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Rural Health Information Hub

Pathways Vermont Housing First Program

  • Need: Ending a local Vermont population's homelessness experience.
  • Intervention: In 2010, Pathways Vermont implemented a first-of-its-kind, rural-focused Housing First program in order to provide housing and support services to those with mental health and substance use conditions experiencing homelessness.
  • Results: Since its initial start-up, Pathways Vermont has assisted over 560 Vermonters — about 70% from rural areas — experiencing homelessness using the Housing First model. The organization has collaborated with the state mental health department, corrections department, local healthcare systems and providers, and other organizations to end homelessness. In addition, programmatic work has expanded to reach other local populations, including veterans and at-risk families.


Pathways Vermont logo

A 2020 academic paper detailed a well-recognized bidirectional link: those with severe mental health diagnoses often experience homelessness and those experiencing homelessness can experience worsened mental health conditions or experience new issues with depression and suicidal thoughts.

Housing and mental health experts suggest that accessing treatment and entering a recovery trajectory is difficult or near impossible without a permanent home or support services. With that population at the forefront, non-profit Pathways Vermont bases its mission in ending homelessness.

With support from a 2009-2014 Substance Abuse and Mental Health Services Administration (SAMHSA) demonstration grant, the organization used the evidence-based Housing First program to address the local homelessness challenge. By 2011, the organization was also recognized as a strategic partner for the state's corrections department. Pathways was able to assist individuals transitioning from incarceration to community life by using a cost-saving alternative that also proved an effective intervention for breaking recidivism.

Pathways Vermont Housing First county service area
Pathways Vermont Housing First service area.

However, Pathways leadership also recognized the rural challenges in providing home and community-based supports over a wide geographic area with limited public transportation options. As the first organization to implement the evidence-based practice of Housing First in a rural state, their unique and effective approach to implementation while maintaining outcome measures became well-recognized and is detailed in the American Journal of Public Health.

As of early 2021, Pathways Vermont's work to end the homelessness experience has expanded past the goals of the original grant. It continues to provide the evidence-based model of Housing First in six counties (three of which meet the Federal Office of Rural Health Policy's rural designation: Addison, Franklin, and Washington), but now also uses the rapid rehousing (RRH) intervention. RRH is best explained as an approach that provides intensive support and access to permanent housing for individuals and families who are new to homelessness and have fewer barriers to housing stability. Pathways also has a program, Supportive Services for Veteran Families, which uses the RRH mode.

During the 2020 COVID-19 public health emergency, regional RRH teams also supported referred households needing access to permanent housing.

Since its origin, Pathways has participated in the statewide Vermont Coalition to End Homelessness and continues to advocate for statewide expansion of the Housing First model. The organization also offers training for the model's implementation.

After the original SAMHSA grant, continued support has come from Vermont's Department of Mental Health and Department of Corrections, private donors, and smaller grants. Additionally, partnerships with Vermont State Housing Authority and Burlington Housing Authority ensure program participants have access to state and federal resources for housing.

Services offered

Services are directed to providing support to ensure permanent independent housing for individuals and families with a goal of providing "long-term, multidisciplinary community supports, including service coordination, mental health and substance use peer support, employment assistance, psychiatry, nursing care, and representative payee services."

Services provided:

  • Support team availability by phone on-call 24 hours a day, seven days a week
  • Peer support
  • Wellness services
  • Basic life skills support
  • Supportive employment services
  • Mental, behavioral, and physical healthcare access
  • Nursing care
  • Substance use treatment and recovery support

During the pandemic Pathways was able to facilitate access to and/or provide:

  • Home internet access
  • personal computers
  • Computer literacy training


Housing First results:

As of March 2021, over 560 Vermonters have participated in the Housing First program, about 70% from rural areas.

Consistent with other site's use of evidence-based Housing First, the program's housing retention rate — retention rate as the percentage of tenants who are stably housed on a given night — is 85%.

Housing First Permanent Supportive Housing program:

  • Program census 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

The state of Vermont continues to estimate that Housing First saves over $1,700,000 by supporting 220 individuals by 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)

SSVF program results:

Since 2014, the SSVF program has:

  • Housed over 235 Vermont veteran families
  • Avoided over 170 potential instances of homelessness
  • Served over 180 children

Housing First training results:

Pathways Vermont offers a variety of training related to housing first implementation including training specialized in rural models for ending homelessness, a peer-approach to Housing First, and harm reduction.

State and international clients have included Rhode Island, Massachusetts, the Netherlands, Ireland, Spain, Bhutan, and Great Britain.

Awards and Recognition:

In May 2014, Pathways Vermont was awarded designation as a Specialized Services Agency by the Department of Mental Health, the first such designation awarded to a mental health organization in Vermont since the 1980s.

For more on the program see:

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.


A decade ago, during the demonstration project, challenges faced at that time were also experienced 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.

Making the Housing First model available statewide continues to be a challenge. Other challenges include meeting the long-term housing and service needs of current participants that, in turn, further impacts the ability to support new households. Graduation rates in the permanent supportive housing model do not equate to the number of new individuals and households in need of services. The limited local housing inventory — access to affordable units — also presents a challenge due to low vacancy rates, a challenge in more than one rural community.


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.

Keeping a values-based philosophy is central to any work in this area. Pathways Vermont values central to their work and services include:

  • Individual choice and self-determination
  • Trauma-informed service offerings
  • Harm reduction
  • Peer support
  • Community integration
  • Respect, warmth, and compassion

Contact Information

Lindsay Casale, Program Manager
Pathways Vermont
888.492.8218. Ext 110

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

States served

Date added
January 8, 2016

Date updated or reviewed
April 3, 2021

Suggested citation: Rural Health Information Hub, 2021. Pathways Vermont Housing First Program [online]. Rural Health Information Hub. Available at: [Accessed 21 May 2024]

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.