Harm Reduction & Housing First 1

What is Housing First? An approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness. 2

Housing First: A new model to end chronic homelessness. 1)People do not need to be “housing ready” in order to move and live successfully in housing. 2)Housing is a right. No one should be denied housing for any period of time because they did not meet pre-determined clinical goals or did not choose to participate in services. 3)Homelessness is a terrible treatment plan, whatever alcohol and drugs make bad – homelessness makes worse. 4)People who are homeless, who use drugs/alcohol and or who may have a mental illness can successfully keep and maintain housing. 5)Housing should never be used to coerce people into services they would otherwise not choose. 6)Housing and services are two separate areas with separate criteria for operation and evaluation. 3

What is Supportive Housing? Supportive housing is affordable rental housing combined with supportive services that helps people who are homeless and/or disabled live more stable, independent lives. 4

Benefits of Supportive Housing 1)Reduces stress caused by doubled-up and overcrowding 2)Reduces use of crisis and institutional services 3)Produces better outcomes than the more expensive crisis care system 4)Significantly reduces recidivism rates 5)Ends cycles of homelessness 5

Target Populations Homeless Long Term Homeless/chronic homeless Difficult criminal backgrounds Fleeing domestic violence Under educated Mental and developmental disabilities Generational poverty and homelessness Chronic alcoholic and/or chemical use issues Multiple detox admits Several failed treatment attempts Often been civilly committed Dual diagnosis Vulnerable 6

Why Do Supportive Housing? Reduction in out of home placements Increase in employment Increase in tax revenue Reduction in CD treatment costs Reduction in incarceration Savings to very expensive systems Early identification of children’s issues Stability provides time to get off alcohol/drugs Prevent generational homelessness Access to services

Prevalence of Trauma 90% of public mental health clients have been exposed to trauma Most have multiple experiences of trauma (Mueser et al.;2004, 1998) 97% of homeless women with SPMI have experienced severe physical and sexual abuse-87% experienced this abuse both in childhood and adulthood (Goodman et al, 1997) Up to two-thirds of men and women in SA treatment report child abuse and neglect (SAMSHA CSAT, 2000) 70-90% incarcerated girls- sexual, physical, emotional abuse (DOC, 1998, Chesney & Sheldon, 1991) Women with trauma histories reported more treatment failures than those without (Young &Boyd, 2000) Effects of homelessness of children 8

Harm Reduction Policies, programs and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing substance consumption. Harm reduction benefits people who use drugs, their families and the community. 9

Harm Reduction Principles: 1) Homelessness, poverty, mental health and drug and alcohol use and abuse have always been part of our society and will not be eliminated. Therefore, it is better to work to minimize the harm than to ignore it, or stigmatize the condition 1)Alcohol and drug abuse is a spectrum disorder which ranges from abstinence to severe abuse. Harm reduction acknowledges that reductions in use or adoption of less harmful forms of use are desirable outcomes. Abstinence and recovery are always part of the harm reduction philosophy, but not always the immediate goal. 10

3)Overall quality of life for the individual and the community, not just abstinence, are valid criteria for successful interventions and policies. 3)Harm reduction advocates non-judgmental services and voluntary participation as the best way to engage clients to reduce harmful behavior. 11 Harm Reduction Principles:

5)Harm reduction includes the client in all decisions about the services offered to them. 6)Harm reduction recognizes the self-healing quality of individuals and seeks to empower them to share and support each other in strategies to reduce harm. 12 Harm Reduction Principles

7)Harm reduction recognizes social inequalities, co-occurring conditions, and other barriers that impact individual vulnerability to substance use disorders and their capacity to change behavior 13

8) Harm reduction never minimizes the real harm and danger associated with alcohol and drug use, abuse, and dependency. 14 Harm Reduction Principles

Elements of Harm Reduction Service Delivery 15  Harm reduction recognizes abstinence and/or changed behavior as an ideal outcome, but accepts alternative that reduce harm  Harm reduction promotes low-threshold access to services as an alternative to traditional high threshold approaches  Substance use is a coping mechanism for other issues  Quality of life and well being measure success, not reduction in use or behaviors  The individual sets his/her own goals with the service provider  There are many different harm reduction services and plans The Goal Is Any Positive Step!

Harm Reduction in Supportive Housing 1)Use Motivational Interviewing 2)Incorporate strengths based programming – no one likes to be reminded of their challenges 3)Don’t try to catch people doing things unless it’s an immediate safety issue – it will eliminate trust 4)Keep asking yourself are we really allowing the tenant to make their own choices? 5)Understand the impact of trauma and its relationship with harmful behaviors 16

Trauma Informed Care Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography or sexual orientation. It is an almost universal experience of people with mental and substance use disorders. 17

Thank You !!! 18