The role of housing: A comparison of front-line provider views in housing first and traditional programs

Purpose: Within the mental health system, there are two distinct service models for adults who have severe mental illness and are homeless: one prioritizes treatment before accessing permanent housing (Treatment First) while the other provides permanent housing upfront followed by clinical support (Housing First). Investigating front-line providers working within these two models affords an opportunity to learn more about their implementation from an insider perspective, thus shedding light on whether actual practice is consistent with or contrary to these program models' contrasting philosophical values. Methods: Forty-one providers were recruited from four agencies as part of a NIMH funded qualitative study. Multiple, in-depth interviews lasting 30-45 min were conducted with providers that explored working within these agencies. Thematic analysis was utilized to compare the views of 20 providers working in Housing First versus the 21 providers working in Treatment First programs. Results: Providers viewed housing as a priority but differences emerged between Treatment First and Housing First providers along three major themes: the centrality of housing, engaging consumers through housing, and (limits to...) a right to housing. Conclusion: Ironically, this study revealed that providers working within Treatment First programs were consumed with the pursuit of housing, whereas Housing First providers focused more on clinical concerns since consumers already had housing. Clearly, how programs position permanent housing has very different implications for how providers understand their work, the pressures they encounter, and how they prioritize client goals.