OhCANADA!
Lessons on Housing First from the Canadian Response to Homelessness
Stephen Gaetz Canadian Observatory on HomelessnessProfessor, Faculty of Education, York University, Toronto, Canada
National Housing First
DayJune 7, 2015
Housing FirstThe context …
Part 1
A short history of Housing First in Canada
• Pathways to Housing – New York, Sam Tsemberis
• Toronto – Streets to Homes 2004
• Calgary, Edmonton, Lethbridge, Medicine Hat, Red Deer, Province of Alberta – 2008 - Present
PreventionEmergency Response
Housing and
Supports
Paradign shift from MANAGING the crisis, to
ENDING HOMELESSNESS
The emergency response is EXPENSIVE!!!!
PreventionEmergency Response
Can we move from THIS . . .
Housing and
Supports
PreventionHousing
and
Supports
Emergency Response
. . . to This!
2013 – Government of Canada renews Homelessness Partnering Strategy
for 5 years
Prioritizes
Housing First
Prioritizing needs in terms of
• Transitional - 88-94%• Episodic – 3-11%• Chronic – 2-4%
Chronicity
Aubry et al., 2013
The EVIDENCE
Part 2
Does it work?• Huge body of evidence that says it does
work.
• Between 80-90% of those who receive Housing First are still housed after a year
• The At Home / Chez Soi project has ended more than 6000 person years of chronic homelessness
Does it lead to less use of homeless related services?
Significant differences between Housing First and Treatment as Usual (TAU) in 12 months of service use (per 1,000 people)
• 7,497 fewer nights in institutions (largely residential addiction treatment).
• 42,078 fewer nights in shelters.• 6,904 fewer nights in transitional housing or group homes.• 732 fewer emergency department visits.• 460 fewer police detentions.• 1,260 fewer outpatient visits.• 34,178 fewer drop-in centre visits.
Does it cost more?• On average the HF intervention cost $22,257 per
person per year for ACT participants and $14,177 per person per year for ICM participants.
• For every $10, an average savings of $9.60 for high needs/ACT participants and $3.42 for moderate needs/ICM participants.
• For the highest needs clients (top 10%) every $10 invested in HF services resulted in an average savings of $21.72.
(Goering, et al., 2014 National At Home / Chez Soi Final Report)
Success in Alberta• Edmonton – 30% reduction in
homelessness
• Lethbridge – 65% reduction
• Medicine Hat – poised to be first community to end homelessness in Canada
• Province of Alberta – over 9000 individuals housed.
Implementation Challenges
Part 3
Community RESISTANCE
Matching supports to client acuity
The first three months are a crucial transition period
Nurturing effective
working relations
with landlords
The importance of
rent supplements
How do we consider the needs of the fifteen percent for whom housing stability continues to be a challenge.
How do we support social interaction and meaningful engagement?
Where does ASSESSMENT fit in?
Clinical Assessments
Community Priorities
Intake
Assessment Tool
Interventions
Case Management
Data Management Systems (HMIS, HIFIS)
A word of caution:
Assessment tools are one source of information to guide decision making.
Avoid SCIENTISM!
They are not magic, and they cannot make decisions for you. Trust your own knowledge as well.
Housing FirstWhat’s Next?
Part 4
1 Reframe
the Problem
PreventionHousing
and
Supports
Emergency Response
Where does PREVENTION fit in?
2
A Framework for
Thinking About Prevention
TertiaryPrevention
PrimaryPrevention
TertiaryPrevention
SecondaryPrevention
Working upstream to prevent new cases
Primary Prevention1
Early intervention strategies to stop people from becoming homeless or to help them exit quickly
SecondaryPrevention 2
Stopping homelessnessfrom happeningagain!
TertiaryPrevention3
Addressing the lack of Affordable
Housing
3
The Grand Experiment…
DECLINEIn direct Federal expenditures on affordable housing
INCREASEIncrease in tax expenditures / Subsidies for home ownership
Decline in Federal spending over 25 years
The OUTCOME?
Shrinking investment in affordable rental housing
18% of low income Canadians are in “Extreme Housing Need”
Six key recommendations
The need to address Aboriginal homelessness in Canada
4
Aboriginal Homelessness in Canada
Belanger, et al. 2012
Population Profile based on AgeAboriginal vs. Aboriginal in Canada
0-14 years 15-24 years
25-34 years
35-44 years
45-54 years
55-64 years
over 650
5
10
15
20
25
30
AboriginalNon-Aboriginal
Addressing
YOUTH HOMELESSNESS 5
Does HOUSING FIRST work for youth?
COMING SOON!
More on this in the afternoon
Resources andSupports
Part 4
TOOLKIT
Book on Housing First
www.homelesshub.ca/housingfirstyouth
Housing FirstFramework for Youth
Questions or comments?