In this multi-part blog series we are examining the essential elements of successful housing programs that focus on ending homelessness. Our thanks to Scotti Coles with Jasper Place Health and Wellness Centre for coming up with the suggestion. www.jphawc.ca
PART ONE: Ensuring People Who Are Homeless Get the Right Housing Intervention and Supports to End Their Homelessness
“The homeless”. Ugh. What a bland, homogenizing and completely inaccurate phrase. There are homeless people. There are homeless individuals and families. But “the homeless” is downright demeaning in my opinion. There is considerable diversity within the homeless population. While there may be some striking similarities when it comes to indicators of why/how a person becomes homeless, rarely are two paths into homelessness the same. Understanding the heterogeneity within homeless populations allows us to provide the opportunity of the right supports and right housing to the right person at the right time for the right reason.
To be clear, the focus is on ending homelessness. Housing is the only known cure to homelessness.
Homeless service systems need to have meaningful intake and assessment processes where acuity is determined. They cannot be “first come, first served” if they truly want to end homelessness. Truth is, some individuals will have rather complex needs and a higher acuity warranting one type of intervention, while other individuals will have needs nowhere near as complex and with lesser acuity. In the same way that these two individuals are not the same, the services that are offered and the expectations of those services will also be different.
I am frequently frustrated by intake processes. Too often they have evolved to become, “Come in. Let me take your information. I’m not sure why I am asking the questions that I am asking. Oh, and I am not sure what I am supposed to be doing with the information either. I might make a referral somewhere else. No guarantees though.”
In Malcolm Gladwell’s book Outliers, he says: “To build a better world, we need to replace the patchwork of lucky breaks and arbitrary advantages that today determine success with a society that provides opportunities to all.”
When people seek access to homeless and housing services – whether through a central intake or through a more standardized process used across organizations in the same community – we need to have an intake process that will permit us to make informed decisions about what service choices we may present to the individuals. To be clear, we never want to PLACE people into a program. We want to offer it as a choice.
In our extensive research of homeless populations, we have come to realize that there are three dominant categories that provide general descriptors of the intensity of service to be offered based upon information gleaned through intake. Within each of these the autonomy of the individual, their unique needs and individual circumstances are still respected and worked with. What these categories intend to do is help create a service typology so that the right services are offered to the right people at the right time to do the right thing about their homelessness.
The first group is those with lower acuity. Let us keep in mind that most people that ever experience homelessness in their life experience it for a short period of time and are never homeless again. In many communities this can be upwards of 60% of all people who experience homelessness in a given year. Do these people need case management? No. Do they need service offerings that are going to keep them homeless longer – like life skills training within a shelter? No. Truth is, many of these households can be diverted from the shelter in the first place. If they do get in, they tend to use shelters for the purpose they were originally designed – short term and infrequent use. These households may need some instruction on how to apply for benefits. They may need access to a computer. They may need a list of landlords with available rentals. They aren’t going to need much more. Don’t give them anything more. Please. Don’t.
The second group is those with a mid-range acuity. These folks need support with Rapid Re-Housing. Some people erroneously think that Rapid Re-Housing just means getting people who experience homelessness back into housing quickly. Not quite true. Rapid Re-Housing is a specific type of intervention, which our research suggests is between 15-35% of homeless populations. These individuals and families tend to have a few areas in their life with more complex presenting issues, but there are generally two or three areas of higher need in their life. They benefit from having support locating housing and supports once housed maybe for a few months; rarely for more than a year. Most often this will be scattered site housing within the community, most often in the private market, with or without a subsidy or voucher of some kind (depends on the local housing market and local income assistance rates). They benefit from an individualized service planning process and case management supports. They have the ability to reintegrate into mainstream resources more readily than other individuals and families with higher acuity.
The third group is those with higher acuity. These folks benefit from support through Housing First – either Intensive Case Management or Assertive Community Treatment. Housing First is far from housing only. The number of individuals and families requiring a Housing First intervention in a community will be small – between 15-25% of most homeless populations. They will, however, most likely be voracious consumers of services, and the costs of serving this population while homeless tend to be disproportionately higher than other types of individuals and families. They are much more likely to experience chronic homelessness and have more areas in their life where they have complex and/or intensive needs. Given the broader number of issues where it may be reasonably expected that the individual or family have complex issues, it is likely that these people benefit from case management supports over a longer period of time – usually 12 months or more. Research suggests that both permanent supportive housing (like what DESC offers in Seattle) as well as scattered site apartment units with intensive supports (like what Pathways to Housing offers in New York City in the ACT model or what Streets to Homes in the ICM model offers in Toronto) can work for this population. It can take longer to help these individuals and families integrate with other community supports. Given that most will have experienced chronic homelessness just the emotional and psychological adaptation to the reality of housing can take time, patience and intensive support. The service plan for this group definitely needs to be individualized. There is nothing cookie cutter about serving this population.
This latter group – the Housing First folks – have also dealt with considerable stigma within the housing and homeless service sector. They are frequently labeled “service resistant” or “hard to house” or “not housing ready”. The truth is they are none of these things. We cannot blame them for their complexity. Two research studies that I have spearheaded also overwhelmingly support that this population absolutely does want housing, despite this myth that a large group of people choose to be homeless or like the lifestyle. What we need is the right services that are individualized, supportive, non-punitive, non-coercive and oriented towards harm reduction. What we need is access to different types of housing models that people can access rather quickly without arduous bureaucratic processes, with supports that wrap around them in a way that makes sense and is centred on their needs.
There are a couple of other important considerations for the Rapid Re-Housing and Housing First crowd. The first is that they have to make an informed choice about their participation in the program and supports. We cannot force or coerce people to accept a support intervention and expect it to work. The second is that we want people to know in advance that there will be home visits where case management supports will be provided, and we want them to know that they will receive supports to create an individualized service plan that will focus on helping them achieve housing and greater life stability. They need to know that they guide the case management process and get to determine the type, frequency, intensity and duration of services. The third is that we will be supporting them – not forcing them, tricking them or using any other type of punitive measure in the process of delivering supports. It is their supports, not ours, and there is nothing “cookie cutter” about our approach to individualizing services.
Focusing attention on an intake and assessment process that will help service providers and help people seeking service access the right type of service intensity, supports and housing is an important component of having a successful housing program in your community.
Iain De Jong has helped many communities throughout North America retool their homeless service system based upon an understanding of the heterogeneity of homeless populations. Through his work communities see reduced lengths of homelessness and increased accountability in service delivery. Stay tuned for the second installment in the blog series, which looks at the Service Orientation for effective service delivery.