Housing First Webinar

Housing First:Housing First:Ending Homelessness for People

with Mental Illness and Addictionwith Mental Illness and Addiction

Brought to you by:

January 12, 20113:00 CST/2:00 CST


with Mental Illness and Addiction

PRESENTER


Sam Tsemberis, PhD

PRESENTER

Founder and CEO Pathways to Housing

Email: [email protected]

Website: www.pathwaystohousing.orgWebsite: www.pathwaystohousing.org



SPEAKER


SPEAKERTim Sheehan, Ph.D.Professor and Director of Institutional EffectivenessHazelden Graduate School of Addiction Studies

Presentation ObjectivesPresentation Objectives

Participants will be able to describe:

• the essential ingredients of operating a g p gHousing First program

• core values and program components of p g pHousing First: services, treatment and housing

• steps in starting a Housing First program p g g p g

• available resources, including the Housing Firstmanual, training, and consultation , g,

ll iPoll Question

In what profession do you currently practice?

A. Mental health, substance abuse, or , ,co-occurring treatment

B. Supportive housing

C. Research

D. Policy development, government, or D. Policy development, government, or administration

E. Other

ll iPoll Question

Does your organization currently provide y g y pany form of supportive housing ?

1. Yes

2. No

Housing FirstHousing First

Introduction

The Origins of the The Origins of the Pathways Program

Program PrinciplesProgram Principles

Program Operations

Program Effectiveness

People who are homeless with pmental health and substance

abuse problemspChronically homeless

Psychiatric disabilitiesy

Addiction and abuse

Health problemsp

Poverty

Isolation

Stigma

Trauma

GINI (Social Disparity)

Are they the homeless mentally Are they the homeless mentally ill or the mentally ill homeless?

Why are people with psychiatric Why are people with psychiatric disabilities over-represented among

the homeless?the homeless?

Traditional Treatment andSobriety then Housing programs

$$$$there

$$$$are cost

$$$$$$$$implications

$$$$PERMANENT

Housing

TRANSITIONAL H iTRANSITIONAL HousingSHELTER (housing readiness)

O t h Ch ll D i l t d tOutreach

Drop-in

Challenges:1)Housing readiness is not needed2)Clinical assumptions are not substantiated

Dx is related to ability to function3) Cost implications

Single Siteg(congregate housing)

New or rehab building

Tenants are people with special needsspecial needs

Property management and social services are on site

Psychiatric treatment and sobriety usually required (can have harm reduction (can have harm reduction models as single-site programs )

Rules, regulations, and shared housing

Single Site Single Site Effectiveness (cont’d)

About half stayed 3 years or more

Only one-third of leavers went to stable alternative Only one third of leavers went to stable alternative housing (“positive leavers”)

“Negative leavers” had more severe levels of mental gillness, greater incidence of substance abuse, higher supportive service needs

(O’Hara, 2007)

When people cannot accessWhen people cannot accessor keep housing

• Shelters: 10% of the chronically homeless utilize 50% of the system resourcesutilize 50% of the system resources

• Hospitals/Detoxes: 3% of clients use 28% of all Medicaid funding for these servicesg

• Jail/Prison: High rates of incarceration and recidivism rates: poverty and drug related p y gcharges for people who are mentally ill and homeless. 25% of prison population have mental health problemsmental health problems.

PathwaysPathwaysHousing First

Scatter site apartments

Immediate access

Treatment 0r sobriety are not required

Ad i i it i Admission criteria is inclusive, not restrictive

Wh i H i Fi ?What is Housing First?

An evidence-based, consumer-driven program, rooted in the principles of:

Psychiatric rehabilitation

H d tiHarm reduction

Consumer movement

Recovery oriented practiceRecovery oriented practice

Wh i H i Fi ?What is Housing First?

A clinical and housing intervention that provides intervention that provides immediate access to permanent housing and

d isupport and treatment services for people with mental health and addiction problemsand addiction problems

Four Essential Ingredients of Four Essential Ingredients of Pathways’ Housing First

1. Consumer Choice Philosophy

2. Separation of Housing and Services

3 Recovery Oriented Services3. Recovery Oriented Services

4. Community Integration

1. Client Choice is the Foundation of the Pathways’

Housing First Program

Choice drives both housing and clinical servicesservices

Clients choose among housing options: location size floor neighborhood location, size, floor, neighborhood, furnishings and other household items of their apartmentso t e apa t e ts

Clients choose among the services: type, frequency and intensityq y y

Top choice: Independent i i apartments in community

settings (Scatter Site Housing)

Given the choice -- most consumers prefer own place in normal settings

Creates sense of homeCreates sense of home

Privacy, safety, security

Integrated housing (rented from i l dl d d l community landlords and rent less

than 20% of units in any one building)

Top choice: Independent i i apartments in community

settings (Scatter Site Housing)

Tenants rights - housing is permanent, client holds lease

Tenants have the same rights and Tenants have the same rights and responsibilities as any other tenant in the building

Social services are off siteSocial services are off site

Visits are required

Treatment is offered not mandated

Landlords as program p gpartners

Landlord, program and participants have a common goal - All want safe, decent, well managed housing

1.Agency ensures rent is paid on time

2.Agency and landlord communication – responsive to landlord concerns

3.Agency responsible for tenant damages

4.Advantages of using rental market: quick start up, relocation, expansion as needs change, others.

SERVICES: Clinical and support i id d b ACT services provided by ACT

or ICM Teams

M hi h l l f i h ’ d• Matching the level of services to the person’s needs

• Hi Need: ACT is a multidisciplinary team and provides support and services directlyprovides support and services directly

• Moderate Need: ICM case management team provides support and brokers services pp b

• Services provided in the participant’s home or community (group meetings offered at offices or other community settings)

• ACT and ICM – Off site and call services 7-24

• All teams use a recovery orientation

LIMITS to consumer choice:li i l l l i & clinical, legal, economic &

practical issues

There are clinical, legal and practical limits to choice:

1 Must agree to weekly apartment visit by team1. Must agree to weekly apartment visit by team

2. Danger to self or others may lead to involuntary hospitalization

3 Other legal social issues (abuse violence illegal activity etc )3. Other legal social issues (abuse, violence, illegal activity, etc.)

Limits on housing choice

E i t i t h i h i 4. Economic constraints on housing choice

5. Must sign lease, pay 30% of income towards rent and observe

responsibilities of standard leaseresponsibilities of standard lease

2 Separation of 2. Separation of Housing and Services

The home isitThe home visit

2. Separation of Housing p gand Treatment Services

Use different criteria for success in housing and success in treatment services

R l i i i d l i li i l i Relapse is anticipated; relapse is clinical issue, not a housing problem

Relapse does not mean eviction or loss of housingRelapse does not mean eviction or loss of housing

It means obtaining treatment and returning home

Similarly, eviction from housing does not mean Similarly, eviction from housing does not mean discharge from the program (it usually means relocation)

i i h h h iProgram commitment is to the person not the housing

l i hiRelationship

True caring and honest concern

“See” the individual and treat as a whole personSee the individual and treat as a whole person

“Can do!” messages

Facilitative partnership

Collaborative relationship, Non-judgmentalp, j g

Person as the driver of his or her own life and recoveryy

S C R hSome Core Research

World Health Organization studies (Whitaker)

The Vermont Study (Harding)

What Helps What Hinders Recovery? What Helps What Hinders Recovery? (Onken, Ridgway et al.)

E l ti f P & St f Exploration of Process & Stages of Recovery

Key Elements of the yParadigm Shift

What helps/what hinders:

Change in view of those servedChange in view of those served

Change in goals of the system

Change in power relationships

Change in focus and locus of careg

Change in treatment culture

Recovery Focused yTreatment

People need self-directed approaches e.g., supported employment, wellness self-management, IDDT, supported educationsupported education

Other Evidence-Based Practices (EBPs) are incorporated into treatment services incorporated into treatment services

They also need knowledge and skills to self-manage their condition their condition

An emphasis on holistic wellness and positive lifestyle is healing (address emotional physical social cultural is healing (address emotional, physical, social, cultural, and spiritual needs)

Recovery Extends Beyond Recovery Extends Beyond the Mental Health Field

M i f l S i l R lMeaningful Social Roles

Peer Support and Recoverypp yRole Models Are of

Primary ImportancePrimary Importance

Opportunities/Opportunities/Choices/Options

Choices really matter!

People have often been stuck in programs People have often been stuck in programs with few options and opportunities that perpetuated dependence and helplessnessperpetuated dependence and helplessness

Benefits so low as to be life-stealing

Meeting basic needs—housing, income, transportation, health care

Opening doors to community integration

4 Community Integration4. Community Integration

i l l iSocial Inclusion

4 C it I t ti4. Community Integration

i h i l h i id (l Housing that is normal housing provides (least restrictive setting – (Olmstead Decision)

d f lProvide opportunities for social integration

Building community supports in integrated neighborhoods (self-help, spiritual, cultural, personal skills and interests)

Services assist participants with community integration activities – orientation to building

Mapping of their neighborhood and community

Community IntegrationCommunity Integrationand Graduation

Services can be reduced over time or stopped altogether when the person no longer needs altogether when the person no longer needs them. This makes for smooth graduation.

d l h dIn Housing First model, the service providers walk away and the person stays home

Graduation, services ,walk away and the

person stays home!person stays home!

ff iProgram Effectiveness

St di f Studies of Program g

Effectiveness

Evaluating Housing FirstEvaluating Housing First

Highly effective program for the ‘hard to house’

85% housing retention rates across many cities and 85% housing retention rates across many cities and programs

Access problems eliminated, retention increasedAccess problems eliminated, retention increased

Reduction in acute care services and significant cost savings (pre=post)savings (pre post)

Improves quality of life Tsemberis effectiveness (2004); HUD Pearson 6 cities (2007); VA Rosenheck 11 cities (2007);Larimer, cost (2009).

High Choice PSH gPrograms, Choice &

Psychiatric SymptomsPsychiatric Symptoms

reductionP

Psychiatricreduction

ProgramAssignment

ChoicePersonal

increase

Symptoms

Proportionof time

ChoiceMastery

Adapted from Greenwood et al, 2005.

of timehomeless

R h E idResearch Evidence

• Residential stability (85%)

Red ctions in ser ice tili ation• Reductions in service utilization

• Improved mental health statusp

• Reduction in drug & alcohol consumption

• Cost effectiveness (over 35 studies)

Research Evidence:Research Evidence:Pathways’ Housing First is an evidence based practicean evidence based practice

Housing First in Housing First in U.S. & Canada

Housing First Housing First in Europep

St di i PStudies in Progress

• Mental Health Commission of Canada

• ($110 M; 5 city longitudinal rct)

• European Union (10 cities hf compared to tau)p p

• France (4 city implementation)

Fi l d ( it i l t ti )• Finland (4 city implementation)

For more information For more information about Pathways to

H iHousing

Please visit our website at pathwaystohousing.org

Or send email [email protected]

Ab t H i Fi tThe manual includes:

About Housing FirstThe manual includes:

information about the program's philosophy, operations, and administration

Staffing patterns and day-to-day operations of the clinical and support services

property management and housing services

protocols for assisting clients with the search for housing building search for housing, building relationships with landlords, and the overall community integration process

the research evidence for the

Cost: $49.95for the manual alone With a 30% discount =the research evidence for the

effectiveness of the Pathways model $34.97

Ab t H i Fi tAbout Housing First

About the DVD:

Th DVD ill t t th The DVD illustrates the concepts presented in the manual, offering client success stories helpful tips success stories, helpful tips, and model teams in action.

See a preview of the DVD atSee a preview of the DVD atwww.bhevolution.org Cost: $265.00 for the

manual and the DVD With a 30% discount =$185.50

www.BHEVOLUTION.orgg

Sign up for Funding Alerts and N l ttour e-Newsletter

This presentation pcovered:

• the essential ingredients of operating a Housing First program Housing First program

• core values and program components of Housing First: services treatment and housing Housing First: services, treatment and housing

• steps in starting a Housing First program

• available resources, including the Housing Firstmanual, training, and consultation

The Series Continues!J i th d W d d f th fJoin us the second Wednesday of every month for more

information about treating co-occurring disorders…

February 9:

Applying the Individual Placement and Support Model with SupportedSupport Model with Supported Employment

Ti f Di iTime for Discussion

For more information about Housing First materials or to order call 1-800-328-9000

You will receive a follow-up e-mail with information about receiving credit for Continuing Education gthrough NAADAC or APA

Participants in this web f ill iconference will receive

a 30% discount on Housing First

U thi d t dUse this code to order:SMIREWARD

Six Steps to Obtain Continuing Six Steps to Obtain Continuing Education credit through NAADAC and APA

1) Go to www.hazelden.org/professionaled2) Click on “Course Catalogue”2) Click on Course Catalogue3) Search for the course: Housing First Learner

Assessment4) Pay the administrative fee ($10.00) for the

assessment) T k th t5) Take the assessment

6) Print your certificate!