Effectiveness of the “housing first” approach: a systematic review
Homeless people diagnosed with substance abuse and mental illnesses often encounter problems in their quest to find housing since sobriety and psychiatric treatments are frequently required to qualify for a housing program. These programs are based on the “treatment first” approach, meaning individuals must first be treated before being admitted in a housing program. The relevancy of this approach is being questioned and change is occurring due to the implantation, in the United States, of the Housing First approach initiated by the Pathways to Housing organisation. The general premise of this model is that homeless people must first be housed before their other needs are taken care of. Private independent apartments are the preferred model of housing while intensive case management (ICM) or assertive community treatment (ACT) constitute the possible interventions. Pathways to Housing model influenced the creation of several hybrid programs, based on the Housing First approach. They combine a diverse range of housing (private, specialized, mixed, reserved, etc.) with an array of interventions using varying levels of intensity (ICM, case management, ACT, need-based interventions). This systematic review addresses the effectiveness of programs based on the Housing First approach. With the results provided in this review, we conclude that, in the province of Quebec, these types of programs, typified by varying levels of housing and intervention intensity, should be promoted. However, they must take into account the ever present dichotomy between the rural and urban realities of Quebec.