This document summarizes a presentation given at the European Research Conference on Housing First. It discusses the evidence that Housing First is effective at helping homeless people maintain housing, even those with complex issues like mental health or addiction problems. However, it notes that Housing First has more mixed results on helping people recover from those issues or achieve greater community integration and financial independence. It argues Housing First should aim for the highest possible integration tailored to individual goals, but that structural barriers like lack of affordable housing and discriminatory policies also need to change to fully address homelessness. The presentation raises questions about what supports are needed after housing is obtained to help address issues like social isolation, community participation, meaningful activities, and substance abuse issues.

1. 1
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Recovery Orientation and
Realistic Expectations
Dr. Volker Busch-Geertsema
GISS, Association for Innovative Social Research and Social
Planning, Bremen, Germany
Coordinator of the European Observatory on Homelessness
Coordinator of « Housing First Europe » until August 2013
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Housing First!
 Evidence shows that the overall majority of homeless
people want to live in regular housing.
 There is plenty of evidence that even homeless people
with complex problems (mental health problems and
addiction) are able to sustain a regular tenancy if
appropriate support and individual choice is provided.
 High housing retention rates in Housing First projects
have been documented in a rapidly growing bulk of
evidence, in the US, in Canada, in various European
countries and elsewhere.

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
“Where do you want to live in the future?”
Answers of clients registered by NGO services for homeless
people Germany 2010
no request for
housing, already
living in a regular flat
12.4%
“sta onary"
ins tu on for
homeless people
10.1%
shared housing /
group home
1.6%
furnished room
1.6%
alterna ve form of
accommoda on
0.5%
other
0.8%
own dwelling for one
person 63.8%
own dwelling for two
persons 6.4%
own dwelling for a
family 3.0%
own self‐contained dwelling = 73.2%
Basis: 8,134 homeless persons, BAG W 20111
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Amster-
dam
Copen-
hagen
Glasgow Lisbon
Buda-
pest
Total number of service users housed 165 80 16 74 90
Unclear cases (death, left to more
institutional accommodation, left with no
information if housed or not etc.)
23 16 2 6 na
Basis for calculation of housing
retention
142 64 14 68 na
Positive outcome (still housed)
138
(97.2%)
60
(93.8%)
13
(92.9%)
54
(79.4%)
29
(< 50%)
 Still housed with support from
HF programme
122
(85.9%)
57
(89.1%)
13
(92.9%)
45
(66.2%)
0
 Housed without support from
HF programme
16
(11.3%)
3
(4.7%)
0 9
(13.8%)
29
(< 50%)
Negative outcome (lost housing by
imprisonment, eviction, “voluntary”
leave into homelessness etc.)
4
(2.8%)
4
(6.3%)
1
(7.1%)
14
(20.6%)
na
Housing retention rates in Housing First Europe test sites
Source: Local final reports, own calculations. See Busch-Geertsema (2013)2 www.housingfirsteurope.eu

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Regular housing as a platform for further integration
 Housing basis for “ontological security” (constancy, daily
routines, privacy and identity construction; Padget 2007)3.
 Padget on the results of a HF study in New York: “Yet, just
as a house (or apartment) does not make a home, a home
does not make a life. Other core elements of ... recovery
such as hope for the future, having a job, enjoying the
company and support of others, and being involved in
society (...) have only been partially attained by this study’s
participants. Having a ‘home’ may not guarantee recovery
in the future, but it does afford a stable platform for re-
creating a less stigmatized, normalized life in the present.”4
 Results of Housing First “underwhelming” in these fields?5
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
High expectations. Too high?
 In Sweden a Housing First tenant was elected as “tenant of
the year“.
 Some rehousing projects present ex-homeless clients who
study at university, have found a job, have married and
moved to a detached house.
 Are these the right examples to promote the Housing First
approach?

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Evaluation Results
 Results on recovery from mental illness and addiction are
indeed mixed in many HF projects, though Housing First
Europe provided evidence on improvements even for
heroin and severe alcohol addicts (for some, but not for all)
 Many homeless single people re-housed in scattered
housing face (initially) loneliness and social isolation
 If they remain in contact with the former peer group (which is the
rule if they are rehoused in congregate housing), and are
struggling with addiction, problems with managing the reduction
of their substance use tend to be reported.
 If they try to cut contacts with their former homeless peers – as
many rehoused homeless people do – it is not easy for them to
create a new social network.
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Evaluation Results
 The majority of service users remain poor and most remain
excluded from regular labour market though some projects
achieve surprisingly good results regarding community
integration and finding something meaningful to do.
 Sam Tsemberis (2010): “„Housing First (programs) may
end homelessness but do not cure psychiatric disability,
addiction or poverty. These programs (...) help individuals
graduate from the trauma of homelessness into the normal
everyday misery of extreme poverty, stigma and
unemployment.”6
 Given the complex support needs of the main target group
of Housing First, further integration might take more time
and structural constraints play a role as well.

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Relative integration and ambitious goals
 Housing First cannot change structural conditions of labour
markets and welfare systems. Here – as well as in housing
policies – fundamental changes are necessary!
 Under given conditions “relative integration” legitimate goal
for some when re-housing severely marginalised people.7
 “Practitioners and policy makers should keep their goals
clearly in mind. More specifically, they should remember
that [rehousing homeless people]* is not identical with
ending poverty, curing mental illness, promoting
economic self-sufficiency, or making needy people
healthy, wealthy and wise.” (Shinn and Baumohl, 1998)8
*quote focused on prevention of homelessness
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Relative integration and ambitious goals
 However, HF support staff should always be ambitious and
aim at the highest level of integration possible, following the
individual goals and preferences of HF service users.
 Not always easy:
 Change in balance of power
 It’s the tenant who has the key
 Support offers have to be useful and attractive
 Service users preferences about their lives and recovery may
vary considerably and have to be taken seriously
 Respect, warmth and compassion for all clients!
 Ability to build trustful relationships is needed, “personal factor”
should not be underestimated when selecting support workers

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Housing First. What’s Second?
 Given that we agree that HF approaches and housing led
strategies are the right way to reducing homelessness or
even ending it for most people (and accepting that some of
our presenters are challenging this assumption), what is
needed after integration into regular housing is secured?
 What are successful ways to overcome loneliness and social
isolation? But also: How to reduce financial barriers to building
and maintaining social networks?
 How can community integration be promoted? But also: How do
communities need to change for being integrative?
 How could integration into employment be improved? But also:
What is to be done to make labour markets less excluding? And
are there non-discriminating and attractive ways to provide
something meaningful to do (other than employment)?
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Housing First. What’s Second?
 What is needed to offer people with problematic substance use
harm reduction and – if wanted – ways out of addiction? But
also: Which changes are needed in drug policies and addiction
services?
 These are some of the questions and ideas behind the
theme of our Research Conference: “Housing First. What’s
Second?”.
 Not all of these questions will be tackled by presentations in
the seminars, other important themes will be discussed.
 However, there should be time and plenty of opportunities
to discuss these questions during this conference.
 All the best for lively debates and new insights!

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Contact
Dr. Volker Busch‐Geertsema
Gesellschaft für innovative Sozialforschung und Sozialplanung e.V.
(GISS, Association for Innovative Social Research and Social Planning)
Kohlhökerstraße 22
28203 Bremen, Germany
Fon:+49‐421 – 33 47 08‐2
Fax: +49‐421 – 339 88 35
Mail: vbg@giss‐ev.de
Internet: www.giss‐ev.de
Housing First Europe evaluation: www.housingfirsteurope.eu
EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Notes and References
1) BAG W, Bundesarbeitsgemeinschaft Wohnungslosenhilfe e.V. (ed.; 2011) Statistikbericht 2010.
Auswertungstabellen [Statistical Report. Tables] (2011): http://www.bagw.de/agstado/5.phtml
2) Busch-Geertsema, V. (2013) Housing First Europe. Final Report:
http://www.socialstyrelsen.dk/housingfirsteurope/copy4_of_FinalReportHousingFirstEurope.pdf
3) Padget, D.K. (2007) There’s no place like (a) home: Ontological security among persons with
serious mental illness in the United States, Social Science & Medicine 64 (2007),1925–1936
4) Ibid., p. 1934
5) Atherton, I. and McNaughton-Nicholls, C. (2008) Housing First as a Means of Addressing Multiple
Needs and Homelessness. European Journal of Homelessness, 2, pp. 289-303; Johnsen, S. and
Teixeira, L (2010) Staircases, Elevators and Cycles of Change: Housing First and Other Housing
Models for People with Complex Support Needs (London: Crisis). Johnsen, S. and Teixeira, L. (2012)
‘Doing it Already’?: Stakeholders Perceptions of ‘Housing First’ in the UK. International Journal of
Housing Policy (2012, 12 (2)); McNaughton-Nicholls, C. and Atherton, I. (2011) Housing First:
Considering Components for Successful Resettlement of Homeless People with Multiple Needs.
Housing Studies, 26:5, pp. 767-77; Pleace, N. (2011) ‘The Ambiguities, Limits and Risks of Housing
First from a European Perspective’ European Journal of Homelessness 5, 2, pp. 113-127; 7;
Waegemakers Schiff, J. and Rook, J. (2012) Housing First: Where is the evidence (Toronto: Homeless
Hub), see http://www.homelesshub.ca;)

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EUROPEAN RESEARCH CONFERENCE
Housing First. What’s Second?
Berlin, 20th September 2013
Notes and References
6) Tsemberis, S. (2010) Housing First: Ending Homelessness, Promoting Recovery and Reducing
Costs, in: Gould Ellen, I. and O’Flaherty, B. (eds.) How to House the Homeless (New York: Russell
Sage Foundation), p. 52
7) Busch-Geertsema, V. (2005) Does Re-Housing Lead to Reintegration? Follow-Up Studies of Re-
Housed Homeless People, INNOVATION - The European Journal of Social Science Research, 18(2)
pp.205-226
8) Shinn, M. and Baumohl, J. (1999) Rethinking the Prevention of Homelessness, in: Fosburg, L. &
Dennis, D.L. (eds.) Practical Lessons: The 1998 National Symposium on Homelessness Research
(U.S. Department of Housing and Urban Development and U.S. Department of Health and Human
Services)