Keynote del prof. Josè Ornelas al Corso Base sull'Housing First, organizzato da fio.PSD a Torino in occasione del lancio del Network Housing First Italia

1. Casas Primeiro
Changing social policies
towards ending homelessness
José Ornelas
ISPA-Instituto Universitário
Lisboa Portugal
Torino, 28 febbraio 2014

2. INTERVENTION
PUBLIC
POLICIES
THEORY
CHANGE
Outline of the presentation
Changes that housing first approach brings to:

3. Housing first principles
• Separation of housing and services: people are not required to
participate in psychiatric treatment or attain a period of
sobriety in order to obtain housing.
• Individualized and scattered site apartments in mainstream
neighborhoods. Apartments are not in the same building or
street.
• Participants choice and self-determination
• Recovery orientation
• Commitment to working with participants for as long as they
need

4. Separation of housing and services
• Staircase model: not effective in terms of facilitating the access
to housing and community adjustment (Carling, 1992)
• Housing first reduces homelessness: 80% to 90% housing
retention rates (Tsemberis & Eisenberg, 2000; Tsemberis et al., 2004; Busch-Geertsema,
2013)
• Housing first reduces the use of emergency services,
hospitalizations and jailing; and improve health and mental
health (Cheng et al., 2007; Greenwood et al., 2005; Srebnik et al., 1995)
• Casas Primeiro: the number of participants reporting having to
use 112 emergency service decreased 87%. The number of
admissions in psychiatric hospitals decreased by 90% and no
one reported having spent the night on a police station after
moving into housing (Ornelas, 2013).
Research

5. Implications for practice
• Immediate access to permanent housing
• Provision of services (24-7 on call) to help participants
keep housing, facilitate recovery and community
integration:
– Home visits; but participants don't live with staff
– Support services are provided in community contexts
(access to community resources and services)
• No risk of losing the house in case of crisis or
hospitalization – separation between these situations
and housing maintenance, rent payment, contract
renewal, etc.
Separation of housing and services

6. Scattered-site housing
Independent apartments
•Individualized housing is associated with more engagement in meaningful
activities in the neighborhood and sense of community belonging (Yanos et
al., 2007)
•Housing in integrated neighborhoods and with access to diverse
community resources, such as commerce and transports, was positively
associated with levels of community integration (Hall, Nelson, & Fowler, 1987;
Parkinson, Nelson, & Horgan, 1999; Segal & Aviram, 1978)
•Better quality of housing environment (apartment and neighborhood) is
positively associated with the increase of housing stability, as well as
psychological wellbeing and with community participation (Evans et al., 2000;
Kloos & Shah, 2009; Nelson et al., 1998; Newman, et al., 1994; Wright & Kloos, 2007)
•Integrated housing facilitates the contact and relations with people that
could be natural supports, like the neighbors (Ornelas, 2013)
Research

7. Social housing

8. Community neighborhoods

9. Scattered-site housing
Independent apartments
Implications for practice
• Regular rental housing market
• Quick access to housing (leaving the street) and easy
relocation if necessary
• Allows more choice, based on housing and location
preferences
• Contact with neighbors and local community as a
normative context for community participation
• Landlords as partners

10. Participants choice and self-determination
Research
• Most participants prefer:
– an indepent accommodation (their own apartments)
– to live with a friend or partner, not with other people with
mental illness
– staff available, but they don’t want to live with them
(Nelson, Hall & Forchuck, 2003; Tanzman , 1993)
• Participants’ choice and control about their house and the support
they receive increase:
– housing satisfaction
– perceived quality of life
– community integration
(Gulcar et al., 2007; Nelson, Sylvestre, Aubry, George, & Trainor, 2007;
O’Connell et al., 2006; Yanos et al, 2004).

11. Implications for practice
• Participants choose where they want to live and with whom
• Participants are encouraged and supported in selecting
priorities and decision making regarding their future and new
stages of their lives
• Collaboration:
– participants’ knowledge, experience and interests are
valued
– collaboration in drawing, implementing and monitoring
the intervention
– mutual learning
– rebalance of power in their relation with professionals.
Participants choice and self-determination

12. Recovery orientation
Research
Recovery is a social process of regain:
• access to community resources
• access to valued social roles
• social relationships
• community participation
• sense of community
(Ahern & Fisher, 2002; Chamberlin & Rogers, 1990; Revell et al, 2000;
Ridgway, 2007; Salzer, 2006; Tsemberis et al, 2004; Torrey et al, 1995)
Peers can be mentors for recovery. Sharing similar experiences
increases people's understanding about their situation and
strengthen their personal and social resources to deal with their
problems and take control of their lives
(Davidson, Chinman, Kloos, Weingarten, Stayner & Thebes, 2005;
Jacobson & Curtis,2000; Levy, 2000, Randall & Salem, 2005)

13. Recovery orientation
• focus on concrete problem
resolution
• support services provided in
community contexts
• facilitates the access to services
and resources that are available
to the general population
• strengthening of social contacts
and natural supports
• collaboration with other
community stakeholders
Implications for practice
Ecological intervention

14. Recovery orientation
• Mutual help group
• Peers as service providers
Implications for practice
Mutual help

15. Commitment to working with participants for
as long as they need
Research
• Some people take more time to get housing stability
• Because recovery is not a linear process the
intensity of support depends on participants’ needs
over time
• Support needs changed over time: new challenges
and options like education, employment or contact
with families
(Ornelas, 2013; Ralph, 2005; Tsemberis, Gulcar, & Nakae, 2004)

16. Implications for practice
• Support is not limited in time
• Support services are flexible, individualized
and tailored to participants‘ needs and
objectives
• Continuous support of participants even when
they are hospitalized, in crisis, in temporary
absence from the program or when changing
address.
Commitment to working with participants for
as long as they need

17. • Addressing homelessness as a social problem:
shifting from an individualist perspective focused on
individual problems and treatment to an ecological
one
• To avoid concentration in social neighborhoods by
subsidizing renting on scattered site housing in
regular neighborhoods
• Promotion of a dynamic rental housing market
Implications for public policies

18. • Innovation is sustainable and economic efficient:
Housing First is cost effective, the costs are
significantly lower than other services:
 Casas Primeiro - 16,40 euros per client per day (€498,83 per month
 Night Shelters - 18,60 euros per client per night
 Hostels rooms - 30,77 euros per client per day
 Psychiatric hospitalization in acute wards have a one time cost of
€2500 per client
• Public polices should be based on scientific evidence
in order to address structurally social problems
instead of maintaining assistance practices like
shelters and social canteens
Implications for public policies