Local Strategies for Housing First

Local Strategies for Housing First

Creating enough permanent supportive housing is important for the success of a Housing First approach. This can be especially important in high-cost cities, such as Boston and Seattle (pictured), where a lack of affordable housing options has increased the prevalence of homelessness. Photo credit: SeaRick1 / Shutterstock.com

In March 2023, the National Low Income Housing Coalition (NLIHC) held its annual Housing Policy Forum, "Onward to Housing Justice." During a panel discussion titled "Homelessness is a Housing Problem: Best Practices in Housing First," speakers discussed the underlying causes of homelessness and how communities can use the Housing First approach to quickly provide housing to people experiencing homelessness without preconditions for sobriety, treatment, or participation in supportive services. Panelists included Clayton Page Aldern, coauthor of Homelessness Is a Housing Problem: How Structural Factors Explain U.S. Patterns; Ana Rausch, vice president of program operations at the Coalition for the Homeless of Houston/Harris County; and Claudine Sipili, director of lived experience and innovation at Destination: Home. Alayna Calabro, senior policy analyst at NLIHC, moderated the discussion.

Understanding the root causes of homelessness is critical to ending it. In their book, Aldern and coauthor Gregg Colburn investigate the reason for the regional variations in rates of homelessness in the United States. Although precipitating events such as a divorce or job loss may result in homelessness, the authors posit that these events are not the root causes. Instead, they found that housing markets explain the regional variation of homelessness. Aldern indicated that poverty and homelessness have an inverse relationship; cities with higher poverty rates have lower homelessness rates, and cities with lower vacancy rates (or tight housing markets) have higher homelessness rates. For example, coastal boom towns such as Boston, Seattle, and San Francisco have higher levels of homelessness than their Rust Belt counterparts such as Detroit and Cleveland. Variations in housing market conditions such as high housing costs and low supply, they argue, explain why homelessness rates differ by location.

Several U.S. cities are implementing Housing First strategies, which focus in part on increasing the supply of permanent housing units for people experiencing homelessness. Rausch shared how the city of Houston, Texas, successfully reduced rates of homelessness by implementing a Housing First approach. The Coalition for the Homeless is a nonprofit organization that is the lead agency for The Way Home, the Continuum of Care for a three-county region that includes Houston. The Way Home launched in 2011 at a time when Houston had the nation's sixth-largest population of people experiencing homelessness. In 2012, the Coalition for the Homeless led community planning sessions composed of local partners to address homelessness through collective impact, consolidating the team under a shared agenda for ending homelessness as measured by the number of housing placements. In 2013, the coalition began integrating Housing First strategies into its operations, including a standardized triage system for coordinated entry to determine clients' individual needs; housing placement through rapid rehousing (RRH) and permanent supportive housing (PSH); housing navigators who refer people to housing and services to help them remain stably housed; and robust landlord engagement, including financial incentives for leasing units to people experiencing homelessness. By 2017, the coalition had created 3,000 PSH units to meet the needs of people experiencing chronic homelessness. In October 2020, as part of its Community COVID Housing Program to limit the spread of COVID-19, the coalition adopted an ethos of "housing as health care" and worked to use "rapid rehousing as a bridge to permanent supportive housing to house people immediately, so they're not waiting on the streets for a slot to open up," Rausch stated. Since 2011, Houston has housed more than 28,000 people experiencing homelessness, representing a 63 percent reduction in homelessness rates. In addition, Houston's Housing First approach has led to approximately 90 percent of clients remaining stably housed 2 years after their placement. 

During a panel discussion at the National Low Income Housing Coalition's annual Housing Policy Forum held in March 2023, speakers shared success stories of implementing Housing First in local communities and the importance of giving a voice to those with lived experience of homelessness.

Sipili explained how her nonprofit organization, Destination: Home, developed a collective impact agenda and is working to end homelessness in California's Santa Clara County. Like Houston's Coalition for the Homeless, Destination: Home follows a collective impact model, which aims to improve coordination among Santa Clara County officials, housing providers, and nonprofit organizations through a joint plan to end homelessness in the Silicon Valley region. Destination: Home and its partners developed the Santa Clara County 2020–2025 Community Plan to End Homelessness, which draws on a Housing First approach to house more than 20,000 people experiencing homelessness through PSH, RRH, low-barrier shelters, financial assistance, expanded street outreach, and supportive services. The county is nearly halfway to its goal according to its 2022 year-end report, which indicates that 9,645 people have received housing placements in PSH and RRH units. Housing First is "not housing only," and, as Sipili explained, the work of Destination: Home and its partners helps people remain stably housed by connecting them to service providers who offer life skills workshops, transportation assistance, and other wraparound supportive services. 

Panelists also emphasized the need for service providers to humanize their approach to service delivery. The Community Plan to End Homelessness received considerable input from people who previously experienced homelessness, and, as someone with lived experience, Sipili emphasized how including such perspectives in decisionmaking can foster informed policy decisions and match supportive services to specific needs. Aldern explained that people lose their housing for numerous reasons, and one-size-fits-all solutions are not appropriate. "Instead, you meet people where they are and ask them what they need," he stated. Giving voice to lived experience can lead to programs that are better tailored to the challenges people face. As Sipili indicated, however, policymakers and stakeholders must go beyond inviting people with lived experience to the table and remove the barriers that hinder their participation by providing transportation, paying them for their time, and offering child care. 

As the panelists explained, a Housing First approach that incorporates streamlined triage systems, information sharing, and shared goals across partners can be successful. Collaboration among service providers, housing navigators, and street outreach teams can lead to faster housing placements linked with resources that are tailored to individual needs. Such strategies will help reduce gaps and ensure continuity of care for people in need.