1. How to Implement Housing First
Presented by:
Sylvia Starosta, Director of Clinical Operations, Cota
Pam Nir, Manager, Clinical Services, Cota
Jo Connelly, Program Manager, Toronto North Support Services
October 22, 2014
OAA Conference

2. Learning Outcomes
Enhance knowledge of the Housing First model in ACT and Intensive Case Management (ICM)
Widen the discussion about possible adaptations to standard ACT and ICM to better meet the needs of individuals experiencing homelessness
Explore possibilities of collaboration between ACT and ICM teams through Housing First partnerships
Q & A

5. What is Housing First (HF)?
• An intervention that supports people who are homeless to move quickly from the street or emergency shelters into permanent housing with supports that vary according to participant need
• An effective tool for working on chronic or episodic homelessness while reducing pressure on other emergency services
• An evidence-based approach with measurable outcomes

6. Housing First is… HF Philosophy Systems Approach Program Model
Intervention

7. HF: 6 Core Principles
Immediate access to housing with no housing readiness requirements
Consumer choice and self-determination
Individualized, client-driven and recovery-oriented supports
Separation of housing and services
Harm reduction
Community integration

8. What is Not Housing First?
Programs… • That only help people find housing • That only support participants in housing • In which the housing is temporary or transitional • With any requirements for housing/support, other than case manager home visits – requirements such as mental health and/or addiction treatment, support groups, etc.

9. Step Model from Sam Tsemberis

10. Evidence-Based Approach in Canada
In 2009, the MHCC launched the At Home /Chez Soi 4 year research demonstration project in 5 cities across Canada
The Study Objectives:
To determine the effectiveness and
cost-effectiveness of Housing First
for homeless people with mental
illness in the Canadian context

11. Toronto Context Homelessness City population: 2.5 million
5000 people are homeless every night
27,000 people use shelter each year
25-33% have schizophrenia, major depressive disorder, or bipolar affective disorder

12. Housing First: Study Results (Toronto)
After 2 years in study:
Participants receiving Housing First services were stably housed 80% of time compared to 54% of the control group
In the last 6 months of the study, 12% of HF clients were homeless compared to 39% of the control group.

13. Costs Housing First costs (average per participant per year)
High needs (ACT): $21,089
Moderate needs (ICM): $14,731
Every $10 invested in Housing First resulted in average saving of:
$15.05 for high needs participants
$2.90 for moderate needs participants

14. HF Systems Approach: Toronto

16. Lessons Learned
Get Housing First right – teams demonstrating higher fidelity to the model achieved better outcomes
Housing stability, quality of life, and community functioning outcomes were all more positive for programs that operated more closely to HF standards
This finding indicates that investing in training and technical support can pay off in improved outcomes

17. Resources Canadian Housing First Toolkit National Film Board
National Film Board
Homelessness Partnering Strategy.

18. Sylvia Starosta starosta_s@cotainspires.ca
Thank you!
Sylvia Starosta