1. Pathways to Housing Calgary A ‘Housing-First’ Program

2. 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

3. 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

4. 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

5. 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)

6. 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 = $

7. Calgary’s Beginnings
Launched in October 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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)

15. 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

16. 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

17. 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

18. 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

19. 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%)

20. 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

21. 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

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

23. Questions?