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Pathways Vermont Housing First Program

  • Need: To provide housing for the chronically homeless who face mental health and/or substance abuse challenges in the rural areas of Vermont.
  • Intervention: Pathways Vermont initiated a rural version of the Housing First program that provides access to permanent rental housing and numerous services to help sustain housing stability.
  • Results: Participants reported decreased time spent homeless, a significant improvement in their standard of living, and hundreds of thousands of dollars were saved on behalf of Vermont.


Pathways Vermont logo

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. All too commonly, the chronically homeless experience a combination of severe mental illness, substance abuse problems, and other disabling medical conditions.

Moreover, SAMHSA, and other experts alike, state it is extremely difficult for chronically homeless people to recover from an illness or obtain the treatment they need without a permanent home or support services. They are also likely to need services in an assortment of areas, such as primary and mental healthcare, substance abuse treatment, income and employment, and life skills delivered through a well-integrated system. Without these services, successful communal integration has a high fail probability.

In December 2009, Pathways Vermont adapted the evidence-based Housing First program in rural Vermont as a demonstration project under a five-year SAMHSA grant. The Housing First program provides independent housing and community-based supports for chronically homeless Vermonters who struggle with severe mental health issues, substance addiction or both. Participants in the program have significant mental health challenges that impede their ability to live successfully in the community without support. Additionally, over 90% of Pathway Vermont participants self-identify as having trauma histories.

Pathways' housing specialists recruited over 85 landlords, procured housing units, assisted with property management issues, and served as liaisons with landlords. After recognizing the challenges of providing home and community-based supports over a wide geographic area with limited public transportation options, the organization also integrated internet-based services.

From 2009-2014, Pathways Vermont was funded through a grant from SAMHSA. From 2014 to current, Pathways substituted SAMHSA grant money with funding from the Vermont Department of Mental Health. In 2011, Pathways established funding through the Vermont Department of Corrections which has since continued.

Services offered

At the core of every Housing First program, there are three critical elements:

  • Assistance in accessing and sustaining permanent rental housing
  • Services delivered to promote housing stability and individual well-being on an as-needed basis
  • Developing standard lease agreements for housing without any mandated therapy or services compliance required

Services are most often provided in an individual's natural environment, such as an apartment, neighborhood, or workplace. Pathways Vermont's Housing First program provides a wide range of support services to clients including:

  • Service coordination
  • Peer support
  • Wellness services
  • Basic life skills support
  • Supportive employment services
  • Access to a psychiatrist
  • Nursing care
  • Substance abuse and recovery support
  • Computer literacy training
  • Home internet access
  • A refurbished computer
  • Support team availability on-call 24 hours a day, seven days a week

Additionally, Pathways Vermont expanded Housing First to serve individuals transitioning out of incarceration and back to life within the community.


While there is no time limit on how long a client can participate in the Housing First program, people usually stay at least a year given the standard one-year lease agreement. However, some individuals have been with the program since its inception. To date, the program has supported over 200 individuals who transitioned from chronic homelessness to permanent housing. Over 150 program participants have also transitioned from institutions, such as hospitals or prisons, to permanent housing. Outcomes from Housing First include:

  • In roughly three years, the Housing First program achieved a housing retention rate of 85%
  • Program average in excess of 200 clients
  • Over 1000 hours of services provided per month
  • Improved everyday functioning and general well-being for participants
  • Improved orientation towards employment and recovery

Each year the state of Vermont saves over $1,700,000 by supporting 220 individuals maintaining permanent housing in the community. In addition, Pathways Vermont avoids over $2 million per year in hospitalization costs. On average per month, the program saves:

  • $260,000 in psychiatric hospital stays
  • $170,000 in incarceration costs
  • $40,000 in emergency housing costs (motel stays)

On a per night basis, Housing First is the least expensive alternative compared to other more typical options for people experiencing homelessness.

Published research relating to Pathways Vermont Housing First program

Stefancic, A., Henwood, B., Melton, H., Shin, S., Lawrence-Gomez R., Tsemberis S. (2013). Implementing Housing First in Rural Areas: Pathways Vermont. American Journal of Public Health, 103(2), 206-209. Free Full-text   


Program staff reported the biggest barrier to rapid housing were two common challenges faced nationwide: a shortage of housing subsidies and low vacancy rates. A third challenge was the "small town" nature of rural environments. For example, landlords might hold onto negative experiences further impacting the re-housing process.

Funding was another challenge encountered by Pathways Vermont. Anticipating its original 2009 SAMHSA funding to cease in October 2014, Pathways team members realized that nearly 200 Housing First clients were at risk of returning to the street. By educating their state legislators on the program's successes, additional funding was approved. Pathways Vermont was able to obtain financial support from Vermont's Department of Mental Health, and allowed to bill Medicaid for services. Telemedicine remains an uncovered service.


Following Housing First's evidence-based program with strict fidelity led to success for Pathways Vermont's rural program. Two important implementation factors were aligning with partners willing to adhere to evidence-based methods, and using separate teams for housing and social services in order to disperse workload and achieve more in less time.

Contact Information

Lindsay Casale, Program Manager
Pathways Vermont
Pathways Vermont Housing First Program
888.492.8218. Ext 110

Behavioral health
Home and community-based services
Human services
Mental health
Substance use and misuse

States served

Date added
January 8, 2016

Date updated or reviewed
February 19, 2017

Suggested citation: Rural Health Information Hub, 2017. Pathways Vermont Housing First Program [online]. Rural Health Information Hub. Available at: [Accessed 25 October 2020]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.