In September 2019, the Comprehensive Planning Committee hosted a lively discussion about housing and implementation of different models. Their goal was to uncover what the Ryan White program can do to cut down on housing insecurity as a way to improve health among people living with HIV. It was an exciting conversation – if you’d like to review it in depth, you can find it in the Comprehensive Planning Minutes + Materials page on the website.

The housing conversation started with the Housing First Model, founded by Dr. Sam Tsemberis in 1992. The committee thought it would be important to delve into multiple housing models to see how they work.

Let us begin with the Housing First Model, which can be broken down into 5 core principles:

1) Immediate Access to Permanent Housing with no Housing Readiness Conditions: When we think about homelessness and housing, we may picture many requirements and demands on clients. This may include dealing with addiction, mental health, and personal hardships in a specific way. These prerequisites are viewed as signs of stability and “readiness” for entering the system. However, the Housing First Model theorizes (with many studies to support the theory, such as this one) that outcomes are better when starting with housing first, then addressing other issues. Planning Council Co-Chair Sharee Heaven explains that Housing First’s “general idea is starting with a permanent place to live. Participants don’t need a certain amount of clean time or to meet a bunch of pre-requisites. It’s meeting the participant where they are.”

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Permanent housing is a way to assist people and get them back on their feet. Housing First suggests that once people do not have to prioritize finding a place to sleep, shower, feel safe, etc., they will be more inclined to prioritize other services (such as addiction services, mental health services, or vocational services). After all, safety and physiological needs are basic needs, and are foundational for reaching other needs.

2) Consumer Choice and Self-Determination: Clients have more of a say in what they want in terms of housing and support. For example, clients will participate in deciding the location and type of housing they will receive. Clients are also able to decide when they would like to partake in support services of their choosing.

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3) Recovery Orientation: The third principle is recovery orientation, in which clients are provided with support in reaching self-defined goals. This part of the model focuses on harm reduction without pushing abstinence in any way. Goals may also be related to work, family, education, and more.

4) Individualized and Client-Driven Support: The fourth principle of Housing First recognizes that clients not only need different services unique to their situations and experiences, but also need different amounts of those supports. Services should be unique and appropriate for each individual client. Principle four recognizes that some clients may need support indefinitely, while others may not.

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5) Social and Community Integration: The fifth principle involves ensuring that clients are not socially isolating themselves, and instead feel like they’re part of a community. Thus, the Housing First model attempts to create housing (e.g. scattered housing) that is not detached from the wider community while also supporting the client’s engagement in community activities. Once a client feels integrated into the broader community, there is more motivation to remain stably housed. When people feel welcomed and accepted, they are more likely to stay in the environment that makes them happy.