BackgroundHousing 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.MethodsWe 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.ResultsA 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.ConclusionsOur 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.

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. (From -To) REPORT DATE (DD-MM-YYYY) 01-07-2006 REPORT TYPE Annual DATES COVERED PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBERVirginia Polytechnic Institute Blacksburg, Virginia 24060-3325 SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR'S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 SPONSOR/MONITOR'S REPORT NUMBER(S) DISTRIBUTION / AVAILABILITY STATEMENTApproved for Public Release; Distribution Unlimited SUPPLEMENTARY NOTES ABSTRACTSee Executive Summary Page 2 SUBJECT TERMSNo subject terms provided. ACKNOWLEDGMENTSWe thank the Department of Defense, Natural Resources Division (Jackson Guard), Eglin Air Force Base, for funding this project. Personnel at Eglin were uniformly supportive of and helpful with our work. We thank Range Control for working with us on a daily basis to provide safe access to research sites. We are especially grateful to the members of Jackson Guard for their willingness and ability to coordinate management of the base with our research activities, and for their contributions to the research. The work described here was truly a joint venture between our university research team and Jackson Guard. Several members of Jackson Guard deserve special mention. Dennis Teague contributed to collection of field data. First Carl Petrick and then Bruce Hagedorn provided leadership and input to study design, and secured funding for the project each year. In the early years of the project Bruce managed much of the data and facilitated coordination between our research and other management activities on Eglin. Kathy Gault led our university research team in the early years of the project and continued to contribute to data collection and performance of management activities, as well as managing some of the data and coordinating our work with base natural resource management, after moving to Jackson Guard. Bruce and Kathy participated in annual reviews of population data and a variety of other activities, and generally contributed to the project on a daily basis.We are also indebted to o...