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Housing First is a program that effectively engages, houses, and supports the recovery of individuals with complex clinical needs who are experiencing homelessness. This program’s philosophy is rooted in psychiatric rehabilitation, its ethos is founded on values of social justice and human rights, its advocacy is modeled after the consumer movement, and its clinical practice is informed by evidence-based interventions and delivered with respect, compassion, and in the spirit of creating new possibilities. These elements are woven together with a sturdy and flexible thread of pragmatism and tenacity and the net result is Housing First: A program that operates from the perspective of consumer choice and offers immediate access to housing and a wide array of support and treatment services. In Housing First, a place to live is offered as a right, not as a reward for participation in treatment, achieving a period of sobriety, or compliance with program rules. This chapter describes the genesis of the Housing First program—how it evolved from conducting outreach on the streets to a program offering housing to those on the streets, and it describes its growth from a small experiment in New York City’s Hell’s Kitchen to its replication and dissemination as a national and international evidence-based practice.