1. HOUSING FIRST JUNE, 2016 - REGINA’S HOUSING FIRST PROGRAM 27 MAY 2016
SAM TSEMBERIS, PH.D.
FOUNDER AND CEO
PATHWAYS HOUSING FIRST INSTITUTE

2. Families and youth have similar patterns
WHO IS HOMELESS? HOW LONG ARE THEY HOMELESS? HOW ARE THEY SERVED?
Families and youth have similar patterns
RENT SUPPORT
RENT + CASE MNGMT
RENT + INTENSIVE SUPPORTS
N=293
640 from
N=233 2

3. What are the root causes of homelessness?
employment
Housing
Addiction
Mental illness
Poor choices
Health
justice
education

4. Some Underlying Assumptions In Programs Addressing Homelessness
Clinical program practices
Attitudes about the poor
Combining housing and services
Housing Policy and Funding 4

5. Staircase (Treatment First) approach
Permanent housing
Transitional housing
Level of independence
Shelter
Homeless
Treatment compliance + + psychiatric stability + abstinence 5

6. Staircase Model Has Unrealistic Expectations for chronic group
ALMEDALEN 2014 6

7. Legacy of Systems Failure: Why We Focus on the Chronically Homeless
10% of POPULATION USES 50% OF SYSTEM RESOURCES
10% of 233
Institutional Circuit 7 7

8. Pathways’ Housing First Model
Permanent supportive housing
Transitional housing
Immediate Access Ongoing, flexible support
Harm Reduction
Housing as a Right
Emergency Shelter Placement
Homeless
>Immediate Access to A Place of Your Own 8 8

9. Key Elements of the Paradigm Shift
Change in how WE work:
View of people served
Program Philosophy
Treatment orientation
Power relationships
Practice and operation - access
Change based on clinical and research evidence (taking psych rehab to the streets)
Audio: Housing First represents a paradigm shift in the view of those being served, goals, power relationships, treatment cultures, and the focus and locus of care. It is a marked departure from the “housing readiness” approach that assumes people must have certain skills and services before they are offered permanent housing. In contrast, Housing First assumes that housing is a basic human right.

10. Principles and Practices of Housing First
Consumer Choice
Separation of Housing and Support Services
Service Array Matches Needs of Consumers
Recovery orientation (Social Inclusion)
Team Operations

11. Discuss service choices
Client Directed vs System Directed “No Wrong Door”
Family/
Friends
Legal/ Justice
Education
Spiritual
EMPLOY
MENT
CLIENT
SOCIAL
SUPPPORT
HEALTH
Discuss service choices
Arts /
Creativity
SELF-DETERMINATION
IS THE FOUNDATION OF
PROGRAM PHILOSOPHY
Addiction Tx
Mental
Health
HOUSING

12. Neighborhood Location
CHOICE of neighborhoods in affordable areas

13. Clinical and Support Services 70%-80% in the home13

14. Separation and Coordination of Housing and Services

15. Landlords as Program Partners
Agency ensures rent is paid on time
Agency and landlord communication; responsiveness to landlord concerns
Advantages of using rental market: quick start up, relocation, expansion as needs change

16. Recovery Focused Services What Helps and What Hinders Recovery?
Peer support
Knowledge
Skills to self-manage
Emphasis on hopeful, inspiring culture
Summarize and emphasize the idea of where the locus of control is.. That is now with the client.. Give a hint about why MI works well with this perspective

17. The Ultimate Goal of Housing First is Recovery17

18. Mental Health Commission of Canada: At Home/Chez Soi
Program Effectiveness 18

19. 5 Cities of Different Sizes and Composition Across Canada
Housing First Research Demonstration
5 Cities of Different Sizes and Composition Across Canada
Vancouver
Pop: 578, 000
Moncton
Pop: 107,000
Montreal
Pop: 1,621,000
Winnipeg
Pop: 633, 000
The graphs show that housing stability does not differ much across the sites. On the y axis is the % of time spent in stable housing, and on the x axis is the number of months spent in the study. The red line represents participants receiving the Housing First Intervention, the blue line represents the participants receiving treatment as usual.
Toronto
Pop: 2,503,000 19

20. Percentage of time housed
Housing First Achieves Similar Housing Outcomes for Moderate and High Need Participants
Percentage of time housed
HEALTH COMMISSION OF CANADA/AT HOME/CHEZ SOI 20

21. Cost Offsets Vary Depending on Need Level
C Cost Analysis: HF with ACT
H Housing First costs $22K per person per year
A Coverage net cost offset of $21.4K CAD (96%) per person.
$ $10 CAD invested in HF with ACT saved $9.60 CAD
C Cost Analysis: HF with ICM
H Housing First costs $14K CAD per person per year
A Coverage net cost offset of $4.8K CAD (34%) per person.
$ $10 CAD invested in HF with ICM saved $3.42 CAD 21

22. HPS Federal Mandate Housing FCommunity Approachirst as a
Introducing Housing First Principles, Values and Practices to the Community
HPS Mandate Identifies Chronic Homelessness
Individuals Already Well Known to the Community
Consensus Among Multiple Stakeholders
Opportunity to improve the overall system 22

23. What is Program Fidelity and Why Does It Matter?
Assess the degree to which the Housing First program is being implemented correctly
Program Operational features:
what does the housing look like?
What services are provided?
Philosophy, values: participant choice? Harm reduction? 23

24. Steps needed to Introduce System Change
Target Population: Community sets priority among homeless population
Collaboration: Partnership among agencies (identification, data sharing, resource sharing, etc.). Lead Roles, Accountability
Operations: Design or re-design system so there is a clear map for all providers and participants
Measure: Set specific targets and timelines and track outcomes as a community (transparency)
Leadership/Collaboration model 24

25. Pine Street Inn, Boston
– Lydia Downey from Managing to Ending homelessness 25

26. Shelter utilization and capacity ‘let’s do the math’
Shelter of 100 beds = 36,500 bed nights
Average stay per guest:
10 people staying 10 nights = 100 bed nights
10 people staying 180 nights = 1,800 bed nights
Annual Service Capacity
10 nights per guest = ,650 guests/year
180 nights per guest= guests/year 26

27. Program Building Blocks27

28. Redesigning the System: System Transformation
Permanent housing (scatter-site,
off site services)
Permanent Single Site
(on-site services)
Community-based, Residential Treatment
(on-site clinical staff)
Longer term Institutional Care
>Less restrictive to more restrictive > 28 28

29. Thank You Questions? Comments?29