HUD, the Department of Health and Human Services and the Office of National Drug Control Policy jointly released a “Treatment First” toolkit for communities on Aug. 12. The action pivots federal homelessness policy away from the “Housing First” model that has dominated for more than a decade.
Housing First prioritizes placing homeless individuals in permanent housing before addressing addiction or mental health conditions. The new Treatment First framework prioritizes addiction treatment before or alongside housing placement, a fundamental philosophical shift in federal homelessness policy.
The three-agency rollout signals a coordinated administration effort to redefine the ideological and programmatic basis of federal homelessness spending. Communities receiving federal Continuum of Care grants — the primary federal funding stream for homelessness services — will face pressure to align with the new framework.
Housing First has been the dominant federal homelessness policy framework since its adoption under the Obama administration. Research supporting the model showed that homeless individuals were more likely to remain housed when given immediate access to stable housing without preconditions.
Treatment First advocates argue that Housing First fails to address the root causes of chronic homelessness — primarily substance use disorders and mental illness — and that housing alone does not resolve these underlying conditions.
The policy shift affects tens of thousands of shelter beds, service providers and unhoused individuals in cities across the country. Homeless service providers that have built their programs around the Housing First model will need to restructure their approaches to align with the new federal framework.
The National Alliance to End Homelessness and other advocacy organizations have expressed concern that Treatment First requirements could result in homeless individuals being denied housing until they complete treatment programs.
An estimated 653,000 people experience homelessness on a single night in the United States, according to the most recent HUD point-in-time count.