Principle and practice: Housing First, Harm Reduction, and Crisis De-escalation National Alliance to End Homelessness National Conference on Solutions for Individual Homeless Adults February 22, 2019 San Diego Daniel Malone DESC Seattle

DESC components Shelter – low-barrier survival services, 450 beds Behavioral health treatment: crisis services, outreach, outpatient treatment and ongoing care Permanent supportive housing – 1350 units (1000 single site, 350 scattered site) – all Housing First for people with highest needs

DESC client population (n=~3500) Common characteristics Long-term homelessness Highly vulnerable Serious mental illness Substance use disorder Other complex medical problems Criminal justice system involvement Heavy use of crisis services Repeated failed treatment attempts

Harm Reduction Seat belts vs. guardrails

Seat belts Needle exchange Reducing amount used Using screen/rubber tubing for crack use MAT for opioid substitution Alcohol monitoring/management Paying rent before buying drugs Smoking vs. injecting Drug testing kits Harm reduction groups

Guardrails

Guardrails desc.org

Guardrails desc.org

Guardrails desc.org

Guardrails desc.org

Challenges for staff Fear of doing the wrong thing The need to see measurable success Balancing positive regard for the individual with concerns about the behavior Concern about endorsing substance use Stress leads to desire for rules/structure