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Housing First approach highly effective

A version of this commentary appeared in the Toronto Star, Huffington Post and the Guelph Mercury

Something largely overlooked by wide media coverage of the federal government’s Economic Action Plan 2013 was that it marked a significant change in the way we will tackle homelessness in this country.  The Plan includes an investment on ending homelessness by providing five years of renewed funding for the Homelessness Partnering Strategy (HPS), and placing a strong emphasis on the Housing First approach.

The sizeable investment, $119M per year for 5 years, is commendable in two ways:  it increases the funding cycle of HPS from three to five years and, notably, it signals a significant change of course by the ministry — addressing homelessness will now include more direction by the federal government, combined with effective local community planning.

Approximately 60 communities across the country are supported by HPS funds, and 80% of the funding goes to Canada’s ten biggest cities.  Without HPS funding, the number of people who are homeless would increase dramatically.

But the federal government has done more than allocate scarce budget resources to a growing concern, they’ve also advocated a Housing First approach to homelessness.  What does this mean exactly? It means that the policy lens dramatically shifts across the country from supports for ‘helping the homeless’ to ‘ending homelessness.’

Housing First programs have been shown across the US to effectively end homelessness by providing immediate access to housing and support services and then providing treatment and support services.  Previously, individuals had to meet milestones (such as sobriety and mental health counseling) just to be eligible for housing.

In Canada, we conducted the largest randomized controlled trial of its kind in the world on homelessness by comparing Housing First to services as usual (the At Home/Chez Soi study) involving 2,255 participants who were homeless across five Canadian cities (Moncton, Montreal, Toronto, Winnipeg and Vancouver).  The one-year results, recently reported by the Mental Health Commission of Canada, indicate that HF is significantly more effective than services as usual in providing stable housing for people who had been homeless for years and who have complex clinical needs.

Also compelling was the finding that for every two government dollars invested in the HF program, one dollar was saved.  Savings were even greater for those who used services the most,  with three dollars saved for every two dollars spent.

It’s no wonder the federal government supports Housing First: it is highly effective and can save money.

So Canada is on the right track. We have both funds and evidence-based policy for moving forward on homelessness.  However, we still face two major hurdles in order to successfully meet a Housing First model.

First, the majority of programs currently funded across the country can be described as ‘providing services for people who are homeless.’ Shelters, drop-in centers, and especially transitional or short term housing programs must be helped to shift resources to programs that ‘end homelessness’ instead.  We will need to invest in providing training and consultation services to communities so they will obtain the guidance and support, time lines, and performance indicators necessary to move the system towards this new, much needed direction.

The second hurdle concerns implementing Housing First programs so that they are consistent with the basic principles of the model that achieved the outstanding outcomes in the At Home/Chez Soi study.  Housing First moves people rapidly from shelters or the streets into stable housing and provides evidence-based clinical and social supports to address social, mental health, health, addiction, educational, employment and other issues.  By providing services using a team approach and coordinating housing, clinical, and social supports this model reduces problems associated with fragmentation of services and improves inter-sectoral collaboration that usually plagues individuals and families seeking treatment.

In other words, Housing First, if implemented properly will transform public services across the country as we know them, and to do this effectively, teams will need adequate support and guidance to do so.

Continued investment in a homeless strategy and advocating for the widespread implementation of the Housing First approach is the right thing to do — a humane and effective intervention.  It is also the smart thing to do — basing federal policy on rigorous research findings is a model that is laudable in any ministry.

The need now is for a sound implementation plan so we can move our community resources quickly from serving the homeless to ending homelessness in our communities.

Sam Tsemberis is Founder and CEO of Pathways to Housing, Inc. in New York City that developed the Housing First program, and a member of the National Research Team for Canada’s At Home/Chez Soi project.  Vicky Stergiopoulos is an expert advisor with EvidenceNetwork.ca, Associate Professor at the University of Toronto, and an investigator in the At Home/Chez Soi study.

April 2013

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