Experts make the case for 'housing first' approach to homelessness

December 1, 2016 by Dipali Pathak, Baylor College of Medicine

In a new perspective published today in the New England Journal of Medicine, five experts, including Dr. David Buck with Baylor College of Medicine, make the argument for Housing First as an approach to end homelessness across the country.

The Housing First approach offers permanent supportive to the homeless without prerequisites that traditional approaches require, such as psychiatric or substance use treatment or attaining sobriety before receiving housing. The approach also combines financial support for housing with offers of psychiatric, medical and social rehabilitative support. Studies have shown that this type of intervention has resulted in faster exits from homelessness and more time spent in housing compared to traditional approaches.

However, authors of the paper caution against the argument that this approach provides , arguing that high-quality randomized, controlled trials have not demonstrated net cost savings for this approach. The authors say that there should be no expectation that these types of health and save money, but instead should focus on the quality-adjusted life-years gained. They argue that insisting on cost savings of such programs devalues the lives of homeless people.

Other institutions who contributed to the perspective include the University of Alabama at Birmingham School of Medicine, Harvard Medical School and the University of California, San Francisco.

"We see Housing First as the indispensable strategy for ending homelessness," said Buck, professor of family and community medicine at Baylor. "We didn't want people to discredit programs when claims about economic costs don't hold up under scrutiny."

Instead, Buck and his co-authors insist that a more sound argument to favor the Housing First approach should look at , economic considerations and moral values. Scientific research has shown that this approach is more effective in promoting residential stability. From an economic perspective, the program has a relatively low cost of $8,000 to $18,000 per year of housing, with returns on investment being partially offset by the use of emergency medical and judicial services, as well as the creation of a more livable community and more welcoming space for commercial development. The authors estimate $100,000 to $150,000 per quality-adjusted life-year for selected medical interventions. Finally, from an ethical perspective it fulfills a collective responsibility to remediate persistent homelessness in one of the wealthiest countries in the world.

Buck is the founder of Healthcare for the Homeless – Houston, which offers health services for the homeless in Houston. Buck also founded and is president of Patient Care Intervention Center, which aims to improve healthcare quality and costs for the underserved through data integration and care coordination. He also directs the Houston Outreach Medicine, Education and Social Services (HOMES) clinic, which is managed by medical students at Baylor and the McGovern Medical School at The University of Texas Health Science Center and College of Pharmacy students at the University of Houston. HOMES is a clinic of Healthcare for the Homeless – Houston.

The HOMES clinic aims to provide acute care for the homeless on Sundays when they would otherwise have access to only an emergency room. While the clinic does not provide long-term care, patients are referred to Healthcare for the Homeless – Houston for their primary care. Since it's opening in 1999, the shared leadership of the HOMES clinic among the three healthcare institutions has provided care for more than 5,000 patients and has involved thousands of student volunteers.

Explore further: Homeless, mentally ill youth benefit from housing program

More information: Stefan G. Kertesz et al. Permanent Supportive Housing for Homeless People—Reframing the Debate, New England Journal of Medicine (2016). DOI: 10.1056/NEJMp1608326

Related Stories

Homeless, mentally ill youth benefit from housing program

September 28, 2016
(HealthDay)—A subsidized independent-living intervention appears to help homeless young people with mental illness get and keep a roof over their heads, a new Canadian study indicates.

Treating ill health might not be enough to help homeless people get off the streets

October 23, 2014
Health care providers should recognize that any effective strategy to address homelessness needs to include both interventions to improve the health of homeless individuals as well as larger-scale policy changes, according ...

Housing First program has success in study of homeless people with mental illness

March 3, 2015
It sounds simple, but it appears to be working: Give homeless people financial help to find free-market rental accommodation in the community as well as mental health support services, and the success rate in ending their ...

Recommended for you

Engineered enzyme eliminates nicotine addiction in preclinical tests

October 17, 2018
Oct. 17, 2018—Scientists at Scripps Research have successfully tested a potential new smoking-cessation treatment in rodents.

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

How healthy will we be in 2040?

October 17, 2018
A new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario ...

Study finds evidence of intergenerational transmission of trauma among ex-POWs from the Civil War

October 16, 2018
A trio of researchers affiliated with the National Bureau of Economic Research has found evidence that suggests men who were traumatized while POWs during the U.S. Civil War transmitted that trauma to their offspring—many ...

Father's nicotine use can cause cognitive problems in children and grandchildren

October 16, 2018
A father's exposure to nicotine may cause cognitive deficits in his children and even grandchildren, according to a study in mice publishing on October 16 in the open-access journal PLOS Biology by Pradeep Bhide of Florida ...

Many supplements contain unapproved, dangerous ingredients: study

October 13, 2018
(HealthDay)—U.S. health officials have issued more than 700 warnings during the last decade about the sale of dietary supplements that contain unapproved and potentially dangerous drug ingredients, new research reveals.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.