Scaling Up Housing First Pilots – Drivers and Barriers




Housing First, Scaling-up, Social Innovation, Homelessness, Institutional Change, Drivers and Barriers


There has been an increased interest in Housing First services in Sweden over the past few years. The model was first developed in New York by the organization Pathways to Housing. The growing interest in Housing First as a response to ending long-term homelessness is seen not only in the US and Canada, but also in Europe. One reason for this is the mass of evidence showing high housing retention rates with Housing First services as compared with traditional services. This article aims to analyse the drivers and barriers that hinder or facilitate the scaling up of Housing First pilots. The research question is: Is it possible to incorporate lessons learned from the Housing First pilot into the existing system of homelessness services? In other words: Is it possible to put new wine into old bottles?

This is an ongoing research project on Housing First services in Sweden, with the specific focus on the Housing First pilot in the city of Helsingborg. The empirical material consists of in-depth interviews and focus group interviews with project managers, support workers and other stakeholders. The main results show that leadership is essential and a key driver for the scaling-up process. Another driver is the importance of repeating the vision and goals of the idea to keep the story alive. A third key driver is that the staff has identified the Housing First approach as a relative advantage and believes in the idea. The main barrier to the scaling-up process lies in the structures that maintain and surround the social housing programme.


Arnold, K. R. (2004). Homelessness, citizenship, and identity: The uncanniness of late modernity. Albany: State University of New York Press.

Barnett, J., Vasileiou, K., Djemil, F., Brooks, L., & Young, T. (2011). Understanding innovators’ experiences of barriers and facilitators in implementation and diffusion of healthcare service innovations: A qualitative study. BMC Health Services Research, 11, 342–342.

Brandsen, T., Evers, A., Cattacin, S., & Zimmer, A. (2016a). Social innovation: A sympathetic and critical interpretation. In: T. Brandsen, A. Evers, S. Cattacin, & A. Zimmer (Eds.), Social innovations in the urban context. Nonprofit and Civil Society Studies. Springer International Publishing.

Brandsen, T., Evers, A., Cattacin, S., & Zimmer, A. Brandsen, (2016b). The good, the bad and the ugly in social innovation. In: T. Brandsen, A. Evers, S. Cattacin, & A. Zimmer (Eds.), Social Innovations in the urban context. Nonprofit and Civil Society Studies. Springer International Publishing.

Clarke, S., & Stevens, E. (2008). Sustainable leadership in small rural schools: Selected Australian vignettes. Journal of Educational Change 10(4), 277–293.

Davis, M. H. (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85.

Dupuis, A., & Thorns, D. C. (1998). Home, home ownership, and the search for ontological security. The Sociological Review, 46(1), 24–47.

Essén, A., & Lindblad, S. (2013). Innovation as emergence in healthcare: Unpacking change from within. Social Science & Medicine, 93, 203–211.

Felton, B. J. (2003). Innovation and implementation in mental health services for homeless adults: A case study. Community Mental Health Journal, 39(4), 309–322.

George, A. L., & Bennett, A. (2005). Case studies and theory development in the social sciences. Cambridge, MA: MIT Press.

Godin, B. (2012). Social innovation: Utopias of innovation from c.1830 to the present. Project on the intellectual history of innovation. Working Paper No. 11. Retrieved from

Greenhalgh, T., Macfarlane F., Barton‐Sweeney, C., & Woodard, F. (2012). If we build it, will it stay? A case study of the sustainability of whole-system change in London. Milbank Quarterly, 90(3), 516–547.

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629.

Hardy, C., & Maguire, S. (2008) Institutional entrepreneurship. In: R. Greenwood (Ed.), The SAGE handbook of organizational institutionalism. London: SAGE.

Hartley, J. (2005). Innovation in governance and public services: Past and present, Public Money & Management, 25(1), 27–34.

Iriss (2016). Innovation and improvement. Retrieved from

Johnson, S. (2010). Where good ideas come from: The natural history of innovation. New York: Riverhead Books.

Kazepov, Y. (2010). Rescaling social policies towards multilevel governance in Europe: Some reflections on processes at stake and actors involved. In: Y. Kazepov (Ed.), Rescaling social policies: Towards multilevel governance in Europe. Farnham: Ashgate.

Klein, J-L. (2013). Introduction: Social innovation at the crossroads between science, economy and society. In: F. Moulaert, D. MacCallum, A. Mehmood, & A. Hamdouch (Eds.), The international handbook on social innovation: Collective action, social learning and transdisciplinary research. Cheltenham: Edward Elgar.

Knutagård, M. (2009). Skälens fångar. Hemlöshetsarbetets organisering, kategoriseringar och förklaringar. [Prisoners of reasons: organization, categorizations and explanations of work with the homeless]. Dissertation. Malmö: Égalité.

Knutagård, M. (2015). Bostad först som strategi eller strategisk strimma [Housing First as Strategy or Strategic Streak], Alkohol & Narkotika (4), 12–15.

Knutagård, M., & Kristiansen, K. (2013). Not by the Book: The Emergence and Translation of Housing First in Sweden. European Journal of Homelessness, 7(1), 93–115.

Knutagård, M. & Kristiansen, K. (2016). Scaling Up Housing First Pilots – Drivers and Barriers. Paper presented at the Third ISA Forum of Sociology, The Futures We Want: Global Sociology and the Struggles for a Better World, Vienna, Austria, July 10–14, 2016.

Kristiansen, A. (2013). Utvärdering av Bostad först-projektet i Helsingborg. Slutrapport. [Evaluation of the Housing First project in Helsingborg. Final report]. Helsingborg: Socialförvaltningen, Helsingborgs stad.

Kristiansen, A., & Espmarker, A. (2012). Sen är det ju mycket det här att man får vara ärlig också och det är man ju inte van vid... Bostad först ur de boendes perspektiv. [Then it is a lot of this that you can be honest too, and you are not used to that ... Housing first from the perspective of the residents]. Lund: Socialhögskolan, Lunds universitet, Working paper serien 2012:4.

Lind, H., & Lundström, S. (2007). Bostäder på marknadens villkor [Housing on the conditions of the market]. Stockholm: SNS.

Lindbom, A. (2001). Dismantling Swedish housing policy, Governance, 14(4), 503–526.

Martinelli, F. (2012). Social innovation or social exclusion? Innovating social services in the context of a retrenching welfare state. In: H. W. Franz, J. Hochgerner, & J. Howaldt (Eds.), Challenge social innovation: Potentials for business, social entrepreneurship, welfare and civil society. Berlin and Heidelberg: Springer Berlin Heidelberg.

Mazzucato, M. (2013). The entrepreneurial state: Debunking public vs. private sector myths. London: Anthem Press.

Milat, A. J., King, L., Bauman, A. E., & Redman, S. (2012). The concept of scalability: Increasing the scale and potential adoption of health promotion interventions into policy and practice. Health Promotion International, 28(3), 285–298.

Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.

Moulaert, F., MacCallum, D., & Hillier, J. (2013). Social innovation: Intuition, precept, concept, theory and practice. In: F. Moulaert, D. MacCallum, A. Mehmood, & A. Hamdouch (Eds.), The International Handbook on Social Innovation: Collective Action, Social Learning and Transdisciplinary Research. Cheltenham: Edward Elgar.

NBHW (2017). Hemlöshet 2017: omfattning och karaktär. [Homelessness 2017: Extent and Character]. Stockholm: National Board of Health and Welfare.

Padgett, D. K. (2007) There’s no place like (a) home: Ontological security among persons with serious mental illness in the United States. Social Science & Medicine, 64, 1925–1936.

Padgett, D. K., Henwood, B., & Tsemberis, S. (2016). Housing first: Ending homelessness, transforming systems, and changing lives. New York: Oxford Press.

Pleace, N. (2016). Housing First Guide Europe. Retrieved from

Pleace, N., Culhane, D., Granfelt, R., & Knutagård, M. (2015). The Finnish Homelessness Strategy – An International Review. REPORTS OF THE MINISTRY OF THE ENVIRONMENT 3en | 2015.

Radley, A., Hodgetts, D., & Cullen, A. (2005). Visualizing homelessness: A study in photography and estrangement. Journal of Community & Applied Social Psychology, 15(4), 273–295.

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.

Rønning, R., Knutagård, M., Heule, C. & Swärd, H. (2013). Innovationer i välfärden - möjligheter och begränsningar. [Innovations in welfare - possibilities and limitations]. Stockholm: Liber.

Rønning, R., & Knutagård, M. (2015). Innovation in Social Welfare and Human Services. New York: Routledge.

Sahlin, I. (2005). The staircase of transition. Survival through failure. Innovation, 18(2), 115–135.

Sahlin, I. (2015). Searching for a homeless strategy in Sweden. European Journal of Homelessness, 9(2), 161–186.

Salveron, M., Arney, F., & Scott, D. (2006). Sowing the seeds of innovation: Ideas for child and family services. Family Matters, 73, 38–45.

Sievanen, L., Leslie, H. M., Wondolleck, J. M., Yaffee, S. L., McLeod, K. L., & Campbell, L. M. (2011). Linking top-down and bottom-up processes through the new U.S. National Ocean Policy. Conservation Letters, 4(4), 298–303.

Streeck, W., & Thelen, K. A. (2005). Introduction: Institutional change in advanced political economies. In: W. Streeck, & K. A. Thelen (Eds.), Beyond continuity: Institutional change in advanced political economies. New York: Oxford University Press.

Talukder, M., & A. Quazi (2011). The impact of social influence on individuals’ adoption of innovation. Journal of Organizational Computing and Electronic Commerce, 21(2), 111–135.

Tsemberis, S. (2015) Housing First: The pathways model to end homelessness for people with mental health and substance use disorders. Revised and updated for the DSM-5 edition. Center City, MN: Hazelden.

What Works Scotland Evidence Review (2015). Scaling-up innovations. Retrieved from

Wibeck, V. (2010). Fokusgrupper: om fokuserade gruppintervjuer som undersökningsmetod. [Focus groups: on focused group interviews as a research method] 2., uppdaterade och utök. uppl. Lund: Studentlitteratur.

Zeldin, S., Camino, L., & Mook, C. (2005). The adoption of innovation in youth organizations: Creating the conditions for youth–adult partnerships. Journal of Community Psychology, 33(1), 121–135.

Keys open doors




How to Cite

Knutagård, M., & Kristiansen, A. (2019). Scaling Up Housing First Pilots – Drivers and Barriers. Nordic Journal of Social Research, 10(1), 1–23.