In this powerful episode of Doing What Works: Innovations in Homeless Services, we speak with Dr. Sam Tsemberis, founder of the Housing First model and CEO of the Pathways Housing First Institute. Drawing from decades of experience in psychology and frontline mental health services, Dr. Tsemberis shares the journey that led him to challenge the status quo of homelessness treatment—shifting from a "treatment first" approach to one that prioritizes permanent housing without preconditions. From his early days at Bellevue Psychiatric Hospital to founding Pathways to Housing, Dr. Tsemberis witnessed firsthand the systemic gaps and human costs of policies that deny housing to those not yet "compliant" with treatment. Through compelling stories, research-backed results, and global replication efforts, this episode explores why Housing First isn’t just effective—it’s a matter of human dignity. Listeners will also hear his thoughts on workforce needs, replication of successful models like SMC's Homeless Services Certificate Program, and why shared public vision is essential to ending homelessness.
What You'll Learn in This Episode
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What if the first step out of homelessness isn’t treatment, but trust? Discover how prioritizing housing flips conventional wisdom—and gets results.
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Why do so many well-meaning systems fail the people who need them most? Explore the systemic blind spots and how Housing First addresses them.
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Could a simple apartment key change everything? Learn why offering a home without conditions is more powerful than you think.
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What do survival skills from life on the street reveal about resilience—and readiness? Hear how those same skills translate into success when housed.
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How can a community college program reshape a workforce—and a movement? Find out why training for frontline workers is more than just a job pipeline.
About Our Guest
Dr. Sam Tsemberis is a clinical psychologist and the founder of the Pathways Housing First program, a globally recognized model built on the principle that housing is a basic human right. His approach, now implemented across the U.S., Canada, Europe, Australia, and beyond, emphasizes immediate access to housing without preconditions and supports individuals through consumer-driven services. He is the founder of both Pathways to Housing and the Pathways Housing First Institute, which provides education, consultation, and implementation support internationally. Dr. Tsemberis currently serves as Executive Director of the VA-UCLA Center of Excellence for Training and Research on Veterans Homelessness and is on the faculty at UCLA’s Department of Psychiatry and Biobehavioral Sciences. His contributions have earned him numerous honors, including TIME Magazine’s 100 Most Influential People of 2024 and awards from the American Psychological Association and the Canadian government. Dr. Sam Tsemberis’ research has helped establish Housing First as an evidence-based practice with consistently high rates of housing stability, and his work has redefined how systems approach chronic homelessness around the globe.
Impactful Quotes
“ …So my first job was dishwasher…that was my Friday night, then Sunday morning job for quite a while. And what that taught me, strangely…is the "customer's always right." And that's something I've taken with me in my work in mental health as well.”
“ But then in psychiatry, it's a whole other situation because there isn't a surgery to be performed. There's a person to be learned. And in order to shift from telling people what to do so that you can learn something about them. You have to change your focus and go from being the expert to being the learner.”
— Sam Tsemberis
“ What does that mean? Severe mental illness? …While I worked at Bellevue, this was in the eighties now, one of the things that happened in the country was that the federal government stopped funding the building of public housing…in a very short time, I got to see on my way to work the people that had been treated in Bellevue's psych ward, on the streets, still sometimes in their Bellevue pajamas… And at that point I changed jobs.”
“ Many of the people were just desperate and poor, high, exhausted, distraught. And for someone with mental illness, it was a frightening kind of a space. And they would not go there. They would rather hide in the crevices of a building overnight rather than risk being in a shelter. That actually ended up giving them a reputation that these people were resisting shelter or not ready to be housed. In fact, they were making a very different choice based on what their emotional capacity was.”
“ And then we did a randomized control trial, where we had 225 people. We randomly assigned them to our, what we called, the Housing First program and then to the Sobriety Treatment and Housing Eventually programs. It was housing first and then treatment first, and the results were spectacular. 80% success in the Housing First program, 40% success. We published it in the American Journal of Public Health and that's when there was a kind of a sea change of people saying, "that won't work," to, "could you come and tell us how it would work here?"
”...people who are homeless don't have a microphone. They don't have a voice, and they're not represented in the conversation. So what we have done is we end up talking about them as if they're a separate group of people. But if you're working in homelessness and you start to get to know people, this is somebody's brother and this is somebody's sister and somebody's aunt and uncle. And it takes away this sense of us and them. It's like, who's on the street? It's not them. It's us.”
