Housing First, Emerging Federal Policy Changes, and the Need for Rigorous Evaluation

Research has consistently shown that Housing First (vs. Treatment First) participants are more likely to experience stable housing, decreased emergency department visits, and reduced hospitalization rates, whereas data on mental health and substance use outcomes are inconclusive. Economic analyses suggest that a Housing First approach is more cost-effective than a Treatment First approach. The author synthesizes findings from systematic reviews that focus on evidence related to Housing First as an approach to addressing chronic homelessness. He also questions the benefit of the policy shift toward Treatment First and offers a hypothetical example as an illustration of the potential effects. The shift away from Housing First runs counter to the existing evidence base and poses the risk of significant harm to vulnerable populations. The author issues a call to action for rigorous research to study the impacts the federal policy shifts may have.