What Do We Mean by Housing First?

1. What Do We Mean by Housing First? Categorising and Critically Assessing the Housing First Movement from a European Perspective Nicholas Pleace and Joanne Bretherton ENHR Conference 2012 Housing: Local Markets and Local Welfare in a Globalized World Lillehammer

2. The Rise of Housing First • Three homelessness policy problems • The rise of “chronic” homelessness • Service failure of treatment led services • Financial costs “Million Dollar Murray” • Pathways Housing First, NYC, as the “solution” • Specifically focused on “chronic” homelessness • Effective service generating significant cost offsets • Evidence base accepted by Federal Government • 88% housing retention @ 5 years, 75% @ 4 years

3. Housing First Everywhere • Housing First model is globally influential • Treatment-led models were quite widely used, but the apparent influence of Housing First is still wider • Australia, Austria, Canada, Denmark, Finland, France, Hungary, Ireland, the Netherlands, Norway, New Zealand, Portugal and, to a limited extent, the UK • EU wide evaluation led by Volker Busch-Geertsema

4. The First Doubts: Ambiguity • Appearances are deceptive • What appears to be a globally influential idea has been simplified, diluted and sometimes significantly changed • Pathways Housing First (PHF) model/paradigm is not fully reflected in a growing number of services calling themselves ‘Housing First’

5. The First Doubts: Ambiguity • Two main trends • ‘Housing First’ used to describe ‘housing-led’ services that are not treatment led/staircase services but are not PHF either • ‘Housing First’ used to describe services that are not following PHF model/paradigm but which reflect or are influenced by the PHF paradigm

6. Concerns about Ambiguity • PHF is relatively well evidenced • The “Housing First” variants may not be as well evidenced as PHF • Need to understand these variants, what works, what does not work, they are not the same as PHF • Risk of ‘damage by association’ to PHF/Housing First • Fuzzy definitions, conflating the line between ‘housing-led’ and ‘Housing First’ • Uniqueness of PHF may not be properly understood (UK)

7. Overcoming Ambiguity • “Housing First” is, in practice, a term used to describe services other than PHF • The idea that PHF can simply be replicated is problematic, PHF was designed for New York, there must be modifications of the approach to work in other contexts, particularly in other welfare/housing systems, PHF cannot be entirely consistent • So an attempt to reclaim “Housing First” as only relating to PHF services is problematic

8. Overcoming Ambiguity • There is evidence that services that are influenced by (but do not replicate) the PHF model are more effective at providing sustained exits from homelessness • Services developed without reference to PHF, reflecting some of the ideas are more effective at providing sustained exits from homelessness • The full ‘positive influence’ of PHF on services is not being understood if a narrow definition used

9. Housing First as a Broader Concept • If PHF is effective in its own right • And there is evidence that services that reflect or are influenced by PHF are more effective • Indicates that Housing First should perhaps be seen as a broader concept

10. Three ‘types’ of Housing First • Pathways Housing First (PHF) • Communal Housing First (CHF) • Housing First ‘Light’ (HFL)

11. Pathways Housing First (PHF) • The original form • Comparatively rare • Immediate/rapid access to ordinary scattered housing, mobile support team providing ACT and ICM services • Housing as basic human right, respect warmth and compassion, provided for as long as needed, separation of housing and support, consumer choice, recovery orientation and harm reduction

12. Communal Housing First (CHF) • Accommodation based services i.e. communal or congregate housing everyone living in the same building which is only open to service users • Services provided on-site • Generally targeted on highest need groups • Separation of housing and support, harm reduction, respect, warmth compassion • Widely used in Finland and USA

13. Housing First Light (HFL) • Mobile support team • Immediate/rapid provision of ordinary scattered housing • Low intensity support centred on case management • Separation of housing and support, harm reduction, consumer choice • Can be used for homeless people with lower support needs

14. Second doubts: The limits of Housing First • There is evidence that all three ‘Housing First’ variants are more successful than other service models at delivering housing sustainment, an exit from homelessness/ avoiding the risk of homelessness • Evidence is not always very rigorous, some question the robustness of the data on PHF services • Failure of treatment-led models, continuum, LRT, staircase is not absolute

15. Three limits to effectiveness? • Housing sustainment for whom? • Cherry picking, particularly around PHF ‘avoiding’ homeless people with the most problematic drug and alcohol use • Effectiveness in other respects • Some evidence of stabilisation and reduction of drug and alcohol use, but most service users are still using in PHF services (different evidence for CHF) • Data suggesting social and economic integration, improvements in social supports are patchy • Cost effectiveness when not working with highest need groups

16. Perspective on limits • Housing First service models end homelessness at an unprecedented rate for vulnerable groups, they deliver housing stability and a sustained exit from homelessness for most service users • Housing First ends homelessness • Debates about exact definition are less important than understanding that adopting key elements of the broad philosophy of Housing First appears to enhance service effectiveness in ending homelessness

17. Conclusions • Delivering housing ‘ first’, Harm reduction, separation of housing and support, consumer choice, respect, warmth and compassion keep service users engaged • Does not mean we should cease to be critical. Housing First is not a panacea and must not be presented as such. • Better evidence needed on outcomes around drugs and alcohol, social and economic inclusion • Questions around whether sustained exits can be achieved more cheaply HFL versus PHF

18. Conclusions • Have to focus on the positives of Housing First as a broad philosophy that enhances service outcomes • Not focus too much attention on what is or what is not ‘Housing First’ but at the same recognise separation of housing and support, harm reduction, choice and immediate provision of accommodation as fundamental – a service that does not do this is not a form of ‘Housing First’

19. Thanks • Thanks for listening • Nicholas Pleace, Centre for Housing Policy, University of York www.york.ac.uk/chp/nicholas.pleace@york.ac.uk and European Observatory on Homelessness www.feantsaresearch.org