International rapid evidence review of services for homeless people with substance misuse problems that considers models of service delivery and outcome measurement within a Scottish context SDF User Involvement Response

We welcome this report and feel the issue requires urgent attention to save lives

No pre-conditions to receiving housing We welcome recognition that abstinence/stabilisation pre-conditions to receiving housing may often be unhelpful Therapeutic relationship undermined when people feel they have to lie about ongoing drug/alcohol misuse problems If pre-conditions too strict people may disengage which costs lives

Harm Reduction We welcome the recognition that harm reduction interventions keeps service users safe which is demonstrated by the New York model Pathways Housing First Pathways Housing First philosophy accept service users where they are at in their life (no hoops to jump through!) and provide long term intensive and flexible support

Meeting Needs You can’t tackle a chaotic drug or alcohol use problem without stable accommodation! We think that it would be much better for service users if all their problems –which may include drug use, alcohol use, homelessness and mental health issues – are dealt with by one organisation at the same time such as the Pathways Housing First model This would also allow the maintenance of reliable relationships with worker/s from one organisation and help build therapeutic alliances

Realistic Outcomes Realistic outcomes are helpful to both the service provider and the service user Abstinence should not be viewed as the only successful outcome Whilst the report recognises the value of harm reduction, we were disappointed by the language of the report in terms of describing harm reduction goals as “more limited" Keeping people alive is not a limited goal!

Funding We feel that short term investment will only ever achieve short term goals You can’t put a time limit on recovery Uncertainty for the future of the service provider means uncertainty for the future of the service user We agree that there should be long term investment to sustain long term, intensive and flexible interventions

Parents and children Report is good but it would have been helpful if there had been more detail on good practice relating to services for parents and children We would support the development of more addiction and homelessness services for parents and children in order to keep families together if this is assessed as the best outcome for all

Rural Areas Report is good but we feel it could have investigated the issue of providing effective services in rural areas in more depth Peer research required to find out what the service users in rural areas really want

Service User Involvement Service Users should be involved in all aspects of their own recovery including agreeing their treatment goals Service user involvement groups should be involved in the planning, commissioning and development of addiction and homelessness services

Conclusions No abstinence/stabilisation pre-conditions Harm reduction interventions save lives! Pathways Housing First accept people where they are at and provide flexible support for as long as necessary All problems should be dealt with at the same time Realistic outcomes Long term funding Parents and children - need to know more about what works Rural areas – peer research Service User Involvement – at all levels

Action! We have read reports like this before which have ended up in filing cabinets and forgotten The SDF National User Involvement Peer Research Group would like to see the findings from this report discussed at the most senior level and consideration given to establishing Pathways Housing First type projects across Scotland!