1. Oh CANADA! Lessons on Housing First from the Canadian Response to Homelessness Stephen Gaetz Canadian Observatory on Homelessness Professor, Faculty of Education, York University, Toronto, Canada National Housing First Day June 7, 2015

2. Housing First The context … Part 1

6. A short history of Housing First in Canada Pathways to Housing – New York, Sam Tsemberis Toronto – Streets to Homes 2004 Calgary, Edmonton, Lethbridge, Medicine Hat, Red Deer, Province of Alberta – 2008 - Present

7. Prevention Emergency Response Housing and Supports Paradign shift from MANAGING the crisis, to ENDING HOMELESSNESS

8. The emergency response is EXPENSIVE!!!!

9. Prevention Emergency Response Can we move from THIS... Housing and Supports

10. Prevention Housing and Supports Emergency Response... to This!

12. 2013 – Government of Canada renews Homelessness Partnering Strategy for 5 years Prioritizes Housing First

13. Prioritizing needs in terms of Transitional - 88-94% Episodic – 3-11% Chronic – 2-4% Chronicity Aubry et al., 2013

14. The EVIDENCE Part 2

16. Does it work? Huge body of evidence that says it does work. Between 80-90% of those who receive Housing First are still housed after a year The At Home / Chez Soi project has ended more than 6000 person years of chronic homelessness

17. Does it lead to less use of homeless related services? Significant differences between Housing First and Treatment as Usual (TAU) in 12 months of service use (per 1,000 people) 7,497 fewer nights in institutions (largely residential addiction treatment). 42,078 fewer nights in shelters. 6,904 fewer nights in transitional housing or group homes. 732 fewer emergency department visits. 460 fewer police detentions. 1,260 fewer outpatient visits. 34,178 fewer drop-in centre visits.

18. Does it cost more? On average the HF intervention cost $22,257 per person per year for ACT participants and $14,177 per person per year for ICM participants. For every $10, an average savings of $9.60 for high needs/ACT participants and $3.42 for moderate needs/ICM participants. For the highest needs clients (top 10%) every $10 invested in HF services resulted in an average savings of $21.72. (Goering, et al., 2014 National At Home / Chez Soi Final Report)

19. Success in Alberta Edmonton – 30% reduction in homelessness Lethbridge – 65% reduction Medicine Hat – poised to be first community to end homelessness in Canada Province of Alberta – over 9000 individuals housed.

21. Implementation Challenges Part 3

22. Community RESISTANCE

23. Matching supports to client acuity

24. The first three months are a crucial transition period

25. Nurturing effective working relations with landlords

26. The importance of rent supplements

27. How do we consider the needs of the fifteen percent for whom housing stability continues to be a challenge.

28. How do we support social interaction and meaningful engagement?

29. Where does ASSESSMENT fit in? Clinical Assessments Community Priorities Intake Assessment Tool Interventions Case Management Data Management Systems (HMIS, HIFIS)

30. A word of caution: Assessment tools are one source of information to guide decision making. Avoid SCIENTISM! They are not magic, and they cannot make decisions for you. Trust your own knowledge as well.

31. Housing First What’s Next? Part 4

33. 1 Reframe the Problem

34. Prevention Housing and Supports Emergency Response Where does PREVENTION fit in? 2

35. A Framework for Thinking About Prevention Tertiary Prevention Primary Prevention Tertiary Prevention Secondary Prevention

36. Working upstream to prevent new cases Primary Prevention 1

37. Early intervention strategies to stop people from becoming homeless or to help them exit quickly Secondary Prevention 2

38. Stopping homelessness from happening again! Tertiary Prevention 3

39. Addressing the lack of Affordable Housing 3

40. The Grand Experiment… DECLINE In direct Federal expenditures on affordable housing INCREASE Increase in tax expenditures / Subsidies for home ownership

41. Decline in Federal spending over 25 years

42. The OUTCOME?

43. Shrinking investment in affordable rental housing

44. 18% of low income Canadians are in “Extreme Housing Need”

46. Six key recommendations

47. The need to address Aboriginal homelessness in Canada 4

48. Aboriginal Homelessness in Canada Belanger, et al. 2012

49. Population Profile based on Age Aboriginal vs. Aboriginal in Canada

50. Addressing YOUTH HOMELESSNESS 5

51. Does HOUSING FIRST work for youth ?

52. COMING SOON! More on this in the afternoon

53. Resources and Supports Part 4

54. TOOLKIT

56. Book on Housing First

57. www.homelesshub.ca/housing firstyouth Housing First Framework for Youth

58. Questions or comments?