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Complexity of need among men entering a ‘housing first’ model in Sydney. Elizabeth Conroy, Centre for Health Research UWS Mat Flynn, Service Manager, MISHA. MISHA model. Permanent housing Support period 2-3 years ( Aspirational ) multidisciplinary team (nurse, occupational therapist etc.).

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complexity of need among men entering a housing first model in sydney

Complexity of need among men entering a ‘housing first’ model in Sydney

Elizabeth Conroy, Centre for Health Research UWS

Mat Flynn, Service Manager, MISHA

misha model
MISHA model
  • Permanent housing
  • Support period 2-3 years
  • (Aspirational) multidisciplinary team (nurse, occupational therapist etc.)
fidelity to housing first
Fidelity to ‘housing first’
  • ‘Housing first’ model (as described by Tsemberis 2010)
    • Rapid access to permanent housing (2 weeks for Pathways)
    • Consumer choice
    • Separation of housing and services
    • Recovery as an ongoing process
    • Community integration
    • (Having a multi-disciplinary team)
recruitment housing of clients
Recruitment & housing of clients
  • Eligibility criteria:
    • History of homelessness (any kind)
    • 25 years or older
    • Wanted support
    • Connection to Western Sydney
  • Tried to get a mix of low and high needs:
    • Rough sleepers (assumed to have high needs) – target of 30-35%
    • Mix of low and medium need
  • Time lapsed between recruitment of clients and when they were housed
    • Case management commenced immediately (or co-case managed)
    • Not necessarily housed straight away
research question
Research question
  • Anecdotal feedback: intensity of case management was similar for rough sleepers and clients from accommodation services
    • Unexpected
    • Impact on case loads
    • Employed team leader
  • Does the survey data reflect this?
complex needs
Complex needs
  • Rankin and Regan (2004)
    • Breadth – multiple needs, interconnected
    • Depth of need – severe, intense
  • Often equated with:
    • sleeping rough
    • substance use
    • mental disorder
  • But no ‘generic’ complex needs case (Rankin & Regan, 2004)
past 12 months homelessness
Past 12 months homelessness
  • Chronic rough sleepers – 20% (n=15)
    • Defined as 6 months continuous episode of sleeping rough OR four or more separate episodes of sleeping rough
results
Results
  • No differences found between the two groups
    • Regardless of definition used
      • Breadth & depth of problems
      • OR substance use & mental health
  • Issue of small sample size
    • Replicated on the Michael Project sample (n=250)
    • Same results
  • Confirms what MISHA staff noticed anecdotally
    • Amount of time spent on case management was similar for those recruited from the streets and accommodation services
    • Where they come from bears little relation to their level of need when housed
discussion conclusions
Discussion & conclusions
  • What does this mean for ‘housing first’?
    • Identifying the right balance of complex and non-complex clients  impact on case management workloads
  • What does this mean for accommodation services?
    • Expectation that those coming from services would cope better  ‘housing ready’
    • Our findings confirm that the two groups are similar in terms of complexity of need
    • Being housed is stressful even if you come from an accommodation service
discussion conclusions cont
Discussion & conclusions (cont.)
  • Learning and practising life skills
    • Accommodation services –
      • safe, structured environments
      • limit exposure to circumstances or situations that case management can perhaps have the most benefit with
    • ‘Housing first’ models
      • Allow complexity to unfold
      • Learn ‘in situ’ (i.e. managing emotions and stress etc)
acknowledgements
Acknowledgements
  • MISHA clients
  • MISHA staff
    • Claudia, Wally, Adam, Belinda, Rachel, Amber, Jeff, Carmel
  • Mission Australia
    • Lesley Butt
  • Philanthropic donor
  • Research team
    • UWS: Marina Athanassios, Danielle Lacey
    • UNSW: Lucy Burns, Tony Eardley
    • UWA: Paul Flatau
    • Mission Australia: Bronwen Dalton