Background: Housing first models have become increasingly popular for supporting persons experiencing homelessness. The housing first model is based on the theory that requiring homeless individuals to attain mental health or substance use treatment and remain clean and sober in order to gain housing builds as many barriers as it removes. However, housing first model outcomes have varied from program to program. The current study tested the predictors of successfully securing housing in program that primarily served homeless veterans and homeless individuals with substance use and co-occurring mental health diagnoses.

Methods: Potential participants were referred to a housing first homelessness reduction program in Indiana through community outreach, internal sources (psychiatrists, adult community services, residential services, recovery engagement services) and external sources (local shelters). To be eligible for referral, participants had to meet the McKinney-Vento Act definition of chronic homelessness. Once enrolled in the program, participants met regularly with a recovery coach who helped them find housing, enroll in benefits, get a job, receive substance misuse treatment, and acquire mental and physical healthcare. Assessment data were collected at baseline and at a six-month follow-up (n=76). We constructed a logistic multilevel model to evaluate both time varying and time invariant factors that included demographic characteristics, depression, drug use, health status, and employment status as predictors of securing housing.

Results: At the six-month follow-up, 48 (63.1%) of the program participants were housed. We found that being employed (Beta=1.14, p=.02, OR=3.15) and the number of days a client reported being depressed (Beta=-0.05, p=.004, OR=0.95) were significant predictors of being housed at the six-month reassessment.

Conclusions: The finding that only 63% of participants were successfully housed at the six-month follow-up can likely be attributed to a delay in receiving the funding for the project. The initial proposal for the project was rejected. However, a year later the project was unexpectedly funded. As a result, connections within the community to secure housing had to be quickly reestablished presenting a challenge to house participants in the early stages of the project. The findings from the logistic multilevel suggest that housing first programs should consider employment and mental health treatment services as program add-ons to increase the likelihood of securing housing for clients.