Family Health Centers-Louisville Housing First Project for Homeless Adults (Housing First), of Louisville, Kentucky, was awarded a SAMHSA treatment for the homeless grant on September 30, 2008. Housing First is a consumer driven EBP that emphasizes the provision of housing as the first priority of treatment for homeless persons with mental health and/or substance abuse disorders (co-occurring disorders). Because a stable living environment is viewed as essential for meaningful recovery, housing is provided independent of mental health, substance abuse, and other services. Staff also practice Motivational Interviewing to encourage participants to explore their ambivalence about substance abuse and other problems and develop independent paths to recovery.

Housing First participants work with case managers to find scattered site private market apartments where they live independently. In addition to case management, participants receive access to a range of substance abuse and mental health treatment options that assist them in pursuing personalized recovery plans. As of March 2011, the project has housed more than 100 formerly homeless persons, 95 percent of whom were chronically homeless. More than 80 percent of participants have maintained housing for more than 6 months, and 31 of the program's original participants have stayed in housing for 2 years or more. According to GPRA intake and follow-up interview data, participants report less severe use of alcohol and illegal drugs, decreased occurrence of mental health symptoms, greater connections to support networks, and increases in personal income.

Housing case manager, Karan Vertrees (second from right), leading a weekly small group meeting with program participants (left to right), William Bruner, Bill Acker, and Philip Snyder.

Housing Case Manager Supervisor, Nolan Nelson, had this to say about the program, "I’m very grateful for the doors our SAMHSA program has been able to open for our clients. It’s one thing to refer a person for substance abuse or mental health treatment and have them wait in line, but it is another thing for our clients to access this treatment almost immediately upon referral. With the additional services our SAMHSA program provides, clients are able to access treatment as soon as they are ready for change. In addition, I think how we’ve chosen to operate our program has proven to be very effective for our clients, especially those traditionally referred to as the most difficult to serve. In adopting a Housing First approach, we’ve been able to create an environment where clients who might have been terminated using another approach are able to maintain their housing, stabilize, and continue working toward change."

Although housing is offered separate of other services, the project is administered through a Federally Qualified Health Center which allows for continued engagement between staff and the consumer. Participants report strong relationships with their case managers, mental health counselors, and primary medical care providers. These relationships allow for integrated, ongoing, and personalized treatment in meeting the long-term needs of the consumer.

Housing First staff consists of a team of case managers who assist clients in maintaining their housing, meeting day-to-day needs, and setting personal goals for happy and productive lives. A psychiatric nurse practitioner meets with many participants in their homes to address their mental health needs and assists them in their transition from homelessness to independent housing. The project is overseen by the project coordinator, and the project evaluator regularly conducts participant GPRA interviews and other assessments of the project's progress in meeting its goals and objectives.

Project Coordinator, Andy Patterson, explained what the program means to him, "Housing First means that housing is a basic human right for everyone. Our first priority is to provide safe, decent, and affordable housing for homeless and chronically homeless persons. Many of these people have not been well served by other programs that require treatment as a precondition to housing, and they are often considered to be one of the most difficult groups to serve. Housing First, however, has proven very successful in serving the needs of this population.  We are proud to report that we have nearly 40 clients who have remained housed for two years or more."

At the program's 2010 fall cookout, Garland Teague and Dori Wilson received certificates for recognition of two successful years in housing.

Partnerships include St. John's Day Center and the Society of St. Vincent de Paul who assist in providing case management services and housing voucher management. HUD housing voucher programs allow Housing First to offer decent and affordable housing to participants, and private landlords provide housing units. Most importantly, the project relies on the partnerships and perseverance of its participants who overcome incredible challenges to end their homelessness.

When CHAB asked Carey D. Addison, Jr., Healthcare for the Homeless Project Evaluator, what about this program may be interesting to grantees across the Nation, he said, “The project has demonstrated great success in providing long-term permanent supportive housing for a population that has traditionally been difficult to serve. Participants are served by a flexible network of services rather than a ‘one size fits all’ approach to treating consumers that provides meaningful recovery from substance abuse, mental health disorder, and homelessness.”