Housing First

Housing First

“Housing First” is a concept towards ending homelessness that emphasizes permanent housing placement for people experiencing homelessness.  The approach is based on the understanding that housing is a key social determinant of health, and stable housing serves as a platform from which an individual can pursue personal goals and improve their quality of life, including health-related outcomes.  In addition, Housing First emphasizes the importance of client choice in housing selection and service participation and understands that including a client as part of the housing selection process results in better housing outcomes and retention.   The Housing First approach can be applied across the continuum of homeless services, including homeless outreach, emergency and transitional shelter, rapid rehousing, and permanent supportive housing.

“Housing First” can refer to both the approach, as well as to specific programs for people experiencing chronic homelessness.  While the Housing First approach can be applied broadly across a range of homeless services, the term also refers to a specific type of permanent supportive housing for people experiencing chronic homelessness.   Both the State of Hawaii and the City & County of Honolulu administer specific Housing First programs for chronically homeless individuals and families.

Housing First in Hawaiʻi

The Department of Human Services has incorporated the Housing First approach into contracts for all State funded homeless programs, including outreach, emergency and transitional shelter, rapid rehousing, and permanent supportive housing.   For example, State-funded homelessness programs place an emphasis on assisting individuals using homeless services to connect quickly to permanent housing.  The goal of State-funded homelessness programs is not only focused on rapid placement into housing but also emphasizes housing retention to ensure that individuals remain stably housed instead of falling back into homelessness.

Section 346-378, Hawaii Revised Statutes, established the State Housing First Program and requires the Department of Human Services to implement the program in consultation with the U.S. Department of Housing and Urban Development.  The program is targeted for chronically homeless individuals and families and provides permanent supportive housing that includes long-term housing subsidies and supportive services. Individuals and families are referred to the State Housing First Program through the Coordinated Entry System (CES) for the respective Continua of Care – Partners in Care on Oahu and Bridging the Gap for the islands of Hawaii, Maui, and Kauai.

The providers administering the State Housing First Program for each island are:

The Department of Human Services submits an annual report to the Hawaiʻi Legislature on the status of the State Housing First Program, including the total cost of the program, number of people served, types of services offered, and duration of services.

Cost Savings Related to the Housing First Program

The University of Hawaiʻi recently conducted a final evaluation of a local Housing First program – the Hawaii Pathways Project – that included pre- and post-interviews with 107 clients in the program.  The evaluation found an estimated healthcare cost savings of $6,197 per client per month for clients that were housed compared to those that were not housed.  This represents a 76% decrease in healthcare costs after housing placement.  After considering average monthly rent and supportive services costs, the net cost savings from reduced healthcare utilization by stably housed clients was $4,246 per month per client.  Analysis of the Hawaii Pathways Project data showed evidence that stable housing contributed to significant healthcare cost savings.

In addition, Housing First programs can contribute to cost savings related to arrests and incarceration.  An evaluation of the City & County of Honolulu’s Housing First program by the University of Hawaii College of Social Sciences found that two years after being housed, Housing First clients had 61% fewer arrests and incarcerated less than half as many days as they were prior to obtaining housing.  In addition, the evaluation determined the cost of incarceration at the Oahu Community Correctional Center for one  year is about $51,000 per person, in comparison to an estimated annual cost of $20,000 to $30,000 per person enrolled in Housing First.   A snapshot of the evaluation related to a Costs-Benefits Analysis of the City & County of Honolulu’s Housing First program in 2022 can be found here.

Scaling Housing First Inventory

In 2017, the Corporation for Supportive Housing (CSH) estimated that 1,807 additional units of permanent supportive housing were needed to fully meet the needs of chronically homeless individuals and families on the island of Oahu.  CSH projected that this need could be met through a combination of housing vouchers and new construction at a cost of $278,891,232.00 in one-time costs, and an additional $38,258,508.00 in recurring annual operating costs.  CSH recommended that the overall need for Oahu could be addressed over a ten year period, and that for every 180 new permanent supportive housing units produced, the community would see an estimated  $9,900,000.00 in estimated annual healthcare cost savings alone (not including cost savings in other areas, such as corrections and law enforcement).  The CSH financial modeling projections and recommendations are posted online here.

The Hawaii Appleseed Center for Law and Economic Justice later conducted a further analysis of the initial CSH projections, and estimated that an investment of $766,000,000.00 in permanent supportive housing over a ten year period would result in $2,166,000,000.00 in healthcare costs savings over the same period.  The Hawaii Appleseed Center’s analysis and presentation to the Hawaii Interagency Council on Homelessness can be found here.

Below is an updated estimate of the number of supportive housing units needed statewide, both for individuals experiencing homelessness and for other sub-populations that are not considered “homeless” by the HUD definition.

How to determine if a program is using a Housing First approach?

To determine if a program is using a Housing First approach, you may use the United States Interagency Council on Homelessness Housing First Checklist and Self-Assessment below to determine if the program incorporates Housing First principles.

The key principles of the Housing First approach include:

  • Moving homeless individuals into housing directly from streets and shelters, without a precondition of accepting or complying with treatment; provided that the department may condition continued tenancy through a housing first program on participation in treatment services;
  • Providing robust support services for program participants, predicated on assertive engagement instead of coercion;
  • Granting chronically homeless individuals priority as program participants in housing first programs;
  • Embracing a harm-reduction approach to addictions, rather than mandating abstinence, while supporting program-participant commitments to recovery; and
  • Providing program-participants with leases and tenant protections as provided by law.