Social Determinants of Health: Permanent Supportive Housing with Housing First (Housing First Programs)

The CPSTF finding is based on evidence from a systematic review of 26 studies (search period through February 2018).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to health equity.

Homelessness is associated with lower income and is more common among racial and ethnic minority populations. Homelessness is also associated with multiple health problems, increased mortality, and increased use of health care and other services. In 2017, nearly half of the people experiencing homelessness had a disabling condition, which the Department of Housing and Urban Development (HUD) defines as having limitations in conducting daily life activities or in working or living independently, or having a diagnosis of HIV infection (including AIDS; Henry et al., 2018).

In the United States, a common approach to serving people who are experiencing homelessness and have a disabling condition, has been referred to as Treatment First, or Continuum of Care (National Academies of Sciences, Engineering, and Medicine, 2018). This approach maintains that clients must take steps, including treatment and sobriety, to become “housing ready” before they receive permanent supportive housing, and they must remain “housing ready” after they are housed.

In contrast, Housing First programs propose that persons experiencing homelessness and living with a disabling condition can maintain a home when provided with services.

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 26 studies.

• Twenty-three studies evaluated interventions that served clients living with disabling conditions (excluding those living with HIV). Compared with clients in Treatment First programs or control group participants receiving treatment as usual, clients in Housing First programs experienced the following:
  • Median 41% greater housing stability (13 studies)
  • Median 88% greater decrease in homelessness (5 studies)
  • Median 5% greater improvement in quality of life (4 studies)
  • Median 5% greater reduction in emergency department use (3 studies)
  • 7% and 36% greater reduction in hospitalization (2 studies)
• There were no apparent differences in physical health, mental health, or substance abuse between the intervention and control groups.
• Three studies evaluated interventions that served clients living with HIV. Compared with control group participants receiving treatment as usual, clients in Housing First programs experienced the following:
  • 63% greater housing stability (1 study)
  • 38% greater reduction in homelessness (1 study)
  • Median 22% greater improvement in physical health (2 studies with 4 data points)
  • 13% greater improvement in mental health (1 study)
  • 32% to 42% greater reduction in mortality (2 studies)
  • 41% greater reduction in emergency department use (1 study)
  • 36% greater reduction in hospitalization (1 study)

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

A systematic review of economic evidence shows the economic benefits exceed the intervention cost for Housing First Programs in the United States.

The economic review included 20 studies (search period through November 2019). Seventeen studies were from the U.S. and three were from Canada. All monetary values are reported in 2019 U.S. dollars.

Intervention Cost

• The median cost per person per year for U.S. studies was $17,069 (17 estimates from 12 studies).
• The median cost per person per year for all studies was $16,873 (23 estimates from 15 studies).

Economic Benefit

Economic benefit is the sum of savings from healthcare, emergency housing, judicial services, welfare and disability costs, and benefits from increased employment.

• The median economic benefit per person per year for U.S. studies was $17,016 (19 estimates from 13 studies).
• The median economic benefit per person per year for all studies was $17,750 (25 estimates from 16 studies).

Benefit to Cost Ratio

• The median benefit to cost ratio for U.S. studies was 1.44, meaning there was a societal cost savings of $1.44 for every $1 invested (14 estimates from 9 studies).
• The median benefit to cost ratio was 1.06 for all studies, meaning there was a societal cost savings of $1.06 for every $1 invested (20 estimates from 12 studies).

The finding should be applicable to people who are living with a disabling condition and experiencing homelessness in urban and suburban areas.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How effective are Housing First programs for families, youth, women, LGBTQ populations, and rural communities?
• Which services do Housing First programs offer? How frequently do clients use offered services? How does program effectiveness vary by services available or used?
• What is the long-term impact of Housing First programs on health outcomes?
• What is the cost-effectiveness of Housing First programs?
• What is the cost-benefit when interventions are implemented for youth or families, or in smaller urban or rural areas?

• Studies were done in urban (24 studies), suburban (1 study), or a mix of urban and suburban (1 study) settings across the United States (23 studies) and Canada (3 studies). None of the included studies were conducted in rural settings.
• Study participants had a mean age of 42.4 years (20 studies) and 74.0% were male.
• Only one study examined a program targeted to families; none of the studies focused on women or racial/ethnic minority populations.
• Study designs included individual randomized control trials (8 studies) and pre-post studies with concurrent comparison groups (18 studies).

Peng Y, Hahn RA, Finnie RKC, et al. Permanent supportive housing with housing first to reduce homelessness and promote health among homeless populations with disability: a Community Guide systematic review. Journal of Public Health Management and Practice 2020;26(5):404-11.

 

Jacob V, Chattopadhyay SK, Attipoe-Dorcoo S, et al. Permanent Supportive Housing with Housing First: Findings from a Community Guide Systematic Economic Review. American Journal of Preventive Medicine 2022;62(3):e188−e201.

Effectiveness Review

• Logic Model
• Text Description

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

• Logic Model
• Text Description

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Effectiveness Review

Summary Evidence Table – Effectiveness Review

Economic Review

Summary Evidence Table – Economic Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Appel PW, Tsemberis S, Joseph H, Stefancic A, Lambert-Wacey D. Housing First for severely mentally ill homeless methadone patients. Journal of Addictive Diseases 2012;31(3):270-7.

Brown MM, Jason LA, Malone DK, Srebnik D, Sylla L. Housing First as an effective model for community stabilization among vulnerable individuals with chronic and nonchronic homelessness histories. Journal of Community Psychology 2016;44(3):384-90.

Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. AJPH 2009;99(S3):S675-80.

Cherner RA, Aubry T, Sylvestre J, Boyd R, Pettey D. Housing First for adults with problematic substance use. Journal of Dual Diagnosis 2017;13(3):219-29.

Clark C, Rich AR. Outcomes of homeless adults with mental illness in a housing program and in case management only. Journal of Psychiatric Services 2003;54(1):78-83.

Crisanti AS, Duran D, Greene RN, Reno J, Luna-Anderson C, Altschul DB. A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population. Journal of Psychiatric Services 2017;14(2):141.

Gabrielian S, Yuan AH, Andersen RM, Gelberg L. Diagnoses treated in ambulatory care among homeless-experienced veterans: does supported housing matter? Journal of Primary Care Community Health 2016;7(4):281-7.

Gilmer TP, Manning WG, Ettner SL. A cost analysis of San Diego County’s REACH program for homeless persons. Journal of Psychiatric Services 2009;60(4):445-50.

Goering P, Veldhulzen S, Watson A, et al. National At Home/Chez Soi final report. Calgary: AB: Mental Health Commission of Canada;2014.

Hanratty M. Impacts of Heading Home Hennepin’s Housing First programs for long-term homeless adults. Housing Policy Debate 2011;21(3):405-19.

Kennedy DP, Osilla KC, Hunter SB, Golinelli D, Maksabedian Hernandez E, Tucker JS. A pilot test of a motivational interviewing social network intervention to reduce substance use among housing first residents. Journal of Substance Abuse Treatment 2018;86:36-44.

Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program. Journal of Urban Health 2006;83(5):860-73.

Larimer ME, Malone DK, Garner MD, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA 2009;301(13):1349-57.

Mares AS, Rosenheck RA. A comparison of treatment outcomes among chronically homelessness adults receiving comprehensive housing and health care services versus usual local care. Journal of Administration Policy in Mental Health 2011;38(6):459-75.

Montgomery AE, Hill LL, Kane V, Culhane DP. Housing chronically homeless veterans: evaluating the efficacy of a Housing First approach to HUD-VASH. Journal of Community Psychology 2013;41(4):505-14.

Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Mental Health Journal 2011;47(2):227-32.

Pankratz C, Nelson G, Morrison M. A quasi-experimental evaluation of rent assistance for individuals experiencing chronic homelessness. Journal of Community Psychology 2017;45(8):1065-79.

Rosenheck R, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless persons with mental illness. Journal of Archives of General Psychiatry 2003;60(9):940-51.

Schwarcz SK, Hsu LC, Vittinghoff E, Vu A, Bamberger JD, Katz MH. Impact of housing on the survival of persons with AIDS. BMC Public Health 2009;9(1):220.

Shinn M, Samuels J, Fischer SN, Thompkins A, Fowler PJ. Longitudinal impact of a family critical time intervention on children in high-risk families experiencing homelessness: a randomized trial. American Journal of Community Psychology 2015;56(3-4):205-16.

Srebnik D, Connor T, Sylla L. A pilot study of the impact of housing first supported housing for intensive users of medical hospitalization and sobering services. AJPH 2013;103(2):316-21.

Stefancic A, Tsemberis S. Housing First for long-term shelter dwellers with psychiatric disabilities in a suburban county: a four-year study of housing access and retention. Journal of Primary Prevention 2007;28(3-4):265-79.

Tsemberis S. From streets to homes: an innovative approach to supported housing for homeless adults with psychiatric disabilities. Journal of Community Psychology 1999;27(2):225-41.

Tsemberis S, Eisenberg RF. Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services 2000;51(4):487-93.

Tsemberis S, Gulcur L, Nakae M. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. AJPH 2004;94(4):651-6.

Wolitski RJ, Kidder DP, Pals SL, et al. Randomized trial of the effects of housing assistance on the health and risk behaviors of homeless and unstably housed people living with HIV. AIDS Behavior 2010;14(3):493-503.

Additional Studies Providing Information for Included Studies

Adair CE, Kopp B, Distasio J, et al. Housing quality in a randomized controlled trial of Housing First for homeless individuals with mental illness: correlates and associations with outcomes. Journal of Urban Health 2016;93(4):682-97.

Aquin JP, Roos LE, Distasio J, et al. Effect of Housing First on suicidal behaviour: a randomised controlled trial of homeless adults with mental disorders. Canadian Journal of Psychiatry 2017;62(7):473-81.

Aubry T, Goering P, Veldhuizen S, et al. A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatric Services 2016;67(3):275-81.

Aubry T, Nelson G, Tsemberis S. Housing first for people with severe mental illness who are homeless: a review of the research and findings from the at home chez soi demonstration project. Canadian Journal of Psychiatry 2015;60(11):467-74.

Aubry T, Tsemberis S, Adair CE, et al. One-year outcomes of a randomized controlled trial of housing first with ACT in five Canadian cities. Psychiatric Services 2015;66(5):463-9.

Bourque J, VanTil L, Gibbons C, et al. Impact of a Housing First intervention on homeless Veterans with mental illness: a Canadian multisite randomized controlled trial. Journal of Military, Veteran Family Health 2015;1(2):52-60.

Cheng A-L, Lin H, Kasprow W, Rosenheck RA. Impact of supported housing on clinical outcomes analysis of a randomized trial using multiple imputation technique. Journal of Nervous Mental Disease 2007;195(1):83.

Cheung A, Somers JM, Moniruzzaman A, et al. Emergency department use and hospitalizations among homeless adults with substance dependence and mental disorders. Addiction Science and Clinical Practice 2015;10(1):17.

Chung TE, Gozdzik A, Palma Lazgare LI, et al. Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial. International Journal of Geriatric Psychiatry 2018;33(1):85-95.

Currie LB, Patterson ML, Moniruzzaman A, McCandless LC, Somers JM. Continuity of care among people experiencing homelessness and mental illness: does community follow-up reduce rehospitalization? Health Services Research 2018;53(5):3400-15.

Fischer SN, Shinn M, Shrout P, Tsemberis S. Homelessness, mental illness, and criminal activity: examining patterns over time. American Journal of Community Psychology 2008;42(3-4):251.

Gabrielian S, Yuan AH, Andersen RM, Rubenstein LV, Gelberg L. VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Medical Care 2014;52(5):454.

Greenwood RM, Schaefer-McDaniel NJ, Winkel G, Tsemberis SJ. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology 2005;36(3-4):223-8.

Gulcur L, Stefancic A, Shinn M, Tsemberis S, Fischer SN. Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. Journal of Community Applied Social Psychology 2003;13(2):171-86.

Gulcur L, Tsemberis S, Stefancic A, Greenwood RM. Community integration of adults with psychiatric disabilities and histories of homelessness. Community Mental Health Journal 2007;43(3):211-28.

Henwood BF, Stefancic A, Petering R, Schreiber S, Abrams C, Padgett DK. Social relationships of dually diagnosed homeless adults following enrollment in Housing First or traditional treatment services. Journal of the Society for Social Work Research 2015;6(3):385-406.

Kirst M, Zerger S, Misir V, Hwang S, Stergiopoulos V. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence 2015;146:24-29.

Kozloff N, Adair CE, Lazgare LIP, et al. “Housing first” for homeless youth with mental illness. Pediatrics 2016;138(4):e20161514.

Macnaughton E, Townley G, Nelson G, et al. How does Housing First catalyze recovery? Qualitative findings from a Canadian multi-site randomized controlled trial. American Journal of Psychiatric Rehabilitation 2016;19(2):136-59.

Nelson G, Patterson M, Kirst M, et al. Life changes among homeless persons with mental illness: a longitudinal study of Housing First and usual treatment. Psychiatric Services 2015;66(6):592-7.

O’Campo P, Stergiopoulos V, Nir P, et al. How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial. BMJ Open 2016;6(9):e010581.

O’Connell MJ, Kasprow W, Rosenheck R. Direct placement versus multistage models of supported housing in a population of veterans who are homeless. Psychological Services 2009;6(3):190.

O’Connell MJ, Kasprow W, Rosenheck RA. Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans. Psychiatric Services 2008;59(3):268-75.

O’Connell MJ, Kasprow WJ, Rosenheck R. Impact of supported housing on social relationships among homeless veterans. Psychiatric Services 2017;68(2):203-6.

O’Connell MJ, Kasprow WJ, Rosenheck RA. Differential impact of supported housing on selected subgroups of homeless veterans with substance abuse histories. Psychiatric Services 2012;63(12):1195-205.

Padgett DK, Gulcur L, Tsemberis S. Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice 2006;16(1):74-83.

Parpouchi M, Moniruzzaman A, McCandless L, Patterson M, Somers JM. Housing first and unprotected sex: A structural intervention. Journal of Health Care for the Poor and Underserved 2016;27(3):1278-302.

Patterson M, Moniruzzaman A, Palepu A, et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Social Psychiatry and Psychiatric Epidemiology 2013;48(8):1245-59.

Patterson ML, Rezansoff S, Currie L, Somers JM. Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of Housing First: a longitudinal, narrative analysis. BMJ Open 2013b;3(9):e003442.

Poremski D, Hwang SW. Willingness of housing first participants to consider supported-employment services. Psychiatric Services 2016;67(6):667-70.

Rezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Procyshyn R, Somers JM. Housing first improves adherence to antipsychotic medication among formerly homeless adults with schizophrenia: results of a randomized controlled trial. Schizophrenia Bulletin 2016;43(4):852-61.

Russolillo A, Patterson M, McCandless L, Moniruzzaman A, Somers J. Emergency department utilisation among formerly homeless adults with mental disorders after one year of Housing First interventions: a randomised controlled trial. International Journal of Housing Policy 2014;14(1):79-97.

Somers JM, Moniruzzaman A, Palepu A. Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care. Addiction 2015;110(10):1605-14.

Somers JM, Moniruzzaman A, Patterson M, et al. A randomized trial examining housing first in congregate and scattered site formats. PLOS One 2017;12(1):e0168745.

Somers JM, Rezansoff SN, Moniruzzaman A, Palepu A, Patterson M. Housing First reduces re-offending among formerly homeless adults with mental disorders: results of a randomized controlled trial. PLoS One 2013;8(9):e72946.

Stergiopoulos V, Gozdzik A, Misir V, et al. Effectiveness of housing first with intensive case management in an ethnically diverse sample of homeless adults with mental illness: a randomized controlled trial. PLoS One 2015b;10(7):e0130281.

Stergiopoulos V, Gozdzik A, Misir V, et al. The effectiveness of a Housing First adaptation for ethnic minority groups: findings of a pragmatic randomized controlled trial. BMC Public Health 2016;16(1):1110.

Stergiopoulos V, Hwang SW, Gozdzik A, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA 2015a;313(9):905-15.

Urbanoski K, Veldhuizen S, Krausz M, et al. Effects of comorbid substance use disorders on outcomes in a Housing First intervention for homeless people with mental illness. Addiction 2018;113(1):137-45.

Economic Review

Basu A, Kee R, Buchanan D, Sadowski LS. Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care. Health Serv Res 2012;47(1 Pt 2):523-43.

Byrne T, Roberts CB, Culhane DP, Kane V. Estimating cost savings associated with HUD-VASH placement. VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs; 2014. Available from URL: https://www.va.gov/HOMELESS/Estimating_Cost_Savings_Associated_With_HUD_VASH_Placement.pdf [Accessed June 26, 2020]

Culhane DP, Metraux S, Hadley TR. The impact of supportive housing for homeless people with severe mental illness on the utilization of the public health, corrections, and emergency shelter systems: the New York-New York Initiative. Housing Policy Debate 2002;13(1).

Flaming D, Lee S, Burns P, Sumner G. Getting home: outcomes from housing high cost homeless hospital patients. Economic Roundtable and Corporation for Supportive Housing; 2013. Available from URL: https://www.csh.org/wp-content/uploads/2013/09/Getting_Home_2013.pdf [Accessed June 26, 2020]

Flaming D, Burns P, Matsunaga M, Sumner G, Moreno MH. Where we sleep: costs when homeless and housed in Los Angeles. Economic Roundtable; 2009. Available from URL: https://shnny.org/uploads/Where_We_Sleep.pdf [Accessed June 26, 2020]

Gilmer TP, Manning WG, Ettner SL. A cost analysis of San Diego County’s REACH program for homeless persons. Psychiatr Serv 2009;60(4):445-50.

Gilmer TP, Stefancic A, Ettner SL, Manning WG, Tsemberis S. Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Arch Gen Psychiatry 2010;67(6):645-52.

Gilmer TP, Stefancic A, Tsemberis S, Ettner SL. Full-service partnerships among adults with serious mental illness in California: impact on utilization and costs. Psychiatr Serv 2014;659):1120-5.

Gilmer TP. Permanent supportive housing for transition-age youths: service costs and fidelity to the housing first model. Psychiatr Serv 2016;67(6): 615-21.

Goering P, Veldhuizen S, Watson A, Adair C, Kopp B, Latimer E, et al. National At Home/Chez Soi Final Report. Calgary (AB): Mental Health Commission of Canada;2014. Available from URL: https://www.mentalhealthcommission.ca/sites/default/files/mhcc_at_home_report_national_cross-site_eng_2_0.pdf [Accessed June 26, 2020]

Holtgrave DR, Wolitski RJ, Pals SL, Aidala A, Kidder DP, et al. Cost-utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV. AIDS Behav 2013;17(5):1626-31.

Larimer ME, Malone DK, Garner MD, Atkins DC, Burlingham B, et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA 2009;301(13):1349-57.

Latimer EA, Rabouin D, Cao Z, Ly A, Powell G, et al. Cost-effectiveness of housing first intervention with intensive case management compared with treatment as usual for homeless adults with mental illness: secondary analysis of a randomized clinical trial. JAMA Netw Open 2019;2(8):e199782.

Lim S, Gao Q, Stazesky E, Singh TP, Harris TG, et al. Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness. BMC Health Serv Res 2018;18(1):15.

Patterson M, Somers JM, McIntosh K, Shiell A, Frankish CJ. Housing and support for adults with severe addictions and/or mental illness in British Columbia. Centre For Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University;2008. Available from URL: http://summit.sfu.ca/item/11157 [Accessed June 26, 2020]

Rosenheck R, et al. Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry 2003;60(9):940-51.

Schinka JA, Francis E, Hughes P, LaLOne L, Flynn C. Comparative outcomes and costs of inpatient care and supportive housing for substance-dependent veterans. Psychiatr Serv 1998;49(7):946-50.

Seligson AL, Lim S, Singh T, Laganis E, Stazesky E, et al. New York/New York III supportive housing evaluation: interim utilization and cost analysis. A report from the New York City Department of Health and Mental Hygiene in collaboration with the New York City Human Resources Administration and the New York State Office of Mental Health; 2013. Available from URL: https://shnny.org/images/uploads/NY-NY-III-Interim-Report.pdf [Accessed June 26, 2020]

Srebnik D, Connor T, Sylla L. A pilot study of the impact of housing first-supported housing for intensive users of medical hospitalization and sobering services. Am J Public Health 2013;103(2):316-21.

Toros H, Stevens M, Moreno M. Project 50: the cost effectiveness of the permanent supportive housing model in the skid row section of Los Angeles County. Research and Evaluation Services, Service Integration Branch, County of Los Angeles Chief Executive Office; 2012. Available from URL: http://zevyaroslavsky.org/wp-content/uploads/Project-50-Cost-Effectiveness-report-FINAL-6-6-12.pdf [Accessed June 26, 2020]

Related Reviews and Recommendations

• The CPSTF identified a recent review that examined the effectiveness of permanent supportive housing, which reaches conclusions similar to those reached here.
  • National Academies of Sciences, Engineering, and Medicine, 2018. Permanent supportive housing: evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. National Academies Press

Implementation Resource

Rural Health Information Hub, Social Determinants of Health in Rural Communities Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of programs to address social determinants of health in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Approaches for Improving Rural Housing Affordability

Effectiveness Review

CDC Librarians searched databases shown in the table through February.

Publications were included in the body of evidence if they met all of the following inclusion criteria:

• Published in peer reviewed literature or government reports
• Published in English
• Conducted in the United States or Canada
• Assessed permanent supportive housing with housing first
• Had concurrent comparison population
• Assessed one or more of the specified outcomes:
  • Housing: homelessness and housing stability
  • Health outcomes: physical health, mental health, substance use, HIV/AIDS-related health, wellness
  • Health service utilization: hospital, ED, clinic, substance treatment

Publications were excluded from the body of evidence if they met one of the following exclusion criteria:

• Pre- post-only study design (i.e. without a comparison population)
• Dissertations or conference abstracts

PubMed

((“housing first”[All Fields] OR “stable housing”[All Fields]) OR “supportive housing”[All Fields]) OR “supported housing”[All Fields]

AND

(“lesson” or “lessons” OR evaluat*[text] OR “outcome”[text] OR “outcomes”[text] or “effect” or “effects” or “effective”)

AND

“Andorra” Or “Antigua” or “Aruba” or “Australia” or “Austria” or “Bahamas” or “Bahrain” or “Barbados” or “Barbuda” or “Belgium” or “Bermuda” or “Brunei” or “Caicos” or “Canada” or “Cayman Islands” or “Channel Islands” or “Chile” or “Croatia” or “Curacao” or “Cyprus” or “Czech Republic” or “Darussalam” or “Denmark” or “England” or “Equatorial Guinea” or “Estonia” or “Faeroe Islands” or “Finland” or “France” or “French Polynesia” or “Germany” or “Greece” or “Greenland” or “Guam” or “Hong Kong” or “Iceland” or “Ireland” or “Isle of Man” or “Israel” or “Italy” or “Japan” or “Korea” or “Kuwait” or “Latvia” or “Liechtenstein” or “Lithuania” or “Luxembourg” or “Macao” or “Malta” or “Monaco” or “Netherlands” or “Netherlands Antilles” or “Nevis” or “New Caledonia” or “New Zealand” or “Northern Ireland” or “Northern Mariana Islands” or “Norway” or “Oman” or “Poland” or “Portugal” or “Puerto Rico” or “Qatar” or “Republic of Korea” or “Russia” or “Russian Federation” or “Saint Kitts” or “Saint Maarten” or “Saint Martin” or “San Marino” or “Saudi Arabia” or “Scotland” or “Singapore” or “Sint Maarten” or “Slovak Republic” or “Slovakia” or “Slovenia” or “Spain” or “St. Kitts” or “St. Martin” or “Sweden” or “Switzerland” or “Tobago” or “Trinidad” or “Trinidad” or “Turks” or “United Arab Emirates” or “United States” or “Uruguay” or “Wales”

Scopus

( ( ( TITLE-ABS-KEY ( “housing ready” ) ) OR ( TITLE-ABS-KEY ( “supported housing” ) ) OR ( TITLE-ABS-KEY ( “housing first” ) ) ) AND ( study OR evidence OR pilot OR intervention OR program* OR improv* OR increas* OR decreas* OR lessons OR success* OR effect* OR efficacious OR comparison OR randomized OR trial ) )

AND

“Andorra” Or “Antigua” or “Aruba” or “Australia” or “Austria” or “Bahamas” or “Bahrain” or “Barbados” or “Barbuda” or “Belgium” or “Bermuda” or “Brunei” or “Caicos” or “Canada” or “Cayman Islands” or “Channel Islands” or “Chile” or “Croatia” or “Curacao” or “Cyprus” or “Czech Republic” or “Darussalam” or “Denmark” or “England” or “Equatorial Guinea” or “Estonia” or “Faeroe Islands” or “Finland” or “France” or “French Polynesia” or “Germany” or “Greece” or “Greenland” or “Guam” or “Hong Kong” or “Iceland” or “Ireland” or “Isle of Man” or “Israel” or “Italy” or “Japan” or “Korea” or “Kuwait” or “Latvia” or “Liechtenstein” or “Lithuania” or “Luxembourg” or “Macao” or “Malta” or “Monaco” or “Netherlands” or “Netherlands Antilles” or “Nevis” or “New Caledonia” or “New Zealand” or “Northern Ireland” or “Northern Mariana Islands” or “Norway” or “Oman” or “Poland” or “Portugal” or “Puerto Rico” or “Qatar” or “Republic of Korea” or “Russia” or “Russian Federation” or “Saint Kitts” or “Saint Maarten” or “Saint Martin” or “San Marino” or “Saudi Arabia” or “Scotland” or “Singapore” or “Sint Maarten” or “Slovak Republic” or “Slovakia” or “Slovenia” or “Spain” or “St. Kitts” or “St. Martin” or “Sweden” or “Switzerland” or “Tobago” or “Trinidad” or “Trinidad” or “Turks” or “United Arab Emirates” or “United States” or “Uruguay” or “Wales”

Embase (Ovid) and PsycINFO (Ovid)

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(supported housing or supportive housing or housing first or stable housing).mp.

2
housing ready.mp.

3
1 or 2

4
(lessons or outcome* or study or studies or assess* or evaluat* or effect* or improv* or increas* or decreas* or intervention* or program* or pilot or longitudinal or cohort or randomi?ed or evidence).mp.

5
(success* or comparison* or comparative or trial or trials).mp.

6
4 or 5

7
systematic review.mp. or review*.ti.

8
6 or 7

9
3 and 8

10
9 AND
“Andorra” Or “Antigua” or “Aruba” or “Australia” or “Austria” or “Bahamas” or “Bahrain” or “Barbados” or “Barbuda” or “Belgium” or “Bermuda” or “Brunei” or “Caicos” or “Canada” or “Cayman Islands” or “Channel Islands” or “Chile” or “Croatia” or “Curacao” or “Cyprus” or “Czech Republic” or “Darussalam” or “Denmark” or “England” or “Equatorial Guinea” or “Estonia” or “Faeroe Islands” or “Finland” or “France” or “French Polynesia” or “Germany” or “Greece” or “Greenland” or “Guam” or “Hong Kong” or “Iceland” or “Ireland” or “Isle of Man” or “Israel” or “Italy” or “Japan” or “Korea” or “Kuwait” or “Latvia” or “Liechtenstein” or “Lithuania” or “Luxembourg” or “Macao” or “Malta” or “Monaco” or “Netherlands” or “Netherlands Antilles” or “Nevis” or “New Caledonia” or “New Zealand” or “Northern Ireland” or “Northern Mariana Islands” or “Norway” or “Oman” or “Poland” or “Portugal” or “Puerto Rico” or “Qatar” or “Republic of Korea” or “Russia” or “Russian Federation” or “Saint Kitts” or “Saint Maarten” or “Saint Martin” or “San Marino” or “Saudi Arabia” or “Scotland” or “Singapore” or “Sint Maarten” or “Slovak Republic” or “Slovakia” or “Slovenia” or “Spain” or “St. Kitts” or “St. Martin” or “Sweden” or “Switzerland” or “Tobago” or “Trinidad” or “Trinidad” or “Turks” or “United Arab Emirates” or “United States” or “Uruguay” or “Wales”

Sociological Abstracts (ProQuest), ERIC (ProQuest)

((“supportive housing” OR “supported housing” OR “housing first” OR “housing ready” OR “stable housing”) AND (lessons or outcome* or study or studies or assess* or evaluat* or effect* or improv* or increas* or decreas* or intervention* or program* or pilot or longitudinal or cohort or randomized or evidence or “systematic review” or success* or comparison* or comparative or trial or trials or failure)) OR ((“supportive housing” OR “supported housing” OR “housing first” OR “housing ready” OR “stable housing”) AND ti(review))

AND

“Andorra” Or “Antigua” or “Aruba” or “Australia” or “Austria” or “Bahamas” or “Bahrain” or “Barbados” or “Barbuda” or “Belgium” or “Bermuda” or “Brunei” or “Caicos” or “Canada” or “Cayman Islands” or “Channel Islands” or “Chile” or “Croatia” or “Curacao” or “Cyprus” or “Czech Republic” or “Darussalam” or “Denmark” or “England” or “Equatorial Guinea” or “Estonia” or “Faeroe Islands” or “Finland” or “France” or “French Polynesia” or “Germany” or “Greece” or “Greenland” or “Guam” or “Hong Kong” or “Iceland” or “Ireland” or “Isle of Man” or “Israel” or “Italy” or “Japan” or “Korea” or “Kuwait” or “Latvia” or “Liechtenstein” or “Lithuania” or “Luxembourg” or “Macao” or “Malta” or “Monaco” or “Netherlands” or “Netherlands Antilles” or “Nevis” or “New Caledonia” or “New Zealand” or “Northern Ireland” or “Northern Mariana Islands” or “Norway” or “Oman” or “Poland” or “Portugal” or “Puerto Rico” or “Qatar” or “Republic of Korea” or “Russia” or “Russian Federation” or “Saint Kitts” or “Saint Maarten” or “Saint Martin” or “San Marino” or “Saudi Arabia” or “Scotland” or “Singapore” or “Sint Maarten” or “Slovak Republic” or “Slovakia” or “Slovenia” or “Spain” or “St. Kitts” or “St. Martin” or “Sweden” or “Switzerland” or “Tobago” or “Trinidad” or “Trinidad” or “Turks” or “United Arab Emirates” or “United States” or “Uruguay” or “Wales”

Cochrane

“housing first” OR “stable housing” OR “supportive housing” OR “supported housing”

Campbell

Keyword or Title

“housing first” OR “stable housing” OR “supportive housing” OR “supported housing”

[above strategy gave 0 (zero) results so housing was searched by itself]

Housing

HUD.gov Online Library Research – Housing for Special Needs

Mental illness

Chronic homelessness

Evaluation

Frail elderly

Veterans

Homeless youth

Supportive housing

Incarceration

Long-term homelessness

Economic Review

In November 2019, a research librarian used the terms listed below to search the following databases: PubMed, Scopus, Embase, PsycINFO, Sociological Abstracts, ERIC, EconLit, Cochrane, Campbell, HUD, and NTIS. The search period covered 1985 (date of database inception for EconLit) through November 2019.

The search was limited to high income countries as defined by the World Bank. The review team also screened reference lists of included studies and consulted subject matter experts about additional studies that may have been missed. Search terms and strategies were adjusted for each database, based on controlled and uncontrolled vocabularies and software.

Database: PubMed

Date Searched : 11/26/2019
Results: 95

Search Strategy:
(((((((lesson[Text Word] OR lessons[Text Word])) OR evaluate*[Text Word]) OR (outcome[Text Word] OR outcomes[Text Word])) OR (effect[Text Word] OR effects[Text Word] OR effective[Text Word]))) AND (((((“stable housing”) OR “housing first”) OR “stable housing”) OR “supportive housing”) OR “supported housing”)) AND (((economic) OR cost effectiveness) OR cost)

AND ( ( “1985/01/01″[PDat] : “3000/12/31″[PDat] ) AND English[lang])

((“housing first”[All Fields] OR “stable housing”[All Fields]) OR “supportive housing”[All Fields]) OR “supported housing”[All Fields]

AND

(“lesson” or “lessons” OR evaluat*[text] OR “outcome”[text] OR “outcomes”[text] or “effect” or “effects” or “effective”)

AND

Economic OR economic OR cost OR cost-effectiveness OR cost-benefit

AND

(“Andorra” or “Antigua” OR “Aruba” OR “Australia” OR “Austria” OR “Bahamas” OR “Bahrain” OR “Barbados” OR “Barbuda” Or “Belgium” Or “Bermuda” Or “Brunei” Or “Caicos” Or “Canada” Or “Cayman Islands” Or “Channel Islands” Or “Chile” Or “Croatia” Or “Curacao” Or “Cyprus” Or “Czech Republic” Or “Darussalam” OR “Denmark” OR England” OR “Equatorial Guinea” OR “Estonia” OR “Faeroe Islands” OR “Finland” OR “France” OR “French Polynesia” OR “Germany” OR “Greece” OR “Greenland” OR “Guam” OR “Hong Kong” OR “Iceland” OR “Ireland” OR “Isle Of Man” OR “Israel” OR “Italy” Or “Japan” Or “Korea” Or “Kuwait” Or “Latvia” Or “Liechtenstein” OR “Lithuania” OR “Luxembourg” OR “Macao” OR “Macau” OR “Malta” OR “Monaco” OR “Netherlands” OR “Netherlands Antilles” OR “Nevis” OR “New Caledonia” OR “New Zealand” Or “Northern Ireland” Or “Northern Mariana Islands” Or “Norway” Or “Oman” OR “Poland” Or “Portugal” Or “Puerto Rico” OR” Qatar” Or “Republic Of Korea” or “Russia” Or “Russian Federation” Or “Saint Kitts” Or “Saint Maarten” or “Saint Martin” or “San Marino” Or “Saudi Arabia” Or “Scotland” Or “Singapore” or “Sint Maarten” Or “Slovak Republic” Or “Slovakia” Or “Slovenia” or “Spain” Or “St. Kitts” Or “St. Martin” Or “Sweden” Or “Switzerland” Or “Tobago” or “Trinidad” or “Turks” or “United Arab Emirates” Or “United States” Or “Uruguay” or “Wales”)

Database: Scopus

Date Searched : 12/06/2019
Results: 40

Search Strategy:
( ( ( TITLE-ABS-KEY ( “housing ready” ) ) OR ( TITLE-ABS-KEY ( “supported housing” ) ) OR ( TITLE-ABS-KEY ( “housing first” ) ) ) AND ( study OR evidence OR pilot OR intervention OR program* OR improv* OR increas* OR decreas* OR lessons OR success* OR effect* OR efficacious OR comparison OR randomized OR trial ) )

AND

TITLE-ABS-KEY ( economic* OR cost OR cost-effectiveness OR cost-benefit )

AND

TITLE-ABS-KEY ( “Andorra” OR “Antigua” OR “Aruba” OR “Australia” OR “Austria” OR “Bahamas” OR “Bahrain” OR “Barbados” OR “Barbuda” OR “Belgium” OR “Bermuda” OR “Brunei” OR “Caicos” OR “Canada” OR “Cayman Islands” OR “Channel Islands” OR “Chile” OR “Croatia” OR “Curacao” OR “Cyprus” OR “Czech Republic” OR “Darussalam” OR “Denmark” OR “England” OR “Equatorial Guinea” OR “Estonia” OR “Faeroe Islands” OR “Finland” OR “France” OR “French Polynesia” OR “Germany” OR “Greece” OR “Greenland” OR “Guam” OR “Hong Kong” OR “Iceland” OR “Ireland” OR “Isle Of Man” OR “Israel” OR “Italy” OR “Japan” OR “Korea” OR “Kuwait” OR “Latvia” OR “Liechtenstein” OR “Lithuania” OR “Luxembourg” OR “Macao” OR “Macau” OR “Malta” OR “Monaco” OR “Netherlands” OR “Netherlands Antilles” OR “Nevis” OR “New Caledonia” OR “New Zealand” OR “Northern Ireland” OR “Northern Mariana Islands” OR “Norway” OR “Oman” OR “Poland” OR “Portugal” OR “Puerto Rico” OR “Qatar” OR “Republic Of Korea” OR “Russia” OR “Russian Federation” OR “Saint Kitts” OR “Saint Maarten” OR “Saint Martin” OR “San Marino” OR “Saudi Arabia” OR “Scotland” OR “Singapore” OR “Saint Maarten” OR “Slovak Republic” OR “Slovakia” OR “Slovenia” OR “Spain” OR “St. Kitts” OR “St. Martin” OR “Sweden” OR “Switzerland” OR “Tobago” OR “Trinidad” OR “Turks” OR “United Arab Emirates” OR “United States” OR “Uruguay” OR “Wales” )

Database: Embase (Ovid)

Date Searched: 11/26/2019
Results: 85

Search Strategy:
1 (supported housing or supportive housing or housing first or stable housing or housing ready).mp. 1316

2 (economic* or cost or cost-effectiveness or cost-benefit).mp. 1180729

3 (lessons or outcome* or study or studies or assess* or evaluat* or effect* or improv* or increas* or decreas* or intervention* or program* or pilot or longitudinal or cohort or randomi?ed or evidence).mp. 21216832

4 (success* or comparison* or comparative or trial or trials).mp. 5721742

5 3 or 4 21624534

6 systematic review.mp. or review*.ti. 619111

7 5 or 6 21714906

8 1 and 2 and 7 169

9 (Andorra or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark).mp. 578806

10 (England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle adj2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania).mp. 1410983

11 (Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic adj2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland).mp. 924172

12 (Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St adj2 Kitts) or (St adj2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales).mp. 1981504

13 9 or 10 or 11 or 12 4375637

14 8 and 13 86

15 limit 14 to yr=”1985 – 2019″ 86

16 limit 15 to english language 85

Database: PsycINFO (Ovid)

Date Searched : 12/03/2019
Results: 19

Search Strategy:
(supported housing or supportive housing or housing first or stable housing or housing ready).mp. 1219

2 (economic* or cost or cost-effectiveness or cost-benefit).mp. 179464

3 (lessons or outcome* or study or studies or assess* or evaluat* or effect* or improv* or increas* or decreas* or intervention* or program* or pilot or longitudinal or cohort or randomi?ed or evidence).mp. 3529832

4 (success* or comparison* or comparative or trial or trials).mp. 664734

5 3 or 4 3629569

6 systematic review.mp. or review*.ti. 158193

7 5 or 6 3673941

8 1 and 2 and 7 104

9 (Andorra or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark).mp. 98040

10 (England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle adj2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania).mp. 171625

11 (Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic adj2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland).mp. 265380

12 (Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St adj2 Kitts) or (St adj2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales).mp. 216467

13 9 or 10 or 11 or 12 681397

14 8 and 13 37

15 limit 14 to yr=”1985 – 2019″ 37

16 limit 15 to english language

Database: Sociological Abstracts (ProQuest)

Date Searched: 12/03/2019
Results: 839

Search Strategy:

(“supportive housing” OR “supported housing” OR “housing first” OR “housing ready” OR “stable housing”)

AND (economic* OR cost OR cost-effectiveness OR cost-benefit)

AND (lessons OR outcome* OR study OR studies OR assess* OR evaluat* OR effect* OR improv* OR increas* OR decreas* OR intervention* OR program* OR pilot OR longitudinal OR cohort OR randomized OR evidence OR “systematic review” OR success* OR comparison* OR comparative OR trial OR trials OR failure)

AND (Andorra OR Antigua OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Barbuda OR Belgium OR Bermuda OR Brunei OR Caicos OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Darussalam OR Denmark OR England OR “Equatorial Guinea” OR Estonia OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Macau OR Malta OR Monaco OR Netherlands OR “Netherlands Antilles” OR Nevis OR “New Caledonia” OR “New Zealand” OR “Northern Ireland” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR Puerto Rico OR Qatar OR “Republic Of Korea” OR Russia OR “Russian Federation” OR “Saint Kitts” OR “Saint Maarten” OR “Saint Martin” OR “San Marino” OR “Saudi Arabia” OR Scotland OR Singapore OR “Saint Maarten” OR “Slovak Republic” OR Slovakia OR Slovenia OR Spain OR “St. Kitts” OR “St. Martin” OR Sweden OR Switzerland OR Tobago OR Trinidad OR Turks OR “United Arab Emirates” OR “United States” OR Uruguay OR Wales)

OR

(“supportive housing” OR “supported housing” OR “housing first” OR “housing ready” OR “stable housing”)

AND (economic* OR cost OR “cost-effectiveness” OR “cost-benefit”)

AND ti(review)

AND (Andorra OR Antigua OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Barbuda OR Belgium OR Bermuda OR Brunei OR Caicos OR Canada OR “Cayman Islands” OR “Channel Islands” OR Chile OR Croatia OR Curacao OR Cyprus OR “Czech Republic” OR Darussalam OR Denmark OR England OR “Equatorial Guinea” OR Estonia OR “Faeroe Islands” OR Finland OR France OR “French Polynesia” OR Germany OR Greece OR Greenland OR Guam OR “Hong Kong” OR Iceland OR Ireland OR “Isle Of Man” OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Macau OR Malta OR Monaco OR Netherlands OR “Netherlands Antilles” OR Nevis OR “New Caledonia” OR “New Zealand” OR “Northern Ireland” OR “Northern Mariana Islands” OR Norway OR Oman OR Poland OR Portugal OR Puerto Rico OR Qatar OR “Republic Of Korea” OR Russia OR “Russian Federation” OR “Saint Kitts” OR “Saint Maarten” OR “Saint Martin” OR “San Marino” OR “Saudi Arabia” OR Scotland OR Singapore OR “Saint Maarten” OR “Slovak Republic” OR Slovakia OR Slovenia OR Spain OR “St. Kitts” OR “St. Martin” OR Sweden OR Switzerland OR Tobago OR Trinidad OR Turks OR “United Arab Emirates” OR “United States” OR Uruguay OR Wales))

Database: ERIC

Date Searched : 12/03/2019
Results: 14

Search Strategy:
(“supportive housing” OR “supported housing” OR “housing first” OR “housing ready” OR “stable housing”) AND (economic* OR cost OR “cost-effectiveness” OR “cost-benefit”)

Limit to English

Database: EconLit (EBSCO)

Date Searched: 12/06/2019
Results: 52

Search Strategy:
AB (housing first OR stable housing OR supportive housing OR supported housing) OR TI (housing first OR stable housing OR supportive housing OR supported housing)

AND

AB (economic* OR cost OR cost-effectiveness OR cost-benefit) OR TI (economic* OR cost OR cost-effectiveness OR cost-benefit )

AND

(Andorra OR Antigua OR Aruba OR Australia OR Austria OR Bahamas OR Bahrain OR Barbados OR Barbuda OR Belgium OR Bermuda OR Brunei OR Caicos OR Canada OR Cayman Islands OR Channel Islands OR Chile OR Croatia OR Curacao OR Cyprus OR Czech Republic OR Darussalam OR Denmark OR England OR Equatorial Guinea OR Estonia OR Faeroe Islands OR Finland OR France OR French Polynesia OR Germany OR Greece OR Greenland OR Guam OR Hong Kong OR Iceland OR Ireland OR Isle Of Man OR Israel OR Italy OR Japan OR Korea OR Kuwait OR Latvia OR Liechtenstein OR Lithuania OR Luxembourg OR Macao OR Macau OR Malta OR Monaco OR Netherlands OR Netherlands Antilles OR Nevis OR New Caledonia OR New Zealand OR Northern Ireland OR Northern Mariana Islands OR Norway OR Oman OR Poland OR Portugal OR Puerto Rico OR Qatar OR Republic Of Korea OR Russia OR Russian Federation OR Saint Kitts OR Saint Maarten OR Saint Martin OR San Marino OR Saudi Arabia OR Scotland OR Singapore OR Saint Maarten OR Slovak Republic OR Slovakia OR Slovenia OR Spain OR St. Kitts OR St. Martin OR Sweden OR Switzerland OR Tobago OR Trinidad OR Turks OR United Arab Emirates OR United States OR Uruguay OR Wales)

Database: Cochrane

Date Searched: 12/09/2019
Results: 38

Search Strategy:

“housing first” OR “stable housing” OR “supportive housing” OR “supported housing”

AND

economic* OR cost OR “cost-effectiveness” OR “cost-benefit”

Database: Campbell

Date Searched: 12/10/2019
Results: 2

Search Strategy:

Keyword or Title

“housing first” OR “stable housing” OR “supportive housing” OR “supported housing”

[above strategy gave 0 (zero) results so housing was searched by itself]

Housing AND Economic terms

Database: HUD.gov

Date Searched: 12/10/2019
Results: 2

Search Strategy:

Mental illness

Chronic homelessness

Evaluation

Frail elderly

Veterans

Homeless youth

Supportive housing

Incarceration

Long-term homelessness

Database: NTIS (EBSCO)

Date Searched: 12/10/2019
Results: 45

Search Strategy:

S1 AND S2 Limiters – Published Date: 19850101-20131231

Database – NTIS 45

S3 S1 AND S2

S2 TI ( (economic* OR cost OR cost-effectiveness OR cost-benefit) ) OR AB ( (economic* OR cost OR cost-effectiveness OR cost-benefit) ) Expanders – Apply equivalent subjects

S1 TI ( (housing first OR stable housing OR supportive housing OR supported housing) ) OR AB ( (housing first OR stable housing OR supportive housing OR supported housing) )

Henry M, Watt R, Rosenthal L, Shivji A. 2017 Annual Homeless Assessment Report (AHAR) to Congress: Part 2- Estimates of Homelessness in the United States. U.S. Department of Housing and Urban Development (HUD); Washington (DC): 2018.

National Academies of Sciences, Engineering, and Medicine. Permanent supportive housing: evaluating the evidence for improving health outcomes among people experiencing chronic homelessness. National Academies Press; Washington (DC): 2018.

The following considerations for implementation are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Community institutions may be resistant to providing programs for people who are not “housing ready.”
• Landlords may not accept low-income tenants with subsidized housing. Unless there are regulations preventing this type of discrimination, landlords may reject rental applications from program participants.
• People experiencing homelessness and living with disabling conditions commonly have diverse needs. Housing First programs can benefit from collaboration among agencies and coordination of services.
• Funding can be a challenge. Currently, there is no coordinated, single source of funding for Housing First programs.

Healthy People 2030

Healthy People 2030 includes the following objective related to this CPSTF recommendation.

• Reduce the proportion of families that spend more than 30 percent of income on housing — SDOH‑04