1. A Low-Barrier Approach to Permanent Housing Stability and Retention
Housing First
A Low-Barrier Approach to Permanent Housing Stability and Retention
D. Cheré Bradshaw, LMSW
Community Alliance for the Homeless
TN-501 CoC Training
April, 27th 2018

2. Housing First: The History
Traditional supportive housing required sobriety and psychiatric treatment to qualify for housing.
One time or small mistakes can lead to evictions, thereby leaving clients with no services or housing
A study of 28 HUD programs in 1999 showed 2/3 returned to homelessness – “coercion” model when housing is only offered as a reward for participation.
This approach left the most vulnerable still outside without services or ability to gain housing

3. Housing First: The History (Cont.)
Pathways to Housing Founder and CEO Sam Tsemberis opened in 1992 in NYC and started Pathways to Housing First.
Paradigm shift in supporting clients in the pursuit of their own goals by housing them first, services second
2007 – SAMHSA adopts HF into the National Registry of Evidence Based Programs; – USICH unveils HF as a core strategy.
Today over 100 cities have replicated the HF Model with 20+ years of scientifically proven success.

4. Transitional/ Group Housing
Housing First was created to offer an alternative to traditional services approach
Social Housing/
Independent Housing
Transitional/ Group Housing
Level of independence
Hostel/
Shelter
Homeless
Treatment compliance + psychiatric stability + abstinence 4

5. Immediate and Direct Access + Supports
Social Housing/
Independent Housing
Transitional/
Group Homes
Shelter/
Hostel
Ongoing, flexible support
Supports must match client needs
Homeless
SOCIAL INCLUSION & COMMUNITY INTEGRATION 5

6. Multi Faceted Method Proven Approach Proven Approach
Principles and Beliefs
Intervention and Actions
Core Components and Community-Wide Elements
Proven Approach
Principles and Beliefs
Multi Faceted Method
Intervention and Actions
Core Components and Community Wide-Elements

7. Principles and Practice of Housing First
Choice in Housing and Services
Separation of Housing and Support Services
Array of Services (Service meet Needs)
Recovery Orientation
Principles and Practice of Housing First

8. Defining Housing First
Housing First is an approach to quickly connect an Individual or Family to housing without preconditions or barriers to entry.
Follows a belief that no one needs to be “Housing Ready” and instead everyone can be move in ready
A philosophy that housing is the foundation for life improvement and stability.
Believes people need basic necessities such as food and a roof over their head before they can effectively start working on other needs such as mental health, substance abuse treatment, employment, etc.

9. Housing First Fundamentals: Home. Support. Success.1
Low barrier to entry 2
Safe, decent, and affordable housing 3
Housing is not conditioned on services 4
Results lead to housing stability and personal recovery
Housing First Fundamentals: Home. Support. Success.

10. Housing First Principles and Beliefs
Housing is a basic human right
Housing and service delivery are separate
Services are formulated using client choice and emphasizes self-determination, with modifications or refusals made at any time.
Clients are treated with respect, compassion, and dignity, while services embody a recovery orientation and harm-reduction approach.

11. Core Components: Minimizing Prerequisites to Entry
Eligibility is not determined by:
Sobriety or completion of treatment programs.
Income
Poor credit, rental history, or most criminal convictions
Willingness to participate in program

12. Core components: Flexible and choice driven
Housing and service goals are highly tenant-driven
Goals should emphasize engagement and problem-solving over therapeutic interventions
Nonjudgmental communication and encouragement for clients to better themselves is utilized, but change/compliance is not required.
Programs should be tailored to fit the clients’ needs, not for the client to “fit the program”

13. Key Elements in Practicing Housing First
Motivational Interviewing
Stages of Change
Harm Reduction Informed Services
Trauma Informed Care
Key Elements in Practicing Housing First

14. Collaboration: Encourages change
Evocation: Intrinsic motivation
Autonomy: Right to self-determination
Motivational interviewing PREPARING PEOPLE FOR CHANGE WILLIAM R. MILLER AND STEPHEN ROLLNICK
Handout 1. Effective Communication Techniques to Support Motivational Interviewing

15. Stages of change James Prochaska, PhD. , and Carlo DiClemente, PhD
Stages of change James Prochaska, PhD., and Carlo DiClemente, PhD. identified stages that people progress through as they make a behavioral change.

16. Stages of change

17. Pre-contemplation Contemplation Action Maintenance Relapse
Stages of change
Stage
Intervention
Pre-contemplation
Contemplation
Action
Maintenance
Relapse
Offer assistance, roll with resistance
Validate and respect. Help tenant “tip the balance”
Support right-sized steps. How is this working?
Reinforce behavior change
A natural part of the process
Adapted from Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change. Applications to addictive behaviours. Am Psychol 47:1102.
Handout 2. Stages of Change

18. HARM REDUCTION
 The Harm Reduction philosophy prioritizes housing stability among persons who have experienced homelessness and who may be facing disabilities.
Although recovery from mental health and substance abuse disorders is always the goal, harm reduction acknowledges that persons may be at different places along the continuum of behavior change.
 Harm reduction focuses on meeting tenants where they are and assisting them to set and achieve goals.
Services focus on helping tenants stay housed by managing problems that interfere with their ability to meet the obligations of tenancy, such as paying rent.

19. HARM REDUCTION
Tenants also are encouraged to explore obstacles toward their goals in an open and non- judgmental atmosphere in which they can contemplate costs and benefits of receiving services addressing their special needs.
This way, staff does not alienate tenants or cause them to begin a dishonest game of hiding their drug use, psychiatric symptoms, etc.
Like any other tenant, tenants receiving services using this philosophy must still pay rent and comply with the terms of their lease.
In working with tenants to reduce harm, it may be helpful to understand the stages of change model.
Workbook: to-think-about-and-ways-to-make-changes.pdf
Booklet

20. Trauma informed care
A trauma-informed approach to the delivery of behavioral health services includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations.
It involves viewing trauma through an ecological and cultural lens and recognizing that context plays a significant role in how individuals perceive and process traumatic events, whether acute or chronic.
TIC involves vigilance in anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma.
It upholds the importance of consumer participation in the development, delivery, and evaluation of services. 

21. Housing First: A critical engagement tool
Engagement with clients is essential to set the tone of the client-provider relationship and the tone for the method of services provided to clients
Strengths-based approaches help to empower clients
Help clients develop self-determination to encourage client-driven motivation
Hand out 3. Engaging Tenants in Voluntary Services
Hand out 4. Engagement Case Studies

22. Property/Housing management and support service staff
Blended management in supportive housing
Role of housing manager?
Role of the support service staff?
Handout 5. Coordinating Property/Housing Management and Services
Handout 6. Maintaining a High-Quality Physical Environment (Discussion)

23. Housing first and tenant responsibilities
Housing First does not remove tenant responsibilities
Housing is a transition period for clients and should be understood that many new obligations and responsibilities will be needed from clients that they may not be used to
Tenant have a standard lease
Tenant rights and responsibilities are similar to any rental agreement: if the agreement is violated there are consequences
Clients should understand consequences that come from repeated violations and subsequent evictions
Handout 7. Sample Rent Repayment Pledge
Handout 8. Housing Retention Conference Guidelines and Policy