Housing and support models: contrasting terminology in the US and the UK

Please note: with the recent announcement of a new US policy on 'Transforming Approaches to Shelter', this page is currently going through a wholesale revision, to incorporate reference to this significant new material. Bear with us...

The text version of this infographic was originally (2017) prepared for and published as an appendix in 'Cross-cultural Dialogues on Homelessness: From Pretreatment Strategies to Psychologically Informed Environments' (editors: Jay S Levy and Robin Johnson).

This glossary aims to outline most of the more technical terms used in the UK and the US for homelessness needs and approaches, hoping to support dialogue and minimise potential confusion between the two countries' approaches.

Each of the terms used here is defined in a few brief sentences. More complete descriptions of each term can be searched on the web, using any search engine. There is also a recently published summary of all terms in the US vocabulary in the 'recommended reading' column here.

In the infographic version below, the more immediately comparable concepts, despite differing terminology, are placed in greatest proximity. It is not an exact fit but it is hopefully a visual guide towards finding the defined versions, in alphabetical order, in the text.

 

Glossary diagram copy

Glossary diagram copy

Recommended reading and viewing

Glossaries

A US/UK vocabulary of homelessness terminology : HERE

US glossary of terms : HERE

UK housing and mental health intersections : HERE

 

PIElink pages on Housing First and PIEs

American PIE : HERE

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

 

Other related PIElink pages

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

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

Outreach, in-reach and pathways : HERE

 

Recommended reading/viewing/listening

An interview with Sam Tsemberis (You tube link)

Framing Housing First (video)

'Staircases, Elevators and the Cycle of Change' (article)

Exploring Effective Systems Responses to Homelessness HERE

Packed with questions HERE

They do things differently there HERE

Red Herrings and Real Achievements HERE

 

Further reading/viewing/listening

Tsemberis et al: Selected works (website).

Housing models, HF and PIEs in the US and the UK

Please note: with the recent announcement of a new US policy on 'Transforming Approaches to Shelter', this page is currently going through a wholesale revision, to incorporate reference to this significant new material. Bear with us...

In the UK over the past ten years there has been a great deal of development of ideas and practice around making any kind of accommodation, temporary or permanent, more 'psychologically informed'.  The PIEs framework arises out of these discussions, and over the past ten years or so it has helped to frame them with a useful vocabulary and a community of practice to continue the discussion and share the learning.

In the US, by contrast, until very recently Housing First was the only model that had significant investment in research and in policy. (In another page in this cluster of PIElink pages on HF and PIEs, we ask: 'Is Housing First already a psychologically informed environments approach?': HERE)

There was however a significant shift in this policy in September 2017, with the recognition of the need for 'recovery housing' in what were seen as exceptional circumstances. (Typical of such compliance-based housing would be the 'dry' households of recovering alcoholics - the model that in fact preceded Housing First. ) Yet the principal concern of the Recovery Housing briefing was not to identify useful models of accommodation that might be long-term or permanent, but still compliance-based, but rather to reconcile the need for such housing with the HF framework, recast now as a strategy (following the example of HF in Canada).

Meanwhile little was discussed, and perhaps relatively little actually known, about the optimum running of transitional supportive housing, or 'shelter'.  The 2022 policy document 'Transforming Approaches to Shelter' therefore marks a significant shift, which brings 'interim' housing back into the 'good practice' fold, echoing the way the PIEs approach in the UK had always done included this kind of provision as legitimate and potentially constructive.

But in part this reconciliation of approaches may depend not so much on the applicability of the fundamental principles of HF, or of the broader reach of the PIE approach, but on a closer examination of the kinds of housing stock available - and the ways we can use various kinds of accommodation for various needs.

 

Divided by a common language

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.  Until recently, US research and policy has been - quite literally - blind to the developments in the UK in improving hostel environments.

 

Ordinary ('general needs') housing as a PIE

A space of one's own of any kind - even a room in a hostel/shelter, or a tent - allows that space to be personalised with quite individual meanings. It would be possible to see accommodation in an ordinary flat - whether in 'congregated' or 'scattered site' housing - as being 'psychologically informed', at least in so far as it may meet profound psychological and emotional needs for the individual - although there is also some concern that the relative isolation of 'scattered site accommodation' may also render some individuals more vulnerable.

Settled accommodation of any kind makes it more possible in principle for services to then address other psychological needs, where other approaches have failed. A secure tenancy gives the additional benefits of a sense of safety and control. The policy of HF is doubly psychologically informed, if it stems for a recognition that rapid housing removes a key source of anxiety and vulnerability.

Recently in the UK there has been some attempt to explore the skills and techniques that are available to help a re-housed individual to feel that they are not just housed, but 'at home'. Though these may be questions over models of support, rather than models of housing itself, they are intimately inter-twined. Here we will go on to explore some of the options.

 

Housing First and the 'staircase' model

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.  (See: 'the early history', in 'Housing First and PIEs - parallel lines meet?' : HERE. )

This is in contrast to what are described as 'staircase' models, a model which expected people to pass through a number of staged rehab programmes and services as part of their recovery, before eventually being deemed ‘ready’ to be independently housed. In this approach, the ability to manage the constraints of semi-independent housing is seen as a necessary test of the individual's ability to self-manage. (For a fuller discussion of the ‘staircase’ concept, see the article by Johnsen & Teixeria; also Strnad & Masat.)

Experience now suggests that there is a useful role for such housing, and principally but not sole in addiction- or dependency-related support. Social, peer and community support is valuable in many forms of recovery (see: Recovery housing in the US and the UK : HERE).

 

PIEs and Recovery - Transitional and/or compliance-based Supported Housing

US policy now recognises the need for social support in addiction, and a role for transitional and even for compliance-based housing, but only in the context of opioid use. There seems  so far little attempt to generalise the learning to other areas, such as - for example - the growing reliance on 'safe' parking lots for people living in cars and vans; a public health response to in-reach to the growing number of encampments; and 're-imagined shelters'.

This is not to say that the PIEs approach and framework is necessarily easily translated into the US context. But it does suggest that some more extended 'transatlantic dialogue' (sic) might be fruitful.   But there has been little exchange of research or views, probably principally because there has been relatively little formal published research on this in the academic press, using this UK terminology.

 

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.

 

 

 

Recommended

PIElink pages on Housing First and PIEs

American PIE : HERE

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

 

Other related PIElink pages

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

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

Outreach, in-reach and pathways : HERE

 

 

 

 

Recommended reading/viewing/listening

PIEs, 'scattered site' and 'networked' housing (PIElink page) HERE

'Recovery Housing' in the US and the UK HERE

An interview with Sam Tsemberis (You tube link)

Framing Housing First (video)

'Staircases, Elevators and the Cycle of Change' (article)

Exploring Effective Systems Responses to Homelessness HERE

Packed with questions HERE

They do things differently there HERE

Red Herrings and Real Achievements HERE

Further reading/viewing/listening

Tsemberis et al: Selected works (website).