1. 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

2. 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

3. 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

4. Harm Reduction Seat belts vs. guardrails

5. 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

6. Guardrails

7. Guardrails
desc.org

8. Guardrails
desc.org

9. Guardrails
desc.org

10. Guardrails
desc.org

11. 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