Housing First Seminar Presentations - Glasgow Homelessness Network

May 10, 2017 - Shelter placement. Transitional housing. Permanent housing. Ongoing flexible support ... Outcomes are best when core HF principles are adhered to .... homes is free to use .... a first step in wider reform of their homelessness strategy/ system. To do this, ... Support? • Can a Golden Ticket approach work?
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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





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-repor