Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review

Area of Science:

• Public Health
• Social Sciences
• Behavioral Health

Background:

• Housing First is a key intervention for chronic homelessness, addressing complex behavioral health needs.
• Harm reduction is a central principle within the Housing First model.
• Understanding harm reduction outcomes and practices is crucial for optimizing Housing First effectiveness.

Purpose of the Study:

• To systematically review harm reduction outcomes and practices within Housing First interventions.
• To examine impacts across substance-related harms, viral health, sexual health, and service use.
• To identify facilitators and barriers to implementing harm reduction in Housing First.

Main Methods:

• A systematic review adhering to PRISMA guidelines was performed.
• Searches were conducted across five major academic databases (PsycINFO, MEDLINE, Embase, CINAHL, Google Scholar).
• Included studies focused on harm reduction outcomes and practices in Housing First settings.

Main Results:

• Twenty-three articles examined outcomes, finding minimal effects on nonspecific substance use problems.
• Severe harms like delirium tremens and substance use-related deaths are under-researched.
• Twelve articles on practices revealed provider flexibility and ambiguity, emphasizing empathetic relationships for engagement.

Conclusions:

• Harm reduction outcomes in Housing First are underexamined; conclusions on intervention impact are premature.
• Effective harm reduction practices are contingent upon robust working relationships between Housing First staff and tenants.