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Pioneered by Dr. Sam Tsemberis, a faculty member of the Department of Psychiatry of the New York University School of Medicine, and the organization Pathways to Housing in New York City in the early 1990s, Housing First is premised on the notion that housing is a basic human right, and so should not be denied to anyone, even if they are abusing alcohol or other substances. Previous and current models may require the homeless to abjure substance-abuse and seek treatment in exchange for housing.
Housing First, when supported by the United States Department of Housing and Urban Development, does not only provide housing. The model, used by nonprofit agencies throughout America, also provides wraparound case management services to the tenants. This case management provides stability for homeless individuals and families, which increases their success. It allows for accountability and promotes self-sufficiency. The housing provided through government supported Housing First programs is permanent and "affordable," meaning that tenants pay 30% of their income towards rent. Housing First targets individuals and families with disabilities. This housing is supported through two HUD programs. They are the Supportive Housing Program and the Shelter Plus Care Program. Pathways' Housing First model has been recognized by the Substance Abuse and Mental Health Services Administration as an Evidence-based practice. 
Housing First is currently endorsed by the United States Interagency Council on Homelessness (USICH) as a "best practice" for governments and service-agencies to use in their fight to end homelessness in America, and is similarly endorsed by government agencies that deal with the homeless in the United Kingdom.
Housing First programs currently operate throughout the United States in cities such as Anchorage, Alaska; New York City; Denver, Colorado; San Francisco, California; Atlanta, Georgia; Chicago, Illinois; Quincy, Massachusetts; Philadelphia, Pennsylvania; and Seattle, Washington, among many others, and are intended to be crucial aspects of communities' 10-Year Plans To End Chronic Homelessness also advocated by USICH.
In Massachusetts, the Home & Healthy for Good program reported some significant outcomes that were favorable especially in the area of cost savings.
The Denver Housing First Collaborative, operated by the Colorado Coalition for the Homeless, provides housing through a housing first approach to more than 200 chronically homeless individuals. A 2006 cost study documented a significant reduction in the use and cost of emergency services by program participants as well as increased health status. Emergency room visits and costs were reduced by an average of 34.3 percent. Hospital inpatient costs were reduced by 66 percent. Detox visits were reduced by 82 percent. Incarceration days and costs were reduced by 76 percent. 77 percent of those entering the program continued to be housed in the program after two years.
In August 2007, the US Department of Housing and Urban Development announced findings of a 30 percent decline in the number of chronic homeless individuals no longer living on the streets or in shelters. Credit for this unprecedented decline, falling from 176,000 people in 2005 to 124,000 people in 2007, has been attributed to the "housing first" movement that has spread to cities and jurisdictions across the United States. 
Housing First technology is also being adapted to decreasing the larger segment of the homeless population, family homelessness. Dennis Culhane, University of Pennsylvania homelessness researcher, states: “There’s a lot of policy innovation going on around family homelessness, and it’s borrowing a page from the chronic handbook - the focus is on permanent housing and housing-first strategies.” 
- ^ "The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness". HUD (July,2007).
- ^ "HUD Homeless Assistance Programs". HUD (December 21,2007).
- ^ "National Registry of Evidence-based Programs and Practices". SAMHSA (November, 2007).
- ^ "MHSA Submits Updated Home & Healthy for Good Report to Legislature: Statewide Housing First initiative reports dramatic cost savings to Commonwealth" - December 2007
- ^ U.S. Reports Drop in Homeless Population, New York Times, July 20, 2008.
- ^ Strides in Fighting Homelessness, Christian Science Monitor, August 8, 2008.