CASE 11.2 Housing First In the early 1990s, most programs that were working to alleviate homelessness in American cities followed a similar model. Homeless men and women could visit shelters but could not obtain permanent hous- ing until they proved themselves "housing ready." That required abstaining from drugs and alcohol and under- going treatment for mental illness (Greenwood et al., 2013). Some preferred to live on the streets rather than experience conditions in the shelters, which were not necessarily conducive to making the changes that were expected. Many would go through an "institu- tional cycle" of hospitals, shelters, and jails and end up chronically homeless (Greenwood et al., 2013, p. 648). In 1992, Sam Tsemberis, a psychologist working in New York, decided the prevailing model had things backward. The way to eliminate homelessness was to place people in homes. Tsemberis's thinking was based on Maslow's hierarchy of needs. If an individual's need for shelter and security could be met, that person then could focus on addressing other problems. If homeless people could be placed in housing first, they would be in a more stable situation in which to receive the ser- vices they needed to overcome their illnesses, return to school, find employment, and rebuild their lives (Cul- hane, 2016). The only requirement for housing would be that the individual agree to a weekly check-in by a team, led by a peer mentor (Greenwood et al., 2013). Most experts were skeptical about the idea, but Tsem- beris decided to test it. The nonprofit he founded to do so was Pathways to Housing, and his new approach became known as Housing First (McCoy, 2015). Since 1992, Housing First has been adopted in cities across the United States and in other countries, with dramatic results. By 2015, Utah reported that it had nearly eliminated chronic homelessness using the Housing First model. Phoenix and New Orleans reported eliminating homelessness among veterans (McCoy, 2015). The U.S. government has adopted Housing First as official policy, and the Department of Veterans Affairs reported that the model has achieved a sharp decline in homeless veterans across the country (Culhane, 2016). As described by Philip Mangano, a national expert on homelessness, Housing First "has moved us from managing to ending; from enabling to engaging; from funding to investing; from inputs to outcome; beyond programs to consumer; from shelter and street to home" (Greenwood et al., 2013, p. 650). How did Housing First go from a radical idea to the national standard, despite initial and persis- tent resistance? One reason was a strategy that used research to evaluate programs and then used data as the foundation of advocacy designed "to persuade key champions and stakeholders of the model's efficacy" (Greenwood et al., 2013, p. 650). Tsemberis incorporated research into his program from the outset, beginning with a four-year longitudi- nal study that compared Housing First to traditional programs on five variables that would be of particular interest to various stakeholders, including consumers (clients), clinicians, housing providers, funders, and policy makers. Studies followed rigorous methodology, and the results were published in academic journals, helping the program to gain credibility. The results proved that Housing First reduced homelessness and at lower cost than traditional approaches (Greenwood et al., 2013). Local nonprofits providing services to homeless people were frustrated with their traditional programs. Seeing the results of Housing First, they began to test it in their own communities. Tsemberis's organization provided research assistance to those using the model. There was still resistance in many communities, which local champions addressed by initiating small-scale efforts and continuing to publicize the research that proved success. These local nonprofit leaders became champions who helped persuade others at the state and national levels. The new approach gained the attention Questions Related to Case 11.2 1. How was the goal of advocacy in the case of Housing First different from that of MADD, as discussed in Case 11.1? 2. How does the case of Housing First reflect the stages described in Box 11.1? 3. Does the case of Housing First reflect Crutchfield's six practices in building successful social of the U.S. Interagency Council on Homelessness (USICH), a federal agency charged with coordinat- ing the government's approach to homelessness across cabinet-level agencies (https://www.usich.gov/about- usich). USICH was impressed by the proven results of Housing First and became a critical ally (Greenwood et al., 2013, p. 653). The tipping point came with a $35-million grant from USICH to support the Collab- orative Initiative to Help End Chronic Homelessness, bringing together three U.S. departments: Health and Human Services, Housing and Urban Development, and Veterans Affairs. Of the 11 organizations funded, 9 adopted the Housing First model. Two dozen other cities that had not received grant funds moved forward to implement the model with their own funds. More than 250 cities developed 10-year plans to eliminate homelessness, using the same approach. Within the span of 20 years, Housing First had become the "gold standard of homelessness intervention in the United States" (Greenwood et al., 2013, p. 658). What was the key to success in overcoming skep- ticism and resistance and making Housing First the gold standard? Most important was the use of social science research that has "impact validity" (Massey & Barreras, 2013). This includes framing the research questions strategically, shaped by local understand- ings of the issue, and having a plan for disseminat- ing the findings to allies and champions who can use the data to influence the opinions of the public and government officials (Greenwood et al., 2013). The "powerful concoction of research and consumer- driven, evidence-based practice, combined with a strong dose of advocacy" may provide a lesson to oth- ers attempting to bring about change in addressing other challenging social problems (Greenwood et al., 2013, p. 660). movements? Does it illustrate any points that may not be captured in those six principles? 4. Think back on (or reread) the discussion of marketing in Chapter 10. Which principles from that chapter seem most relevant to the case of Housing First?