Improving Health Care through Housing First

Devlin Hanson
Sarah Gillespie
July 2021


A randomized controlled trial found Denver’s Housing First program led to positive impacts on health and utilization for individuals experiencing chronic homelessness and frequent periods of incarceration.


The City and County of Denver launched the Denver Supportive Housing Social Impact Bond Initiative in 2016 to provide supportive housing for individuals experiencing frequent periods of incarceration. The supportive housing program took a “Housing First” approach, thus it did not place any requirements for participants to receive treatment for mental health conditions or substance use disorders to receive housing services. Prior research has shown the Denver program to decrease criminal justice system involvement and homeless shelter use. This randomized controlled trial evaluated the impact on health care access through participation in this program compared to services as usual in the community, which included emergency shelter and short-term housing assistance but not supportive housing.


Program participants experienced increased use of mental health care; decreased emergency department visits caused by asthma, substance use, or dental issues; and increased access to prescription medication. Program participants did not have significant differences in their access to physical health care or substance use treatment, or in rates of mortality.


This study provides evidence that providing housing supports with a Housing First approach can increase access to some types of preventive care and reduce acute care utilization for people who experience homelessness, frequent jail stays, and frequent interactions with police. This study along with previous research suggest that a supportive housing model for people experiencing homelessness can lead to reduced spending on incarceration, reduced acute care utilization, and increased access to preventive care.

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