Housing First: Lessons from the United States and Challenges for Australia

• Author: Guy Johnson,Stefan G. Kertesz
• Published date: 01 June 2017
• Date: 01 June 2017
• DOI: http://doi.org/10.1111/1467-8462.12217

Policy Forum: Australian Homelessness—Research and Policy

Insights

Housing First: Lessons from the United States and Challenges

for Australia

Stefan G. Kertesz and Guy Johnson*

Abstract

Efforts to end long-term homelessness have

embraced a Housing First approach. Housing

First emphasises rapid placement of clients

into independent, permanent accommodation

and eschews traditionally favoured require-

ments that clients demonstrate sobriety or

success in treatment programs prior to being

offered housing. Although housing retention

rates are superior to those obtained from

traditional programs, some claims made on

behalf of the Housing First approach remain

controversial. The present article reviews

results from Housing First research to date,

as well as challenges and concerns that remain

in regard to clinical outcomes, f‌idelity of

implementation and application in the

Australian context.

1. Introduction

The prevalence of visible homelessness has

spurred increased policy attention on develop-

ing Housing First initiatives for chroni-

cally homeless individuals. The expression

‘Housing First’is applied when programs

combine permanent community-based housing

with support services that assist chronically

homeless individuals to sustain their housing

and work toward a community-based recovery

and reintegration. Housing First eschews

traditional ‘linear model’preconditions of

sobriety or treatment before individuals are

offered independent accommodation (O’Con-

nell, Kasprow and Rosenheck 2009; Johnsen

and Teixeira 2010). An implicit assumption in

the linear approach is that chronically homeless

people cannot sustain accommodation without

‘restoration of behavioural self-regulation’

(Kertesz et al. 2009, p. 500), yet Housing First

initiatives have attained superior housing out-

comes, compared to linear approaches. Indeed,

the success of Housing First in the United

States has resulted in worldwide interest.

Despite credible housing outcomes, a num-

ber of issues remain unsettled. For example,

uncertainty surrounds the question of whether

Housing First programs can reliably confer

signif‌icant medical and behavioural benef‌its.

Additionally, contradictory evidence besets the

attractive claim that it costs less to house

chronically homeless individuals than to leave

them homeless. Successful implementation of

Housing First remains a complex undertaking

that involves collaboration across domains

such as health, housing and public f‌inance.

* Kertesz: Birmingham Veterans Administration Medical

Center, U.S. Department of Veterans Affairs, Alabama

35233 United States, and School of Medicine, University

of Alabama at Birmingham, Alabama 35205 United States;

Johnson: Centre for Applied Social Research, RMIT

University, Victoria 3000 Australia. Corresponding

author: Kertesz, email <skertesz@uabmc.edu>.

The Australian Economic Review, vol. 50, no. 2, pp. 220–8

°

C2017 The University of Melbourne, Melbourne Institute of Applied Economic and Social Research

Published by John Wiley & Sons Australia, Ltd