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Cited by 70Homelessness and Social IssuesHIV, Drug Use, Sexual RiskSubstance Abuse Treatment and Outcomes

Housing First and harm reduction: a rapid review and document analysis of the US and Canadian open-access literature

Open access
Watson, Dennis P., Shuman, Valery, Kowalsky, James, Golembiewski, Elizabeth, Brown, Molly·2017·Harm Reduction Journal
DOI 10.1186/s12954-017-0158-xPMC PMC5442650
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Abstract

BACKGROUND: Housing First is an evidence-based practice intended to serve chronically homeless individuals with co-occurring serious mental illness and substance use disorders. Despite housing active substance users, harm reduction is an often-overlooked element during the Housing First implementation process in real-world settings. In this paper, we explore the representation of the Housing First model within the open-access scholarly literature as a potential contributing factor for this oversight. METHODS: We conducted a rapid review of the US and Canadian open-access Housing First literature. We followed a document analysis approach, to form an interpretation of the articles' content related to our primary research questions. RESULTS: A total of 55 articles on Housing First were included in the final analysis. Only 21 of these articles (38.1%) included explicit mention of harm reduction. Of the 34 articles that did not discuss harm reduction, 22 provided a description of the Housing First model indicating it does not require abstinence from substance use; however, descriptions did not all clearly indicate abstinence was not required beyond program entry. Additional Housing First descriptions focused on the low-barrier entry criteria and/or the intervention's client-centeredness. CONCLUSIONS: Our review demonstrated a lack of both explicit mention and informed discussion of harm reduction in the Housing First literature, which is likely contributing to the Housing First research-practice gap to some degree. Future Housing First literature should accurately explain the role of harm reduction when discussing it in the context of Housing First programming, and public agencies promoting Housing First uptake should provide resources for proper implementation and monitor program fidelity to prevent model drift.

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  • The ongoing role of harm reduction in Housing First support approaches remains an under-researched area, heightening the research-practice gap related to the intervention and undermines the provision of person-centred care.

    “However, the ongoing role of harm reduction in Housing First support approaches remains an under-researched area, heightening the research-practice gap related to the intervention and undermines the provision of person-centred care (Watson et al., 2017).”

    From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Watson et al., 2017

    The Abstract Conclusions report that inadequate discussion of harm reduction in Housing First literature is likely contributing to the research–practice gap to some degree. The Discussion also describes inconsistent coverage of harm reduction. The paper does not establish that this gap undermines person-centred care, and the claim states the effect on the gap more firmly than the source does. (LLM, conf=0.84)

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  • Harm reduction, in the context of Housing First, most commonly refers to programs not requiring tenants to abstain from using substances in order to access housing and services.

    “Harm reduction, in the context of Housing First, most commonly refers to programs not requiring tenants to abstain from using substances in order to access housing and services (Watson et al., 2017).”

    From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Watson et al., 2017

    The Background says Housing First does not require sobriety for program entry or service continuation. But the Results distinguish that feature of Housing First from definitions of harm reduction: the definitions reviewed ranged from non-abstinence to broader strategies for reducing substance-related harms. The paper therefore supports the non-abstinence aspect, but not the claim that harm reduction most commonly refers specifically to access without an abstinence requirement. (LLM, conf=0.83)

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1 of the 89 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [15]Pearson CL Locke G McDonald WR The applicability of Housing First models to homeless persons with serious mental illness: final report 2007 Washington DC US Department of Housing and Urban Development, Office of Policy Development and Research
  2. [65]Institute of Medicine (US) Commitee on Quality of Healthcare in America. Crossing the quality chasm: a new health system for the 21st century. Washington: The National Academies Press; 2001. 25057539

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Authors
Watson, D. P., Shuman, V., Kowalsky, J., Golembiewski, E., & Brown, M.
Affiliations
  • Indiana University Indianapolis (US)
  • Heartland Alliance (US)
  • DePaul University (US)
Corresponding author
Watson, Dennis P.
ORCID
Venue
Harm Reduction Journal
Publisher
Springer Science and Business Media LLC
Published
2017-05-23
Volume
14
Issue
1
Pages
30-30
ISSN
1477-7517 (ISSN-L)
DOI
10.1186/s12954-017-0158-x
PMC
PMC5442650
OpenAlex
W2618208464
Cited by
70
References
89
Citations by year
2026: 5 · 2025: 13 · 2024: 9 · 2023: 4 · 2022: 8 · 2021: 12 · 2020: 6 · 2019: 2 · 2018: 8 · 2017: 3
FWCI
0.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Harm Reduction Journal (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc-nd)
  • Purdue University Indianapolis (Indiana University) (submittedVersion, cc-by-nc-nd)
  • PMC
Funders
National Institute on Drug Abuse (R34DA036001)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
Housing First, harm reduction, chronic homelessness, abstinence, model drift, research-practice gap, implementation fidelity
MeSH terms
Canada, Documentation, Ill-Housed Persons, Housing, Humans, United States, Substance-Related Disorders, Access to Information, Harm Reduction, Drug Users

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