Housing First is an approach to remove programmatic barriers so that people experiencing homelessness get access to the interventions they need, while focusing those interventions on housing outcomes, without preconditions like sobriety, income, or other measures of “readiness.” It puts housing forward as the solution to homelessness and holds us to the commitment to end homelessness for all—not just those our programs are best positioned to serve. In that way, it puts people over programs. And yes, for some providers and communities, it involves changing the way they do business.

VA’s system-wide adoption of Housing First as the approach used by its homelessness programs is a marvelous example of using evidence to drive policy. VA’s National Center on Homelessness Among Veterans recently released an Implementation Brief that tells the story of how VA used a pilot initiative to gather the dramatic evidence about the impact of Housing First approaches, translated that understanding to practice, and applied those lessons to all of its programs in action. Retooling processes like this can be challenging for programs. They can be life-saving for the people that programs serve.

VA’s Housing First Pilot found high housing retention and significant healthcare impacts, including decreased emergency room visits, lower inpatient hospitalizations, and decreased overall costs. These findings joined a vast and growing body of evidence on the impact of Housing First and helped to drive VA’s adoption of Housing First as the policy of its homelessness programs.

They don’t say, “Doctor, I’m not sure this particular patient is ready for surgery in a sterile environment that will yield a higher likely of success and reduced risk of infection.”

Clear evidence provides a faster path toward broad adoption, but sometimes discussions of Housing First get mired in debates that feel more ideological than practical. Here’s an analogy:  there was a time when aseptic technique was not common place for surgeries, and surgeries were fraught with exposure to infection. Evidence and practice have long converged on the importance of a sterile, germ-free environment for optimal surgical outcomes. Surgeons may still have fierce debates about the particular surgical approach or technique in specific cases, but they don’t say, “Doctor, I’m not sure this particular patient is ready for surgery in a sterile environment that will yield a higher likely of success and reduced risk of infection.”  Surgeries are performed under sterile conditions every time, because we now know that’s what works best.

So should it be with Housing First. We have the evidence. I hope we have the wisdom and courage to ensure that practice follows. USICH’s Housing First Checklist can help programs—all programs, not just permanent supportive housing—and communities as a whole adopt Housing First principles.  

Last week, I participated in a panel discussion at the National Coalition for Homeless Veterans (NCHV) conference with leaders applying Housing First principles to ending Veteran homelessness: Steve Berg from the National Alliance to End Homelessness, Shane Groen from the Arizona Coalition to End Homelessness,  Kristine DiNardo and Rita Chapdelaine from the New England Center for Homeless Veterans, and Tramecia Garner from Swords to Plowshares. Our shared task was to provide resources and programmatic examples of Housing First in action—the kind of practical information that programs ending Veteran homelessness across the country could use in applying Housing First to their work. Here is a link to the USICH presentation slides from that discussion.  Please use and share!  And please reach out to USICH for more information on how you can help your community to fully implement evidence-based practices like Housing First.

See USICH’s slides from this presentation, containing a variety of Housing First resources. 

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