Housing First Seminar Presentations - Glasgow Homelessness Network

#HFScot17 @GHNtweets @turningpointsco

International Evidence for Housing First What is it and why should we do it?

Prof Sarah Johnsen

Outline Ÿ What is Housing First? Ÿ Why should we do it?

Origins Dr Sam Tsemberis and Pathways to Housing, NYC

Basic Philosophy - 1 Ÿ NOT treatment first (traditional ‘staircase’ model)… Permanent housing Transitional housing Shelter placement Street homeless

Basic Philosophy - 2 Ÿ But rather, housing first (with ongoing flexible support) Permanent housing Transitional housing Shelter placement Street homeless

Ongoing flexible support

Target Group(s) Ÿ Originally, chronically homeless people with severe mental health problems Ÿ Subsequently, homeless people with ‘complex needs’, i.e. co-occurring mental health and alcohol and/or drug problems Ÿ Also recently (to lesser extent) ‘lower / less complex needs’ groups, e.g. families

Key Principles

Key Principles 1. People have a right to a home 2. Flexible support is provided for as long as it is needed 3. Housing and support are separated 4. Individuals have choice and control 5. An active engagement approach is used 6. The service is based on people’s strengths, goals and aspirations 7. A harm reduction approach is used Source: Housing First in England: the principles (Homeless Link, 2016)

Evidence re Effectiveness Ÿ Substantial international evidence base from US, Canada, Australia and Europe (incl. UK) Ÿ Rigorous quantitative and qualitative methods Ÿ Consistency and ‘weight’ of evidence highly convincing

Outcomes Ÿ Housing retention: generally 80-90% still accommodated after 2 years Ÿ Health: clinical outcomes more mixed but positive on balance Ÿ Criminal and anti-social behavior: decreased involvement; (understandable) stakeholder anxieties re ASB rarely borne out Ÿ Financial wellbeing and social support: typically improve, but clients often still ‘poor’ and/or lonely

Cost Ÿ Compelling evidence in some contexts (esp. US, Canada and France) that cost effective and delivers cost savings Ÿ In UK, evidence on costs is limited, but estimates suggest that: Ÿ no more expensive than hostels, and may deliver substantial cost savings (c. £15k pppa) Ÿ JRF estimate that if 58,000 people with complex needs in England [‘Hard Edges’ group] housed via HF, could save £200mill pa after 2 years

Source: Bramley et al. (2015) Hard Edges: mapping severe and multiple disadvantage. England. (LankellyChase Foundation, London)

Key Messages Ÿ HF is not ‘rocket science’, but a simple concept that challenges established practice Ÿ Evidence showcasing HF’s effectiveness is far stronger than is true of any other intervention targeting rough sleepers or homeless people more generally Ÿ Housing First demonstrates exceptionally positive housing (and other) outcomes for a group that has historically been poorly served Ÿ Outcomes are best when core HF principles are adhered to

Key References - Guides Ÿ Housing First in England – key principles: http://www.homeless.org.uk/sites/default/files/siteattachments/Housing%20First%20in%20England%2 0The%20Principles.pdf Ÿ Housing First Guide Europe: http://housingfirstguide.eu/website/ Ÿ ‘Original’ Pathways to Housing Manual: https://www.amazon.com/Housing-First-ManualHomelessness-Addiction/dp/1592859984

Key References - Evaluations Ÿ

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Housing First Europe evaluation: http://housingfirstguide.eu/website/wpcontent/uploads/2016/03/FinalReportHousingFirstEurope.pdf Evaluation of 9 services in England: http://www.homeless.org.uk/facts/our-research/housing-first-in-englandevaluation-of-nine-services Evaluation of Glasgow pilot: http://www.turningpointscotland.com/wp-content/uploads/2014/02/TPSHousing-First-Final-Report.pdf Canadian Chez Soi project evaluation: http://www.mentalhealthcommission.ca/English/document/24376/nation al-homechez-soi-final-report Early review of (mainly US) evidence base: http://www.crisis.org.uk/data/files/publications/Housing%20Models%20 Report.pdf


HF Getting Started Patrick McKay [email protected]

Aims of presentation TPS and HF Does Fidelity matter Getting it right at the start Implementation in a real world Conclusion

TPS and HF Delivering HF within 3 Local authorities:l Glasgow l East Dunbartonshire l Renfrewshire Discussion in the main relates to Glasgow, most mature HF service – operating since 2011 l Response to drug death in Glasgow 2010 l When supported accommodation doesn’t work l Currently providing a service to 42 SU l Specifically working with individuals who have substance dependency issues l Working in conjunction with 13 RSL’s

Does Fidelity Matter? We have scored our HF Glasgow Service in terms of its fidelity to the Pathway model in NY. Possibly some things matter more than other things Those things the matter most:l No test of housing readiness l Security of tenure l Dispersal vs Congregate l Choice of location l Team composition particular focus on Peer Support Workers l From referral to allocation getting the right service user l Support contract hours at least one visit per week

Implementation in a real world l Reaching saturation and still providing choice within a stock transfer LA l Sustaining a relationship with those who are hard to engage l Tenancy sustainment for those with the most complex needs: anti social behaviour (the fear and the reality). l Having the right partners – working with HF l When does HF end

Conclusion l Housing First is a model which works to give a tenancy to those with MCN and without them having to demonstrate Housing Readiness. l The higher the level of fidelity the more successful the project. Question: What positive aspects does your local area already have in place to help those getting started with Housing First?


The principles of Housing First in England Mark McPherson Homeless Link

www.homeless.org.uk

Let’s end homelessness together

What is Housing First?

• Unlike traditional staircase approach • Permanent offer of a home • No conditions other than maintaining tenancy • Flexible, person-centred support • Internationally strong evidence base

www.homeless.org.uk


Who is Housing First for? Poor mental/psychological health Violence and abuse Drug and/or alcohol use

Unemployment Amicus Horizon

Contact with criminal justice system Physical health conditions Homelessness/unstable housing

www.homeless.org.uk


The principles 1. People have a right to a home 2. Flexible support is provided for as long as is needed 3. Housing and support are separated 4. Individuals have choice and control 5. An active engagement approach is used 6. The service is based on people’s strengths, goals and aspirations 7. Harm reduction approach is used

www.homeless.org.uk


The QUESTION ARE THESE THE RIGHT PRINCIPLES FOR SCOTLAND? IS ANYTHING MISSING?

www.homeless.org.uk


Any questions? More information:

@hf_england Join the movement! Visit www.hfe.homeless.org.uk

www.homeless.org.uk



Housing Planning for Families ‘considering the balance’ Ruth Robin Operations Manager

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Housing First Modelling Housing First is of interest, can it be modelled for different groups?

Housing First Elements;

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•

Non conditional

•

Wrap around support

•

Harm reduction approach

•

Stickability

Poor relationships

Substance misuse

Self worth

Mental health

Physical health

What are the elements we support? How can we support the ‘poverty’ and GIRFEC agenda?

Permanent Home – with a choice

Self Directed & Personalised Plan

35

Shared ownership

Empowered by Peer Support

Housing Planning Our ‘Pilot’ site South Lanarkshire – Commissioned Housing Support Service

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•

Personal Housing Plan

•

Partnership Agreement

•

Contribution and planning in allocations

•

Shared ownership

•

Choice

Until there is a home for everyone. Ruth Robin e: [email protected] t: 07811 748 920

Until there’s a home for everyone

Roundtable Discussion Question

In what ways do you think Housing First for families needs to be distinct from an approach for single people?

Until there’s a home for everyone


FUNDING MECHANISM TO UPSCALE HOUSING FIRST

Tom Bennett www.bigsocietycapital.com @BigSocietyCap

May 2017

Daily Record May 1st

BIG SOCIETY CAPITAL We are an independent financial institution with a social mission, set up to help charities and social enterprises find the right kind of repayable finance they need to do more of their fantastic work. Homes for Good

Who are social investors? Social Investment Fund Managers

Housing Associations

Eg. Social Investment Scotland, CAF Venturesome, Big Issue Invest

Trusts and Foundations

Individual investors

Eg. Esmee Fairbairn, Joseph Rowntree, Robertson Trust

Eg. Triodos Bank customers buying charity bonds

Philanthropy

Social return

Social investment

Traditional investment

Financial return

HOUSING FIRST Thomas – Bench Outreach, Lewisham

Why housing first? UK and international experience has shown that Housing First uses a relatively small amount of housing can have a disproportionate social impact by: enabling charities to provide much better outcomes for the individuals they serve bringing an asset framed approach to support services giving an indefinite commitment to housing and support protecting rights through the separation of housing and care

…and wider society can benefit too From the cost savings in health and criminal justice services A more humane, personal approach to homelessness Improvements to the local area around former hostels.

The Housing First Transition Fund will provide short term secured loans to homeless charities and housing associations to replace congregate living with independent housing.

How it works

1. The Fund provides funding to acquire homes on the open market locally. The housing association which will own the homes is free to use conventional or grant to fund part of the purchase costs.

2. The charity commissioned to provided Housing First support transitions clients from hostel or the street to homes. Clients are provided with standard tenancies and ongoing support is provided in their home.

3. Transition requires systemic change so the Fund provides funding to cover increased interim operational costs for the support provider and the housing association during the transition period.

4. The hostel closes and the vacant site is sold to repay the Fund. Frequently the most valuable option will be for the hostel to be converted to ordinary housing increasing the supply of homes locally.

Housing First Transition Fund Partnerships between housing associations and charities providing Housing First support to formerly homeless people apply to the Fund. What is the fund? A not-for-profit lender run as a charity for charities

Who can apply? Homelessness charities and housing associations providing existing residential services

Who will invest in the fund? Social investors: Trusts and Foundations, Individuals and Impact Funds

And when loans are repaid? Money is returned to the fund to lend to help other charities transition

Repaying the fund once a Housing First transition is complete enables a resources to be redeployed to support other services transitioning to Housing First

Helping to scale Housing First LAUNCH PILOT, GLASGOW 2017 • Proof of concept in a city strategically committed to Housing First

25 PROJECTS BEFORE 2022 • In cities across the UK

• Testing and continuous improvement

• Six-monthly application rounds for charities and housing associations

• Complements Liverpool feasibility study

• Rapid expansion of UK Housing First capacity

PRIVATE HOSTEL BUY-OUTS • Extend funding offer to enable charities to take over substandard places • Business model challenged by income reduction • Homeless charities supporting more vulnerable people

For more information

Margaret-Ann Brunjes Glasgow Homelessness Network

Jo Karatzidis Social Investment Scotland

[email protected]

[email protected]

Suzanne Fitzpatrick Institute for Social Policy, Housing and Equalities Research

Tom Bennett Big Society Capital

[email protected]

[email protected]

bigsocietycapital.com @BigSocietyCap

Big Society Capital Limited is registered in England and Wales at Companies House number 07599565. Our registered office is New Fetter Place, 8-10 New Fetter Lane, London EC4A 1AZ. Big Society Capital is authorised and regulated by Financial Conduct Authority number 568940.


Housing First to Scale in the Liverpool City Region Chris Hancock – Head of Housing

The Feasibility Study

• Housing First as the default Housing Offer – System Change • Not delivering a Pilot • 5 month timeframe, January to June • Funded jointly by Housing First Hub - FEANTSA and DCLG • 3 Elements to the Research • The Model • The Economics – Cost and Savings • The Policy – What needs to change locally and nationally to support roll out?

• Hope to inform devolution deal and council’s commissioning plans

Housing First to Scale

• People with lived experience group • Steering Group with UK and European Reps • Local Project Group – Themed meetings • Extensive Consultation – in all localities • Production of a Toolkit - Aim to inform UK and European wide roll out of Housing First


The Liverpool City Region Scale of Need and Supply

• 140% increase in rough sleeping in LCR from 2015 to 2016; 43 people on an average night in LCR (DCLG stats)

• ½ of those rough sleeping were in the city; ¼ in the Wirral • In 2015/16, 5373 individuals were assessed and recorded on the

Mainstay system; some of them will have been assessed multiple times

• 59% of these assessments were done within Liverpool city • 49% of the Liverpool city assessments led to a placement; 72% of the other LCR assessments led to a placement

• 1484 Commissioned support beds across LCR (723 in the city) • 822 have 24 hour cover

Taking Housing First to Scale

[email protected]

Taking Housing First to scale

The Vision To build an effective Housing First service in the region, which LCR can use as a first step in wider reform of their homelessness strategy/ system. To do this, the service needs to be:

• Large enough to free up sufficient financial resources from elsewhere in the homelessness system to pay for itself

BUT The transition has to be planned and paced so that:

• Service quality and safety comes first; • Commissioners are reassured; and • We build on current strengths & resources, with as much collaboration as possible


Current system Homelessness prevention activity Gateways - LA housing options/Other providers

Advice/information

Temporary accommodation

Mainstream housing Supported Housing system– Accommodation based 822 units

622 units

24/7

Non - 24/7

Tenancies in selfcontained housing

Floating Support if needed (Liverpool city; other LAs tbc)

Future system?

Homelessness prevention activity Gateway - LA Housing Options Teams Advice/information

Residual emergency accommodation 24/7 Nos. tbc

Mainstream housing – Housing Led system Housing First On-going & intensive support

Some shared housing? No on-site support

Tenancies in self-contained housing

Floating Support if needed

Housing organise d by Social Lettings Agency

Dedicated nurse??

Team Leader

4 x Housing Support Workers (2 with lived experience)

Work as a team to support 20 people

Homeless Healthcare (Seconded?) Mental health worker Local Area Coordinator/ Wellbeing facilitator Existing services or support more than one team?

24/7 on call service

• Understanding what this is and who it is for? • • • •

What has come before? Housing First or Housing Led or Both? How to assess eligibility without applying condition? Local Connections and entitlement to Public Funds

• What's the real challenge Housing Supply or Housing Access? • Property Conditions? • Role of the PRS? • Social Lettings Agency

• What services need to be ‘in-house’? • Can mainstream services respond quickly and flexibly enough? • What do we mean by Mental Health Support? • Can a Golden Ticket approach work?


[email protected]

• Commissioning • • • •

A transitional approach – not an overnight solution Everything isn’t in sync and isn’t available everywhere Chance to complement an enhanced prevention (or reduction) focus A Proactive response ahead of 2019

• Political Support • What's the motivation? Financial? Moral? Presentational? • Queue Jumping and Sustainable Communities? • Part of a devolution deal – welfare flexibility

What Elements of the Liverpool City Region approach to scaling up Housing First could we use here in Scotland?


[email protected]


HOUSING FIRST SCOTLAND SEMINAR David Carroll Depaul Director of Services & Development May 2017

How did we get here? Our History § Depaul UK 1989 London § Depaul Ireland 2002 Dublin 2005 Belfast § Now part of Depaul International… Services in UK, Ireland, Slovakia, Ukraine, USA and France and Croatia

Depaul’s 4 Service Areas: Homelessness & Prevention

Homelessness & Families

Homelessness & Addiction

Criminal Justice & Mental Health

Our Services on the Map

Housing First Commencement § Pilot commenced January 2013 in Belfast by a reallocation of existing resourses from one Depaul service to this one. § Expansion of the Belfast service supported in late 2014 § Expansion to Derry City in mid 2015 § External evaluation report completed early 2016 of pilot phase

Recent Development : Street to Home

§ Street to Home Pilot: November 16 to April 17 § 10 rough sleepers targeted for Housing First Tenancies § Partnership with Northern Ireland Housing Executive , Welcome organisation, other service providers.

Basis for Classifying Level of Need in Relation to Level of Service Level of Need

Level of Service

High Level

5 plus hours per week of Housing First staff engagement: In the initial 4 – 6 weeks all cases are categorised as high. In these early weeks needs and risk assessment are conducted and the support plan is agreed and implemented. The requirements of external agency involvement are assessed and the engagement process commences. Highly complex cases and where service users enter a period of crises are also categorised as high level.

Medium Level

3 hours but less than 5 hours per week of Housing First staff engagement: This may in some cases begin from Week 5 onwards and may also be a time of crises where stabilisation is resumed quickly.

Low Level

1 but less than 3 hours per week of Housing First staff engagement: This would be when service users have reached a stage of prolonged stability and where necessary are engaging with other support services. The service user may be ready to exit the Housing First service or may only require periodical link in with the Housing First support worker.

In addition, service users are categorised into three tiers, as follows: Short term

1 year

Medium term

2 – 4 years

Long term

4 years plus

Referral Agencies, with Date Referrals Started and Number of Referrals April 2013 to June 2015

Referral Agency

Date referrals commenced

Number of referrals for total period

Percentage of referrals

Depaul – Stella Maris

April – June 2013

44

42%

Housing Rights Prisons Service

October – December 2013

19

18%

Drug Outreach Team

October – December 2014

14

13%

Homeless Support Team

January – March 2015

3

3%

Centenary Crash, Salvation Army

April – June 2015

6

6%

Welcome Centre

April – June 2015

19

18%

105

100%

Total referrals

Note: There have been 108 referrals in total. However, in 3 cases there is no information on the source of the referral hence the base for this table is 105 referrals.

Tenure & Type of Landlord 160 144 140 120 100

100 80 58

60 40

49 37

40

34 26

20 0 Private Rented Sector

NI Housing Executive Number of Cases

Housing Association % of Cases

Total

Tenure & Type of Landlord

NO OF CASES Private Rented Sector

NI Housing Executive

Housing Assoication

26%

40%

34%

Mean Level of Grant per Service User

Mean level of SP Grant per Service User [per week?] £250

£150

£200

£100

£150

£50

£129 £80

£0

£66.02 Range: £30£103

Housing First Pilot Jan '13- Sept '14 Post Restructuring Sept '14 Floating Support Services

£100 £50

£217 £80

£0 Accomodation based Services Post Restructuring Sept '14

Challenges Challenge 1:

Sourcing private rental accommodation

Challenge 2:

Lack of social housing accommodation

Challenge 3:

Tenants’ deposits having to be paid in advance

Challenge 4:

Housing Benefit not covering the full rent

Challenge 5:

Clients with no access to public funds

Challenge 6:

Accommodating changes in the staffing complement

Challenge 7:

Clients potentially losing their Common

Waiting List

points if they engage with Housing First Service: Challenge 8:

Formulating partnerships and devising interagency agreements

Challenge 9

Getting the Housing First model understood

The SROI Evaluation of the Pilot The benefits of the service were identified as follows: •

Still in tenancy at end of 2014: 19 / 24 (79%);

•

Of these, 3 died during 2014[1], 1 abandoned the tenancy, 1 returned to custody;

•

Significant/moderate reduction in the use of alcohol & drugs achieved by 15/24 service users (63%);

•

Improved self care and living skills = 19 / 24 (79%);

•

Skills and knowledge in money management = 24 (100%)

•

Improved physical health = 63% and stable physical health 21%;

•

Improved self confidence and motivation = 79%

•

Better use of time = 79%

•

Improved family relationships = 67%; stable relationship with family 21%

•

Reduced Use of A&E = 50%

•

Improved mental health = 39%

•

The social return ratio for this analysis is: £923,926 / £61,637 = 15.06: 1. This means that for every pound invested by NIHE and Depaul in the Housing First service in Belfast during 2014 there was a social value created of £15.06

Scaling Up: Housing

§ Hard to lets

§ Strategic approach to identifying Housing stock

§ Rent setting and role of top ups § Allocation of housing first tenancies as part of the social housing development programme

Fidelity

§ Fidelity of the Housing First Model

§ Development of a tool for testing fidelity linked to commissioning § Communication with the sector in relation to fidelity

Strategic Intention

§ Regional Strategy in relation to Housing First development

§ Clear criteria § Identification of need and profiling of the homeless population within a pathways model § Costing: housing and health

Housing Solutions Interface

§ NIHE Housing Solutions Team

§ One point of assessment § Clarity on referral criteria § Strategic Identification and targeting of rough sleeping population

Relationships

§ Interagency Relationships

§ Ending of brokered relationships; formal recognition of each others role within SLA process § Supporting People commissioning framework § Communication and risk management protocols

Health

§ Role of Health

§ Funding and strategic Commitment § Fast tracking into substitute Prescribing

Workforce

§ Training § Workforce Development

§ Renumeration § Risk management supports § Health and well-being supports


What areas of learning from Ireland can we use to inform our approach to scaling up Housing First in Scotland?


European End Street Homelessness Campaign Linda Butcher, Coordinator Housing First Scotland Seminar Stirling 10 May 2017

European End Street Homelessness Campaign A movement of cities working together to permanently house Europe’s most vulnerable people and end chronic street homelessness, including: BARCELONA

BRIGHTON

BRUSSELS

CROYDON

LEICESTER

BUDAPEST

VALENCIA

GLASGOW

TORBAY

WESTMINSTER

Building and Social Housing Foundation Coordination §

An independently-funded international housing charity

§

Through our relationships with the United Nations we aim to be a catalyst for positive change

§

We identify great housing projects through our World Habitat Awards

§

We help them grow and help transfer them to where they are needed most

Homelessness in Europe: An urgent problem

‘The number of people experiencing homelessness has increased in all countries under review except for Finland’. The State of Housing in the EU in 2015

Campaign Principles 1.Housing First: Working towards ensuring homeless people are housed in permanent, safe, appropriate and affordable housing with the support necessary to sustain it. 2.Knowing who’s out there: Getting to know every homeless person by name by going onto the streets to find them and assess their needs. 3.Tracking progress: Regularly collecting person-specific data to accurately track progress toward ending homelessness. 4.Improving local systems: Building coordinated housing and support systems that are simple to navigate, while targeting resources quickly and efficiently to the people who need it the most. 5.Learning from and sharing with others: to help the campaign make the biggest difference to those who are homeless.

Campaign City: London, England

Campaign City: Valencia, Spain

Challenges

• Local housing market/conditions

• Implementation • Resources

• Competition • Political will • Fear • Commissioning • Partnerships

Early Results • Rough Sleepers are central • New relationships • Fresh ideas and approaches • Changes to commissioning and/or practice • Improved referrals

• Being prepared to shine a spotlight • Gaining political commitments • More ambitious plans • Rough sleepers into HF housing

Links to additional resources • BSHF - Homelessness • Campaign Toolkit • From Halving Homelessness to Ending It • Streets to Homes • 100,000 Homes Campaign • Y Foundation


What do we need to do in Scotland to ensure that Housing First is directly available for people sleeping rough?
