title: Association of housing first implementation and key outcomes among homeless persons with problematic substance use.
abstract: OBJECTIVE
  Housing First is a supportive housing model for persons with histories of chronic homelessness that emphasizes client-centered services, provides immediate housing, and does not require treatment for mental illness or substance abuse as a condition of participation. Previous studies of Housing First have found reduced governmental costs and improved personal well-being among participants. However, variations in real-world program implementation require better understanding of the relationship between implementation and outcomes. This study investigated the effects of Housing First implementation on housing and substance use outcomes.
  
  
  METHODS
  Study participants were 358 individuals with histories of chronic homelessness and problematic substance use. Clients were housed in nine scatter-site Housing First programs in New York City. Program fidelity was judged across a set of core Housing First components. Client interviews at baseline and 12 months were used to assess substance use.
  
  
  RESULTS
  Clients in programs with greater fidelity to consumer participation components of Housing First were more likely to be retained in housing and were less likely to report using stimulants or opiates at follow-up.
  
  
  CONCLUSIONS
  Consistently implemented Housing First principles related to consumer participation were associated with superior housing and substance use outcomes among chronically homeless individuals with a history of substance use problems. The study findings suggest that program implementation is central to understanding the potential of Housing First to help clients achieve positive housing and substance use outcomes.
authors.affiliation: Ms. Davidson, Dr. Neighbors, Dr. Hall, Dr. Hogue, and Dr. Morgenstern are with the Division of Health and Treatment Research and Analysis, National Center on Addiction and Substance Abuse (CASAColumbia), Columbia University (e-mail: clare.e.davidson@gmail.com ). Dr. Morgenstern is also with the Department of Psychiatry, Columbia University Medical Center, New York City. Mr. Cho is with the United States Interagency Council on Homelessness, Washington, D.C. Mr. Kutner is a consultant with the Corporation for Supportive Housing, New York City.
authors.forename: Clare
authors.initials: C
authors.lastname: Davidson
authors.forename: Charles
authors.initials: C
authors.lastname: Neighbors
authors.forename: Gerod
authors.initials: G
authors.lastname: Hall
authors.forename: Aaron
authors.initials: A
authors.lastname: Hogue
authors.forename: Richard
authors.initials: R
authors.lastname: Cho
authors.forename: Bryan
authors.initials: B
authors.lastname: Kutner
authors.forename: Jon
authors.initials: J
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015397:Program Evaluation; D011638:Public Housing; D012946:Social Welfare; D019966:Substance-Related Disorders / Q000453:epidemiology*