1. Housing First an Effective Solution to Homelessness in Alaska
Presented by Sarah Shimer MPH
141st Annual Meeting - American Public Health Association
Tuesday, November 18, 2014
Institute for Circumpolar Health Studies ● Providence Drive ● Anchorage, AK 99508
Phone ● Fax

2. Presenter Disclosures
Sarah Shimer
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose.

3. Overview
Introduction
Methods
Health findings
Qualitative analysis
Summary

4. Study Personnel David Driscoll, PhD, MPH Rick Brown, PhD
Janet Johnston, PhD 
Travis Hedwig, PhD
Chelsea Chapman, PhD(c)
Sarah Shimer, MPH
Rebecca Barker 

5. Homeless in Alaska Demographics Geography Lifestyle
731,000 residents in Alaska
Geography
1.3 people per square mile
Lifestyle
Fishing, hunting, foraging
Seasonal work
How many homeless in Anchorage and Fairbanks? PIT?
Urban homelessness in Alaska is characterized by a harsh climate and threats from wildlife. Many of those who are homeless have a co-occurring physical and mental illness.  Housing First is an evidence-based solution to homelessness and emphasizes harm reduction. Beginning in December 2011, two project-based Housing First facilities opened to house the most vulnerable among urban homeless chronic alcoholics in Anchorage and Fairbanks

6. Housing First Housing without preconditions of treatment or compliance
Robust services with no coercion to participate
Tenancy is not dependent on participation in services
Most vulnerable
Harm reduction
Lease agreements, tenant protections, rent payment
Project-based or scattered site
Two sites in Alaska, much public pushback, not in my backyard.
An evaluation help add to the feasibility of HF in Alaska and contribute to the body of work already in support of Housing First throughout the country

7. Data Collection Methods
Move into Housing First
Semi-structured qualitative life history interview
Quantitative health survey
Staff interviews
12-18 months after move in
Semi-structured qualitative interview
Alaska.Methods: Ninety-four tenants participated across two facilities.  Tenant semi-structured interviews and quantitative health surveys were conducted at the time of move in and one year later.  Participant interviews asked about social life, engagement with services, health status, housing & employment history, and alcohol consumption.  Staff interviews asked about experiences with tenants and working at Housing First. 

8. Tenant Demographics Many years homeless
Frequent use of “sleep off” facilities
Frequent use of emergency medical services
Age range is 24 to 66
Approximately 2/3 of tenants are male
Most born in Alaska
69% of tenants have at least a high school degree or GED
68% of tenants ≥50 years old
Results: Both Housing First facilities had over 80% tenant retention over the course of the evaluation.  Tenants reported a significant decrease in alcohol consumption, with a 30% decrease in daily drinking.  Tenants reported an 8% increase in high medication adherence.  There are an array of benefits of living at Housing First facilities such as reconnecting with family members, decreased exposure to violence, and engagement in preventative medical services.
Conclusions: This evaluation adds to the evidence that living in a project-based Housing First facility provides significant health benefits over living in camps and shelters, although some challenges still remain.  Successful implementation of Housing First facilities in Alaska provides additional support to policymakers considering project-based Housing First facilities in other urban centers in sparsely populated states.

9. Health Conditions at Baseline

10. Health Complaints in Past Month

11. Health Provider Visits

12. Medication Adherence

13. Alcohol Consumption Quantity
17 drinks is a fifth of hard liquor
Include quotes and discussion of safety at having a home
Well, I can say that I drink less now because I've got somewhere safe to sleep, somewhere safe to go, instead of being out there and drinking and getting drunk and drunk.
“Have another one or I’ll punch you again.” [hm] (pause) That’s just part of my life I lived. They’ll fucking kick your ass if you don’t drink. [Is it like that here at Karluk as well?] (pause) No because I just say hey man, I’ll catch you later I’m going back to my room. I just remembered something I gotta watch on YouTube.

14. Alcohol Consumption Frequency
Baseline
Follow Up
But after I sobered up, you know, we get along. She’s happy (laughs) I am happy too, I’m really happy I get to have contact with her. When I sobered up, all my family started talking with me. [That’s very good] Yeah. [I’m happy for you.] Makes me so happy. Makes me want to be sober
If they're drunk, I don't open my door. I peek, I know who's going to make problems. They get tired of knocking. I just tell them, I think you're intoxicated. I don't open the door, they get tired of knocking.
Reduced drinking, from every day to once every 4 or 5. For me, that’s a big difference.
Interviewee: Went to the hospital a couple times. Doctor told me I gotta quit drinking, so I've been sober for about a week.
Interviewer: How does it feel?
Interviewee: I'm starting to get my brain back, and I was starting to function better is what I'm trying to say. Yeah, starting to return to normal. I don't see things so blurry. Things come more clear. But he said it's gonna be like that for a while. It takes a while to recover.
Speaker #2 Probably less because if I was out there, I’m always drinking, you know. It’s better because it’s a nice warm place.

15. Home and Habits A place to call home Relationships Daily activities
Family
Friends
Staff
Daily activities
Games
Food
Movies
It's a roof over my head. Safe place to be.
I got two neices that's homeless in Anchorage. I check on them every day, worry about them because they're camped out by the Sullivan arena and I don't want them to get harmed.
I feel safe once I – all I gotta do is come through them doors, even if I'm intoxicated or whatever, and can't make it – which I can make it, long as I get through those doors. They'll take me to my room, or I walk to my room, and I'm safe. I feel safe here. Not like on the street. You never know what's gonna happen.
[How about staff?]
Oh man, they're awesome. They come in, check up on us, everything. They make sure that we make it to our house, they make sure we're good and especially when I'm hungover, I call and I say, can you come check on me even if I'm sleeping? If I’m home, can you please come and check on me like every hour, they would make sure it's on the dot.

16. Success at Housing First
“Their lives are better than they were when they came off the street and they have dreams again. You see people that walk around with no dreams. You see it in their eyes, and to be able to walk in and tenants have dreams again and connections with their family and be pretty comfortable with who they are, where they are, I think that’s successful.” Staff

17. Conclusions
Most tenants enter the facilities with one or more serious health condition
Self-reported changes include:
Improved medication adherence
Fewer ER visits
Reduced drinking
A shift in relationships to family and staff
A shift in daily activities to include non-drinking activities

18. Acknowledgements
Thank you to all those who have made this project possible, especially to:
Tenants and staff at Karluk Manor and South Cushman
Alaska Housing Finance Corporation
Alaska Mental Health Trust Authority
Tanana Chiefs Conference
RurAL Cap
The communities of Anchorage and Fairbanks

19. Contact Information
Institute for Circumpolar Health Studies: ichs.uaa.alaska.edu
Sarah Shimer:
Thank You