P. EstecahandyNational coordinator operational side

DIHAL

First results of HF experimentation in France and next steps

General Context

Homelessness: a key issue for public policy Link between homelessness and health

Life expectancy 30 to 35 years shorter for homeless people 30% suffer from severe mental illness (SAMENTA Survey, 2010) Difficult access to care, poor continuity of care, and discrimination.

2007 the DALO Law : the right to housing 2008 Report on Emergency Housing by French parliamentarian,

Etienne Pinte 2010 Creation of the DIHAL (Interministerial Delegation for Access to

Housing for the Homeless and Inadequately Housed) 2010 National report on Healthcare for the Homeless 2011: Creation of Housing First program in France A housing led policy and a stair case system

Testing HF in France using RCT Provide and evaluate new solutions for access and retention in housing,

access to health care, human rights and citizenship of homeless people with severe mental disorders and high needs

4 cities (Paris, Marseille, Toulouse, Lille) Long-term homeless people with severe mental disorders and high

needs (addiction 79%) In term of intervention : Pathways to Housing modle (fidelity scale) Operational side :

Rapid access to self-contained housing units with security of tenure Priority given to user choice, respect and empathy Recovery orientation and harm reduction approaches Flexible, open ended offer of floating support (ACT team) Client-centred approach and individual support plan High degree of staff availability to users (1/10)

Budget intervention side Ministry of health: 2,5 M Ministry of housing : 3,4 M

Testing HF in France using RCT In term of research : similar to the Canadian protocole

800 participants expected Test and control groups randomly allocated

Quantitative evaluation every 6 months over 24 months Principal outcome: number of hospitalized days Secondary outcome: Quality of life, revovery, clinical aspects,

social cost, addiction Ongoing qualitative evaluation

Analysis of implementation Recovery individual process and trajectory Professional practices

Final results expected in 2016 Comparisons cost / effectivness Assessment between the two groups

First results : 3 years 14 structures involved in the governance

(hospital, social and housing associations)60 professionals in 4 teamsA research team consortium Local dynamics around steering committee prefectural (ARS DDCS, DRIHL, local authorities, social and medical partners, the housing sector)

705 people included in the research program 353 in the un chez soi arm

382 apartments - 11.5% in the public sectorAverage 4 weeks (48 hours to more than one year) Sustained support for 328 people by multidisciplinary teams Nearly 35,000 contacts : 4 sites / 3 years

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

First results at 12 months

Conclusion

Housing retention : 86% No predictive criteria in the capacity to live in a independant

accomodation Increase the ontological security of the participants Needs :

time High reactivity of the team Multidisciplinar teams Change in professional practices and in representations

The program manage to break down some barriers betweensocial, medical and housing fields But a positive collaboration of stakeholders is needed

Conclusions

The main challenges The need of affordable accommodation for every one (social or

private housing) Issue of poverty

Solvability guarantee : lease should "slides" to the person who becomes a "real" tenant

Access to ordinary employment Segmentation of services : social, medical, housing Resistance to change : housing first strategy

Professional training at all levers Perspectives : 2 more years

modelisation

Thanks for your attention

For more informations :Dr Pascale EstecahandyDIHALpascale.estecahandy@developpement-durable.gouv.fr