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Housing First

Housing First. Dr Sarah Johnsen. Linear ‘Treatment First’ models - 1. Permanent housing. • Assist homeless people to move ‘up’ staircase, into progressively more ‘normal’ accommodation • ‘Treatment first’ philosophy: indept . housing only provided when deemed ‘housing ready’.

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Housing First

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  1. Housing First Dr Sarah Johnsen

  2. Linear ‘Treatment First’ models - 1 Permanent housing • Assist homeless people to move ‘up’ staircase, into progressively more ‘normal’ accommodation • ‘Treatment first’ philosophy: indept. housing only provided when deemed ‘housing ready’ Transitional housing Shelter placement Street homeless 2

  3. 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

  4. 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 Street homeless Ongoing flexible support 4

  5. 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

  6. HF Principles - 1 • •Provides mainstreamhousing • 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

  7. HF Principles - 2 • •Permanent housing and support • accomm. retained if incarcerated or hospitalised • only evicted for same reasons as other tenants; evictees re-accommodated 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

  8. 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

  9. 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

  10. What added value might Housing First bring to homelessness policy and practice in Scotland?

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