Housing First and PIEs in the US

Housing First in the US

The term "Housing First" (often abbreviated to "HF") describes an approach developed initially in the United States, which took the view that it was more effective to fast-track re-house homeless people with multiple problems such as substance abuse, trauma and mental illness, and then offer them treatment in and from their own homes, on a purely voluntary basis.

This is in contrast to what they termed "staircase" models, which expected people to pass through a number of rehab projects and programmes, as part of their recovery, before eventually being deemed ‘ready’ to be independently housed. Typical of such compliance-based housing would be the 'dry' households of recovering alcoholics. (For a discussion of the ‘staircase’ concept, see Johnsen & Teixeria)

There is some debate currently as to how far the HF and PIEs approaches should be seen as different parts of the same spectrum. Clearly the HF approach, despite a strong right-based philosophy, has its roots in psychology. The HF model was originally developed and described by a psychologist, Sam Tsemberis and it has some very sound social psychology at its heart, especially around questions of empowerment and choice, and the negative effects of institutionalisation.  

PIEs and Permanent Supported Housing 

The principal contribution of the PIEs framework, however, may lie not in the general principles of HF, but in their particular application in the Permanent Supported Housing that HF proposes, as a constructive alternative to both the shelter system, and short-term “half-way” or “Transitional Housing”.

The permanent housing which HF expects may come in either of two forms – “scattered sites’ and ‘congregated sites”, and the latter can take the form of several dozen or more individuals living, each with independent tenancies and some degree of shared facilities, in the same building.  This appears to be the fastest growing version of Housing First; yet there has been so far little discussion of positive practice, or the nature of the social environment that is created there.

PIEs and Transitional/Compliance-based Supported Housing 

Little is discussed, and perhaps little is known, about the optimum running of transitional supportive housing, or long-term/permanent, but still compliance-based, accommodation.  This seems the form of housing closest in outline to the operation of the UK 'hostels' (see elsewhere on this site). But there has been little exchange of research or views, probably principally because there has been little formal published research on this in the academic press. 

Nevertheless, what published research there may be is still largely hidden from research searches by the terminology. Few service provider looking for models, or research or policy stakeholders looking for evidence, will be aware that in the UK the term 'shelter' is now rarely used; and the term 'hostel', which IS the common term is the UK, would not be used in a search. 

'Scattered site' and 'networked' housing

There appears to be some concern that some individuals struggle to establish themselves in scattered site housing, by contrast to the potential for community amongst street- and camp-dwelling homeless people. More intensive individual support may then be needed, where peer support might have been as effective or more, and at considerably lower cost. 

Yet 'networked' housing - by which we mean semi-dispersed housing units with a deliberate attempt to create, offer and sustain a common social network - such as the Keyring, Clubhouse or ‘core and cluster’ model - seem to be relatively un-known and certainly under-developed in this field, although the Clubhouse model itself developed in substance abuse services in the US, and the core-and-cluster model originated in learning difficulties services in Canada in the 1980s.

Social work and values-based practice

One of the surprise discoveries from the Editor's field trip yo the US in Spring 2016 was that the profession most involved in managing support services and outreach in the US seemed to be social work. This is not the case in the UK; and in this, it may be the UK that is out of step with the rest of the world.

This puts in a rather different light the values-based practice - person-centred, pragmatic, holistic and systemic - that characterises Housing First. It is an issue that we will explore, especialy in the context of the new social psychiatry, in subseqent workshops and papers.

 

Recommended

Recommended reading/viewing/listening

An interview with Sam Tsemberis (You tube link)

Calgary Homeless Foundation: Framing Housing First (video)

Johnsen S & Teixeria L (2010) 'Staircases, Elevators and the Cycle of Change' (article)

Unnamed Michigan resident speaks on "Sobriety housing and peer support' (podcast

 

Further reading/viewing/listening

Tsemberis et al: Selected works (website).