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Using Housing First in Integrated Homelessness

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Using Housing First in Integrated Homelessness Using Housing First in Integrated Homelessness Strategies A Review of the Evidence Nicholas Pleace February 2018 Copyright © University of York, 2018 All rights reserved. Reproduction of this report by photocopying or electronic means for non- commercial purposes is permitted. Otherwise, no part of this report may be reproduced, adapted, stored in a retrieval system or transmitted by any means, electronic, mechanical, photocopying, or otherwise without prior written permission of the Centre for Housing Policy, University of York. ISBN: 978-0-9929500-6-4 Further copies of this report or any other Centre for Housing Policy publication can be freely obtained by visiting our website: https://www.york.ac.uk/chp/ Contents Acknowledgements .................................................................................................................... i Disclaimer ................................................................................................................................. ii Summary ................................................................................................................................... iii About this Report ....................................................................................................................... v 1. New Approaches to Homelessness ............................................................................... 1 Introduction ................................................................................................................................ 1 Changes to the Understanding of Homelessness ....................................................................... 1 The Emergence of Housing First ................................................................................................. 4 2. The Evidence ................................................................................................................ 8 Introduction ................................................................................................................................ 8 An Overview of Services.............................................................................................................. 8 A Critical Review of the Evidence.............................................................................................. 10 The UK Context .................................................................................................................. 10 Accommodation-based Services ....................................................................................... 11 Summary ........................................................................................................................... 18 Floating Support Services .......................................................................................................... 18 Ending Homelessness ........................................................................................................ 19 Summary ........................................................................................................................... 22 Housing First ............................................................................................................................. 22 Ending Homelessness ........................................................................................................ 24 Summary ........................................................................................................................... 31 Cost Effectiveness ..................................................................................................................... 32 Summary ................................................................................................................................... 35 3. Discussion ................................................................................................................... 36 Introduction .............................................................................................................................. 36 Using Housing First ................................................................................................................... 36 Strategic Integration.......................................................................................................... 36 Services for Specific Groups .............................................................................................. 38 Acknowledgements My thanks to St Mungo’s for commissioning this evidence review and in particular to Lucy Holmes at St Mungo’s for her support. This piece of work draws on a range of earlier evidence reviews and research supported by DIHAL, FEANTSA, the Finnish Ministry of the Environment, the Simon Communities of Ireland, the Scottish Government, the Northern Ireland Housing Executive and the then Department for Communities and Local Government (DCLG, now the Ministry for Housing, Communities and Local Government). Nicholas Pleace Centre for Housing Policy University of York February 2018 i | P a g e Disclaimer Views reported in this piece of work are not necessarily those of the University of York or St Mungo’s. ii | P a g e Summary Housing First is highly effective in ending there is a shared philosophy, the operational homelessness among people with high and practices of Housing First in the UK are quite complex needs, but it does not constitute a different from Canada or France, as UK solution to single homelessness, or rough Housing First services have much lower sleeping, in itself. The international evidence operating costs and do not deliver support in shows that Housing First services need to be the same way. a part of an integrated homelessness Housing First services perform very well strategy to be truly effective. against inflexible, abstinence-based services An integrated homelessness strategy, that attempt to end homelessness by making characterised by extensive interagency someone ‘housing ready’ before they move working, uses preventative services and a into their own home. However, many UK range of homelessness services (of which services tend to follow a more flexible Housing First services are one group) to model, emphasising service user choice and effectively meet the diverse needs of single working within a harm reduction framework. homeless people. Integrated strategies, The evidence base has limitations, but there incorporating Housing First within a mix of are data and research results that show that service types, have reduced homelessness to existing UK homelessness services often very low levels in Denmark, Finland and effectively address the bulk of the single Norway. homelessness they are presented with. There is strong evidence that Housing First Equally, some services of intensive service can end homelessness among people with provision, such as the Tenancy Sustainment high and complex needs, typically achieving Team model developed under the Rough sustained housing for at least one year for Sleepers Initiative, achieve comparable around eight out of every ten people results to Housing First with people with high Housing First services work with. Housing and complex needs. First has delivered very similar results in UK homelessness services had often adopted North America, Europe and the UK. various core elements of the Housing First However, outcomes in respect of addiction, model before the idea of Housing First mental health, physical health and social and arrived in the UK. Flexible, tolerant working economic integration can be more variable practices, harm reduction and an emphasis for Housing First. on service user choice have been The evidence base for Housing First requires mainstream in UK homelessness service careful interpretation. All Housing First provision for over two decades. services share a common philosophy and To assume that foreign research results on core principles, but operational differences Housing First can simply be assumed to be can be considerable, with services ranging directly applicable to the UK neglects often from intensive, high cost, multidisciplinary important differences, both in how Housing models, through to models that employ First functions and in the operations and forms of intensive case management with ethos of the existing homelessness services lower operating costs. Success in ending with which Housing First is being compared. homelessness is very considerable, but while iii | P a g e Existing UK homelessness services – both accommodation-based models and floating support – often have more commonalities with Housing First than the existing homelessness services (‘treatment as usual’) with which Housing First has been compared in North America and in Northern Europe. The evidence base has limits, but the possibility that Housing First does not outperform existing services to the same extent in the UK as is the case elsewhere needs to be considered. Housing First is not the only service innovation that can be effective in reducing homelessness among people with high and complex needs. There is evidence from Denmark and the USA indicating that the Critical Time Intervention approach can also achieve impressive results in ending homelessness. There are good reasons to employ Housing First as a means to reduce single homelessness among people with high and complex needs in the UK. This includes some people who repeatedly sleep rough and individuals whose needs cannot always be met by existing homelessness services. However, Housing First is
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