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Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations

Yinan Peng1, Robert A Hahn, Ramona K C Finnie

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Housing First programs significantly reduce homelessness and improve housing stability compared to Treatment First. This approach also yields substantial health benefits and decreases healthcare utilization for homeless individuals.

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Area of Science:

  • Public Health
  • Health Services Research
  • Social Policy

Background:

  • Homelessness is a complex issue linked to poor physical and mental health, and substance use disorders, affecting millions annually in the U.S.
  • Individuals experiencing homelessness have disproportionately high rates of healthcare utilization, social services engagement, and involvement with the justice system.
  • Traditional 'Treatment First' models require individuals to be 'housing ready' before receiving permanent housing, posing a barrier for many.

Purpose of the Study:

  • To systematically review and compare the effectiveness of Housing First versus Treatment First approaches.
  • To evaluate the impact of these housing models on housing stability, health outcomes, and healthcare utilization among individuals with disabilities experiencing homelessness.

Main Methods:

  • A systematic literature search was conducted across 8 databases (inception to February 2018) using keywords like 'housing first,' 'treatment first,' and 'supportive housing.'
  • Included studies assessed Housing First programs in high-income nations with concurrent comparison groups, focusing on housing stability, health, and healthcare use.
  • Study design and validity were assessed using Community Guide methods, with medians calculated where appropriate.

Main Results:

  • Twenty-six studies from the U.S. and Canada met the inclusion criteria.
  • Housing First programs demonstrated an 88% reduction in homelessness and a 41% improvement in housing stability compared to Treatment First.
  • For individuals with HIV, Housing First led to a 37% reduction in homelessness, 22% reduction in viral load, 13% decrease in depression, 41% less emergency department use, 36% fewer hospitalizations, and a 37% reduction in mortality.

Conclusions:

  • Housing First is a more effective approach than Treatment First for improving housing stability and reducing homelessness.
  • Housing First programs offer significant health benefits, including improved mental health and reduced healthcare service utilization.
  • Healthcare systems should integrate effective housing services, like Housing First, to enhance the health and well-being of homeless populations.