Block 5 explores the significant paradigm shift in homelessness policies towards unconditional, long-term housing solutions, exemplified by housing-led and Housing First programmes. These approaches prioritise immediate access to long-term housing without prerequisites related to employment, substance use or enrolment in specific programmes. Despite evidence of improved outcomes and cost savings, the implementation of these approaches remains limited in many OECD and EU countries. This block provides guidance on mobilising housing units, addressing intersectional needs, and improving evaluation to scale up housing-led and Housing First approaches to pursue systems change.
OECD Toolkit to Combat Homelessness
Abstract
Since the 1990s, homelessness policies have undergone a significant paradigm shift among many experts, advocates and service providers to shift the focus of housing support away from a reliance on emergency accommodation towards the provision of unconditional, long-term housing solutions. This transition has paved the way for the adoption of Housing First and housing-led programmes in many countries. Housing First and housing-led approaches aim to provide long-term, immediate housing solutions to people experiencing homelessness, as distinct from “staircase models” that make access to housing contingent on the completion of counselling or treatment programmes (Box 5.1). There is broad consensus underpinned by strong evidence that Housing First and housing-led solutions are an effective and resource‑efficient pathway out of homelessness and towards housing stability. They have proven successful for diverse populations in a variety of country contexts (Pleace, Baptista and Knutagård, 2019[1]; Jacob et al., 2022[2]). Providing long-term housing to people experiencing homelessness as quickly as possible maximises the benefits of stable housing (Busch-Geertsema, 2005[3]) and minimises the negative outcomes associated with emergency accommodation (McMordie, 2020[4]) and rough sleeping (Aldridge et al., 2019[5]).
In practice, there are broadly two approaches to the provision of immediate, long-term housing, depending on the complexity and intensity of an individual’s service needs:
Individuals with more complex challenges and higher-intensity service needs, including mental health conditions or substance use disorders, can be supported through Housing First programmes, which have been proven to lead to improved housing stability and health outcomes (Keenan et al., 2021[6]; Roggenbuck, 2022[7]; Tsai, 2020[8]).
For individuals with low-service needs, the provision of housing and tailored, low-intensity assistance have been found to reduce homelessness and enhance housing stability (U.S. Department of Housing and Urban Development (HUD), 2016[9]) – these can be effectively addressed through housing-led models.
Housing First
Housing First models provide tailored, intensive support for people experiencing homelessness with high and/or complex service needs by providing them with long-term, immediate housing and enabling them to exercise control over their support services (OECD, 2024[10]). A series of randomised controlled trials have shown that Housing First can produce greater housing retention among the chronically homeless compared to treatment-as-usual groups (Pleace, Baptista and Knutagård, 2019[1]). Importantly, Housing First does not mean housing only: the provision of tailored, targeted wraparound services is an essential part of the Housing First model (see Block 6).
Housing-led
Housing-led models emphasise the provision of long-term, immediate housing, but are rather targeted towards people with limited (or no) service needs. In short, housing-led solutions are generally understood to accommodate “people whose needs can be largely, or entirely, addressed by the provision of an adequate, affordable and secure home” (Pleace, Baptista and Knutagård, 2019[1]).
In the United States, Housing First programmes have been found to be cost-effective and to reduce homelessness and increase quality of life: every dollar invested in Housing First programmes results in USD 1.44 in cost savings. In France, an evaluation of the Un chez-soi d’abord Housing First programme demonstrated significant savings, primarily through reduced use of services, with 70% of savings from fewer hospitalisations and 30% from reduced use of accommodation facilities. The programme’s annual cost per person of EUR 14 000 has been found to be completely offset by the savings generated relative to traditional service models (Délégation interministérielle à l’hébergement et à l’accès au logement (DIHAL), 2024[11]). Housing First has also been shown to be a more efficient allocation of resources than traditional services in the United Kingdom and North America (Albanese, 2019[12]) and for youth in the Netherlands (CEBEON, 2023[13]). Indeed, providing housing assistance without preconditions improves employment outcomes for people able and willing to work and reduces health costs for people experiencing homelessness, making it therefore both rehabilitative and cost-effective, offsetting public service programme costs within 18 months (Cohen, 2022[14]), (Brennan et al., 2024[15]).
Nevertheless, while Housing First and housing-led approaches have been gaining ground for many years, they are not yet sufficiently widespread or scaled up in most OECD and EU countries. According to the 2023 OECD QuASH:
28 OECD and EU countries report that a Housing First and/or housing-led approach to homelessness exists; 8 countries report that such an approach does not exist.
16 OECD and EU countries report that a Housing First and/or housing-led approach to homelessness exists at national level; 12 countries report that this approach exists at the regional level in their country; and 25 countries report that a Housing First and/or housing-led approach to homelessness exists at local level in their country.
Only six OECD and EU countries report data on the number of spaces available in Housing First units. Such data are not available in most other countries.
The following set of operational questions aims to assist policy makers and policy advisors when introducing, scaling up, or improving existing Housing First and housing-led programmes:
How to help people transition into long-term housing?
How to implement and scale up housing-led and Housing First approaches to pursue systems change?
How to mobilise housing units for housing-led and Housing First programmes?
How can Housing First and Housing-led solutions support people’s intersectional needs?
How to measure the success of housing-led and Housing First programmes?
Subsequent Blocks provide further discussion on wraparound services (Block 6), funding and financing (Block 7), governing (Block 8), and building the political buy-in to scale and institutionalise Housing First approaches (Block 9).
How to help people transition into long-term housing?
Directing people to an appropriate housing solution through an in-depth needs assessment
In Finland, finding the right housing solution from the start is done through an in-depth needs assessment. People experiencing homelessness first visit a service centre where an in-depth interview is carried out to decide which type of housing solution is most suitable. During the search for the appropriate housing solution, people experiencing homelessness can stay in the service centre, free of charge. Options include i) support housing (accommodation provided with limited social support and guidance); ii) supported housing (which includes integrated social and healthcare services, such as cleaning, substance use support, financial guidance and staff that is always present); and iii) other supported housing (additional forms of accommodation from different service providers (e.g. the Salvation Army)). Although there is no evaluation of housing readiness, people experiencing homelessness must participate in a discussion with a case worker who guides them to the appropriate housing support. Wraparound services are always provided on a voluntary basis (Juhila, Raitakari and Ranta, 2022[16]; Kaakinen, 2023[17]).
Making Rapid Rehousing a priority for households with low to moderate service needs
In the United States, Rapid Rehousing programmes aim to swiftly assist households in need of housing with the main goal of promptly ending homelessness and securing stable housing. Rapid Rehousing programmes offer the resources necessary for a smooth transition into stable, long-term housing. Rapid Rehousing can include a range of resources, including assistance in finding suitable housing, offering financial assistance to secure housing (e.g. security deposits, application fees, payment of rental arrears), rental assistance payments, and housing-related social support services. A dedicated case manager offers support to overcome barriers like credit issues or legal matters and other beneficiaries, together with volunteers, offer resources to improve overall well-being (USICH, 2018[18]). These programmes have shown effectiveness in reducing the number of families experiencing homelessness (Gubits et al., 2018[19]). Notable programmes include the Rapid Re‑housing Demonstration Program, the Homelessness Prevention and Rapid Re‑housing Program, Supportive Services for Veteran Families, and the Family Option Study (Gubits et al., 2018[19]). The United States also provides transitional housing programmes, providing up to 24 months of temporary housing with supportive services for individuals and families. While both Rapid Rehousing and transitional housing can provide supportive services and varying lengths of housing assistance – ranging from a few months to two years – transitional housing can be better suited for individuals who need more support developing life skills to live independently or who need a safe place to stay while they search for stable permanent housing.
Scotland (the United Kingdom) is also developing rapid rehousing plans as part of the government’s efforts to end homelessness.
Providing one‑time unconditional cash transfers to help people experiencing homelessness find a home
In Canada, in a cluster-randomised trial, researchers tested if providing a solution for one of the main drivers of homelessness – lack of financial resources – can sustainably reduce homelessness. Fifty participants experiencing homelessness in Vancouver were given CAD 7 500 (USD 5 360) while 65 others were part of the control group. Results showed that cash recipients spent fewer days in homelessness, saved and spent more money, with no increase in frivolous spending. Researchers calculated that this saved CAD 777 (USD 555) per recipient in societal costs. Further experiments also highlighted public mistrust in individuals experiencing homelessness managing money and effective messaging to support cash transfer policies for homelessness reduction (Dwyer et al., 2023[20]). In the United Kingdom, the Centre for Homelessness Impact (CHI) is conducting three randomised controlled trials (RCTs) to test financial support projects, including one‑off cash transfers for people sleeping rough and young people who age out of the care system (CHI, 2024[21]); these evaluations, for which interim findings are expected in autumn 2025, will be key to understanding the long-term impact of such programmes.
In the United States, similar programmes are being piloted across the country. One example is the Denver Basic Income Project (DBIP), that explores the feasibility and impact of providing regular, unconditional cash transfers to unhoused individuals and families in Denver. Led by the University of Denver’s Center for Housing and Homelessness Research, this randomised controlled trial (RCT) compares three cash payment models. Year one results indicate significant improvements in housing stability, reduced time spent unsheltered, and substantial public cost savings. Ongoing monitoring of medium- and long-term outcomes will be essential to assess the programme’s sustained impact (DBIP, 2024[22]). A similar programme focussed on youth homelessness has been implemented in New York City (Morton et al., 2020[23]).
How to implement and scale up housing-led and Housing First approaches to pursue systems change?
Setting regional targets for the provision of new Housing First units based on actual needs and capabilities
In Ireland, the Department of Housing, Local Government, and Heritage in Ireland unveiled the Housing First National Implementation Plan from 2018 to 2021. Collaboratively, the Department and local authorities established regional targets for annual Housing First unit deliveries, informed by data and homelessness needs assessments. The overarching national objective was to provide 663 tenancies by 2021, facilitating the programme’s inaugural expansion into all regions of the country. By October 2021, 722 Housing First tenancies had been established, surpassing the national target, and expanding the programme’s reach across the nation (Department of Housing, Local Government and Heritage (Ireland), 2022[24]).
In 2022, the Irish Government introduced the Housing First National Implementation Plan for 2022‑26, following a similar model as the previous plan. To ensure alignment of these defined targets with regional needs, the government drew on research conducted by The Housing Agency and engaged local governments in assessing Housing First needs along criteria set by the government. This comprehensive effort resulted in a commitment to make an additional 1 319 Housing First units available by 2026, strategically distributed across regions with a phased rollout from 2022 to 2026 (Department of Housing, Local Government and Heritage (Ireland), 2022[24]). This approach has helped the government closely monitor progress and provide targeted support where needed, all within a framework based in the assessed needs of local communities, facilitating responsible and effective programme scalability.
Assessing housing outcomes and cost-savings to cement Housing First as the backbone of national homelessness strategy
As outlined in Block 1, Housing First has been a core strategy in Finland since 2008, with four consecutive government programmes committing to a strategy to end homelessness by 2027. The Ministry of the Environment takes a lead co‑ordination function, collaborating with the Housing Finance and Development Centre of Finland (ARA), the Ministry of Social Affairs and the Health Funding Centre for Social Welfare and Health Organizations (STEA). They actively direct funding to third-sector organisations for housing projects and the acquisition of apartments from the market, subsequently making these apartments available to be rented by people experiencing homelessness (Juhila, Raitakari and Ranta, 2022[16]). The funding structure is a blend of central and municipal government funding as well as funds from Finland’s Slot Machine Association, RAY. Tenants pay a share of their income in rent (usually between 25‑35%) (see further discussion of the funding structure in Block 7). Initial evaluations showed that while Housing First was a costly upfront investment, the intensified support and accommodation provided to people experiencing homelessness delivers annual savings of about EUR 21 000 due to the reduction in the numbers of hospital visits and use of rehabilitation services. These savings have helped make the case to scale up the programme (Centre for Public Impact, 2019[25]).
Combining intervention with research to monitor results
In Lisbon, Portugal, Housing First programmes have been steadily expanded and are supported by research to evaluate their outcomes. Since 2009, Lisbon’s Casas Primeiro Housing First programme has provided immediate access to long-term housing and personalised support services for chronically homeless individuals with mental health and addiction issues. The programme prioritises a housing solution, without treatment or sobriety prerequisites. Results of the two‑year pilot study found a 90% housing retention rate, significant improvements in quality of life, housing satisfaction, and community integration, a decrease in alcohol and drug consumption by 68%, a reduction in emergency service utilisation by 87% and psychiatric hospitalisations by 90% (Ornelas and Duarte, 2018[26]). The programme offers dispersed individual apartments throughout the city and uses diverse funding sources (including public funds from national and municipal governments), private foundations and corporate donations. Occupants contribute 30% of their monthly income towards rent. In the last 10 years, combining intervention with research has been essential for establishing and expanding the programme. Since 2020, the programme has been implemented nationwide and currently offers over 400 spots.
Using rigorous evaluations to make the case to expand Housing First
In France, the Housing First programme, Un chez-soi d’abord, has recorded growth since its inception, from around 350 units in 2017 across four cities (Paris, Marseille, Toulouse and Lille) to 2 570 units in 32 cities in 2022 (Tinland et al., 2020[27]; Délégation interministérielle à l’hébergement et à l’accès au logement (DIHAL), 2023[28]). This substantial growth over a six‑year period is underpinned by encouraging results from the programme’s evaluation (Délégation interministérielle à l’hébergement et à l’accès au logement (DIHAL), 2023[28]), using a randomised controlled trial, which found that the initiative had led to reduced in-patient days, enhanced housing stability, and cost savings for individuals with schizophrenia or bipolar disorder who were experiencing homelessness (Tinland et al., 2020[27]; Loubière et al., 2022[29]). These findings prompted the government to expand and scale up the programme, extending it to medium-sized cities and rural areas as part of the government’s Logement d’abord 2023‑27 plan (Délégation interministérielle à l’hébergement et à l’accès au logement (DIHAL), 2023[28]).
New Zealand has made significant progress in expanding their programmes on Rapid Rehousing targeted for people with low to moderate service needs and Housing First for those with higher service needs (U.S. Department of Housing and Urban Development (HUD), 2023[30]; Litmus, 2023[31]). Housing First provision more than doubled over the 2020‑22 period, reaching 2 468 individuals in 2022 (OECD QuASH 2023). Māori are disproportionately affected by homelessness. Since 2020, 58% of the households supported by the Housing First programme are Māori.
Mobilising Housing First Networks as advocates to shift the paradigm in homelessness policy
In the Netherlands, the Housing First network demonstrates how a network can help advocate for a shift from housing-led solutions co‑existing with a more prominent staircase model to a focus on housing-led and Housing First approaches as a centrepiece of the strategy to tackle homelessness (Housing First Europe, 2023[32]). It also showcases the importance to assess and cater to specific needs of the person experiencing homelessness when providing services (Housing First Netherlands, 2021[33]). The first Housing First programme was established in the Netherlands in 2006, and many municipalities have adopted the model thereafter. However, the staircase model of tackling homelessness remains prominent. Thus, Housing First Netherlands, along with training and peer exchange activities, advocates for system change to shift away from the staircase model (Housing First Europe, 2023[32]). This paradigm shift is also reflected in the latest strategy on homeless in the Netherlands (National Homelessness Action Plan, 2022[34]).
How to mobilise housing units for housing-led and Housing First?
Mobilising housing in the private rental market through social rental agencies, which offer incentives to private landlords to lease their dwelling at an affordable rent
The Coup de Pouce programme in Luxembourg, operational since 2019 and backed by the Ministries of Housing and Family, Integration, and the Greater Region, offers a viable solution to find housing options for people experiencing homelessness. Through the social rental management system, the service rents private properties to extend housing to individuals and families in need. Dedicated social workers assist beneficiaries with their potential service needs that go beyond housing, ranging from training programmes to employment opportunities. This initiative stands out for its holistic approach that engages property owners, ensures rent security and offers tax exemptions of up to 50% on net rental income. The Coup de Pouce programme attempts to empower individuals to use local resources by applying a community-oriented approach.
In Spain, landlords renting their properties have fiscal deductions on their annual income tax return. Deductions vary depending on the characteristics of the dwelling rented, the conditions established on the rental contract – including the duration and the price – and the characteristics of the renter. Deductions range from 50% to 90%.
Additional examples of social rental schemes are discussed in Block 4.
Charging a dedicated government agency to scan the private housing stock to identify potential units and negotiate with owners
In Wallonia, Belgium, the Walloon Observatory on Homelessness created the housing sensor in 2013 to identify and utilise private housing units to provide Housing First and affordable housing. Operating in most major cities in the Walloon Region (e.g. Liège, Charleroi, Namur, Mons, La Louvière, Tournai), the housing sensor, which is a regional government agency made up of housing and homelessness experts, regularly scans the private housing stock to identify suitable housing units and negotiate directly with owners. Although owners typically receive lower rent in Housing First or housing-led programmes compared to the private market, the housing sensor makes participation more attractive by minimising risk. The housing sensor assumes the risk of tenants not paying rent or causing damages and can also act as efficient mediators if conflict arises. Tenants also receive support with administrative processes (i.e. signing the lease and performing inventories), moving in and applying for rent or social subsidies, further minimising the risk of non-payment or conflict between the tenant and the owner.
Developing co‑operation agreements with social housing providers to reserve some units for Housing First
In Austria, the government adopted a new Housing First programme, in which 2 500 people are planned to receive their own homes over the next two years with apartments being supplied by non-profit housing associations and private providers (BMSGPK, 2024[35]). The programme builds on past Housing First experiences in Belgium, which functioned with co‑operation agreements between social NGOs and social housing providers, which allocated a certain number of dwellings to Housing-First tenants (Housing Europe Observatory, 2018[36]). Lessons from these experiences found that strong partnerships between the different partners relied on clear division of roles and responsibilities (social housing providers acted as the landlord and manager of dwellings, while social services were delivered by the relevant NGO(s)); a continuity of co‑operation between the partners and a good social mix within social housing units (avoiding the spatial concentration of Housing-First tenancies) (Housing Europe Observatory, 2018[36]).
Similarly, in Belgium, as part of a three‑year test phase in eight cities, the Housing First Belgium programme supported 150 people experiencing homelessness with access to housing and intensive support services. Housing-First tenants accessed public social housing through exceptional agreements with social housing landlords; monthly rental payments were largely supported by the tenants’ primary income source (the minimum income scheme) (Housing Europe Observatory, 2018[36]).
Exploring the potential for small-scale collective, long-term accommodation with tailored services
In France, pensions de famille – small-scale, collective residential settings that propose a “family atmosphere – have been in place since a pilot project in 1997. Currently, around 22 000 people live in these structures, which offer an individual dwelling space, without a time limit, along with access to shared, communal spaces and hosts who provide additional, tailored support to residents.
How can housing-led and Housing First solutions support people’s intersectional needs?
Engaging people with lived experience in the design and implementation of housing-led and Housing First solutions
When developing a Housing First programme, people with lived experience should be actively involved throughout the process to ensure that housing and related supports are best conceived to meet a range of needs. Approaches such as incorporating the feedback of impacted individuals during pilot phases, promoting peer-led outreach during rollout, and systemising peer-support in case service can make a programme more nuanced, egalitarian, and effective. Refer to Block 1 and Box 1.3 for further discussion and country examples.
Tailoring Housing-First to the specific needs of youth
Practical experiences have demonstrated that the Housing First model can and should be tailored to the specific needs of young people. Originally developed in Canada by the Canadian Observatory on Homelessness, the Housing First for Youth (HF4Y) was designed as a rights-based intervention aimed at individuals aged 13 to 24 who are experiencing, or are at risk of experiencing homelessness, based on the premise that the causes and conditions of youth homelessness are different from those of adults (Homeless Hub, 2024[37]). The model seeks to address the immediate housing needs of young people, while facilitating their transition to adulthood through the provision of age‑appropriate supports relating to health, well-being, life skills, education and employment, and social inclusion. The model can be adapted to the needs of specific populations (e.g. care leavers, Indigenous youth), and housing solutions can vary, depending on the individual’s needs (ranging from, for instance, facilitating safe returns to a family member’s home through family reconnection, to supportive or transitional housing options). The five principles of Canada’s HF4Y model include:
A right to housing with no preconditions.
Youth choice, youth voice, and self-determination.
Positive youth development and wellness orientation.
Individualised, client-driven supports with no time limits.
Social inclusion and community integration (Homeless Hub, 2024[37]).
Interventions based on the Canadian model have been replicated in various countries.
Ireland has put in place the Housing First for Youth programme to help address the specific needs of vulnerable youth. The programme, managed by the NGO Focus Ireland, takes a holistic approach, prioritising housing stability for young individuals, regardless of their background or the causes of their homelessness. By providing secure housing and age‑appropriate support services, the programme empowers young people, equipping them with the skills needed for independent living. Unlike Housing First programmes for adults, the programme recognises that young people may frequently change residences and offers flexible, tailored services that adapt to their needs. Housing First for Youth in Ireland has achieved zero homelessness among programme participants, a 96% sustainment rate, tenancies for 76% of young people, and access to education or employment for nearly a third of participants. This approach not only provides immediate housing solutions but also focuses on long-term stability and independence, effectively breaking the cycle of youth homelessness. Collaborations with partners such as local authorities and Ireland’s Child and Family Agency have allowed for resource pooling and expertise sharing, contributing to the programme’s success and sustainability. Additionally, under the national Youth Homelessness Strategy, a housing-led intervention named Supported Housing for Youth (SHY) is currently being developed.
In France, the logis jeunes project in Lyon supports youth aged 18 to 21 transitioning out of care by offering tailored assistance, including housing. The institution managing the project holds the tenancy of multiple dwellings, allowing beneficiaries to sublet housing for 18 months, with the option to transition to tenancy (Eurocities, 2023[38]). Additionally, it provides support in securing alternative housing tailored to beneficiaries’ needs and preferences. In 2023, 14 people entered the programme and 12 exited it. Of those exiting the programme, half transitioned to independent living (ACOLEA, 2024[39]).
In Spain, the H4Y FUTURO project provides housing solutions for people experiencing homelessness aged 18 to 25. Jointly managed by Provivienda and Hogar Sí, the project follows the Housing First for Youth methodology, providing immediate housing access while allowing participants flexibility in planning their transition to independent living, ensuring their active involvement in this process (Provivienda and Hogar Sí, 2023[40]). Based on a preliminary evaluation comparing baseline data with data collected seven months into the programme, 92% of participants remained housed. When asked about their perception on the possibility of moving into autonomous housing within the next year, on a scale of 1 to 7, the average response was 4.94.
Tailoring Housing-First to the specific needs of veterans
In the United States, more than 35 000 veterans experienced homelessness in January 2023, according to the latest point-in-time count, an 8% increase from the year before (VA Homeless Programs, 2024[41]). The Department of Veteran Affairs housed 46 552 Veterans experiencing homelessness in permanent housing by the end of 2023 and provided them with wraparound services (Diaz, 2023[42]), (United States Interagency Council on Homelessness, 2024[43]). The majority of veterans housed through the Department’s homelessness programmes moved into rental apartments with short or long-term subsidies. A smaller percentage were housed through rentals without a subsidy, through home ownership or through permanently reuniting with family or friends.
Developing transitional Housing programmes with a gender perspective
Intimate partner violence (IPV) is a leading cause of homelessness and can harm physical and mental health and financial outcomes (OECD, 2023[44]). The Domestic violence Housing First (DVHF) model in the United States aims to support recent survivors of domestic violence who are or are at risk of becoming homeless. A group of researchers from Michigan State University, in collaboration with the Washington State Coalition Against Domestic Violence, studied the effects of DVHF through a quasi‑experimental, longitudinal study in comparison to services as usual (SAU) (e.g. support groups, counselling, advocacy, and referrals). They found that victims/survivors who received the DVHF intervention experienced improved housing stability, safety, and mental health over two years compared with those who received SAU. Victims/survivors who received DVHF also reported higher prosocial behaviours from their children compared to parents who received SAU (Sullivan et al., 2023[45]; OECD, 2023[44]). The Australian programme, Keeping Women Safe in Their Homes, is another relevant example, discussed in Block 4.
Young people who identify as LGBTI are over-represented among the youth population experiencing homelessness, and family conflict is the leading cause of youth homelessness. In February 2016, the YMCA Sprott House opened Canada’s first transitional housing programme designed specifically for the needs of LGBTI+ youth in partnership with the city of Toronto. Findings from an evaluation indicated that youth recipients experienced a higher level of safety, improved mental health, and a higher perception of safety in their day-to-day lives compared to their previous experiences in programmes that were not specific to LGBTI+ populations (Abramovich and Kimura, 2019[46]).
Further discussion of how governments can best address the support needs of individuals at risk of or experiencing homelessness are found in Block 6.
How to measure the success of housing-led and Housing First programmes?
Regular reporting of households in Housing First units to assess programme performance
New Zealand monitors progress in the delivery of the Housing First Programme by reporting on a monthly basis the number of households staying in Housing First units (Figure 5.1). Beyond this, the Housing Dashboard collects monthly data on public and transitional housing, other housing built by the government, Housing First, the Public Housing Register, and other housing support provided. The dashboard is freely accessible and is updated at the end of every month. This allows to visualise the evolution of the programme within the city or country where it is being implemented, in order to monitor and evaluate its performance. In addition to the Housing Dashboard, there are other regularly updated products that provide visibility of a range of housing programmes, and progress towards overall strategic goals outlined in the government Policy Statement on Housing and Urban Development. For instance, MAIHI Ka Ora, Ka Mārama is a Māori housing dashboard collated and hosted by Te Tūāpapa Kura Kāinga – Ministry of Housing and Urban Development (HUD). It includes data on programmes that support Māori housing aspirations, and data that describes the disproportionate effects of the housing crisis on Māori.
Number of households currently in service of the Housing First programme in New Zealand (June 2019‑June 2024)
Note: The number above refers to households currently being supported through the Housing First programme.
Source: (Statistics New Zealand, 2024[47]), The Housing Dashboard, www.hud.govt.nz/stats-and-insights/the-government-housing-dashboard/housing-support#tabset.
Choosing the right indicators to monitor progress
An external assessment of HOGAR SÍ’s Hábitat programme methodology in Spain demonstrates how to include a range of economic indicators in a cost-effectiveness analysis of its Housing First model (Panadero Herrero, 2021[48]). The report tracks the costs of the Hábitat programme in comparison to programme alternatives, as well as housing retention rates, participant satisfaction, and participant use of social services. The study also monitored participant discrimination, level of victimisation, happiness, and physical and mental health. The evaluation found both direct positive outcomes (reducing homelessness) and indirect positive outcomes (other positive socio‑economic and health outcomes), especially when accounting for the reduction in social service consumption.
Recent research from the United States measures the economic impacts of Housing First on income and healthcare costs, finding that the provision of housing assistance without preconditions improves employment outcomes (for people able and willing to work) and reduces health costs for people experiencing homelessness and is therefore both rehabilitative and cost-effective. In Los Angeles, California, a novel dataset combining administrative records from multiple public agencies and a random case manager assignment was used to show that Housing First assistance was both rehabilitative and cost-effective, resulting in reduced homelessness and crime, as well as increases income and employment. The savings from an increase in income and employment are large enough to offset public service programme costs within approximately 18 months (Cohen, 2022[14]). In Massachusetts, research on Medicaid enrolees who are chronically experiencing homelessness also leveraged administrative data, and found that individuals who receive support from Housing First experience greater reductions in healthcare service utilisation and incur significantly lower healthcare costs (Brennan et al., 2024[15]).
Cost-benefit analyses of some Housing First programmes provide evidence on the return on investment of such policies. In Canada, the At Home/Chez Soi study provided Housing First accommodation and wraparound services for individuals experiencing homelessness with mental health conditions in five cities over a two‑year period. A cost-effectiveness evaluation of the study found that 69% of the costs of the intervention were balanced out by savings in other social services, such as emergency shelters (For the At Home/Chez Soi Investigators, 2020[49]). In the United States, the Denver Supportive Housing Social Impact Bond Initiative was launched in 2016 and it aimed to provide individuals experiencing chronic homelessness with permanent housing and support services. An evaluation of the programme from 2016 to 2020 found that participants had fewer shelter stays, police interactions, jail time, and detox facility visits compared to those in the control group (Cunningham et al., 2021[50]). Regarding cost offsetting, approximately half of the annual cost per programme participant was covered by reductions in the expenses of other public services (Gillespie et al., 2021[51]).
Housing-led and Housing First approaches, which prioritise providing unconditional, long-term housing, are an essential component of the paradigm shift to effectively address homelessness. Evidence has shown that these models are effective in reducing homelessness and improving housing stability, particularly for individuals with complex needs. Preliminary evidence suggests that Housing First can be cost-effective, particularly when considering the cost savings from reduced reliance on shelters, emergency rooms, and other public services. More evidence of this kind could strengthen the case for Housing First approaches.
Although Housing First programmes have shown signs of cost-effectiveness and better outcomes compared to traditional models, they are not yet widely scaled in most OECD and EU countries. Scaling-up of Housing First programmes systematically will be the challenge for most countries in the coming years. The block addresses how to mobilise housing units, engage diverse populations, and monitor progress, encouraging governments to integrate these approaches into national strategies.
Building on these operational issues, the following recommendations can help policy makers and practitioners to install, scale up or improve housing-led and Housing First programmes:
Pursue housing-led and Housing First as core policies to provide housing solutions alongside comprehensive wraparound services, tailored to an individual’s support needs.
Facilitate rapid transitions into appropriate long-term housing, using a detailed needs assessment and a housing-led approach for individuals with low to moderate support needs.
Leverage the existing housing supply and social protection system to facilitate long-term housing solutions, including through social rental schemes, co‑operation agreements with social housing providers, and other opportunities to mobilise housing in the private stock.
Tailor housing-led and Housing First programmes to the needs of specific socio-demographic groups, such as youth, LGBTI, women, older people, Indigenous groups, and migrants, ensuring inclusivity, appropriate housing solutions, and targeted support.
Track the progress and effectiveness of housing-led and Housing First programmes through systematic monitoring and evaluation and rigorous research.
Scale up housing-led and Housing First programmes to end homelessness, including by leveraging mainstream social services to support housing retention, setting regional targets, using research and evaluation to monitor outcomes and cost savings, and advocating for a system-wide shift in homelessness policy.
References
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