Slide 1

Report
Housing First
Dr Sarah Johnsen
Linear ‘Treatment First’ models - 1
• Assist homeless people to move ‘up’ staircase, into
progressively more ‘normal’ accommodation
• ‘Treatment first’ philosophy: indept. housing only
provided when deemed ‘housing ready’
Permanent
housing
Transitional
housing
Shelter
placement
Street
homeless
2
Linear ‘Treatment First’ Models - 2
• But, with complex needs clientele:
• high attrition rate / ‘too many hurdles’
• allows little room for ‘haphazard’ (non-linear)
recovery from addiction / mental health problems
3
Introducing Housing First - 1
• Developed in NYC in1992, by Pathways to Housing, for
chronically homeless with severe mental health problems
• Bypasses transitional accomm; places homeless people
directly into independent tenancies with support
Permanent
housing
Transitional
housing
Shelter
placement
4
Street
homeless
Ongoing flexible
support
Introducing Housing First - 2
• ‘Housing first’ (cf. ‘treatment first’) philosophy: no
readiness or treatment prerequisites
• Housing as a human right, not something to be
earned or used as enticement to treatment
• Independent permanent housing as stable platform
from which other issues can be addressed
HF Principles - 1
• Provides mainstream housing
• independent self-contained flats (in PRS), leased by
Pathways
• scatter-site
• 30% of income paid toward rent / utilities
• No ‘housing readiness’ prerequisites
• do not need to exhibit indept. living skills
• no requirements re sobriety / abstinence
• Harm reduction approach
• separates clinical issues from housing issues; clinical crisis
(e.g. relapse) does not compromise housing
6
HF Principles - 2
• Permanent housing and support
• accomm. retained if incarcerated or hospitalised
• only evicted for same reasons as other tenants; evictees reaccommodated elsewhere
• no time limits on support
• Comprehensive multidisciplinary support
• ACTs: social workers, nurses, psychiatrists, peer
counsellors, employment workers
• assertively delivered in home and community
• Consumer choice philosophy
• choice re apartment / furnishings
• choice re degree of engagement with support (above
minimum level)
• Targets most vulnerable
7
HF Outcomes
• Housing outcomes excellent (80%+ retention over 2
years)
• Challenges assumption that people with complex
needs unable to sustain independent tenancy
• Clinical outcomes mixed, but generally positive:
• Positive impact on mental health
• Reduced alcohol consumption
• No increase in drug use
• Highly cost-effective
8
HF Replication
• Controversial initially, but now:
• endorsed by US Federal Govt.
• widely replicated across Europe
• endorsed in European policy
• Increasing interest in HF within UK
• a potentially valuable complement to services, esp. for
‘hardest to reach’?
• first UK pilot in Glasgow (Turning Point Scotland): 18
homeless people actively involved in substance misuse
What added value might Housing
First bring to homelessness policy
and practice in Scotland?

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