1. How to Implement Housing First Presented by: Sylvia Starosta, Director of Clinical Operations, Cota Pam Nir, Senior Manager, Clinical Services, Cota Jo Connelly, Program Manager, Toronto North Support Services (TNSS) 2015 Annual Addictions and Mental Health Conference May 25, 2015

2. Learning Outcomes 1.Enhance knowledge of the Housing First Model in ACT and Case Management 2.Widen the discussion about possible adaptations to standard ACT and Case Management to better meet the needs of homeless individuals with serious mental illness and addictions 3.Identify steps taken to promote a recovery orientation 4.Q & A 2

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5. What is Housing First (HF)? An intervention that supports people who are homeless to move quickly from the street or emergency shelters into permanent housing, with supports that vary according to participant need An effective tool for working on chronic or episodic homelessness while reducing pressure on other emergency services An evidence-based approach with measurable outcomes 5

6. Housing First is… Philosophy Systems Approach Program ModelIntervention HF 6

7. Step Model from Sam Tsemberis 7

8. Evidence-Based Approach in Canada In 2009, the MHCC launched the At Home /Chez Soi 4-year research demonstration project in 5 cities across Canada The Study Objectives: To determine the effectiveness and cost-effectiveness of Housing First for homeless people with mental illness in the Canadian context 8

9. Toronto Context Homelessness City population: 2.5 million 5000 people are homeless every night 27,000 people use shelter each year 25-33% have schizophrenia, major depressive disorder, or bipolar affective disorder 9

10. Housing First: Study Results (Toronto) After 2 years in study:  Participants receiving Housing First services were stably housed 80% of time compared to 54% of the control group In the last 6 months of the study, 12% of HF clients were homeless compared to 39% of the control group. 10

11. Costs Housing First costs (average per participant per year) High needs (ACT): $21,089 Moderate needs (ICM): $14,731 Every $1 invested in Housing First resulted in average saving of: $1.50 for high needs participants $0.30 for moderate needs participants 11

12. HF Systems Approach: Toronto 12

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14. Lessons Learned Get Housing First right – teams demonstrating higher fidelity to the model achieved better outcomes Housing stability, quality of life, and community functioning outcomes were all more positive for programs that operated more closely to HF standards This finding indicates that investing in training and technical support can pay off in improved outcomes 14

15. Resources Canadian Housing First Toolkit –http://www.housingfirsttoolkit.ca/http://www.housingfirsttoolkit.ca/ National Film Board –http://athome.nfb.ca/#/athome Homelessness Partnering Strategy. –http://actionplan.gc.ca/en/initiative/homelessness-partnering- strategy 15

16. Thank you! Sylvia Starosta starosta_s@cotainspires.ca