What Is “Housing First”?
Open Minds; Laura Morgan, 6/2/2014
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We had a question from one of our readers about“Housing First.” What is it – and how is it funded?
Housing First is an evidence-based intervention focused on the needs of a very specific group of individuals – chronically homeless individuals with dual diagnoses of mental health and addictive disorders. About 30% of people who are chronically homeless have mental health conditions and about 50% have a co-occurring addictive disorder (see ).
Housing First initiatives move individuals directly into permanent supportive housing that offers supportive services. But consumer choice is a key element of the approach – there is no requirement for enrollment or maintenance of treatment services. The premise is, increasing housing stability is a necessary first stepbeforeaddressinganindividual’s mental illness and substance-related disorders.Using a“harm reduction” approach to alcohol and substance use, Housing First models then provideintensive case management and wraparound services.
How are Housing First programs funded? The interplay between comorbid behavioral health conditions, homelessness, andtheabsence of a sobriety or treatment preconditionmeans provider organizations leading these initiatives must weave together a complex network of funding and agency partnerships.Typically, program funding includes:
- Medicaid for medically necessary behavioral and rehabilitative services, including mental health case management for tenants eligible and enrolled inMedicaid (only 35%of individuals with serious mental illness were Medicaid enrolled at time ofentry into Housing First programs in a 2007 HUD study, see )
- State and local safety net funding for short-term and crisis needs, including medical services for those individuals not enrolled in Medicaid
- Foundations and other private sources to cover gaps in funding for operational costs and outreach efforts
- Federal funding for rental housing subsidization
According to the latest report from the (NAEH), homelessness in America is on the decline (see ). Not only did overall homelessness drop by 3.7% between 2012 and 2013, but the number of individuals who are chronically homeless declined by 7.3%. What is causing this decline? The NAEH credits a larger decline dating back to 2007, to successful efforts to move people into permanent supportive housing.
Housing First program successes have made themthe permanent supportive housing intervention of choice. Success in retaining individuals in housing was deemed “unassailable” by the Office of Assistant Secretary for Planning and Evaluation (ASPE) as far back as 2011 (see ), and yet SAMHSA reports only around 100 programs are currently in operation (see ).
For provider organizations interested in offering permanent supportive housing using Housing First, Medicaid expansion combined with new Medicaid service delivery mechanisms – health homes, enhancements to home and community-based services, and targeted 1115 managed care waiver demonstrations – will increase opportunities to partner with payers and communities in developing supportive housing service packages (see ). Housing First successes in reducing emergency room use and incarceration rates – 34% and 76%, respectively, by the Denver Housing First Collaborative (see ) – will further raise the interest of potential partners.
If your organization is considering offering “Housing First” services, getting all the stars aligned is a big first step. As a place to start, check out:
For a more detailed look at Housing First initiatives, premium members can access our latest OPEN MINDS Market Intelligence Report: