Housing First: Ending Homelessness and Supporting Recovery - Dr Sam Tsemberis

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Housing First: Ending Homelessness and Supporting Recovery - Dr Sam Tsemberis
Presentation delivered by Dr Sam Tsemberis at the Housing First conference organised by Athlone Institute of Technology and Midlands Simon on 30 September 2013.

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  • Discuss service choices
  • Summarize and emphasize the idea of where the locus of control is.. That is now with the client.. Give a hint about why MI works well with this perspective
  • Housing First: Ending Homelessness and Supporting Recovery - Dr Sam Tsemberis

    1. 1. Sam Tsemberis, PhD Founder and CEO Pathways to Housing September 30, 2013 www.pathwaystohousing.org
    2. 2. Presentation Outline 1. Program Philosophy 2. Program Operations 3. Policy and Systems Change 4. Program Effectiveness 5. Implementation and Dissemination
    3. 3. Who is served by Housing First?  Homeless  Mental health problems Addiction and abuse  Health problems  Poverty  Isolation  Stigma  PTSD/Trauma GINI (Social Disparity) Housing First is also an economic intervention
    4. 4. Why Focus on Chronic Homelessness?  Most in Need/Vulnerable  High Rates of Service Utilization (Aubrey 12% use 50%)  Public Health Concerns – most visible  Community Consensus  Most Challenging for Traditional System to Engage
    5. 5. Traditional system Homeless Shelter placement Transitional housing Permanent housing Levelofindependence Treatment compliance + psychiatric stability + abstinence
    6. 6. System Renovation Using Housing First Homeless Shelter placement Transitional housing Permanent housing Levelofindependence Treatment compliance + psychiatric stability + abstinence
    7. 7. 1A. Consumer Choice in Housing Matching the housing type to the person’s needs  Consumer Choice drives the provision of housing  Consumers choose among housing types, rental market and social housing  Choose neighborhoods, size of unit, furnishings and other household items for their apartments  Tenants rights and responsibilities (terms and conditions of standard lease)  Rent contribution about 30% of income
    8. 8. Housing Choice: Independent apartments in community settings (Scatter Site Housing Model)  Most consumers prefer own place in normal settings  Independent apt  Create sense of home  Integrated housing  Services are off site
    9. 9. Pathways has served: 22 People in Washington County 46 People in Chittenden County 18 People in Windham. Etc. Pathways tenants live in 4 counties and 8 different cities
    10. 10. Pathways VT: Housing First In Rural Areas
    11. 11. Some Operations Issues for the Housing Component of the Program  Separation of Housing and Services: Commitment is to the person  Choice in location, unit, and life style  Developing and Managing Relationships with Private Market Community Landlords  Repairs, Relocations and Relatives
    12. 12. After housing… Health &Wellness/Weight Loss/Exercise Finances/Budgeting/ Money Management Alcohol/Drug -- Use Abuse Mental Health Issues JOB, JOB, JOB eviction
    13. 13. Services Provided Directly or Brokered  choice Spiritual Wellness/ Nutrition Arts / Creativity HOUSING Addiction PEER SUPPORT Income Entitlements Employment/ education Mental Health Friends & Family ant ACT Team provides most services directly ; Transdisciplin ary practice. ICM teams broker services. Clients No wrong Door – Immediate access— Client directed CLIENT RN/MD
    14. 14. Clinical and Support Services for Housing First: ACT, ICM, and CM Teams  Consumer choice in type, frequency and intensity of services  Team meeting - (1-5 times a week)  Team structure and team philosophy  Art and science of the Home Visit  Working as a team: “We have each other’s back”, geographic coverage, cross coverage, etc. Rural variations include teleconferencing between 2 or more smaller teams  Managing the 7/24 on-call
    15. 15. Team Operation Logistics  Google groups, teleconferencing morning meeting  Outlook coordinated calendars  Team approach to case management  Smaller teams  Teaching online skills to tenants – telemedicine  Managing the 7/24 on-call
    16. 16. Housing First Program Fidelity 5 Domains/Factors I) CHOICE in Housing and Services II) Separation of Housing and Services III) Service Philosophy IV) Service Array V) Program Structure
    17. 17. Operations: Lessons learned  Match services to client need  There’s no place like home  The importance of hiring peers  HF is not only a new program it is a culture change
    18. 18. Homeless Rapid-rehousing prevention Low support Low needs (families) Moderate support & moderate needs High support & high needs Relationship of housing and supports: Depends on who we serve.
    19. 19. • Poverty must be addressed as a component of recovery • Programs must address client’s practical concerns (e.g., it’s not housing it’s making a home –furniture, phone, tv, etc.) • Employment, education, meaningful activity Economic Recovery – It’s not housing it’s a home
    20. 20. Housing First Treatment Philosophy: Recovery Focused Mental Health Services Relationships are foundational Peer support Knowledge and skills to self- manage Emphasis on welcoming, hopeful, inspiring culture
    21. 21. • • Moving forward requires taking risks Harm reduction, lease co-signs, Balancing risk and Responsibility
    22. 22. Housing First As Systems Change and Program Effectiveness  Begin with the assumption of capability  Less transitional and emergency and more permanent with supports  NYU study of staff time and energy  Canadian study program and cost outcomes
    23. 23. Street/shelt er/hosp/jail Community Placement Transitional Housing Permanent housing Ongoing, flexible support Harm Reduction Housing First Model
    24. 24. Community-based, Residential Treatment (on-site clinical staff) Permanent Single Site (on-site services) Permanent housing (scatter-site, off site services) Redesigning the System: System Transformation Longer term Institutional Care Least restrictive to more restrictive setting
    25. 25. Front-Line Practice Differing Provider Perspectives by Program Model: A Program Implementation Paradox TF providers were consumed by the pursuit of housing HF providers focused on clinical concerns Housing First Model Treatment First Model Focus on Housing Focus on Treatment Stanhope, V., Henwood, B.F. & Padgett, D.K. (2009). Understanding service disengagement from the perspective of case managers. Psychiatric Services, 60, 459-464.
    26. 26. MENTAL HEALTH COMMISSION OF CANADA (2009): AT HOME/CHEZ SOI -- 5 CITIES, RCT N=2,215
    27. 27. MHCC At Home / Chez Soi 5 Cities Moncton, Montreal, Toronto, Winnipeg, Vancouver Housing First (n=1267) Client Interviews every 3 months: Residential stability, mental health, addiction, quality of life, social integration Treatment as Usual (n=990)
    28. 28. Lessons in Implementation and Dissemination Science • 1. Program – is the intervention well understood? • 2. Outer setting - economic, political, and social • context • 3. Inner setting – org experience, staff stability, org • culture • 4. Individuals - attitudes towards intervention, believe it will work or I necessary, leadership, • 5. Process - planning, engaging, executing
    29. 29. • Prevention must be an integral part of the strategy to end homelessness • Employment, education, and other meaningful activity • Poverty must be addressed as a component of recovery There is much more to do:
    30. 30. We cannot afford not to end homelessness for those on the streets.
    31. 31. For additional information  Please visit our website: www.pathwaystohousing.org  Or send an email to: stsemberis@pathwaystohousing.org

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