Is the Housing First Model Effective? Different Evidence for Different Outcomes

For more than two decades since the development of the Housing First model, there have been debates about the model's effectiveness in serving individuals experiencing homelessness. Although the Housing First model has various fidelity standards, its hallmark feature is the provision of immediate access to permanent, subsidized, independent housing with no prerequisites such as mandating treatment participation or requiring sobriety. This feature is theorized to provide an effective pathway for homeless individuals to achieve positive outcomes. Various time-trend analyses have been conducted showing that increases and decreases in homelessness have coincided with increases and decreases in housing vouchers, housing units, or implementation of the Housing First model during the same period. However, the old adage remains true that "correlation does not equal causation," and these analyses are subject to threats to internal validity, such as history effects or other confounding factors occurring concurrently. Instead, one should look to the gold standard of research designs-the randomized controlled trial. I provide a brief synthesis of the evidence (or lack thereof) from randomized controlled trials for the Housing First model to further discussions and inform policymaking.