The Debate is Over! Housing First Works!

York University
October 07, 2013

Earlier this year the Government of Canada renewed the Homelessness Partnering Strategy for five years, much to the relief of communities and citizens across the country concerned with the State of Homelessness in Canada. The renewal came with a shift in program emphasis - communities are now being asked to adopt a Housing First framework.

While this shift is certainly welcome, but when your funder asks you to do something new, there is going to be some apprehension. People may have heard of Housing First, but may not be clear about what exactly it means beyond making sure people get housing, first. Questions abound - Does it work? How does it work? What is the difference between a Housing First philosophy and program model? How do we get from the status quo to a Housing First approach?

Some of these questions are easy to answer. The debate over whether Housing First works is over. While there is a real lack of evaluation research on the effectiveness of homelessness interventions, this is not the case with Housing First. The body of research from the United States, Europe and Canada attests to the success of the program, and it can truly be described as a 'Best Practice'.

The At Home/Chez Soi project, funded by the Mental Health Commission of Canada is the world’s most extensive examination of Housing First. They conducted a randomized control trial where 1000 people participated in Housing First, and 1000 received 'treatment as usual'. The results are startling: you can take the most hard core, chronically homeless person with complex mental health and addictions issues, and put them in housing with supports, and you know what? They stay housed. Over 80% of those who received Housing First remained housed after the first year. For many, use of health services declined as health improved. Involvement with the law declined as well. An important focus of the recovery orientation of Housing First is social and community engagement many people were helped to make new linkages and a stronger sense of self.

So we now know that Housing First is effective, and that ironically, it's cheaper than keeping people mired in emergency services. Now we have to do it. But how do we move forward? Yogi Berra is quoted as having said, "If you don't know where you are going, you might not get there". Communities need support in moving from treatment as usual, to a Housing First approach. One can get the idea but may need support in figuring out how to make the move.

A new book, "Housing First in Canada: Supporting Communities to End Homelessness" is being released that is intended to help communities plan and implement an effective Housing First response. The book contains a Framework for Housing First that explains the concept, outlines core principles and differentiates a Housing First philosophy, from a systems approach, a program, or a team. A Housing First approach will only work if there is fidelity to the principles of the model, and this chapter helps clarify what it means.

The book also contains eight Case Studies of Housing First in Canada, from larger communities (Calgary, Edmonton) to smaller ones (Victoria, Lethbridge). The case studies explain how communities moved from the 'aha' moment of inspiration to planning and implementing Housing First. We learn about the opportunities and challenges of putting this approach in place, and how communities were able to move forward in a way that has led to significant results. For instance, Edmonton has seen a 30% drop in homelessness since it made the shift five years ago. The book concludes with a chapter on "Lessons Learned", where we pull together key themes in terms of planning, working with landlords, bringing the community along, etc.

We now are building a solid knowledge base about Housing First and strategies for implementation. We know it works, that’s not the issue. We just need to go out and do it.

Stephen Gaetz is a Professor in the Faculty of Education and is the Director of the Canadian Observatory on Homelessness and the Homeless Hub. He is also President of Raising the Roof, a leading Canadian charity that focuses on long term solutions to homelessness. 

Dr. Gaetz is committed to a research agenda that foregrounds social justice and attempts to make research on homelessness relevant to policy and program development. His research on homeless youth has focused on their economic strategies, health, education and legal and justice issues, and more recently, he has focused his attention on policy and in particular the Canadian Response to homelessness.  He has recently edited two volumes on homelessness in Canada, including: Housing First in Canada – Supporting Communities to End Homelessness. (2013) and Youth homelessness in Canada: Implications for policy and practice (2013). In addition, he has published a book on community-based responses to youth problems in Ireland and written numerous reports and articles published in a wide range of peer reviewed journals. Dr. Gaetz was Associate Dean of Research and Professional Development in the Faculty of Education Prior to his time at York University, Dr. Gaetz worked in the Community Health Sector, both at Shout Clinic (a health clinic for street youth in Toronto) and Queen West Community Health Centre in Toronto.

Dr. Gaetz has played a leading international role in knowledge dissemination in the area of homelessness. York played host to 2005’s Canadian Conference on Homelessness – the first research conference of its kind in Canada. In addition, York University now hosts the Canadian Observatory on Homelessness and the Homeless Hub the first comprehensive and cross-disciplinary web-based clearinghouse of homelessness research in the world. The focus of this network is to work with researchers across Canada to mobilize research so that it has a greater impact on homelessness policy and planning.  Through the CHRN Dr. Gaetz is publishing policy relevant research, including two recent reports on youth homelessness: A Safe and Decent Place to Live: Towards a Housing First Framework for Youth. (2014) and Coming of Age:  Reimagining our Response to Youth Homelessness in Canada. (2014), as well as The Canadian Definition of Homelessness (2012), The Real Cost of Homelessness. Can we save money by doing the right thing? (2012), Can I See Your ID?  The Policing of Homeless Youth in Toronto (2011), and  Family Matters: Homeless youth and Eva’s Initiatives “Family Reconnect” Program. (2011).

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.