Housing First and PIEs - where parallel lines meet?

NB: There is currently a very significant shift in US policy towards homelessness and homelessness services, as indicated by policy documents released in December 2022: 'Transforming Approaches to Shelter'.

This shift will require - and offers the opportunity for - a major overhaul of all discussions on the 'American PIE' sections of this site. Whilst this is being undertaken - and whilst US policy and practice evolved - much of the content of this site will need considerable re-drafting to bring out the opportunity that this creates.


Housing First and PIEs - the early history

The origins of Housing First ('HF') lie in the United States, and arose there through a particular combination of circumstances, in the closure of psychiatric hospitals in 1980s and 1990s, and a failure to develop local community based mental health support.

Combined with an insurance-based healthcare system which relied on those insured being in employment, this contributed to a growing flood of individuals with mental health problems into the major cities - New York in particular - by the turn of the century.

The characteristics and needs of this new group were significantly different to those of the previous populations at greatest risk of homelessness. These had been principally issues of poverty complicated by dependency on alcohol; and for the previous population, under the influence of a vocal 'user movement' via Alcoholics Anonymous, 'dry houses' that required abstinence had been developed for those with the more severe problems; and some supportive preparation for abstinence housing was seen as necessary.

For this new cohort, with their very different needs, a very different approach was needed. HF therefore argued that it is more effective to 'fast-track' re-house homeless people with multiple problems such as substance abuse, trauma and and mental illness, and then offer them treatment, but in and from their own homes, and on a purely voluntarist basis.

As a consequence, HF in the US had at first been seen as incompatible with, even antagonistic towards, a requirement for abstinence or even ‘transitional housing’ - at least for this particular group - and in many areas it is still promoted as a better alternative for all.

Since the PIE approach arose originally in the context of the UK's hostels ('transitional accommodation') and was focussed on identifying what works most effectively there, PIEs and HF seemed to be at odds.


'Congregated' and 'scattered site' housing.

More recently, the position in the US had become considerably more nuanced, with a growing recognition that there may be a legitimate and valuable role for 'transitional housing', even for a degree of 'conditionality', for those with long-standings substance abuse problems. This form of more integrated and more communal support is now termed 'recovery housing'. In the US and Canada, more different models of HF in practice are therefore emerging.

Especially relevant are different models of permanent supported housing (PSH), as the accommodation element in HF’s rapid housing placement and support philosophy.  In New York, apartments may have been the typical housing stock available; but many other areas are developing 'congregated care' sites - multiple units on the same site, or 'campus'.

This is perhaps partly for reasons of cost (the reduced cost and greater flexibility of support staff), and partly for concerns at the risks of loneliness and the increased vulnerability for those housed alone, which are now being identified as a worrying problem for such provision in the US. (See the pages on "PIEs,  'scattered site' and 'networked' housing' : HERE for a discussion of such issues).


Parallel lines crossing?

In contrast to the US, in Europe the range of welfare rights and services and the gaps in their safety nets are very different; and as early as 2010, in Staircases, Elevators and Cycles of Change by Johnsen & Texeria, some began to question the simple applicability of US-model HF to the UK context (and also to inquire about the particular needs of particular sections of 'the' homeless population.

Housing First England, for example, is taking a different stance, seeing Housing First as one of a range of legitimate positive approaches – one tool in the tool kit for meeting the full diversity of complex needs. In other european nations, where - even just within Europe - there are many different jurisdictions and cultures of welfare, an incremental/experimental approach is being taken.

This difference undoubtedly reflects the far greater investment over several decades in the UK in improving the quality of “hostels” (NB: the UK term for “transitional housing”). Both in terms of overall size of homelessness resettlement units and their physical condition (via, for example, the Places for Change programme) and, more recently, the psycho-social environment – currently expressed in the language of PIEs - the short stay accommodation we have in the UK is now closer in spirit and in practice to 'recovery housing'.

Meanwhile, in the UK permanent supported housing in the HF programme tends still to be seen as meaning individual, isolated tenancies (in the US and Canada, this is called 'scattered site PSH'), and 'congregated care sites are found primarily in our 'hostels'.    It would appear, then, that for the moment, we have an odd contrast. The PIE framework is more readily applicable in PSH in the US, and more applied in transitional housing in the UK.

(For a preliminary analysis from 2016 of the links between Housing First, PIEs, TIC, pretreatment and system change approaches, see Principles and practice in the psychology of homelessness,  by Robin Johnson)


Parallel lines meet?

More recently, however, we see a further evolution, made possible by the conscious decision to seek a wider understanding of the range of responses to psychological needs in homelessness, in the revision of the earlier accounts of what makes for a PIE. The working party that produced the new model - which we call therefore 'PIEs 2.0 '- had been explicit that the framework needed to consider new approach such as HF.

As a result, we now find those services in the UK - and to some extent in Europe - that are familiar with the PIE approach finding that the most effective way to develop their HF services is to use the PiEs framework to supply the thinking and the operational cues for developing in all the areas that the HF framework for consistency chooses not to touch upon.

At this point, it seems these parallel lines finally touch.


NB (1):This is also in part a reflection of the short-termism – typically a maximum of 2 years - that has characterised “housing related support” in the UK, ever since the expansion of support services under the Supporting People programme.  This severely limits the extent of permanent support in housing, under the homelessness service umbrella, and now requires the proponents of Housing First to seek new funding partnerships for extended support episodes. These are currently proving as difficult to establish in the UK as they are in the US.

Such short-termism in the funding of 'housing-related support' services in the UK reflects the historical origins of this kind of support - as its name suggests - in housing costs, rather than in social work or healthcare budgets.  The UK is unusual in not regarding homelessness as a suitable area for social work, an aspect of community care.

It may also help to explain why the belief persists that being or becoming a PIE means having a psychologist to ‘do’ the informing. A trained psychologist is an expensive resource that must be targeted on the more immediate transitions, and in the UK, this more intensive resettlement work has mainly been offered in hostels.    (See the training video, “Does it take a psychologist to make a PIE?”, for a critique of this view).


NB (2): See also the pages here on 'pretreatment', which can be seen as the effective skill set for outreach work in Housing First - or any other programme with excluded and marginalised individuals. For details and examples, and further links see the section on this site: Pretreatment.

Further background reading/listening/viewing

PIElink pages on Housing First and PIEs

Housing First and PIEs - how do they work together? : HERE

Is Housing First itself a PIE approach? : HERE

(Balancing) principles and pragmatism in PIEs and HF : HERE

Housing First and PIEs - where parallel lines meet? : HERE

Housing First, PIEs and the Pizazz (Special Interest Group) : HERE

Housing models, Housing First and PIEs in the US and the UK : HERE

Housing First and PIEs in Europe : HERE

Housing First in the 'new world' : HERE

The lasting legacy of 'Supporting People' : HERE


Other related PIElink pages

American PIE : HERE

'Recovery Housing' in the US and the UK : HERE

PIEs, 'scattered site' and 'networked' housing : HERE

Outreach, in-reach and pathways : HERE





Library items

Housing First England is the natural home for HF development in England; and has many links to news and project reports.

Staircases, Elevators and Cycles of Change (Johnsen and Texeria) : HERE

Principles and practice in the psychology of homelessness, (Robin Johnson) : HERE

How gaps in US services had evolved; a discussion with April Connolly and John Yaswinski : HERE




Video & audio

Research, impact and community; a discussion on Housing First developments in the UK a discussion with Glasgow Housing Network

 “Does it take a psychologist to make a PIE?” (

NB: cartoon version) for a critique of the assumption that it does.

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