Abstract
This chapter describes the Pathways Housing First (PHF) model. This program pioneered the practice of offering choices to individuals with co-occurring psychiatric and addiction diagnoses including the option to move directly from homelessness into a place of their own with supports. Pathways offered housing as a right, not something that must be earned through participating in psychiatric treatment or attaining a period of sobriety. Intensive treatment and support services are provided using community-based multidisciplinary teams that are mobile and make home visits. The program’s philosophy is guided by principles of self-determination and empowerment, and interventions are primarily directed by the service user. Participants are not discharged from the program if they relapse or if they are evicted from their housing; the support team services are continuous and assist with rehousing. The Pathways Housing First (PHF) program represents a 180-degree turn from traditional supportive housing or other group home programs serving this population which typically use a treatment-first approach and require participation in psychiatric treatment and a period of sobriety as a prerequisites for obtaining and maintaining housing. Research studies are presented comparing Housing First to Treatment First programs on measures of housing stability, quality of life, and cost-effectiveness. Results of these studies built an evidence base that influenced policy makers to advocate for implementing the Pathways Housing First model to address homelessness for individuals with complex needs which has led to the programs’ dissemination across the United States, Canada, and Europe.
References
Atherton I, Nicholls CM (2008) ‘Housing First’ as a means of addressing multiple needs and homelessness. Eur J Homelessness 2:289–303
Anthony W (1993) Recovery from mental illness: the guiding vision of the mental health system in the 1990s. Psychosoc Rehabil J 16:11
Anthony W, Blanch A (1989) Research on community support services: what have we learned? Psychosoc Rehabil J 12(3):55–81
Anthony WA, Cohen M, Farkas M (1982) A psychiatric rehabilitation treatment program: can I recognize one if I see one? Community Ment Health J 18(2):83–96
Appel PW, Tsemberis S, Joseph H, Stefancic A, Lambert-Wacey D (2012) Housing first for mentally ill homeless methadone patients. J Addict Dis 1:270–277
Aubry T, Goering P, Veldhuizen S, Adair CE, Bourque J, Distasio J, … Tsemberis S (2016) A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatr Serv 67(3):275–281. doi:10.1176/appi.ps.201400587
Author (2014) Priced Out, Technical Assistance Collaborative, Boston
Bharel M, Lin W, Zhang J, O’Connell E, Taube R, Clark R (2013) Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the affordable care act. Am J Public Health 103(Suppl 2):S311–S317
Burt RM (2016) Three decades of homelessness. In: Burnes D, DiLeo D (eds) Ending homelessness. Lynne Rienner Publishers, Boulder, pp 47–66
Busch-Geertsema V (2011) Housing first Europe: a “social experimentation project”. Eur J Homelessness 5(2):209–211
Carrier S (2015) Room for improvement. Mother Jones. Online version
Crowley S (2016) Homelessness is about housing. In: Burnes D, DiLeo D (eds) Ending homelessness: why we don’t and how we can. Lynne Rienner Publishers, Boulder, pp 159–175
Culhane D, Metraux S, Hadley T (2002) Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing. Hous Pol Debate 13:107–163
Davidson L, Roe D (2007) Recovery from versus recovery in serious mental illness: one strategy for lessening confusion plaguing recovery. J Ment Health 16(4):459–470. doi:10.1080/09638230701482394
Deegan PE (2007) The lived experience of using psychiatric medication in the recovery process and a shared decision-making program to support it. Psychiatr Rehabil J 31(1):62–69
DiLeo D (2016) How we’ve learned to embrace homelessness. In: Burnes D, DiLeo D (eds) Ending homelessness: why we don’t and how we can. Lynne Rienner Publishers, Boulder, pp 141–158
Dolbeare C, Crowley S (2002) Changing priorities: the federal budget and housing assistance 1976–2007. National Low Income Housing Coalition, Washington, DC
Drake R, Bond G, Becker D (2013) IPS supported employment: an evidence- based approach. Oxford Press, New York
Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J et al (2011) The at Home/Chez Soi trial protocol: a pragmatic, multi-site, randomized controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open 1(2):e000323. doi:10.1136/bmjopen-2011000323
Goering P, Veldhuizen S, Nelson G, Stefancic A, Tsemberis S, Adair C et al (2016) Further validation of the pathways housing first fidelity scale. Psychiatr Serv 67(1):111–114
Greenwood RM, Schaefer-McDaniel NJ, Winkel G, Tsemberis SJ (2005) Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol 36(3–4):223–238. doi:10.1007/s10464-005-8617-z
Greenwood RM, Stefancic A, Tsemberis S, Busch-Geertsema V (2013) Implementations of housing first in Europe: successes and challenges in maintaining model fidelity. Am J Psychiatr Rehabil 16(4):290–312
Harp HT (1990) Independent living with support services: the goal and future for mental health consumers. Psychosoc Rehabil J 13(4):85–89
Henwood BF, Shinn M, Tsemberis S, Padgett DK (2013) Examining provider perspectives within housing first and traditional programs. Am J Psychiatr Rehabil 16(4):262–274
Hopper K, Jost J, Hay T, Welber S, Haugland G (1997) Homelessness, severe mental illness, and the institutional circuit. Psychiatr Serv 48(5):659–665
Jacobs J (1992) The death and life of great American cities. Vintage Books, New York
Kane V, Tsemberis S (2016) From hospital to community: transforming the VA medical center hospital system to adopt Housing First. Paper presented at the 2nd international housing first conference, July 8, Limerick
Kertesz S, Baggett T, O’Connell J, Buck D, Kushel M (2016) Permanent supportive housing for homeless people – reframing the debate. N Engl J Med 375(22):2115–2117
Larimer ME, Malone DK, Garner MD, Atkins DC, Burlingham B et al (2009) Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA 301:1349–1357
Ly A, Latimer E (2015) Housing first impact on costs and associated cost offsets: a review of the literature. Can J Psychiatr 60(11):475–487
Macnaughton E, Nelson G, Piat M, Goering P (in press) Moving evidence into policy: the story of the at Home/Chez Soi initiative’s impact on federal homelessness policy in Canada, and its implications for the spread of Housing First in Europe and Internationally. Eur J Homelessness
Macnaughton E, Townley G, Nelson G, Caplan R, Macleod T, Polvere L, … Goering P (2016) How does housing first catalyze recovery? Qualitative findings from a Canadian multi-site randomized controlled trial. Am J Psychiatr Rehabil 19(2)
Mares A, Rosenheck R (2007) HUD/HHS/VA collaborative initiative to help end chronic homelessness national performance outcomes assessment preliminary client outcomes report. VA Northeast Program Evaluation Center, Washington, DC
Marlatt GA (1998) Basic principles and strategies of harm reduction. In: Marlatt GA (ed) Harm reduction: pragmatic strategies for managing high-risk behaviors. The Guilford Press, New York
Mate G (2009) In the realm of hungry ghosts: close encounters with addiction. Knopf Canada, Toronto
Monroe-DeVita M, Teague G, Moser L (2011) The TMACT: a new tool for measuring fidelity to assertive community treatment. J Am Nurses Assoc 17(1):17–29
Montgomery AE, Hill LL, Kane V, Culhane DP (2013) Housing chronically homeless veterans: evaluating the efficacy of a housing first approach to HUD-VASH. J Community Psychol 41(4):505–514. doi:10.1002/jcop.21554
Padgett DK (2007) There’s no place like (a) home: ontological security among persons with serious mental illness in the United States. Soc Sci Med 64(9):1925–1936. doi:10.1016/j.socscimed.2007.02.011
Patterson ML, Rezansoff S, Currie L, Somers JM (2013) Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of housing first: a longitudinal, narrative analysis. Br Med J Open 3(9):e003442. doi:10.1136/bmjopen-2013-003442
Pearson C, Montgomery AE, Locke G (2009) Housing stability among homeless individuals with serious mental illness participating in housing first programs. J Community Psychol 37(3):404–417
Prilleltensky I (1994) Empowerment in mainstream psychology: legitimacy, obstacles, and possibilities. Can Psychol 35(4):358–375
Rappaport J (1987) Terms of empowerment/exemplars of prevention: toward a theory of community psychology. Am J Community Psychol 15:121–148
Ridgway P, Zipple A (1990) The paradigm shift in residential services: from the linear continuum to supported housing approaches. Psychosoc Rehabil J 13(4):11–31. doi:10.1037/h0099479
Shern DL, Tsemberis S, Anthony W, Lovell AM, Richmond L, Felton CJ, Winarski J, Cohen M (2000) Serving street-dwelling individuals with psychiatric disabilities: outcomes of a psychiatric rehabilitation clinical trial. Am J Public Health 90(12):1873–1878
Stefancic A, Tsemberis S (2007) Housing first for long-term shelter dwellers with psychiatric disabilities in a suburban county: a four-year study of housing access and retention. J Prim Prev 28(3–4):265–279
Stefancic A, Schaefer-McDaniel NJ, Davis AC, Tsemberis S (2004) Maximizing follow-up of adults with histories of homelessness and psychiatric disabilities. Eval Program Plann 27(4):433–442
Stefancic A, Henwood B, Melton H, Shin SM, Lawrence-Gomez R, Tsemberis S (2013a) Implementing housing first in rural areas: pathways Vermont. Am J Public Health 103:206–209
Stefancic A, Tsemberis S, Messeri P, Drake R, Goering P (2013b) The pathways housing first fidelity scale for programs serving individuals with psychiatric disabilities. Am J Psychiatr Rehabil 16:240–261
Stein LI, Test MA (1980) Alternatives to mental hospital treatment. Arch Gen Psychiatry 37(4):392–397
Stergiopoulos V, Hwang S, Godzik A, Nisenbaum R, … Goering P (2015) Effect of scattered site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA 313(9):905–915. doi:10.1001/jama.2015.1163
Szalavitz M (2016) The unbroken brain: a revolutionary new way of understanding addiction. St. Martin’s Press, New York
Teague B, Bond G, Drake R (1998) Program fidelity in assertive community treatment: development and use of a measure. Am J Orthopsychiatry 68(2):216–232
Toro PA, Tompsett CJ, Lombardo S, Philippot P, Nachtergael H, Galand B, … Harvey K (2007) Homelessness in Europe and North America: a comparison of prevalence and public opinion. J Soc Issues 63(3):505–524
Tsemberis S (1999) From streets to homes: an innovative approach to supported housing for homeless adults with psychiatric disabilities. J Community Psychol 27:225–241
Tsemberis S (2010a) Housing first: the pathways model to end homelessness for people with mental illness and addiction. Hazelden, Center City
Tsemberis S (2010b) Housing first: ending homelessness, promoting recovery, and reducing costs. In: Gould EI, O’Flaherty B (eds) How to house the homeless. Russell Sage Publications, New York, pp 37–56
Tsemberis S, Eisenberg RF (2000) Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatr Serv 51(4):487–493
Tsemberis S, Moran LL, Shinn M, Asmussen SM, Shern DL (2003) Consumer preference programs for homeless individuals with psychiatric disabilities: a drop-in center and a supported housing program. Am J Community Psychol 32:305–317
Tsemberis S, Gulcur L, Nakae M (2004) Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health 94(4):651–656
U.S. Interagency Council on Homelessness (2013) Ending veterans homelessness: HUD-VASH makes housing first a priority. Retrieved from http://usich.gov/population/veterans/veterans_homelessness_in_focus/ending_veterans_homelessness_hud_vash_makes_housing_first_a_priority/
U.S. Substance Abuse and Mental Health Services Administration (2007) National registry of evidence-based program and practices: pathways’ housing first program. Available: http://www.nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=195 www.cbc.ca/radio/asithappens/as-it-happens-thursday-edition-1.3074402/medicine-hat-becomes-the-first-city-in-canada-to-eliminate-homelessness-1.3074742
Yanos PT, Barrow SM, Tsemberis S (2004) Community integration in the early phase of housing among homeless persons diagnosed with severe mental illness: successes and challenges. Community Ment Health J 40(2):133–150
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Tsemberis, S., Macnaughton, E. (2017). Homelessness and Challenges of Community Care. In: Okkels, N., Kristiansen, C., Munk-Jørgensen, P. (eds) Mental Health and Illness in the City. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-2327-9_6
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