1. Sam Tsemberis, PhD
Founder and CEO
Pathways to Housing, Inc.
JUNE 12, 2013

2. Who is served by Housing First?
 Homeless
 Mental health problems
Addiction and abuse
 Health problems
 Poverty
 Isolation
 Stigma
 PTSD/Trauma

3. Frequent users of acute care services
Jail
Shelter
Hospital/
Detox
Streets Institutional Circuit

4. Housing and Support Services:
Rearranged (Housing first) and
Redesigned (consumer driven)

5. Levels of Program Fidelity
consumers
Hundreds of choices, change
over time & have tradeoffs r
Management issues include team-
consumer, landlord-tenant, landlord-
team, and team-agency interactions
Operations
Variety of services and
housing options
Decisions about housing
status and consumer
engagement
Principles
Consumer choice Separation of housing and
treatment

6. Homeless
Shelter
placement
Transitional
housing
Permanent
housing
Ongoing, flexible support
Harm Reduction
Housing First Model

7. MHCC At Home / Chez Soi
5 Cities RCT N=2,257
Moncton, Montreal, Toronto, Winnipeg,
Vancouver
Housing
First
(n=1267)
Interviews every 3 months:
Residential stability, mental
health, addiction, quality of
life, social integration
Treatment
as Usual
(n=990)

8. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
3M 6M 9M 12M
Time Spent in Stable Housing Over Year One
HF TAU

9. / 9
Housing First shows cost offsets
Annualized costs: Total sample Annualized costs: High Service Users (defined as
those in top 10% of prior service costs
TAU Intervention Difference TAU Intervention Difference
Est. annual cost:
Non-study services
$23,849 $14,599 $ (9,250) $ 56,431 $30,216 $ (26,215)
Est. annual
intervention cost
$17,160 $ 17,160 $16,825 $16,825
Total $ 23,849 $ 31,759 $ 7,910 $ 56,431 $ 47,041 $ (9,390)
High Service Users:
• There is an overall savings of $9,390 per person per year
• Every dollar spent on Housing First for these participants saves $1.56 through reduced
use of other shelter, health and justice services
Total Sample:
• An investment in Housing First requires only an additional investment of $7910 per year
• For every dollar spent 54 cents is saved through reduced use of other shelter and
health are services after only one year
Table 1 – Costs of Housing First versus use of other health, justice and social services after one year

10. Peer Support:
Recovery Focused Mental Health Services
Hope-instilling
practice
Socially supported
wellness
knowledge and
skills to self-
manage
Emphasis on
holistic wellness
and positive
lifestyle as healing

11. Son returns from tour in Afghanistan and stays
with (formerly homeless) dad in his apartment.
Social connections are key and
and housing should adjusts accordingly

12. Community-based,
Residential Treatment
(on-site clinical staff)
Permanent Single Site
(on-site services)
Permanent
housing
(scatter-site,
off site services)
Redesigning the System:
System Transformation
Longer term
Institutional Care
Least restrictive to more restrictive setting

13. • People are much
more capable than
we imagined
possible.
Capabilities

14. For Additional Information
Web sites:
www.pathwaystohousing.org
 Or send an email to
stsemberis@pathwaystohousing.org