Little more than two decades ago, the “Housing First” (HF) approach pioneered by Pathways to Housing, Inc. was a small but determined challenge to the burgeoning yet ineffective service system for homeless persons. Today, the success of HF has brought about paradigm-shifting systems change not only in the homeless “industry” but in related service systems. Drawing on rigorous research and the hard work of “institutional entrepreneurs,” HF has been adopted both nationally and internationally, presenting an unusual blend of evidence-based practice and consumer choice. As a result, it has changed ... More

Little more than two decades ago, the “Housing First” (HF) approach pioneered by Pathways to Housing, Inc. was a small but determined challenge to the burgeoning yet ineffective service system for homeless persons. Today, the success of HF has brought about paradigm-shifting systems change not only in the homeless “industry” but in related service systems. Drawing on rigorous research and the hard work of “institutional entrepreneurs,” HF has been adopted both nationally and internationally, presenting an unusual blend of evidence-based practice and consumer choice. As a result, it has changed the conversation away from “housing readiness” and “managing homelessness” to the “right to housing” and “ending homelessness.” This book employs conceptual frameworks drawn from theories of institutional change and innovation, as well as from implementation science, to explore the rise in homelessness in the United States, the “lineages” of responses to the problem, and the subsequent rise of HF. Research on HF has produced consistent findings including rates of housing stability of 75% to 95% when compared with non-HF programs. In addition, qualitative studies describe the profound benefits of having a home as well as the challenges of recovering from a life of adversity. Findings from studies of HF in the United States, Canada, Europe, and Australia have converged on a bottom line: Providing immediate access to an apartment and support services to someone with mental illness and addiction is not only humane but effective. This book traces the origins of HF as a paradigm shift that has transformed homeless services in the United States and abroad.