1. IMPLEMENTATION OF HOUSING FIRST AT HOME/CHEZ SOI LESSONS LEARNED FOR ICM Addictions & Mental Health Conference, May 25, 2015

2. LINKED TO HOUSING FIRST Believing in recovery is hard Seeing harm reduction as a continuum Effects of trauma are everywhere Assessing risk keeps everyone safer

3. BELIEVING IN RECOVERY IS HARD The right to make mistakes and learn from them The client, not their worker, has the right to decide when they are “ready” for housing Housing First is the foundation upon which other steps towards recovery can be made This means supporting our clients through evictions, hospitalizations, detoxes, or jail and being ready to help them find housing again, and keep learning

4. SEEING HARM REDUCTION AS A CONTINUUM Harm reduction is any program or policy designed to reduce harms without requiring the cessation of substances Abstinence and harm reduction are on a continuum of use The case manager provides information about real harms, and support to reduce harms but ultimately it is the client’s choice Substance use has lead to problems in our clients’ tenancies, but often we find that use decreases after being housed

5. EFFECTS OF TRAUMA ARE EVERYWHERE Severely traumatized clients are challenging to engage. Provide clear, firm boundaries Provide access to concrete items (food, clothing, furniture) Display genuine warmth Be careful not to display “too much kindness” or clients may feel they ”owe staff.” Staff need to work on pacing disclosures both for their clients’ safety but also to protect themselves from vicarious trauma Don’t promise what you can’t deliver Be trustworthy

7. ASSESSING RISK KEEPS EVERYONE SAFER Get as much collateral information on potential clients as possible—past history is the best indicator of potential for violence Intake and initial work with client often done in pairs Double visits if risk increases Intuition vs. observation If aggression is heightened, give a bit of space, while ensuring community’s safety Be creative in service delivery---in home visits, in public places, or back off to phone support if unsafe to work in person

8. But Does It Work?

9. LESSONS LEARNED Charlie was a man in his 50s, of Metis background, who had lived both on and off Reserve before moving to Toronto in his early 40s. He suffered from fetal alcohol syndrome, was poly addicted, and due to many assaults and aggression had burned most of his bridges with family and friends up north. He was extremely choosey about where he wanted to live, and was very specific about what kind of apartment he wanted. He fired his first worker before he even looked at an apartment. How do you think he is doing now? How did we work with him?

10. SALLY Sally was someone who pushed all of her belongings in a shopping cart for many years. She was in her 60s, but looked older. She shouted at anyone who came near to her, hadn’t been on meds for many years, and had multiple health issues. She could not live in a shelter, getting into too many arguments with other guests, and was a loner. She told anyone she did talk with that she believed she wasn’t going to live much longer. How do you think she is doing now? How did we work with her?

11. LARRY Larry had spent most of his adult life in jail. When he was referred to us he had just assaulted shelter staff who hadn’t given him the TTC tokens he had demanded. He was a very strong man in his late 30s, a loner on the streets, who presented himself as a violent, angry person. He had been very traumatized as a child by both the men and the women in his life. As a teenager, a female staff in his group home had also sexually abused him. He didn’t trust anyone and was actively smoking crack when we met him. How is he doing now? How did we work with Larry?

12. 3 “SUCCESSFUL” CLIENTS Charlie Sally Larry

13. NOT ALL OF OUR CLIENTS HAVE BEEN SUCCESSFUL Tony—successfully lived in his unit for 5 years but aggressive towards women in building, fired all of his workers—what happened? Kathy—had her 5 th child while in the program with us, had gotten clean and sober and was keeping this baby (previous 4 taken away by CAS)— started relapsing—what happened?

14. NUTS AND BOLTS Intake suggestions Engagement phase Continuum of housing options client choice independent units supportive housing interim housing Roles of support persons (with low client/staff ratio) Housing support Case managers Peer support Psychiatrist/G.P.

15. MORE NUTS AND BOLTS Team meetings Housing support—liaison with landlords, finding units, rent subsidies make for greater choice Continuum of levels of support Proactive outreach Ability to bring specialized support to client 3X /week, double visits, once a month, phone support only “Maintenance”/discharge/graduation/returning Ability to provide “step up” and “step down” support with Cota ACT

16. RESOURCES Https:///www.nfb.ca/film/at_home “Here at Home—Evicted” by Manfred Becker Https:///www.nfb.ca/film/at_home http://socialsciences.uottawa.ca/crecs/eng/videos_tmw1-5.asp “Findings for the At Home/Chez Soi Project in Canada” by Tim Aubry http://socialsciences.uottawa.ca/crecs/eng/videos_tmw1-5.asp https://www.youtube.com/watch?v=pwdq2VWavtc “Housing First 5 Principles” Thank you! Jo Lynn Connelly, MSW; joc@tnss.ca Program Manager with Toronto North Support Services Manager of the Toronto At Home ICM team since 2009