1. Threshold Housing First
Deborah Quilgars and Nicholas Pleace

2. Background
Success in USA, Canada, Denmark, Finland, France, Norway as national strategy
Successes at local level in Sweden, Portugal, Spain, Italy, Ireland, Scotland, England, Wales, Northern Ireland
Stable exits from homelessness for people with high and complex needs
Works with 7-9 out of every 10 high need homeless people
Including long-term/recurrently homeless people

3. Background Nearly government policy in England
Housing First is government policy in Northern Ireland, Scotland and Wales
But Housing First was designed on the assumption that most homeless people with complex needs are men
We starting to understand that this is not the case

4. Homeless women with high needs
New evidence that women react to homelessness in different ways
Use informal support, friends, relatives, acquaintances
Includes women with high and complex needs
Women’s Homelessness in Europe Network

5. Threshold Housing First
First attempt in the UK to develop Housing First for homeless women with high and complex needs
Women with histories of homelessness and offending behaviour
One of the first attempts anywhere to develop a Housing First service focused on women
Rather than, by default, men

6. Threshold Housing First
Developed at a time when we are starting to see the potential of ‘PIE’ (psychologically informed environments) and trauma focused work providing opportunities to highlight women’s needs
Has been working in three Manchester authorities for two years
Tameside, Stockport and Oldham

7. Threshold Housing First
Two full-time workers and a manager
Supports up to 12 women at any time
Integrated with other services
Particularly women’s centres

8. Activity 33 women used Threshold Housing First over two years
Average age of 32
97% White British
79% were parents, but children not with them
82% single at referral
58% homeless
33% in custody
9% at risk

9. Housing and Support Needs
Most commonly hidden homeless
But five women were living rough at referral
Almost all had experienced domestic violence
Almost all had mental health problems
Seven reported stays in psychiatric hospital/ward
Most had issues with addiction and alcohol
Several reported being fostered and/or in care as children

10. Offending Histories Thirteen women had offended more than ten times
Group included some prolific offenders
Eight had offended just once
This was a Housing First service focused on homeless women offenders
Referrals often came from probation

11. Service Delivery A lot of variation
Some women moved away, disconnected from the service or were returned to prison
But most stayed with the service longer
Provided with intensive case management
Daily phone welfare check
Motivational interviewing
Holistic service
High degree of choice and control
Personalisation
Co-production

12. Housing Outcomes
18 women housed in mix of social rented and private rented
Two supported to remain in existing tenancies after being threatened with homelessness
By June 2017, 20 formerly homeless women with very high and complex needs placed in housing
16 still housed, 80% sustainment rate
Only 1 tenancy abandoned

13. Offending Outcomes Four out of 33 women returned to prison
But reoffending dropped to very low levels among the others
In most cases there was no recorded offending while using Housing First
Seen as a key outcome
Along with the successes in relation to housing

14. Health Outcomes More mixed picture
But mental health and physical health are complex
As is addiction
There were some improvements e.g. around drinking
But women were able to get away from abusive situations
Were reconnecting with family
And were stably housed

15. Views on Threshold Housing First
Very positive
Women using the service
Staff providing the service
External agencies

16. Views on Threshold Housing First
There’s not one thing that I’ve asked for help with and they’ve not helped me, there is nothing that they’ve said no to or I can’t do that, absolutely everything, they are brilliant.

17. Learning
Shows there is a case for services that are targeted on homeless women with high and complex needs
Domestic violence
Untreated trauma
Separation from children
Service for women, run by women
No service is 100% effective, there are clear successes here in ending homelessness
And in reducing offending
Viewed positively by partner agencies

18. Learning A high fidelity model
Follows the core philosophy of the original New York model, Pathways Housing First
Also reflects the modifications to that approach developed specifically for Europe (and UK) in the Housing First Guide Europe
Which involved Sam Tsemberis
Successes reflect what has been achieved elsewhere in the UK and Europe

19. Learning There were some challenges
Housing could not always be found quickly, particularly in the early phases of the Housing First service
New relationships with landlords have been developed
There was some attrition
But these are challenges faced by most Housing First services

20. More about Housing First
Housing First Guide Europe
Housingfirstguide.eu
Housing First England
hfe.homeless.org.uk
And, of course, the toolkit launched today

21. Thanks for Listening Deborah Quilgars Nicholas Pleace
Senior Research Fellow, Centre for Housing Policy
Nicholas Pleace
Director, Centre for Housing Policy