Housing First is a program designed to rapidly house individuals experiencing homelessness regardless of preexisting physical health, mental health, and substance abuse conditions (Pathways to Housing, 2013). The Housing First approach includes four principles: 1) homelessness is first and foremost a housing problem and should be treated as such; 2) housing is a right to which all people are entitled; 3) people who are homeless or on the verge of homelessness should be returned to or stabilized in permanent housing as quickly as possible and connected to resources necessary to sustain that housing; 4) issues that may have contributed to a household’s homelessness can best be addressed once the family is housed (The National Alliance to End Homelessness, p. 1, 2009). While the Housing First approach has shown promise in gaining stability for individuals with serious mental illness and/or histories of substance use (Padgett, Stanhope, Henwood, & Stefancic, 2011; Pearson, Montgomery, & Locke, 2009; Tsemberis, Gulcur, & Nakae, 2004), the mechanisms that lead to this stability are relatively unknown. In order to adequately understand the potential impact of the program, evaluators need to monitor key intermediate indicators believed to be associated with long-term housing stability, management of mental health conditions, and reductions in substance abuse.
An evaluation of the Housing First program on the island of Oahu, HI, delivered by The Institute of Human Services, has designed and implemented an evaluation methodology that includes close monitoring of likely intermediate processes associated with long-term housing stability, improvements in health, and reductions in visits to emergency room, inpatient hospital beds, and correctional facilities. This presentation will include an analysis of the theoretical processes underlining the Housing First model, with special attention paid to the intermediate processes necessary for individuals to maintain housing stability. These include monthly assessments of program participants’ social support (Sherbourne & Stewart 1991), perceived stress (Cohen & Williamson, 1988), ability to obtain needed health services, engagement in the community, satisfaction with life (Diener, Emmons, Larsen, & Griffin, 1985), and health-related quality of life (Centers for Disease Control and Prevention, 2000). These factors, along with measures of program implementation (i.e. fidelity to the model), will be used to demonstrate methods for evaluating the Housing First approach to addressing homelessness for individuals with a history of mental health and substance abuse conditions.