Understanding the Critical Ingredients for Facilitating Consumer Change in Housing First Programming: A Case Study Approach

  • Dennis P. Watson
  • Dana E. Wagner
  • Michael Rivers


Housing First is a form of permanent supportive housing for chronically homeless consumers with mental health and substance abuse issues. In light of the model’s growing popularity and wide diffusion, researchers and policy makers have identified a need to better understand its critical ingredients and the processes through which they affect consumer outcomes. Researchers used a bottom-up approach to understand the critical ingredients of Housing First within community-based programs. Interviews and focus groups were conducted with 60 informants (staff and consumers) across 4 “successful” Housing First programs. Qualitative analysis demonstrated six program ingredients to be essential: (1) a low-threshold admissions policy, (2) harm reduction, (3) eviction prevention, (4) reduced service requirements, (5) separation of housing and services, and (6) consumer education.


  1. 1.
    Tsemberis S, Asmussen S. From streets to homes—the Pathways to Housing Consumer Preference Supported Housing Model. Alcoholism Treatment Quarterly. 1999; 17(1): 113–131.CrossRefGoogle Scholar
  2. 2.
    Mares AS, Rosenheck RA. Evaluation of the Collaborative Initiative to Help End Chronic Homelessness. 2007. Available online at: http://www.hudhre.info/documents/CICH_SystemIntegrationAndClientOutcomes.pdf. Accessed December 22, 2008.
  3. 3.
    Perlman J, Parvensky J. Denver Housing First Collaborative: Cost Benefit Analysis and Program Outcomes Report. Denver, CO: Colorado Coalition for the Homeless; 2006. Available online at: http://www.shnny.org/documents/FinalDHFCCostStudy.pdf. Accessed June 7, 2010
  4. 4.
    Sadowski LS, Kee RA, VanderWeele TJ, et al. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. Journal of the American Medical Association. 2009; 301(17): 1771–1778.PubMedCrossRefGoogle Scholar
  5. 5.
    Greenwood RM, Schaefer-McDaniel NJ, Winkel G, et al. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology. 2005; 36(3–4): 223–238.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health. 2004; 94(4): 651–656.PubMedCrossRefGoogle Scholar
  7. 7.
    Padgett DK, Stanhope V, Henwood BF, et al. Substance use outcomes among homeless clients with serious mental illness: Comparing Housing First with Treatment First programs. Community Mental Health Journal. 2010; 47: 227–232.PubMedCrossRefGoogle Scholar
  8. 8.
    DeSilva MB, Manworren J, Targonski P. Impact of a Housing First program on health utilization outcomes among chronically homeless persons. Journal of Primary Care & Community Health. 2011; 2(1): 16–20.CrossRefGoogle Scholar
  9. 9.
    National Alliance to End Homelessness. A Plan, Not a Dream: How to End Homelessness in Ten Years. Washington DC: National Alliance to End Homelessness; 2000.Google Scholar
  10. 10.
    United States Interagency Council on Homelessness. Opening Doors: Federal Strategic Plan to Prevent and End Homelessness: 2010 Fact Sheet. 2010. Available online at: http://www.ich.gov/PDF/OpeningDoors_2010_FSPPreventEndHomeless.pdf. Accessed September 15, 2010.
  11. 11.
    United States Department of Housing and Urban Development. The 2010 Annual Homeless Assessment Report to Congress. Washington, D.C.: Office of Community Planning and Development, HUD; 2011.Google Scholar
  12. 12.
    George C, Chernega JN, Stawiski S, et al. Connecting fractured lives to a fragmented system: Chicago Housing for Health Partnership. Equal Opportunities International. 2008; 27(2): 161–180.CrossRefGoogle Scholar
  13. 13.
    Henwood BF, Stanhope V, Padgett DK. The Role of housing: A comparison of front-line provider views in Housing First and traditional programs. Administration and Policy in Mental Health and Mental Health Services Research. 2010; 38(2): 77–85.CrossRefGoogle Scholar
  14. 14.
    Pearson CL, Locke G, McDonald WR. The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness. Washington, D.C.: U.S. Department of Housing and Urban Development Office of Policy Development and Research; 2007. Available online at: http://www.huduser.org/publications/homeless/hsgfirst.html. Accessed June 30, 2009.
  15. 15.
    Padgett DK, Gulcur L, Tsemberis S. Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice. 2006; 16(1): 74–83.CrossRefGoogle Scholar
  16. 16.
    Durlak JA. Why program implementation is important. Journal of Prevention & Intervention in the Community. 1998; 17(2): 5–18.CrossRefGoogle Scholar
  17. 17.
    McGraw SA, Larson MJ, Foster SE, et al. Adopting best practices: Lessons learned in the Collaborative Initiative to Help End Chronic Homelessness (CICH). The Journal of Behavioral Health Services & Research. 2009; 37: 197–212.CrossRefGoogle Scholar
  18. 18.
    Smith E, Caldwell L. Adapting evidence-based programs to new contexts: What needs to be changed? Journal of Rural Health. 2007; 23 Suppl: 37–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Corbin JM, Strauss AL. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage Publications; 2008.Google Scholar
  20. 20.
    Eisenhardt KM, Graebner ME. Theory building from cases: Opportunities and challenges. Academy of Management Journal. 2007; 50(1): 25–32.CrossRefGoogle Scholar
  21. 21.
    Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Services Research. 1999; 34(5): 1189–1208.PubMedGoogle Scholar
  22. 22.
    Eisenhardt KM. Building theories from case study research. The Academy of Management Review. 1989; 14(4): 532–550.Google Scholar
  23. 23.
    Glaser BG, Strauss A. The Discovery of Grounded Theory: Strategies for Qualitative Research. New York: Aldine Transaction; 1967.Google Scholar
  24. 24.
    Foster S, LeFauve C, Kresky-Wolff M, et al. Services and supports for individuals with co-occurring disorders and long-term homelessness. The Journal of Behavioral Health Services and Research. 2010; 37(2): 239–251.CrossRefGoogle Scholar
  25. 25.
    McNaughton CC. Transitions Through Homelessness: Lives on the Edge. Palgrave Macmillan; 2008.Google Scholar
  26. 26.
    Padgett DK. There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States. Social Science & Medicine. 2007; 64(9): 1925–1936.CrossRefGoogle Scholar
  27. 27.
    Turner RJ, Brown RJ. Social support and mental health. In: Scheid TL, ed. A handbook for the study of mental health: Social contexts, theories, and systems. 2nd ed. New York: Cambridge University Press; 2009.Google Scholar
  28. 28.
    Marlatt GA, Witkiewitz K. Update on harm-reduction policy and intervention research. Annual Review of Clinical Psychology. 2010; 6(1): 591–606.PubMedCrossRefGoogle Scholar
  29. 29.
    Backer TE, Howard EA, Moran GE. The role of effective discharge planning in preventing homelessness. The Journal of Primary Prevention. 2007;28(3–4):229–243.PubMedCrossRefGoogle Scholar
  30. 30.
    Larimer ME, Malone DK, Garner MD, et al. 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. 2009; 301(13): 1349–1357.PubMedCrossRefGoogle Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2012

Authors and Affiliations

  • Dennis P. Watson
    • 1
  • Dana E. Wagner
    • 2
  • Michael Rivers
    • 2
  1. 1.Indiana University Richard M. Fairbanks School of Public HealthIUPUIIndianapolisUSA
  2. 2.Center for Urban Research and LearningLoyola University ChicagoChicagoUSA

Personalised recommendations