HOUSING FIRST JUNE, 2016 - REGINA’S HOUSING FIRST PROGRAM 27 MAY 2016 SAM TSEMBERIS, PH.D. FOUNDER AND CEO PATHWAYS HOUSING FIRST INSTITUTE
Families and youth have similar patterns WHO IS HOMELESS? HOW LONG ARE THEY HOMELESS? HOW ARE THEY SERVED? Families and youth have similar patterns RENT SUPPORT RENT + CASE MNGMT RENT + INTENSIVE SUPPORTS N=293 640 from N=233 2
What are the root causes of homelessness? employment Housing Addiction Mental illness Poor choices Health justice education
Some Underlying Assumptions In Programs Addressing Homelessness Clinical program practices Attitudes about the poor Combining housing and services Housing Policy and Funding 4
Staircase (Treatment First) approach Permanent housing Transitional housing Level of independence Shelter Homeless Treatment compliance + + psychiatric stability + abstinence 5
Staircase Model Has Unrealistic Expectations for chronic group ALMEDALEN 2014 6
Legacy of Systems Failure: Why We Focus on the Chronically Homeless 10% of POPULATION USES 50% OF SYSTEM RESOURCES 10% of 233 Institutional Circuit 7 7
Pathways’ Housing First Model Permanent supportive housing Transitional housing Immediate Access Ongoing, flexible support Harm Reduction Housing as a Right Emergency Shelter Placement Homeless >Immediate Access to A Place of Your Own 8 8
Key Elements of the Paradigm Shift Change in how WE work: View of people served Program Philosophy Treatment orientation Power relationships Practice and operation - access Change based on clinical and research evidence (taking psych rehab to the streets) Audio: Housing First represents a paradigm shift in the view of those being served, goals, power relationships, treatment cultures, and the focus and locus of care. It is a marked departure from the “housing readiness” approach that assumes people must have certain skills and services before they are offered permanent housing. In contrast, Housing First assumes that housing is a basic human right.
Principles and Practices of Housing First Consumer Choice Separation of Housing and Support Services Service Array Matches Needs of Consumers Recovery orientation (Social Inclusion) Team Operations
Discuss service choices Client Directed vs System Directed “No Wrong Door” Family/ Friends Legal/ Justice Education Spiritual EMPLOY MENT CLIENT SOCIAL SUPPPORT HEALTH Discuss service choices Arts / Creativity SELF-DETERMINATION IS THE FOUNDATION OF PROGRAM PHILOSOPHY Addiction Tx Mental Health HOUSING
Neighborhood Location CHOICE of neighborhoods in affordable areas
Clinical and Support Services 70%-80% in the home 13
Separation and Coordination of Housing and Services
Landlords as Program Partners Agency ensures rent is paid on time Agency and landlord communication; responsiveness to landlord concerns Advantages of using rental market: quick start up, relocation, expansion as needs change
Recovery Focused Services What Helps and What Hinders Recovery? Peer support Knowledge Skills to self-manage Emphasis on hopeful, inspiring culture Summarize and emphasize the idea of where the locus of control is.. That is now with the client.. Give a hint about why MI works well with this perspective
The Ultimate Goal of Housing First is Recovery 17
Mental Health Commission of Canada: At Home/Chez Soi Program Effectiveness 18
5 Cities of Different Sizes and Composition Across Canada Housing First Research Demonstration 5 Cities of Different Sizes and Composition Across Canada Vancouver Pop: 578, 000 Moncton Pop: 107,000 Montreal Pop: 1,621,000 Winnipeg Pop: 633, 000 The graphs show that housing stability does not differ much across the sites. On the y axis is the % of time spent in stable housing, and on the x axis is the number of months spent in the study. The red line represents participants receiving the Housing First Intervention, the blue line represents the participants receiving treatment as usual. Toronto Pop: 2,503,000 19
Percentage of time housed Housing First Achieves Similar Housing Outcomes for Moderate and High Need Participants Percentage of time housed WWW.MENTAL HEALTH COMMISSION OF CANADA/AT HOME/CHEZ SOI 20
Cost Offsets Vary Depending on Need Level C Cost Analysis: HF with ACT H Housing First costs $22K per person per year A Coverage net cost offset of $21.4K CAD (96%) per person. $ $10 CAD invested in HF with ACT saved $9.60 CAD C Cost Analysis: HF with ICM H Housing First costs $14K CAD per person per year A Coverage net cost offset of $4.8K CAD (34%) per person. $ $10 CAD invested in HF with ICM saved $3.42 CAD 21
HPS Federal Mandate Housing FCommunity Approachirst as a Introducing Housing First Principles, Values and Practices to the Community HPS Mandate Identifies Chronic Homelessness Individuals Already Well Known to the Community Consensus Among Multiple Stakeholders Opportunity to improve the overall system 22
What is Program Fidelity and Why Does It Matter? Assess the degree to which the Housing First program is being implemented correctly Program Operational features: what does the housing look like? What services are provided? Philosophy, values: participant choice? Harm reduction? 23
Steps needed to Introduce System Change Target Population: Community sets priority among homeless population Collaboration: Partnership among agencies (identification, data sharing, resource sharing, etc.). Lead Roles, Accountability Operations: Design or re-design system so there is a clear map for all providers and participants Measure: Set specific targets and timelines and track outcomes as a community (transparency) Leadership/Collaboration model 24
Pine Street Inn, Boston – Lydia Downey from Managing to Ending homelessness 25
Shelter utilization and capacity ‘let’s do the math’ Shelter of 100 beds = 36,500 bed nights Average stay per guest: 10 people staying 10 nights = 100 bed nights 10 people staying 180 nights = 1,800 bed nights Annual Service Capacity 10 nights per guest = 3,650 guests/year 180 nights per guest= 203 guests/year 26
Program Building Blocks 27
Redesigning the System: System Transformation Permanent housing (scatter-site, off site services) Permanent Single Site (on-site services) Community-based, Residential Treatment (on-site clinical staff) Longer term Institutional Care >Less restrictive to more restrictive > 28 28
Thank You Questions? Comments? 29