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

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

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

Housing First is… HF Philosophy Systems Approach Program Model Intervention

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

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.

Step Model from Sam Tsemberis

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

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

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.

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

HF Systems Approach: Toronto

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

Resources Canadian Housing First Toolkit National Film Board http://www.housingfirsttoolkit.ca/ National Film Board http://athome.nfb.ca/#/athome Homelessness Partnering Strategy. http://actionplan.gc.ca/en/initiative/homelessness-partnering-strategy

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