Evaluation of Housing First in Sweden. A comparison with the staircase model

1. Evaluation of Housing First in Sweden. A comparison with the staircase model Håkan Källmen, Karolinska institutet and Mats Blid, MidSweden University

2. Background • Homelessnesscan be considered as duetostructuralproblems on an aggregated level (lowhousingconstruction) or as an individual problem withsubstance abuse/psychiatric problems. • The usual housing support to the homeless in Sweden is called the “Staircase model”. According to that model the homeless have to learn and prove step by step the ability to live in an own apartment and adapt to a proper life. • .

3. Background • Although large resources has been allocated to solve the homelessness problem. The prevalence rate increase. • To solve the problem a new paradigm ”HousingFirst” was suggested. This is a conceptcombininghousingbeforeoptional support tosolveindividualproblems.

4. Evaluation • Thisevaluationcompares the usualstaircasemodelto ”HousingFirst” regardingperceived normal housing, psychologicalfactors and misuseofalcohol and drugs over a threeyearfollow-up period. • In the evaluation a comparisonregardingcriminality, incomes and healthcareconsumption is madealthough not presented here.

5. First aim • To evaluate if Housing First leads to perception of a more normal and stable housing over time than the staircase model.

6. Second aim • Another aim is tocompare the developmentofmisuseofalcohol and drugs and also the changes in psychologicalfactors over time.

7. Thirdaim • The thirdaim is tocompare the consumptionofhealthcare, incomes and criminality over time

8. A longitudinal non-equivalentcontrolgroup design Baselineassessment HousingfirstgroupControlgroup Assessmentseverysixthmonthduringthreeyears

9. Participants • Participants in thisstudyare 36 homeless persons assessedboth at baseline and follow-up. Theyhave a long period without a stablehousingand areconsidered as inableto get a housingwithin the staircasemodel. • Theywillhavea wishto live in an own apartment and alsowishtocooperatewith the social sevice

10. Data collection Afterinformedconsent, data from the housingfirstgroupwerecollected by the city mission in Stockholm and the social service in Helsingborg. Data from the controlgroupwerecollectedat ordinaryappointments at the social service in Stockholm. Each respondent received a voucher of 8 Euro worth and eachdatacollectorreceived a ticket tocinema at 9 Euro worth.

11. Results at baseline Table 1. Means and standarddeviation for groups on the assessed variables at baseline and p-values for differences between groups (T-test).

12. Results at sixmonthfollow-up. Table 2. Means and standarddeviation on study variables at six month follow-up P-values for differences between groups with T-test.

13. Results over time Table 3. Testof main effekt of time and interaction time x group

14. Resultscont. • The normalityofhousing, KASAM and Meningfullnessimproved and drug habits mitigated on averageamong all homelessduring 6 months. • However, housingnormalityimprovedeven as a consequenceof ”HousingFirst” butdrugusedid not mitigate as much as in the controlgrup

15. Discussion • The factthat all homelessindividualsimprovedtheirhousingconditions and theirstructure/meaningfullness in life over timemaybe is a consequenceof supervision and social support. The harm reductionphilosofyof ”HousingFirst” can be responsibleof a less decrease in druguseamongthosewhoreceived an apartment from the project.