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Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England
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Recognising and Overcoming the Barriers to Housing First in the European Context: Case Studies from Ireland and England

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  • 1. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Recognising and Overcoming the Barriers to Housing First in the European Context Case Studies from Ireland and England Nicholas Pleace Joanne Bretherton
  • 2. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Presentation Overview  Exploration of critiques and concerns about using Housing First in Europe.  Draws on research projects assessing strategic implementation and the service-level piloting of Housing First during 2012/13.  ‘Finding the Way Home’ housing-led strategy in Ireland  ‘Camden Housing First’ pilot evaluation in London  Conclusions and implications
  • 3. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Critiques of Housing First  High rates of housing sustainment, but concerns:  Model drift  Does not work for all  Cost effectiveness  Mixed results around social integration, health and well-being  Is it really innovative?  Behavioural modification advocates  Too expensive
  • 4. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 ‘Finding the Way Home’: A Housing-Led Strategy in Ireland  Critical review of the Ireland homelessness strategy for the Simon Communities of Ireland  Examined how suitable ‘Housing First’ was for Ireland from various perspectives  Consultation with policymakers and service providers  Representatives from eight major agencies  High level consultative briefing with government and service providers  Consultation with service providers  Simon Communities in Cork, Dublin, Dundalk, Letterkenny, Sligo  Consultation with homeless people  Focus groups with 27 people, 19% women, 81% men
  • 5. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Key findings from Irish research  Housing-led and harm reduction philosophy viewed positively by service providers and homeless people  But also as closely reflecting current practice  Suitability for some people  Affordable housing supply  Joint working  Concern about ‘watering down’
  • 6. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Positive views of Housing First  Rapid housing and support  Own front door/ontological security I am an adult. I am capable of looking after myself…you know, the idea of getting your own key, closing your own front door Homeless Woman.  But, key aspects were normal practice:  Harm reduction, choice, some housing-led services
  • 7. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Positive views of Housing First It’s more effective, the harm reduction, than being given an ultimatum, which I’ve been given through me life and I just left like, just one day you just leave and find yourself homeless again Homeless Man. The dictatorial approach, it would just simply not work, people are where they are at and there’s absolutely no progress unless that person decides to progress themselves, but there is so much dictatorship going on, and if the client makes a mistake and guess what people make mistakes, then that’s it ‘goodbye’, that kind of dictatorial approach does not work with people who have come through homelessness, or even with any of us in the room, that type of approach. Service Provider.
  • 8. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Suitability of Housing First  A few homeless people said they preferred communal services with on site support  History of institutionalization  Isolation, inactivity and boredom  Drugs and alcohol issues  Providers reported that Housing First should not be only choice, might not be the best option for some homeless people
  • 9. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Preference for communal services I suppose it [Housing First] would be handy for some people, but there are a number of people I suppose would struggle…I suppose people would feel on their own, like, you know. I’d say most people would like to be independent but there’s a few who’d be much happier in the [communal service] Homeless Man.
  • 10. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Preference for communal services: Isolation and Drug and Alcohol use It is a problem like, because if you are a drinker, I’m a drinker…if your hands are empty, you say ah I’ll go for one and then you go for two, you know what I mean, it’s a trap in that sense. Homeless Man. Isolation is the thing, isolation is the key. If you’re in isolation you don’t stand a chance, you’ve got to have support, but it needs to be 24 hours a day, it’s no good having a key-worker who visits ten minutes a day… Homeless Man.
  • 11. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Housing First as not suitable for all I think there will always be a need for supported housing, because we have people who go into supported housing who couldn’t then take up a housing-led style apartment or place to live. I think it will depend on the individual, on the assessment, on what they want from us. Service Provider. There are people with more complex needs than others. Like if you get someone whose been heavily entrenched in homelessness for the last six years and put him into an apartment somewhere and have a floating support worker, it might not be enough for that individual, because they might need more contact. Homeless Man.
  • 12. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Joint working  All Housing First services rely on joint working to provide packages of support  Challenges in case management because health, welfare and social care services were being cut back There’s an assumption like, and it’s quite prevalent, particularly in some meetings that we go to…that structurally the services are there like and the gap is with the individual as such like and with the problems of the individual, of which there is many, but it’s an assumption through these models that structurally everything is in place, it’s just a matter of organisation and coordination, which it quite simply isn’t. Service Provider.
  • 13. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Affordable and adequate housing supply  Insufficient supply of affordable, adequate housing People on housing lists for years, who just haven’t been offered anything, and there doesn’t seem to be direct answers or reasons as to why that’s happened. And we would have a number of people who, you know would benefit [from Housing First]…where they would move into a decent property and have the floating service, but it’s often impossible to get that, it’s rare if ever. Service Provider. I’m renting at the moment, I’ve no house from the council or anything like that, which is nearly €70 a week I’m paying, you know rent, that’s without ESB [electricity], gas or putting something in the fridge. You know that’s a lot of money when you’re on social welfare. Very difficult to get a council house in [location]. What I’m looking for is a council house really, which is only €25, €30 a week and they look after you...Homeless Man.
  • 14. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Concerns about ‘watering down’  Concerns that successful Housing First service models would be ‘diluted’  Worry among service providers that government wanted much cheaper, low intensity services  ‘Hiding’ expenditure cuts by presenting as ‘innovative Housing First’ services I think that the Pathways model as it’s employed in New York, Philadelphia and wherever else is great, but I think that the danger in Ireland is that the support side of it will be watered down...you have the mental health expert and the drugs expert, where here, the goal seems to be to have one key-worker support maybe 15 people, doing everything and what’s lost is the assertive community treatment [ACT] teams which are so specialist…Service Provider.
  • 15. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Camden Housing First  An intensive case management, scattered site Housing First service  The pilot had capacity for engagement with up to 10 people  Unusual use of a Housing First approach  Designed to work alongside an existing staircase service system  Focused on chronically homeless people who were ‘stuck’ in staircase system for three or more years, because they were not judged to be ‘housing ready’
  • 16. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Camden Housing First The Study  18-month longitudinal study of a small scale Housing First experiment in central London  Independent study, supported by University of York and SITRA  Tracked outcomes using service user records  Tracked progress of service with regular interviews with frontline and management staff, plus discussions with service commissioners  Interviews with service users  Reviewed costs
  • 17. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Key Findings: Camden Housing First  Successful engagement with people who had not lived in housing for many years or never lived independently.  Could support people with very high needs  Possible to overcome major restrictions in suitable housing supply by using private rented sector  Joint working could be effective  Social integration was a slow process  Possible to replicate successes of NY Pathways Housing First using operational principles rather than exact duplication, raises possibility of comparable cost Housing First models using intensive case management (ICM) and scattered private rented sector housing being used in the EU
  • 18. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Successful engagement  Service users had very high needs  13 in total, 6 women, 7 men, typically in 40s, ethnically and culturally diverse  Almost all had problematic drug/alcohol use  Very high rates of severe mental illness and personality disorder and poor physical health  Long term workless  Histories of anti-social behaviour  At the point that the research stopped:  7 people were still housed  1 rehoused for six months, but lost the tenancy  5 awaiting housing, all successfully engaged with by CAMHF
  • 19. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Ending chronic homelessness  Many service users had never lived independently  All had been in hostels in Camden for at least three years, often far longer. They were defined as not housing ready by other services. People are so institutionalised, all these things people don’t know how to do, they’ve never even thought about, people can be like a kid, leaving home for the first time,. you know, but these people are much older and have much less confidence. But it’s an entirely different mind-set to living in a hostel with all the rules that are being forced upon you, to being self-directed, that is a massive shift, and that’s the ultimate dream for people to be in charge of themselves and to manage themselves. CAMHF Team Member.  However CAMHF had successfully engaged with and was delivering housing sustainment for this group
  • 20. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Service user views of CAMHF It’s been helpful… you know what I mean, got me into this place, away from things I didn’t want around me, and trying to help me get back on my feet…CAMHF Service User. It’s been brilliant, yeah, very good, she’s [specialist floating support worker] been brilliant, and she’s always, when she’s said she’s going to be there, she’s been there, not let me down, you know? She came with me every time to view the flats because we’ve viewed three, she was there with me, she didn’t let me go on my own. And every now and then she rings me and asks me how I am, how is my day going and she’s going to be there for about a year, I’m liking that. CAMHF Service User.
  • 21. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Staff views of CAMHF So much of it is about treating an adult like an adult, getting your message across, most of the time with humour, and actually being there when they do change their minds about things. CAMHF Team Member. It’s not really for us to tell somebody what to change, we can advise and give them their options or explain the consequences, but without the nagging thing attached to it. CAMHF Team Member.
  • 22. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Using private rented housing for CAMHF  Very little social housing available  March 2013, the Greater London Authority reported that 380,301 Londoners were on social housing waiting lists.  This is a 56% increase in the level reported in 2003, equivalent to 4.65% of a total population of 8.17 million people.  However, major challenges in using the PRS:  Victorian and older buildings, poor space standards, insulation, sound proofing  Welfare benefits pay maximum rents of up to £800-£1,000 a month for a one-bedroom / studio apartment (€940-€1,178)  Much private rented housing in central London has rents above these levels
  • 23. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Using private rented housing  Housing service users could take time (average of 75 days)  Adequate and affordable PRS housing is scarce  However, by forming relationships with PRS letting agents, the support team were able to secure adequate, central London housing within rent levels paid by welfare system The first thing he said was- “I don’t want any druggies, I don’t want any junkies, I don’t want any ex-cons” and, of course, but we -spent what, an hour and a half, two hours with him and it ended up with him- showing us properties and in the end he’s housed our clients…and that’s all just because of building the relationships, it’s not because of anyone coming forward saying ‘yeah, I want to work with your clients’. CAMHF Team Member.
  • 24. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Joint / Inter-agency working  Aside from issues accessing the PRS, CAMHF were successful in working with other agencies.  Working effectively with health and care services  Registration with General Practitioners (family doctors) who are the main route of access to health services (all service users)  Connection with drug and alcohol services and mental health services. Evidence of some improvements in mental health and drug and alcohol use
  • 25. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Economic and social integration  Less progress around education, training and employment, but this was a group very ‘distant’ from paid work  Social integration outcomes vary. Interaction with neighbours was sometimes a challenge, but there was some evidence of integration It’s a massive thing, for people who’ve been like completely socially excluded from mainstream society to then actually be a part of it, you know they may not be the most productive members of society, but they are still part of it… CAMHF Team Member.
  • 26. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Replication of Housing First approach  Slightly lower costs than Pathways Housing First (New York)  CAMHF used two full-time case managers with a caseload of 5 each. It provides intensive case management  CAMHF £90k per year, €106k, with caseload of 10, one person, for one year, would be £9k, €10.6k.  Mean cost for hostel/supported housing £10.6k, €12.6k per person, per year  But hostel/supported housing costs could range as high as £17.5k, €20.6k per person, per year for specialist services  These are care costs only, exclude rent/accommodation charges  CAMHF suggests successful Housing First approach can be replicated at slightly lower cost, following operational principles, but not all details, of New York model
  • 27. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Conclusions  Non-housing outcomes, yes, results can vary, but housing sustainment improves situation (shown in other research)  Model drift, yes, but that can be a positive, effective ICM based London service was relatively low cost  Does not work for all, no it cannot, some may not be suited, but London example shows very high need groups can be successfully supported  Cost effectiveness, yes, but emphasis on effectiveness, not on being ‘cheaper’ and while slightly less expensive than New York Pathways model, Camden Housing First was not cheap, not ‘watered down’, it was an ICM model 
  • 28. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Conclusions  Clearly Housing First is different from what has been done in Ireland and England before. London example was able to engage with chronically homeless people defined as ‘not housing ready’ by established services  Behavioural modification as a more effective alternative i.e. the staircase model – nothing to support that conclusion from Irish or English work reported here.  Findings in line with wider evidence base, lots of reasons to continue with Housing First, but also to be careful.
  • 29. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Thanks for Listening  Nicholas.Pleace@york.ac.uk  Joanne.Bretherton@york.ac.uk  www.york.ac.uk/chp/  @CHPresearch

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