An individual who has been using illegal substances for many years is referred to a supportive housing program. The program manager’s FIRST step…

The most appropriate first step is to admit the individual based on the principles of the Housing First model, an evidence-based practice in psychiatric rehabilitation. This model prioritizes providing immediate access to permanent housing without requiring sobriety or treatment compliance as a precondition. Stable housing is viewed as the essential foundation from which an individual can begin to address other issues, such as substance use. Concurrently, providing harm reduction services acknowledges the reality of the individual's substance use and focuses on minimizing its negative consequences, which is a pragmatic and person-centered approach to supporting recovery.

A. refer to inpatient substance abuse treatment program.

This represents a "treatment first" model, which can be a barrier to housing and is often less effective than providing housing first.

B. request a clean drug screen prior to admittance.

This imposes a sobriety requirement, which is a barrier to entry and is contrary to the low-barrier, harm reduction philosophy of modern supportive housing.

C. request compliance with outpatient counseling.

This makes housing conditional on treatment compliance, which contradicts the voluntary nature of services in the Housing First model.

1. Boston University Center for Psychiatric Rehabilitation. (n.d.). Choosing, Getting, and Keeping a Place to Live. In Services: Wellness & Recovery. This resource emphasizes that psychiatric rehabilitation services support individuals in choosing and accessing housing that is not contingent on program compliance. The Housing First model is a key example, where housing is provided without preconditions. The focus is on consumer choice and providing supports after housing is secured.

2. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis. American Journal of Public Health, 94(4), 651–656. https://doi.org/10.2105/ajph.94.4.651

Page 651, Abstract & Introduction: The article explicitly contrasts the Housing First model with traditional models that require participation in psychiatric treatment or sobriety as a prerequisite for housing. It states, "The Housing First program... provides immediate access to independent apartments for individuals who are homeless and who have a psychiatric disability... [it] does not require participation in treatment or sobriety as a precondition for housing."

3. Pratt, C. W., Gill, K. J., Barrett, N. M., & Roberts, M. M. (2014). Psychiatric Rehabilitation (3rd ed.). Academic Press.

Chapter 12, "Supporting a Place to Live," Section on "Housing First": This chapter details the evidence-based practice of Housing First. It explains that the model's core principle is to provide housing immediately and then offer voluntary supportive services, including those for substance use, rather than requiring treatment as a condition of tenancy. This approach respects the person's readiness for change.