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Am J Public Health. 2013 Dec;103 Suppl 2:S206-9. doi: 10.2105/AJPH.2013.301606. Epub 2013 Oct 22.

Implementing housing first in rural areas: pathways Vermont.

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Ana Stefancic and Sam Tsemberis are with Pathways to Housing, Inc., New York, NY. Hilary Melton and Rebeka Lawrence-Gomez are with Pathways to Housing Vermont, Burlington, VT. Benjamin Henwood is with University of Southern California, Los Angeles, CA. Soo-Min Shin is with New York University, New York, NY.


The benefits of Pathways Housing First in addressing chronic homelessness for persons with severe mental illness have been well established. However, the implementation and effectiveness of such programs in rural areas has yet to be examined. We described the model's adaptations in Vermont, including the use of hybrid assertive community treatment-intensive case management teams, which consisted of service coordinators with geographically based caseloads (staff/client ratio of 1:20) and regional multidisciplinary specialists. The program's innovative and widespread inclusion of technology into operations facilitated efficiency and responsiveness, and a pilot telehealth initiative supplemented in-person client visits. The program achieved a housing retention rate of 85% over approximately 3 years, and consumers reported decreased time spent homeless, demonstrating that program adaptations and technological enhancements were successful.

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