Pathways to Housing Calgary A ‘Housing-First’ Program

Calgary’s Fast Facts Total number counted in 2009: greater than 4,500 individuals Over 400 persons were unsheltered on the streets 26% of homeless surveyed had mental illness (this is likely an underestimate) 69% of homeless surveyed had a history of substance abuse Many have “dual diagnosis” of mental illness and addictions 2

Continuum of Homelessness Approaching / Entering Homelessness Entry to Leaving Severity of Most Challenging Least Prevention Services ≈ 10% of Homeless Most Significant $ and Services required 10-20 % of Homeless $ and Services required 70-80 % of Homeless Less Significant $ and Housing

Cost of Homelessness Average cost of homelessness is estimated to be $134,000/person per year in Calgary1 Costs: Hospital: average $800/day = $24,000/month Shelter: $25-50/day = $1,500/month Incarceration: $110/day = $3,300/month Other: Police involvement, EMS, courts, out-patient health services 1Data from research compiled by Calgary’s 10 Year Plan to End Homelessness

Pathways Cost Savings Provides housing and support with an 24/7 Assertive Community Treatment (ACT) team for $34,000/client per year Cost includes housing, furnishings, support team & administration costs Savings to the system is an average of $50-70,000/client per year Other savings - reduced contacts with EMS, CPS, acute care services & corrections Key partners recognize the value of this kind of collaboration for both the client (comprehensive service delivery) and the system (cost savings)

Client Cost Example Walter Walter is a 47 year old male and prior to Pathways had been on the street for five years Multiple health concerns Moved into Pathways September 2008 2007 Costs Hospital costs, walk in clinics, ER treatment = $ 55,520.67 2008 Costs – Prior to Pathways Admission Hospital costs, walk in clinics, ER treatment = $121,446.57 Since Admission to Pathways $500/ER visit x 1 visit = $ 500.00

Calgary’s Beginnings Launched in October 2007. Pilot program to service 50 chronically homeless who continue to cycle from hospitalization into homelessness. First program to be initiated by the Calgary 10 Year Plan to End Homelessness Based on the Pathways to Housing program in New York, NY started in 1992 Program founded in NY by Dr. Sam Tsemberis a psychologist originally from Montreal Pathways New York program represented the beginning of the ‘Housing First’ model in the USA, that is now considered a best practice model

Calgary’s Growth April 2008 confirmed funding to continue the Hospitalization Pathways program for 60 clients November 2008 funding announced to start a 2nd Pathways team to house chronically homeless individuals who continue to cycle through our justice systems April 2009 Pathways Team 2 secures three year commitment from Justice and first client accepted from the justice system in May

Pathways Goal To end homelessness for people who suffer from psychiatric disabilities by providing housing first and giving support and treatment for their recovery and integration into the community.  

Pathways Values Client centered approach to treatment & services Support maximum integration into the community A Harm Reduction Model No “flunk out” policy – allows clients dignity in failure and relapse Belief in recovery that rests on the knowledge that people with mental illness can and do recover their lives completely Enable the client to acquire a meaningful & productive role in the community Support clients in reaching education & vocational goals Reconnection/involvement with family

Housing is a basic human right, not a reward for clinical success Core Beliefs Core Beliefs Once the chaos of homelessness is eliminated from a person’s life, clinical and social stabilization occur faster and more enduring Most current programs require homeless individuals to be “housing ready” with multiple requirements placed on clients before they can be housed (i.e. sobriety periods, medication compliance, involvement in multiple programs, free of criminal charges) In many current programs it may take months to years before a client is housed and there is a high failure rate as many can not meet all the ‘pre-requisites’ to housing Pathways takes clients directly from hospitals or shelters and houses them in a variety of apartments scattered throughout the community without required participation in psychiatric treatment or treatment for sobriety Adhere to principles of Housing First Philosophy but provide support to clients using different approaches: Assertive Community Treatment Team (ACT) Pathways to Housing Intensive Case Management (ICM) Streets to Homes in Toronto Housing is a basic human right, not a reward for clinical success 11 11

Client Criteria Axis I diagnosis (major mental illness) +/- addiction, homeless for at least 6 months Able to live independently and be a good tenant Agrees to have a visit by Pathways staff minimum once per week Agrees to pay 30% of income/financial assistance toward rent

Pathways Staffing Clinical Team Team Leaders (MA in Psychology or MSW) Psychologist/Family Support Specialist Nurse Occupational Therapist Vocational/Justice Specialist Housing Specialist Substance Use Specialist Program Assistant Primary Care Services Housing/Administrative Support Psychiatrist Housing Specialist Family Physician Client Accounting Specialist Nurse Practitioner Cleaning Company Moving Services

Clinical Services Pathways team seeks to provide a comprehensive package of services including: Budget to provide basic furnishings, initial groceries & clothing Community outreach Psychiatric, Medical & Nursing care Vocational/educational assessment & support Crisis intervention Case management Integrated Dual Disorder treatment (IDDT) Family psycho-education Targeted groups (Recreation, IDDT, IMR, Health & Wellness, Supported Employment, etc)

Housing Services Budget to provide basic furnishings, initial groceries & clothing Work with clients to ensure they understand the use and occupancy agreement which clients agree to abide by Separation of housing from services Maintain and repair apartments Provides property management support to clients Clinical Team, Building Managers, & Landlords Re-housing clients Can house an average 4-5 client intakes per month Housing in a variety of open market apartments scattered throughout Calgary with no more than 15% of any building occupied by Pathways clients

On Call Support A Pathways staff member is on call 24/7, 365 days a year to assist clients, landlords, hospitals & CPS/EMS/Fire If a dispatch call involves a Pathways address, the on call Pathways staff can provide the responder with information about the client and/or respond to provide assistance Pathways staff can immediately access client information through the Electronic Web-based case management software

Unique To Calgary PRIMARY HEALTH CARE Physicians support for clinic hours and outreach Medication support and handling - pharmacy delivery Shared Electronic Medical and case management records PARTNERSHIPS WITH: Alberta Health Services, Calgary Region Calgary Police Service (CPS) & Emergency Medical Services (EMS) Corrections

Additional Elements Master Lease Agreement Diversion Court Supports Pro Bono Law Services Development of ACTers software - a comprehensive case management software program Recreation/Life skills Coordinator Benefit Support Specialist

Outcomes Pathways Calgary 86% of clients remain in the program 80% reduction in the number of clients who have had psychiatric hospitalizations 71% reduction in police contacts 73% of clients have retained their original apartment, 27% of clients have been re-housed 20% of all clients are engaged in vocational activities in the community (an increase of 330%)

Pathways Toolkit Pathways Housing First Manual was designed to assist those planning to introduce the program in Canada Materials developed to inspire or assist those who are contemplating a shift from a more traditional homeless program to a Housing First model The Toolkit material was developed from Pathways to Housing, Inc. founded in 1992 in New York City Manual describes philosophy, history, operation of clinical and housing services and research to support the model

Toolkit Highlights… Housing as a basic human right Eligibility and Intake Process Housing Services Support and Clinical Services Incorporating Evidence Based Practices Incorporating Primary Health Care into a Mental Health Team Research and Evaluation

More Information See our Website: Program Contact: www.thealex.ca Shelley Heartwell The Alex Community Health Centre Phone: (403) 513-7410

Questions?