Social Determinants of Health: Permanent Supportive Housing with Housing First (Housing First Programs)
CDC
An Evidence-Based Practice
Description
Housing First programs provide regular, subsidized, time-unlimited housing to individuals and families experiencing homelessness in which the head of household has a disabling condition (e.g., mental health or substance use disorders, difficulties in independent working and living, HIV infection). Clients are not required to be “housing ready,” (i.e., substance free or in treatment) to participate in a program. Once housed, they are encouraged, but not required, to maintain sobriety.
Housing First programs offer clients one or more of the following services to support housing stability:
-Help with housing (e.g., assistance getting furniture and training in money management, including rent)
-Health care
-Mental health services
-Treatment for substance use disorder
-Peer support
-Occupational therapy
-Employment counseling
Housing First programs offer clients one or more of the following services to support housing stability:
-Help with housing (e.g., assistance getting furniture and training in money management, including rent)
-Health care
-Mental health services
-Treatment for substance use disorder
-Peer support
-Occupational therapy
-Employment counseling
Impact
The Community Preventive Services Task Force (CPSTF) recommends permanent supportive housing with Housing First (Housing First programs) to promote health equity for people who are experiencing homelessness and have a disabling condition.
Evidence shows Housing First programs decrease homelessness, increase housing stability, and improve quality of life for homeless persons living with disabling conditions, including those with HIV infection. For clients living with HIV infection, these programs also improve clinical indicators and mental health and reduce mortality. Housing First programs also lead to reduced hospitalization and use of emergency departments for homeless persons with disabling conditions, including HIV infection.
The CPSTF finds the economic benefits exceed the intervention cost for Housing First Programs in the United States. Because homelessness is associated with lower income and is more common among racial and ethnic minority populations, Housing First Programs are likely to advance health equity.
Evidence shows Housing First programs decrease homelessness, increase housing stability, and improve quality of life for homeless persons living with disabling conditions, including those with HIV infection. For clients living with HIV infection, these programs also improve clinical indicators and mental health and reduce mortality. Housing First programs also lead to reduced hospitalization and use of emergency departments for homeless persons with disabling conditions, including HIV infection.
The CPSTF finds the economic benefits exceed the intervention cost for Housing First Programs in the United States. Because homelessness is associated with lower income and is more common among racial and ethnic minority populations, Housing First Programs are likely to advance health equity.
Results / Accomplishments
Twenty-three studies evaluated interventions that served clients living with disabling conditions (excluding those living with HIV). Compared with clients in Treatment First programs or control group participants receiving treatment as usual, clients in Housing First programs experienced the following:
-Median 41% greater housing stability (13 studies)
-Median 88% greater decrease in homelessness (5 studies)
-Median 5% greater improvement in quality of life (4 studies)
-Median 5% greater reduction in emergency department use (3 studies)
-7% and 36% greater reduction in hospitalization (2 studies)
There were no apparent differences in physical health, mental health, or substance abuse between the intervention and control groups.
Three studies evaluated interventions that served clients living with HIV. Compared with control group participants receiving treatment as usual, clients in Housing First programs experienced the following:
-63% greater housing stability (1 study)
-38% greater reduction in homelessness (1 study)
-Median 22% greater improvement in physical health (2 studies with 4 data points)
-13% greater improvement in mental health (1 study)
-32% to 42% greater reduction in mortality (2 studies)
-41% greater reduction in emergency department use (1 study)
-36% greater reduction in hospitalization (1 study)
-Median 41% greater housing stability (13 studies)
-Median 88% greater decrease in homelessness (5 studies)
-Median 5% greater improvement in quality of life (4 studies)
-Median 5% greater reduction in emergency department use (3 studies)
-7% and 36% greater reduction in hospitalization (2 studies)
There were no apparent differences in physical health, mental health, or substance abuse between the intervention and control groups.
Three studies evaluated interventions that served clients living with HIV. Compared with control group participants receiving treatment as usual, clients in Housing First programs experienced the following:
-63% greater housing stability (1 study)
-38% greater reduction in homelessness (1 study)
-Median 22% greater improvement in physical health (2 studies with 4 data points)
-13% greater improvement in mental health (1 study)
-32% to 42% greater reduction in mortality (2 studies)
-41% greater reduction in emergency department use (1 study)
-36% greater reduction in hospitalization (1 study)
About this Promising Practice
Primary Contact
The Community Guide
1600 Clifton Rd, NE
MS V25-5
Atlanta, GA 30329
(404) 498-1827
communityguide@cdc.gov
https://www.thecommunityguide.org/
1600 Clifton Rd, NE
MS V25-5
Atlanta, GA 30329
(404) 498-1827
communityguide@cdc.gov
https://www.thecommunityguide.org/
Topics
Economy / Housing & Homes
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