Housing First Works

Housing First Works

Highlights

• Homelessness continues to be a challenge throughout the United States, especially in areas where affordable housing is scarcest.
• Housing First — an adaptable, evidence-based service model focused on getting families into housing as quickly as possible and offering voluntary supportive services — has been proven to successfully promote housing stability, improve some health outcomes, and reduce the use of high-cost services.
• Federal, state, and local governments can align investments in Housing First approaches as well as efforts to increase the supply of affordable housing to effectively solve homelessness.

High rents, low wages, various forms of discrimination, an inadequate supply of affordable housing, evictions, and other factors contribute to the persistence of homelessness in the United States. Based on HUD Point-in-Time counts, an estimated 582,500 people in the United States were experiencing homelessness on a single night in 2022, roughly 40 percent of them in unsheltered locations unsuitable for human habitation.¹ For a significant minority, mental health and physical challenges further complicate their ability to sustain stable housing.² Yet when policymakers invest sufficient resources, make housing accessible, and offer services through an effective delivery model, they can significantly reduce rates of homelessness in their jurisdictions. Evidence shows that the Housing First model, which focuses on placing unhoused people into housing as quickly as possible without preconditions and offering voluntary supportive services, is a highly effective strategy for addressing homelessness. The Biden-Harris administration has directed the federal government to prioritize the Housing First model when investing resources toward ending homelessness. Several initiatives from HUD and other federal agencies, such as the U.S. Interagency Council on Homelessness (USICH), emphasize and promote the adoption of evidence-based Housing First models. Housing First principles have been used through HUD programs and initiatives such as the Continuum of Care (CoC) program, House America: An All-Hands-on-Deck Effort to Address the Nation’s Homelessness Crisis, and HUD-Veterans Affairs Supportive Housing (HUD-VASH) implemented with local partners across the country. "Homelessness," says USICH executive director Jeff Olivet, "is not inevitable, and it is not unsolvable... The United States of America can end homelessness by fixing public services and systems...."³

Housing First is not "housing only" but is paired with the offer of voluntary supportive services. Photo courtesy of Allison Zapata

What Is Housing First?

Housing First is a flexible and adaptable service model that addresses homelessness by quickly placing individuals and families with children experiencing homelessness into housing without any preconditions or barriers and offering voluntary supportive services to meet individuals’ needs. Jurisdictions may offer these services before placement in housing, as soon as a client interacts with a jurisdiction’s homelessness services entities, but participation in services is not a precondition of placement. HUD clarifies the low-barrier approach in a recent notice of funding availability: "This means the projects allow entry to program participants regardless of their income, current or past substance use, history of victimization (e.g., domestic violence, sexual assault, childhood abuse), and a criminal record–except restrictions imposed by federal, state, or local law or ordinance (e.g., restrictions on serving people who are listed on sex offender registries)."⁴

Crucially, the Housing First approach differs from those that require individuals or families with children to meet criteria such as sobriety or participation in services before receiving permanent housing.⁵ Called the "staircase," "linear," or "treatment first" model, these alternative approaches tie admission to or movement from one program, level of services, or housing type to the next to attainment of treatment goals.⁶ The effectiveness of the staircase model, however, proves to be especially limited in meeting the needs of, and ending homelessness for, people with multiple challenges. Tainio and Fredrikson write, "[T]he insistence on service users being intoxicant-free and able to take control of their life has proven to be an insuperable barrier for many.... They face immense difficulties finding the motivation to receive care or change their lifestyles and need considerable support with everyday life."⁷ A Housing First approach removes barriers to assisting people who are most difficult and costly for public systems to serve, and it helps those people who have difficulty with congregate settings.⁸

The Housing First model originated with the Pathways to Housing program, which was established in 1992 by Sam Tsemberis. The program served clients with addiction or mental health issues by providing rental supplements to secure housing. Although the program initially required clients to agree to two staff visits per month, it provided supportive services on a voluntary basis.⁹ Through voluntary participation in services as well as independent housing and community integration, the approach affirmed "consumer choice" for clients. Pathways to Housing sought harm reduction, not abstinence, from clients.¹⁰ Beginning in 1996, the New York Housing Study included Pathways to Housing as the experimental portion of a randomized trial, comparing it with treatment first programs. The study found higher rates of housing stability and no significant group differences in most health and treatment outcomes (treatment first programs did have higher rates of use of substance abuse treatment services). The success of Pathways to Housing provided a foundation and momentum for the Housing First model to be adopted more widely.¹¹

According to Point-in-Time counts, HUD estimates that 582,500 people were experiencing homelessness on a single night in 2022. Photo courtesy of Allison Zapata

The Housing First approach itself rests on the foundational premise that housing is a basic right and considers homelessness to be primarily a housing problem (and, for many people, the lack of housing is the only problem). As Colburn and Aldern, authors of Homelessness Is a Housing Problem, explain, "[T]he narrative about homelessness is often dominated by a focus on drugs and mental health, which may obscure other (often structural) explanations for the crisis" — namely, a scarcity of affordable housing — and "when housing is scarce, vulnerabilities and barriers to housing are magnified."¹² The primary evidence supporting the conclusion that affordable housing scarcity is driving the homelessness crisis, says Colburn, is that "the places in the United States with the highest rates of homelessness are the places where housing is very expensive and not very accessible."¹³ The individual behaviors and characteristics sometimes posited as explanations for homelessness are spread evenly across the United States, yet rates of homelessness are higher in areas with affordable housing shortages.¹⁴ "Homelessness is driven by the lack of housing that’s affordable to the lowest income families," says Margot Kushel, professor of medicine at University of California San Francisco.¹⁵

Finally, Housing First is premised on the assumption that everyone is "housing ready," meaning that people can be housed successfully and remain in housing without preconditions such as sobriety, a minimum income, or the absence of a criminal record.¹⁶ Moreover, whatever other challenges a person might face, housing instability or homelessness typically compounds those challenges, and housing stability makes addressing them more manageable.¹⁷ Ample evidence suggests that Housing First programs that maintain high fidelity to the model increased housing stability and participants’ use of supportive services compared with programs maintaining lower fidelity to the model.¹⁸

What Housing First Is Not

Housing First has enjoyed bipartisan support for many years. As Urban Institute Metropolitan Housing and Communities Policy Center vice president Mary Cunningham points out, "[I]t’s a strategy based on evidence of what works, not an ideology associated with one political party."¹⁹ Some critics, however, have mischaracterized Housing First approaches, arguing for reduced investment in them in favor of treatment first approaches. Housing First is not a program; rather, it is a service model based on flexible and adaptable principles. It also is not a one-size-fits-all approach, as some critics claim. Jurisdictions can integrate Housing First principles into numerous interventions, including permanent supportive housing, housing vouchers or affordable housing, rapid rehousing or short-term rental assistance programs, and flexible financial assistance, and they can be applied to any subgroup, including youth and veterans, among others. And, crucially, the Housing First model is centered on the client’s ability to choose whether and what services to use. As Resnikoff puts it, "The specific treatment program is voluntary and customized to meet the needs of the client — precisely the opposite of ‘one-size-fits-all.’"²⁰ Clients’ needs will vary and change over time. Housing First combines permanent housing with flexible services that can be adapted as clients’ needs change so that they receive an appropriate level of services.²¹

Housing First is a flexible, evidence-based service model that quickly provides people with housing without preconditions and offers wraparound services. Photo courtesy of Allison Zapata

In other words, Housing First is not "housing only." As Cunningham puts it, "Housing First doesn’t end with housing; it starts with it."²² The offer of trauma-informed, wraparound supportive services as they are wanted and needed is intrinsic to the model. Some people exiting homelessness into housing in a program employing a Housing First approach will not need any additional supports, and others will have complex and significant needs. Colburn notes that homelessness can be both a cause and a consequence of some of the mental and behavioral health issues that people experiencing homelessness may face.²³ This does mean that the funding and capacity for such services are critical components of a Housing First approach, and one or both may be lacking in some cases, thereby reducing fidelity to the model.

Housing First is not a single program or program type; rather, it is a delivery approach. Although Housing First is commonly associated with permanent supportive housing, not all permanent supportive housing programs adhere to a Housing First approach, and other programs, such as rapid rehousing, when implemented with fidelity, are using a Housing First approach. Whatever the program, if it is not adequately funded to provide both housing and services, it will fail to achieve fidelity to the Housing First model.²⁴ Jurisdictions can apply the Housing First approach not only to programs but also to entire communities and systems. Streamlined coordinated entry to match people experiencing homelessness to permanent housing and services, implementation of low barriers to housing and services across mainstream systems, and systemwide training of housing and services staff in evidence-based practices are among the steps that communities can take to adopt a Housing First orientation.²⁵

Some critics have alleged that Housing First is an ineffective approach because homelessness has persisted and, in some contexts, increased despite widespread adoption of the model (albeit with varying degrees of fidelity). Yet, increases in rates of homelessness caused by an insufficient supply of affordable housing are not proof that Housing First is ineffective. As HUD senior advisor Richard Cho puts it, "The increase in homelessness from 2016 to 2020 is not because the Housing First approach is ineffective; in fact, more people were exiting homelessness into permanent housing during this period than ever before. Rather, it is because housing market conditions and other factors were leading more people to become newly homeless than were being exited from homelessness into housing in the prior years."²⁶ As noted above, the scarcity of affordable and accessible housing is the primary cause of homelessness, and rates of homelessness are rising in the places where rental costs are increasing, and vacancy rates are decreasing. Cho notes that rates of homelessness have decreased in two-thirds of CoCs since 2010, when federal policy shifted to Housing First, and even as national rates began to rise in 2016, half of CoCs continued to see decreases in their rates of homelessness.²⁷ The more apt comparisons for evaluating the effectiveness or success of Housing First, says Kushel, are alternative strategies for addressing homelessness, such as treatment first approaches. "When these approaches are compared head-to-head, on which is more likely to house more people, Housing First wins hands-down," says Kushel.²⁸

The Evidence

A number of studies, including some randomized controlled trials, indicate the effectiveness of Housing First approaches for outcomes such as housing stability, health, and reduced use of high-cost services such as emergency departments and jails.²⁹ (See "Housing First: A Review of the Evidence," for a more detailed discussion of the evidence base for Housing First.)

The Biden-Harris administration has centered Housing First approaches in addressing homelessness and aims to reduce homelessness by 25 percent by 2025. Photo courtesy of John Fitzhugh, Open Doors Homeless Coalition

Meta-analysis of randomized controlled trials by Baxter et al. found that Housing First approaches showed significant improvements in housing stability compared with treatment as usual.³⁰ The At Home/Chez Soi study, for example, found that over 2 years, participants in a program with a Housing First approach spent 73 percent of their time in stable housing compared with 32 percent for those receiving treatment as usual.³¹ Similarly, a comparison of Housing First and a program requiring sobriety for chronically homeless individuals with psychiatric disabilities and substance abuse issues found that individuals randomly assigned to a program with a Housing First approach spent less time experiencing homelessness and in psychiatric hospitals compared with those in the program that required sobriety.³²

Compared with treatment as usual, Housing First approaches reduce the use of certain high-cost municipal services. A quasi-experimental study based in Seattle examining people with severe problems with alcohol found that "[i]n this population of chronically homeless individuals with high service use and costs, a Housing First program was associated with a relative decrease in costs after 6 months," and more cost savings were achieved the longer individuals stayed in housing. The participants had reduced number and duration of hospital visits.³³ Likewise, evaluation of the Housing First Charlotte-Mecklenburg program found that Housing First reduced high-cost service uses, including fewer nights spent in shelter, fewer arrests and incarceration events, and fewer health and emergency department visits, but increased the use of less costly supportive services and assistance.³⁴

In their meta-analysis, Baxter et al. found insufficient evidence of the effect of the Housing First approach on mental health and other health outcomes.³⁵ Cho notes that most studies only have a 2-year follow-up, which may not be long enough to observe improvements in many chronic health conditions.³⁶ One area of health improvement, however, was found among individuals with HIV. Meta-analysis by Peng et al. found that, compared with treatment first programs, programs adopting the Housing First approach "decreased homelessness by 88% and improved housing stability by 41%. For clients living with HIV infection, Housing First programs reduced homelessness by 37%, viral load by 22%, depression by 13%, emergency departments use by 41%, hospitalization by 36%, and mortality by 37%."³⁷ More generally, the At Home/Chez Soi randomized controlled trial found improved community functioning and quality of life for Housing First participants.³⁸ Another study found that Housing First was associated with reduced use of stimulants and opiates.³⁹

HUD and Other Federal Efforts

Recognizing the soundness and success of the evidence-based approach, the Biden-Harris administration has adopted various programs and initiatives to recenter the Housing First model and has set an ambitious goal to reduce homelessness by 25 percent by 2025.⁴⁰ The administration calls on state and local governments to follow federal guidance on best practices and ensure that agencies direct federal investments to proven Housing First strategies.⁴¹

One of the more successful demonstrations of the efficacy of the Housing First approach has been the HUD-VASH program, through which the federal government has made significant progress in curtailing experiences of homelessness among veterans. HUD-VASH pairs HUD housing choice vouchers with support services provided by the U.S. Department of Veterans Affairs (VA). VA began implementing a Housing First approach to the HUD-VASH program in federal fiscal year (FY) 2013, although regulations do require clients to communicate with VA case managers at least once a month. Individuals can access wraparound services, often at VA medical centers and sometimes through other community-based service providers.⁴² HUD-VASH’s strides toward ending veteran homelessness suggests a path for ending homelessness among all populations; as the secretaries for VA and HUD and the USICH executive director write, "[W]hen leadership is committed, resources are invested, and government and community partners take collective action, the fight against homelessness is one we can win."⁴³ Since 2010, the number of veterans experiencing homelessness has fallen by 55.3 percent, including an 11 percent reduction since 2020. During 2022 alone, VA housed 40,401 veterans experiencing homelessness in safe, stable homes.⁴⁴

The Houston/Harris County CoC, for example, effectively ended veteran homelessness in 2015 (with ongoing efforts to maintain the reduction) through coordinated investment, including HUD-VASH resources. Supported by extensive regional collaboration among more than 70 partner agencies and organizations, the Houston/Harris County CoC formed The Way Home to coordinate regional efforts to prevent and end homelessness. The development of affordable housing in the region augments the supply of units available for HUD-VASH voucher recipients. For example, Travis Street Plaza provides 192 units in Houston’s Midtown neighborhood, and nearby Midtown Terrace provides 286 units for veterans with access to case management and supportive services.⁴⁵ Likewise, Bergen County, a county of more than 900,000 in northeast New Jersey, met the federal criteria for ending veteran homelessness through a concerted and collaborative effort to identify and track needs, target resources, and invest in a Housing First approach. Before it met the criteria for ending veteran homelessness, the county met the criteria for ending chronic homelessness, and it is now working toward ending youth homelessness while maintaining current levels in other categories.⁴⁶

HUD’s CoC program, which funds efforts by state and local governments and nonprofits to rehouse individuals and families with children experiencing homelessness, prioritizes Housing First approaches in its selection criteria. HUD awards most of its CoC program funding competitively, and applicants receive points for incorporating a Housing First approach. In FY 2021, HUD awarded approximately $2.66 billion, including $77 million in noncompetitive Youth Homelessness Demonstration Program awards and $102 million for domestic violence projects, all of which must adopt a Housing First approach. CoC awards can fund various programs, including permanent supportive housing and rapid rehousing. HUD requires CoC-funded joint transitional housing and rapid rehousing projects to have a Housing First approach. HUD encourages CoCs to assess implementation in their jurisdiction, which will allow them to monitor projects and encourage fidelity to the Housing First model.⁴⁷ The CoC program is a longstanding funding stream for addressing homelessness and aligning it with the Housing First approach represents a long-term commitment to the model.

Jurisdictions need to direct even nonrecurring investments to proven strategies to maximize their impact. In response to the COVID-19 pandemic, the federal government directed significant resources toward housing, including issuing 70,000 emergency housing vouchers and $5 billion in HOME grants as well as $350 billion in Coronavirus State and Local Fiscal Recovery Funds, to address housing instability and homelessness, among other challenges.⁴⁸ As of April 2, 2023, the federal government had issued emergency housing vouchers to 52,861 households.⁴⁹ House America: An All-Hands-on-Deck Effort to Address the Nation’s Homelessness Crisis is a HUD and USICH initiative focused on channeling these and other federal resources to support Housing First programs. Seventy-nine municipalities, 16 counties, a regional leadership council of governments, 4 states, a U.S. territory, and a Tribal nation representing more than half of people experiencing homelessness in the United States have signed on to the initiative.⁵⁰ Under this initiative, communities have issued 22,500 emergency housing vouchers and directed $450 million in Emergency Solutions Grants for rapid rehousing, rehousing 62,000 households, and communities have added 15,500 units of affordable and supportive housing through September 2022. For communities participating in House America, HUD provided $1.25 billion through CoC awards in 2021 for services and housing for people experiencing homelessness; $1.3 billion for housing, shelter, and outreach; and, through a Special Notice of Funding Opportunity, $322 million ($54.4 million of which is set aside for rural communities) for permanent housing, supportive services, and other costs and $43 million for incremental housing vouchers. Finally, HUD and the U.S. Department of Health and Human Services jointly created the Housing and Services Resource Center to foster collaboration among community organizations providing housing and health services.⁵¹

Housing First rests on the premise that virtually everyone is "housing ready" — able to be and remain successfully housed without preconditions. Photo courtesy of Allison Zapata

The administration articulates a comprehensive, whole-of-government framework to address homelessness in the USICH report All In: The Federal Strategic Plan to Prevent and End Homelessness, which highlights the importance of Housing First principles. The report asserts, "To truly bring Housing First to scale for all populations, communities need access to housing and wraparound services and other supports that can be offered to implement this approach with fidelity to the model." The report outlines several strategies needed to ensure fidelity to the Housing First model. Localities will need to maximize the use of existing federal housing assistance; create more safe, affordable, and accessible housing; and increase the supply of permanent supportive housing for individuals and families with children who have complex service needs. The USICH report suggests that when directing federal funds, localities should give preference to owners who agree to use a Housing First approach.⁵²

The report also calls for improving the effectiveness of rapid rehousing for individuals and families with children, strengthening capacity to address chronic health conditions, including mental health and substance use disorders, and maximizing resources that provide voluntary and trauma-informed supportive services and income supports. The report recommends increasing the use of evidence-based service delivery practices across programs; supporting fair housing enforcement and antidiscrimination efforts; and removing and reducing programmatic, regulatory, and other barriers such as eligibility and documentation requirements that systematically delay or deny access to housing for households with the highest needs.⁵³

Homelessness Is Solvable

Cunningham notes that although homelessness is a complex social problem, "it’s also a simple math equation. To reduce homelessness, policymakers need to help people exit homelessness faster than people entering homelessness. Prevention — helping people stay in their housing — is just as important as helping people exit homelessness."⁵⁴ Ending homelessness requires both scaling up the Housing First approach to meet the needs of those currently experiencing homelessness as well as various strategies to prevent new entries into homelessness. In many places, especially those with a high incidence of homelessness, increasing the supply of affordable housing is essential to accomplish both goals. To implement Housing First approaches with fidelity, communities need available housing units for permanent supportive housing and rapid rehousing options along with needed supportive services. A sufficient supply of accessible, affordable housing is also critical for ensuring that people can avoid housing insecurity and homelessness. Expanding the supply of affordable housing is particularly challenging and requires its own set of strategies. The Biden-Harris administration’s Housing Supply Action Plan outlines steps to reduce barriers and increase investment to close housing supply gaps. In addition to dramatically expanding the supply of affordable housing, fair housing enforcement, eviction prevention initiatives, and higher wages can help stem new entries into homelessness. When evidence-based practices align with political will and the investment of resources, homelessness becomes a solvable problem. As Kushel argues, "We have to focus on preserving, protecting, and producing housing that’s affordable for our lowest income households, and it’s the federal government that can solve this problem through both investment in expanding the supply of vouchers and in supporting the development of housing."⁵⁵

1. U.S. Department of Housing and Urban Development. 2022. "The 2022 Annual Homelessness Assessment Report (AHAR) to Congress: Part 1: Point-In-Time Estimates of Homelessness," 2.
2. Jeff Olivet. 2023. "United States Interagency Council on Homelessness, All In: The Federal Strategic Plan to Prevent and End Homelessness," testimony before the Senate Housing, Transportation, and Community Development Subcommittee of the Banking, Housing, and Urban Affairs Committee, 8 March.
3. United States Interagency Council on Homelessness. 2022. "All In: The Federal Strategic Plan to Prevent and End Homelessness," 6.
4. U.S. Department of Housing and Urban Development. 2022. "Notice of Funding Opportunity (NOFO) for Fiscal Year (FY) 2022 Continuum of Care Competition and Noncompetitive Award of Youth Homeless Demonstration Program Renewal and Replacement Grants," 68.
5. This definition of Housing First is drawn from U.S. Department of Housing and Urban Development, n.d. "Housing First in Permanent Supportive Housing," and "Deploy Housing First Systemwide," U.S. Interagency Council on Homelessness website (www.usich.gov/solutions/housing/housing-first/). Accessed 3 April 2023.
6. Marybeth Shinn and Jill Khadduri. 2020. "How Finland Ended Homelessness," Cityscape: A Journal of Policy Development and Research 22:2, 75.
7. Hannele Tainio and Peter Fredrikson. 2009. "The Finnish Homelessness Strategy: From a 'Staircase' Model to a 'Housing First' Approach to Tackling Long-Term Homelessness," European Journal of Homelessness 3, 185.
8. National Low Income Housing Coalition. 2022. "Housing First: Q&A."
9. Stephen Gaetz, Fiona Scott, and Tanya Gulliver. 2013. "Housing First in Canada: Supporting Communities to End Homelessness," 3–4.
10. Deborah K. Padgett, Leyla Gulcur, and Sam Tsemberis. 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, 76.
11. Ibid.
12. Gregg Colburn and Clayton Page Aldern. 2022. Homelessness Is a Housing Problem: How Structural Factors Explain U.S. Patterns, Oakland: University of California Press.
13. Interview with Gregg Colburn, 28 February 2023.
14. Ibid.
15. Interview with Margot Kushel, 14 March 2023.
16. U.S. Department of Housing and Urban Development. n.d. "Housing First in Permanent Supportive Housing".
17. Ibid.
18. Todd P. Gilmer, Ana Stefancic, Benjamin F. Henwood, and Susan L. Ettner. 2015. "Fidelity to the Housing First Model and Variation in Health Service Use Within Permanent Supportive Housing," Psychiatric Services 1:66, 12.
19. Interview with Mary Cunningham, 14 March 2023.
20. Ned Resnikoff. 2021. "Housing First Is Not Housing Only," Benioff Homelessness and Housing Initiative.
21. Richard Cho. 2023. "Testimony of Richard Cho, Ph.D., Senior Advisor for Housing and Services, U.S. Department of Housing and Urban Development before the Senate Banking, Housing, and Urban Affairs Committee," testimony before the Senate Housing, Transportation, and Community Development Subcommittee of the Banking, Housing, and Urban Affairs Committee, 8 March.
22. Interview with Mary Cunningham.
23. Interview with Gregg Colburn.
24. Tim Aubry, Geoffrey Nelson, and Sam Tsemberis. 2015. "Housing First for people with severe mental illness who are homeless: a review of the research and findings from the At Home—Chez Soi demonstration project," Canadian Journal of Psychiatry 60:11.
25. United States Interagency Council on Homelessness. 2016. "Housing First Checklist: Assessing Projects and Systems for a Housing First Orientation."
26. Richard Cho. 2023. Testimony.
27. Richard Cho, electronic communication, 22 March 2023.
28. Interview with Margot Kushel.
29. National Low Income Housing Coalition. 2023. "The Case for Housing First."
30. Andrew J. Baxter, Emily J. Tweed, Srinivasa Vittal Katikireddi, and Hilary Thomson. 2019. "Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials," Journal of Epidemiology and Community Health 73:5.
31. Aubry et al. 2015.
32. Leyla Gulcur, Ana Stefancic, Marybeth Shinn, Sam Tsemberis, and Sean N. Fischer. 2003. "Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes," Journal of Community & Applied Social Psychology 13:2.
33. Mary E. Larimer, Daniel K. Malone, Michelle D. Garner, 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," Journal of the American Medical Association 301:13.
34. M. Lori Thomas et al. 2020. "Housing First Charlotte-Mecklenburg Research & Evaluation Project Final Report."
35. Baxter et al.
36. Richard Cho, electronic communication, 22 March 2023.
37. Yinan Peng, Robert A. Hahn, Ramona K.C. Finnie, Jamaicia Cobb, Samantha P. Williams, Jonathan E. Fielding, Robert L. Johnson, Ann Elizabeth Montgomery, Alex Schwartz, Carles Muntaner, Veronica Helms Garrison, Beda Jean-Francois, Benedict I. Truman, Mindy T. Fullilove, and Community Preventive Services Task Force. 2020. "Permanent Supportive Housing with Housing First to Reduce Homelessness and Promote Health among Homeless Populations with Disability: A Community Guide Systemic Review," Journal of Public Health Management Practice 26:5.
38. Tim Aubry, Paula Goering, Scott Veldhuizen, Carol E. Adair, Jimmy Bourque, Jino Distasio, Eric Latimer, Vicky Stergiopoulos, Julien Somers, David L. Streiner, and Sam Tsemberis. 2016. "A Multiple-City RCT of Housing First with Assertive Community Treatment for Homeless Canadians with Serious Mental Illness," Psychiatric Services 67:3.
39. Clare Davidson, Charles Neighbors, Gerod Hall, Aaron Hogue, Richard Cho, Bryan Kutner, and Jon Morgenstern. 2014. "Association of housing first implementation and key outcomes among homeless persons with problematic substance abuse," Psychiatric Services 65:11.
40. The White House. 2022. "Fact Sheet: Biden-Harris Administration Announces Plan to Prevent and End Homelessness."
41. Ibid.
42. Ann Elizabeth Montgomery and Meagan Cusack. 2017. "HUD-VASH Exit Study: Final Report," Prepared for the U.S. Department of Housing and Urban Development, 2–3.
43. Denis McDonough, Marcia L. Fudge, and Jeff Olivet. 2022. "Drop in veteran homelessness proves we can end homelessness," Military Times, 10 November.
44. U.S. Department of Veterans Affairs. 2023. "VA housed more than 40,000 homeless Veterans in 2022," 26 January press release.
45. U.S. Department of Housing and Urban Development. 2015. "Houston Ends Veteran Homelessness," PD&R Edge.
46. Kristin Kellogg. 2020. "Bergen County, New Jersey: Functional Zero Case Study," Community Solutions.
47. U.S. Department of Housing and Urban Development. "Community Planning and Development Notice of Funding Opportunity (NOFO) for Fiscal Year (FY) 2021 Continuum of Care Competition and Noncompetitive Award of Youth Homeless Demonstration Program Renewal and Replacement Grants."
48. Emergency Housing Vouchers are housing choice vouchers issued by public housing agencies to "assist individuals and families who are homeless, at-risk of homelessness, fleeing, or attempting to flee, domestic violence, dating violence, sexual assault, stalking, or human trafficking, or were recently homeless or have a high risk of housing instability." U.S. Department of Housing and Urban Development. "Emergency Housing Vouchers" (www.hud.gov/ehv). Accessed 6 June 2023; U.S. Department of Housing and Urban Development. "House America: Frequently Asked Questions" (www.hud.gov/house_america/faq). Accessed 31 March 2023.
49. U.S. Department of Housing and Urban Development. "Emergency Housing Voucher (EHV) Data Dashboard" (www.hud.gov/program_offices/public_indian_housing/ehv/dashboard). Accessed 3 April 2023.
50. U.S. Department of Housing and Urban Development. 2022. "Fact Sheet: One-Year Anniversary of HUD's 'House America' Initiative to Address Homelessness," 20 September press release.
51. Ibid.
52. United States Interagency Council on Homelessness 2022.
53. Ibid.
54. Interview with Mary Cunningham.
55. Interview with Margot Kushel.