The document discusses the distinctions in frontline practices between Housing First (HF) programs and traditional approaches to homelessness. It emphasizes the unique service delivery, recovery-oriented models, and harm reduction frameworks employed by HF providers that focus on client choice and support. The conclusion highlights the need for practical applications of harm reduction and considerations for varying provider languages and strategies across different demographics.

1. FRONTLINE PRACTICE WITHIN
HOUSING FIRST PROGRAMS
National Alliance to End Homelessness Annual Conference
July 30, 2014
Presented by:
Benjamin Henwood, PhD, MSW
USC School of Social Work, Los Angeles

2. 1. Why would frontline practice in Housing
First differ from other types of programs?
2. Do HF providers have a different
approach services?
3. What does it mean to deliver recovery
oriented services within HF?
4. How do HF providers implement a
harm reduction framework?

3. 1. Why would frontline practice in Housing
First differ from other types of programs?

4. Traditional system approach
Homeless
Shelter
placement
Transitional
housing
Permanent
housing
Level of independence
Treatment compliance + psychiatric stability + abstinence

5. Housing First approach
Homeless
Shelter
placement
Transitional
housing
Permanent
housing
Ongoing,
flexible
support
Harm
Reduc+on

6. 2. Do HF providers have a different
approach services?

7. Compared to non-HF, HF providers had:
- Greater endorsement of consumer values,
- Lesser endorsement of systems values,
- Greater tolerance for abnormal behavior

8. Implementation paradox
TF providers were consumed by the pursuit of housing.
HF providers focused on clinical concerns.
Front-Line Practice
Housing First Model
Treatment First Model
Focus on Housing
Focus on Treatment
*Henwood, B.F., Shinn, M., Tsemberis, S., & Padgett, D.K. (2013). Examining provider
perspectives within housing first and traditional programs. American Journal of Psychiatric
Rehabilitation, 16(4), 262-274.

9. 3. What does it mean to deliver recovery
oriented services within HF?

10. Provider creates meaningful choices
Provider Reflexivity
Model 1
Reflexivity ↓ Create choice↓
• Providers deny both client
expertise and agency
• Accept traditional power dynamics
Model 3
Reflexivity ↓ Create choice↑
• Choice is an explicit value but
there’s not much consideration of
the values and expertise that
clients bring.
Model 2
Reflexivity ↑ Create choice↓
• Acceptance that client have a
unique perspective but provider
doesn’t allow for providers to make
substantive decisions.
Model 4
Reflexivity ↑ Create choice↑
• Recognition of complicated
decision making processes AND
the importance of clients being the
drivers of their destiny is
embraced.
Low
High
High
Emergent Framework for Promoting Self-Determination
,
* Katz, M., Henwood, B.F., Stefancic, A., & Gilmer, T. (in preparation). In what ways do front-line providers
promote client choice? A comparative analysis based on fidelity to Housing First.
,

11. 4. How do HF providers implement a harm
reduction framework?

12. Figure
1.
Housing
First
harm
reduc1on
emergent
conceptual
model
Strong
consumer-­‐
provider
rela1onship
Poor
consumer-­‐
provider
rela1onship
Open
drug
use
discussion
No/limited
drug
use
discussion
High
self-­‐
determina1on
&
Health
impact
Low
self-­‐
determina1on
&
Health
impact
Holding
Environment
Consumer
Need
*Tiderington, E., Stanhope, V., & Henwood, B. (2012). A Qualitative Analysis of
Case Managers' Use of Harm Reduction in Practice. Journal of Substance Abuse
Treatment, 44, 71-77.

13. Concluding Thoughts
1. Harm reduction: Need more than a conceptual framework;
what are the actual practices?
2. Recovery orientation: But what if other providers don’t speak
this language?
3. HF allows us to bypass an ineffective staircase; what other
types of ‘bypasses’ should we embrace?
4. HF providers have a different approach as compared to
traditional providers; how do HF providers serving youth
approach things differently than those serving adults?