Housing First: Defining and Analyzing a New Treatment Paradigm for Homelessness in the United States
Date of Award
8-2020
Document Type
Open Access Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Public Policy
First Advisor
Michael P. Johnson
Second Advisor
Susan R. Crandall
Third Advisor
Russell K. Schutt
Abstract
As the Housing First approach to homeless service provision has proliferated in the United States in recent years, varied understandings of the model have emerged and a wide range of outcomes have been reported. This study seeks to better understand the variation in the implementation of Housing First, to identify outcomes of interest to stakeholders to improve future evaluations of the model, and to compare Housing First in practice to Housing First in theory. In order to achieve these goals, this study utilizes an exploratory sequential mixed methods research design beginning with a qualitative case study of Housing First programs in the Greater Boston area of Massachusetts followed by the design and distribution of an original online survey to a national sample of organizations operating Housing First programs (n=283) to collect data for quantitative analysis. Qualitative data suggest that the implementation of Housing First is largely determined by the history of the organization, whether the organization chose to transition to Housing First or was compelled to do so by a funder, and the level of staff enthusiasm for the model. Key outcome measures identified by stakeholders include percent of program participants exiting to homelessness, percent of program participants evicted or involuntarily terminated, life satisfaction among program participants, ability of program participants to perform activities of daily living, and program participant progress toward achieving goals beyond attaining and maintaining housing. Quantitative analysis of survey data reveals that in general, practitioners adhere closely to Housing First in theory as it is broadly defined by the United States Interagency Council on Homelessness. There is also widespread adoption of the narrowly defined Pathways Housing First model, with Housing First practitioners most commonly operating scattered-site permanent supportive housing programs that serve people experiencing chronic homelessness. Regression modeling shows that broadly, fidelity to Housing First in theory, level of staff enthusiasm for Housing First, whether the organization chose to utilize a Housing First approach or was compelled to do so by a funder, and the length of time that an organization has been utilizing a Housing First approach are all significantly correlated with key outcomes.
Recommended Citation
Carey, Caitlin A., "Housing First: Defining and Analyzing a New Treatment Paradigm for Homelessness in the United States" (2020). Graduate Doctoral Dissertations. 610.
https://scholarworks.umb.edu/doctoral_dissertations/610