Housing First or Treatment First?

homelessness, housing, Housing Policy

Perhaps the most prominent debate about service delivery models for people who are experiencing homelessness revolves around the question: should housing come before treatment, or should treatment for people who are homeless and experiencing mental illness and/or addiction issues come before housing?

Housing First is a service model that advocates for the provision of permanent housing to people experiencing homelessness before engaging homeless individuals in treatment for mental illness, addiction recovery, or concurrent disorders.

In contrast, the Treatment First service model prioritizes the treatment of mental illness before the housing of homeless individuals (Padgett et. al. 2011). The Treatment First model has informed many service delivery models and public policy designs that require homeless people to provide evidence that they are prepared to live in permanent housing (e.g. the staircase model and continua of care programs operate under the philosophy of Treatment First). The assumption underlying this policy and programming philosophy is that homeless people are not able to sustain tenancy and self-sufficiency without first receiving treatment for mental illness. In other words, sobriety and the active, consistent treatment of mental health disorders act as the necessary pre-conditions for attaining housing.

This philosophy still dominates many of the policy debates over Housing First and Treatment First models, however numerous studies with strong research designs have provided support for the contention that homeless people with mental illness and concurrent disorders are able to sustain tenancy when they are provided with appropriate support for their respective conditions (see Busch-Geertsema 2013, Tsemberis 2011, Tsemberis et. al. 2008, Padgett et. al. 2006).

What do you think should come first–housing or treatment?

 

References:

Busch-Geertsema, Volker (2013). “Housing First Europe Final Report.”: http://www.habitat.hu/files/FinalReportHousingFirstEurope.pdf

 

Padgett, D. K., Stanhope, V., Henwood, B. F., & Stefancic, A. (2011). Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community mental health journal, 47(2), 227-232.

Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74-83.

Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American journal of public health, 94(4), 651-656.

Tsemberis, S. (2011). Housing First: The pathways model to end homelessness for people with mental illness and addiction manual. European Journal of Homelessness _ Volume, 5(2).

*For more information on the Treatment First model (written by advocates of this model), see King, R. and Martin, F. (2016). “Treatment first for mentally ill individuals, not housing” San Francisco Chroniclehttp://www.sfchronicle.com/opinion/openforum/article/Treatment-first-for-mentally-ill-individuals-not-8319570.php

Groton, D. (2013). “Are Housing First Programs Effective? A Research Note”: https://www.wmich.edu/hhs/newsletters_journals/jssw_institutional/individual_subscribers/40.1.Groton.pdf

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Three Quarter Homes in NYC

affordable housing, homelessness, NYC

Three quarter homes, or three quarter houses, are are unregulated dwellings for people who are experiencing homelessness, people with substance abuse challenges, people receiving public assistance, and people with mental health needs or disability services needs.

In NYC, three quarter homes have operated without inspection or regulation for decades, leaving residents in homes no avenue for filing  tenant grievances.  Increasingly unsafe and unhealthy conditions in three quarter homes across New York City prompted the New York Times to run an investigative series on the dilapidated dwellings in May and June 2015.  CLICK HERE to read the original NYT investigation that prompted city officials to take action.

The City of New York responded by removing residents living in unsafe structures from the three quarter homes.  The City has offered them temporary living situations, such as hotels and motels until city housing officials can find a more permanent solution.  The City of New York also created a new task force in June 2015 to ameliorate conditions in three quarter homes.  While the task force has evaluated its performance highly, many residents of three quarter homes feel that they have been left behind while others are joyful to be living in clean, safe spaces.

The New York Times continued its coverage of this issue in the article “New York City Starts Moving Tenants From ‘Three-Quarter’ Homes, but Others Are Left Behind”, written by Kim Barker and published on August 2, 2015.  The article explains that some residents of the three quarter homes have been moved into locations like the Sleep Inn that are clean and affordable.  However, other residents have not been given access to new housing yet.  Barker cites reasons such as disability and substance use as factors preventing the flight of three quarter home residents from the unsafe and unsanitary homes.

For example, Barker tells the story of one man in his mid-50’s whose recent knee surgery prevented him from packing quickly.  His “spot” at the Sleep Inn was filled by the time he was able to pack and get there.  As a result, he has been left behind, as the City does not have enough housing spaces to accommodate everyone who needs to relocate from the three quarter homes.

Experts trace the modern history of three quarter homes in NYC to the public policies of former mayor Michael Bloomberg.  Bloomberg advocated for reducing the city’s homeless shelter rolls, without providing any additional housing for the people expelled from the shelters.  Three quarter homes were developed out of necessity to fill the housing gap for low income residents of NYC.  Three quarter homes are not sanctioned by the City–they are not up to code and they are of shoddy quality–but they provided an alternative to sleeping on the streets for many people experiencing homelessness in the past few decades.

The City of New York has pledged $5 million to repair three quarter homes and bring them up to the building code and move people into higher quality housing.  Let’s hope the pledge doesn’t dissipate before the next election cycle!

Point in Time Counts 2015

homelessness, methods

Point in Time Counting is the method used by the Department of Housing and Urban Development (HUD) to determine how many people are experiencing homelessness on a given night in the United States.  Point in Time data is collected by volunteers recruited by HUD.  It has become one of the main sources of data referenced by policy makers, politicians, and stakeholders at organizations working with people experiencing homelessness.  This data informs policy and plays an integral role in the construction of the political narrative of homelessness.  This year, President Obama’s Chief of Staff, Denis McDonough, joined point in time volunteers in San Francisco.  CLICK HERE to read the ThinkProgress.org article on McDonough’s presence.  I think it is both politically savvy (a great photo op for McDonough) and policy-practical (a great opportunity to observe data collection that informs policy in action) to include policy makers and politicians in the PIT counts.

However, I am curious if PIT counting is the most effective data collection method? Is it reliable? Is it really safe to say that chronic homelessness decreased or increased in a given YEAR based on data collected in the time span of ONE night? While PIT counting is positive in that it draws attention to homelessness and the problems faced by the chronically homeless, I wonder if it should be so influential? What other methods could be employed to paint a more accurate picture of homelessness in America in a given year? Ideas, anyone?