Housing First & Harm Reduction: Fundamental Rights Hand-in-Hand

Our most basic needs for survival are food, water, warmth, and rest, but a person is only able to maintain these things if they first have safety and security.

When someone is living on the street, it takes a huge amount of effort, on a daily basis, to stay on top of these basic needs.  Resolving the issues that led them to be on the street might have to take a back seat. People tell our staff all the time that, prior to housing, they wanted to do something about their underlying issues, but living was the priority. Dealing with serious mental illness, trauma, substance use, or lack of independent living skills are absolutely important, but you might not know-how to start if you also don’t have a picture where your next meal is coming from, or whether you will find shelter during the next heatwave.

Housing First is a philosophical approach that says, let’s start with a permanent place to live. We don’t make our participants prove that they have earned a safe place to lay their head at night. We recognize the need to first get the basics out of the way. We are not going to make you grovel to us and beg for an apartment. Housing is a basic human right. Everything else will carry out from there.

At Pathways to Housing PA we work with a scattered-site approach, which means we work with independent landlords across the city of Philadelphia. We don’t own our own properties but we work closely to support our landlords who are true partners in the fight to end homelessness. This allows us to offer multiple choices to participants so they can inform us where and what type of location they want to live in.  Participant choice and self-determination is crucial to the Housing First model.  People are much more likely to carry through with changes if those changes are what they want rather than what someone else is telling them they ought to do.

Housing First is not, and never should be, housing only.

As Clinical Director of Pathways to Housing PA, I spend a lot of time clarifying what Housing First is, and what it is not. We train staff on the approach, we talk about it with community members and service providers, and we help reinforce it with program participants. Often people think that Housing First is just putting someone in an apartment and wishing them luck. This couldn’t be further from the truth.

Our clinical teams firmly believe in individualized recovery, whether that is from mental health conditions, substance use, or other issues. In order to support a person’s recovery and journey toward wellness, we need to get to know them, and then they help us figure out what is important. Once someone is housed, if something isn’t working, then we need to try something different. We don’t kick them out of the program. 

At Pathways to Housing PA, having multidisciplinary teams connected to integrated health care allows us to support people and their individual needs. To us housing is healthcare. We do our work with compassion, creativity, and commitment to the people we serve. We don’t overprotect, we can’t simply hold hands, and we don’t just prohibit. What we do is help people reduce potential harms associated with potential risk.

We deeply believe in harm reduction. It is this commitment to our participants as individuals that help keep them engaged, where traditional programs may throw up their hands when things get tough.  The truth is sometimes it does get complicated. People’s mental health symptoms, individualized coping mechanisms, or re-establishing social connections after being on the street for a long time could end up in a place where being a good neighbor is hard. That’s where peers, case management, and other staff help work to strategize next steps in housing and care.

Closely adhering to the tenants of harm reduction ensures that we constantly need to adapt to the needs of our participants. We honor their own autonomy while also looking for ways to highlight strengths, individual resources, and their own capacity for adaption around safety. It was this commitment to individualized, harm reduction based supports that the agency created individualized and wholly unique, teams for people with opioid use. Staff is properly trained to offer specific harm reduction based care along with medical support, access to evidence-based therapeutic interventions and a litany of other issues. Many have lived experience and share this in a non-judgmental manner. As a result over 95% of a group of highly vulnerable individuals have maintained their housing and the majority at any given time are voluntarily engaging with medically assisted treatment.

A program participant once told me that while he was on the street he had plenty of people approach him and say they were going to help him move into a place of his own. They’d offer help but then they couldn’t follow through, or, if something got in the way for him, they’d disappear.

“You know what was different about Pathways was that you said you were going to help and you kept coming back and back and back again. You didn’t give up on me.” Housing First allows us the chance to open up the door for people to define what the many pathways to recovery look like to them.

- Matt Tice, LCSW
irector of Clinical Services

Matt Tice will be a speaking for the clinical track at our Statewide Conference: A Safety first Approach to the Overdose Epidemic. His session, Housing First & Harm Reduction: Fundamental Rights Hand-in-Hand, will highlight the successes and challenges of a high-fidelity Housing First program in Philadelphia PA. In this organization, there are specific interventions designed to focus on individuals engaging in high-risk behavior and ultimately foster positive participant-focused outcomes. The session will offer practical examples for safety-related outcomes, participant engagement, and comprehensive care. Join us on October for this groundbreaking event by registering here.


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