Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review

Authors
Yinan Peng
Robert A. Hahn
Ramona K. C. Finnie
Jamaicia Cobb
Samantha P. Williams
Jonathan E. Fielding
Robert L. Johnson
Ann Elizabeth Montgomery
Alex F. Schwartz
Carles Muntaner
Veronica Helms Garrison
Beda Jean-Francois
Benedict I. Truman
Mindy T. Fullilove
Journal Article
September 2020

Programs for individuals experiencing homelessness often use a “Treatment First” approach, where the person is required to be in psychiatric treatment and substance-free before being approved for permanent housing. “Housing First” is a newer approach gaining popularity, and programs using this approach provide permanent housing and supportive services for individuals without requiring treatment for mental health or substance use disorders. This literature review, undertaken by the Community Preventive Services Task Force, measured the effectiveness of these two interventions on the housing stability, health outcomes, and health care utilization of people with disabilities experiencing homelessness.

When compared to Treatment First programs, Housing First programs showed more success in reducing homelessness, hospitalizations, and emergency department use, while also improving housing stability. For homeless individuals living with HIV, increased housing stability improved their physical and mental health and reduced mortality due to increased treatment adherence. These findings indicate that Housing First programs are more effective for reducing homelessness and improving housing stability than Treatment First or treatment as usual programs. Health care stakeholders should continue to review housing status and other social conditions as a source for health problems and invest in potential strategies that will address these upstream issues.  

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Population Addressed
Adults Under 65 with Disabilities
People with Behavioral Health and Social Needs
Key Questions Answered
  • What is the impact of Housing First programs on housing stability, health outcomes, and health care utilization for individuals with disabilities experiencing homelessness?
Level of Evidence
Moderate
What does this mean?