How the Housing First Model Can End Homelessness, in the Words of its Founder


Sam Tsemberis, a nationally recognized expert on solving homelessness, recently told an auditorium of more than 250 social workers and other homelessness providers at Johns Hopkins University’s Montgomery County campus about the housing model he developed, Housing First, and its effectiveness.

Tsemberis, who teaches psychiatry at Columbia University’s medical school and is founder of Pathways to Housing, told the assembled that all people, including homeless people, are entitled as human beings to housing.

When people are given housing, they are more likely to recover from drinking or drug use problems and be productive, he said. Then a service provider like a psychiatrist or social worker has to establish a relationship with the individual to determine what services they need, so that they can be cared for effectively.

Eighty-five percent of people in Housing First are successful in their first year, according to Tsemberis.  “That’s what sells it; it works,” he said. “There is a lot of evidence about Housing First being cost-effective. Repeated trips to emergency rooms and jail are usually eliminated when housing is provided.”

The all-encompassing “wrap-around” services that social workers and psychiatrists refer to are provided to the housed homeless person to match that person’s needs; if their needs are intensive, the services have to be intensive. An interdisciplinary team is needed; that caretaking team is like an extension of the homeless person’s family, demonstrating real care.

“You are their family for a long time; you need to adjust your services to provide that,”    Tsemberis said, adding that the goal is not self-sufficiency but support. “All the great social movements of all time are based on collective action; that’s what recovery is.”

The speaker gave some interesting statistics.  Only 5—10 percent of the homeless are “chronically” homeless.  Eighty percent are “transitionally homeless” and 10-15 percent are“episodically” homeless, which means that the vast majority do not stay homeless permanently.

“Most [homeless] people are safely out of sight,” he said, which keeps them out of mind, allowing the housed public to deny it’s happening. Similar to men and women in the prison system; once off the street and out of view they’re too often invisible and forgotten.

He reminded the audience of the common misperception that “if you’re succeeding, you must be doing something better than others.”  Homeless people occupy the bottom rung of the social ladder – if they’re at the bottom, the thinking goes, they must not be working hard enough.

Tsemberis noted that the administration of former New York City Mayor Michael Bloomberg took an unsuccessful–and unintelligent though well-meaning–stab at reducing homelessness there.  They gave homeless people 80 percent of living expenses for a year, thinking that they’d be self-sufficient in five years.  It didn’t happen; the program ended in three years.

“How is it that so many smart people can get something so wrong?” Tsemberis asked his audience. The foundational values of the program affected its design. Tsemberis outlined his contrasting Housing First model, based on developing a relationship with the homeless person. “The housing [that’s provided] is a step on the journey to recovery.  When [you] do it right, it’s about the people.”

Homeless people do better when they’re provided with an apartment and get regular visits from service providers, according to Tsemberis. Sometimes that initial housing doesn’t work out.  “The person will tell you, and you’ve got to find them another; but that’s still better than putting them back out on the street,” he said.  Most people do better in the next housing placement than they did in the first.

It takes a lot of affordable housing to make Housing First work. Tsemberis expressed concern that the U.S. Department of Housing and Urban Development (HUD) is not increasing the funding for intensive support, and the Veterans Administration has cut back their voucher program.

Responding to a question from a Montgomery County police officer about law enforcement’s role in managing homelessness, Tsemberis said that police officers should meet with other professionals when care providers are determining how best to manage a homeless person’s recovery.

Jennifer Ho, senior advisor for housing and services to HUD Secretary Julian Castro, also spoke to the assembled auditorium crowd.  She said the system in place today is driven by better data. Led by Ho, the Obama administration has been able to make serious progress toward ending veteran homelessness by collecting better data and having stronger collaborations.

“We decided we were going to house every vet,” she said, and the process was given an extra sense of urgency by setting a clear deadline to accomplish that goal. However, she added, you have to keep working to maintain those gains. Ho also noted a national competition for funding from the Obama administration’s Continuum of Care program, which has increased momentum around the country for ending veteran homelessness. With the Obama administration leaving office next January, “It’s going to be a last push of resources to end chronic homelessness,” Ho said.

Not only are more people provided with health insurance under the Obama health plan, health insurance is paying more attention now to people who weren’t insured before.  Also, because a lot of vets have kids, the system can now help treat families.

Ho noted happily that HUD gave her agency new money to work on a pilot system in 10 communities around the country to end youth homelessness. While there is a proposal on the table now that would end family homelessness, she said, more resources would have to be invested wisely for it to work.

“Our goal is not to eliminate the shelter system,” she told the assembled, “but to eliminate the warehousing system [shelters] have become.”

The federal plan to end homelessness has been adopted by Montgomery County as the local plan.


Issues |Housing

Region |Maryland|Montgomery County

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We believe ending homelessness begins with listening to the stories of those who have experienced it.