TABLE 2.
Summary Findings and Limitations Regarding Housing First, Voucher Programs, and Linear Approaches, with Key Studies Noted
| Housing First Studies (and Related Variants) | |
|---|---|
| Housing First | Achieves excellent housing retention in population studied. |
| Permanent supportive housing studies often show that combined housing and service costs are comparable or higher for individuals entering housing, versus persons not housed, with some exceptions based on the particular subpopulation and setting. | |
| Addiction severity not always formally measured but often lower than for homeless persons seeking addiction treatment. | |
| Voucher Programs | |
| Voucher program studies | Rental vouchers result in greater time housed relative to case management. |
| Substance abuse predicts reduced housing tenure. | |
| Overall costs appear to be higher for persons served with rental vouchers. | |
| Linear Approach Studies | |
| Therapeutic communities (TC) | Addiction severity is reduced among retained participants. |
| Retention in traditional programs is low. | |
| Programs modified for homeless persons can improve retention, reduce addiction severity, and slightly improve housing outcomes. | |
| Social interventions | Addiction severity is not consistently improved. |
| Housing outcomes typically improved in before-and-after comparisons, but not in trial arm comparisons. | |
| Abstinence-contingent housing with community reinforcement approach (Birmingham model) | Combined models robustly reduce drug use during and after treatment period of six months. |
| Housing status improves in before-and-after comparisons and in some trial-group comparisons. | |
| Overall percentage housed at one year is modest in the Birmingham studies. | |
| Discontinuities between the treatment program and housing system adversely affect outcomes. | |
Note: Examples of key research studies for each category are noted. A fuller description and bibliography are available in the text of this article.
Sources: Housing first: Kessell et al. 2006; Mares, Greenberg, and Rosenheck 2007; Padgett, Gulcur, and Tsemberis 2006; Tsemberis, Gulcur, and Nakae 2004.
Voucher studies: Hurlburt, Hough, and Wood 1996; Rosenheck et al. 2003.
Therapeutic communities: DeLeon et al. 2000; Mierlak et al. 1998.
Social interventions: Sosin, Bruni, and Reidy 1995; Stahler 1995.
Abstinence-contingent housing: Kertesz et al. 2007; Milby et al. 1996; Schumacher et al. 2007.