Beyond Housing First: Provider Perspectives on Integrated Housing and Behavioral Health Services for Individuals Experiencing Homelessness

Background and Purpose

Despite widespread adoption of Housing First approaches in homelessness policy, individuals experiencing homelessness with co-occurring mental health and substance use needs face persistent barriers to housing stability. Drawing on a structural inequality framework, homelessness is understood not solely as an individual-level issue but as a product of systemic barriers—including limited affordable housing supply, fragmented service systems, and administrative obstacles to accessing benefits—that shape housing access and the implementation of homelessness services.

The Healthy Community Collaborative (HCC) is a state-funded initiative supporting individuals experiencing homelessness with co-occurring behavioral health needs through integrated housing and behavioral health services. This study examines provider perspectives on the implementation of integrated housing and behavioral health services within HCC programs, the structural barriers influencing housing placement and stabilization, and the service delivery strategies providers identify as most effective in supporting housing stability.

Methods

This qualitative study draws on two waves of semi-structured interviews with nine program leaders and service providers across seven urban and rural HCC sites in Texas. Interviews were conducted during the first half of FY26 and explored program implementation, service coordination, operational challenges, and program priorities. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis with a hybrid coding approach, combining deductive codes informed by implementation and service integration frameworks with inductive coding to identify emergent themes. Analysis focused on identifying shared implementation experiences, structural barriers, and strategies used by providers to support housing placement and stabilization.

Results

Findings identified several cross-site themes related to supportive housing implementation. Providers emphasized the importance of person-centered engagement and integrated behavioral health services in supporting housing stability for individuals with complex clinical needs. Cross-sector collaboration among housing providers, behavioral health agencies, and community organizations strengthened service coordination and participant engagement. Providers also described structural barriers—including limited affordable housing, documentation and benefits access challenges, and administrative requirements—that delayed housing placement and complicated service delivery. Providers frequently acted as system navigators, coordinating across fragmented housing, behavioral health, and social service systems to address administrative and eligibility barriers. Importantly, providers noted that housing placement alone was often insufficient for participants with co-occurring behavioral health needs. Instead, stabilization required ongoing coordinated behavioral health treatment, case management, and sustained engagement alongside housing supports. Unlike traditional Housing First models that prioritize housing placement as the primary intervention, providers described an integrated service model in which behavioral health engagement, services, and housing stabilization occur simultaneously.

Conclusions and Implications

Findings highlight the importance of integrated housing and behavioral health service models for individuals experiencing homelessness with co-occurring mental health and substance use needs. However, structural barriers—including housing shortages, fragmented service systems, and administrative requirements—continue to constrain program implementation. Policy efforts that expand affordable housing supply, strengthen coordination between housing and behavioral health systems, and streamline access to benefits may improve housing placement and retention outcomes.