© 2013 Canadian Homelessness Research Network

ISBN 978-1-55014-637-0

Gaetz, Stephen; Scott, Fiona; & Gulliver, Tanya (Eds.), Housing First in Canada: Supporting Communities to End Homelessness. Toronto: Canadian Homelessness Research Network Press.

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This book is protected under a Creative Commons license that allows you to share, copy, distribute, and transmit the work for non-commercial purposes, provided you attribute it to the original source.

The editors wish to acknowledge the work of Sarah Jean Harrison and KC Santo who provided excellent copy-editing services. We would also like to thank the key informants who contributed to the development of each case study: Tim Richter, Katrina Milaney & Alina Turner (Calgary – Calgary Homeless Foundation), Kim Wirth/Katie Davies (Infinity Project), Brad Crewson (Victoria), Amanda DiFalco (Hamilton), John Sharpe & Timothy Ross (Fredericton), Amelia Ridgway (Vancouver), Wally Czech (Lethbridge) and Susan McGee & Alex Abboud (Edmonton).

The Canadian Homelessness Research Network (CHRN) acknowledges with thanks the financial support of the Government of Canada’s Homelessness Partnering Strategy (Employment and Social Development Canada) and the Social Sciences and Humanities Research Council of Canada. The analysis and interpretations contained in the chapters are those of individual contributors and do not necessarily represent the views of the financial contributors of the CHRN. The views expressed in this book are those of the Canadian Homelessness Research Network and do not necessarily reflect the views of the Government of Canada.

Conclusion

Lessons Learned

Stephen Gaetz & Tanya Gulliver

The evidence for the success of Housing First as a strategy for addressing homelessness is well established by extensive research in Canada and elsewhere. Housing First clearly works, even for the most challenging, chronically homeless individuals and families. Yet in spite of the apparent success of Housing First in many communities, there are barriers to buy-in and implementation. Claims such as ‘it’s a fad or a trend’, or ‘it’s an American model, so why would we want it?’ should be discounted as ideological and not based in evidence. Likewise, when people draw anecdotal examples of poor individual outcomes (people being housed in isolated or remote areas, or paying 80% of their income on rent, for example), such examples have more to do with very real problems with implementation, program design or lack of fidelity to the model, rather than with the principles or philosophy of Housing First itself.

In providing both a framework and the eight case studies contained in this book, we are aiming to address the ongoing concerns about the adaptability of Housing First to different community contexts, as well as apprehensions about ‘how it works,’ that can become barriers to implementation. Fortunately, the more we are learning about Housing First the easier it is for us to address these concerns.

This concluding section pulls from literature, the eight case studies and our understanding of Housing First in different contexts including the At Home/Chez Soi project from the Mental Health Commission of Canada to summarize best practices and lessons learned. It is our intention to synthesize the content of the book in order to help communities reduce obstacles in implementing Housing First in their own communities.

UNDERSTANDING BARRIERS TO IMPLEMENTATION

Making the shift from traditional ‘managing the problem’ responses to homelessness is an important exercise in change management. Central to facilitating the shift is addressing concerns and perceived barriers. Some common questions about Housing First include:

How can we implement Housing First with so little affordable housing?

Housing First, on its own, does not add to the affordable housing stock. Organizations must confront the challenge of housing people in a tight rental market when there is not sufficient housing stock while not sacrificing the core principle of consumer choice. Shifting the emphasis to Housing First without a concurrent investment in affordable housing may appear to merely shift the focus of our efforts from the larger and more challenging problem of housing affordability. For most people who become homeless, the underlying problem is a lack of affordable housing supply (and access) and inadequate income levels to pay for housing. An effective response must invariably address these issues.

However, Housing First can still be applied even when the lack of affordable housing seems to be a challenge. Communities such as Toronto, Calgary, Edmonton and Vancouver have some of the tightest housing markets in the country and most certainly have the highest housing prices. Yet in all of these communities Housing First has been successfully applied. Admittedly, in each case, the move to Housing First has usually been accompanied by an investment in increasing the affordable housing supply. At the end of the day, the scalability of Housing First may depend on there being an adequate supply of affordable, safe housing, or on there being robust programs of rent supplements to enable housing people in market housing. Rent supplements address the issue of affordability within a tight rental market without necessitating the development and construction of new housing. Even in communities like Hamilton which doesn’t have as tight of a market, the use of rental supplements has been necessary to make Housing First work.

Can Housing First work in small towns or rural areas?

Most of the best-known examples of Housing First have been applied in large cities in Canada and the United States. Most academic research on Housing First has also been conducted in such contexts. The challenges of small towns and rural areas in terms of infrastructure and supports, on the one hand, and on the availability of rental housing on the other, may become barriers to making the shift to a Housing First orientation.

Housing First can be applied in communities of different sizes. The Moncton site of the At Home/Chez Soi study is an important example of how Housing First can be adapted to work in a smaller city with a weak homelessness infrastructure, and importantly, extend to surrounding rural communities. The success of Housing First in Lethbridge and Victoria likewise demonstrates how smaller communities can create innovative Housing First strategies and programs. In Fredericton, the case study shows that implementing a system response to homelessness is enabled by the smaller size of the community. While it may lack big-city resources there is the possibility of a more cohesive network. Through coordination and formalization of connection, a system of care is being developed with all of the major players needed to address homelessness.

Being from a small community need not be a barrier to application, and in fact, smallness may be an asset in terms of establishing relationships and service coordination necessary for effective service delivery. Context does matter, but shouldn’t become a barrier to adaptation.

How are the needs of sub-populations met through Housing First?

One of the key learnings is that one size does not fit all. Different communities and sub-populations have different needs and a Housing First model must be tailored to meet them. Young people experiencing homelessness often have no independent living experience and therefore require a model of Housing First that includes key elements of transitional housing. Aboriginal people, new Canadians and racialized minorities also have different needs that must be taken into account. Other considerations may need to be given to women (concerns for safety) and families (community integration). Furthermore, there is some evidence that people with severe addictions may not fare as well in Housing First, particularly if there are not sufficient supports put in place.

There are a lot of lessons learned regarding how to deliver Housing First to different sub-populations. One of the key innovations of the Housing First strategy employed in Calgary and Edmonton was to adapt the approach to meet the needs of subpopulations such as youth or Aboriginal people. By recognizing that there are different needs and challenges of working with specific sub-populations, and that Housing First may not necessarily be an immediate and practical solution for all individuals (younger teens, women fleeing family violence), communities can develop targeted Housing First programs designed to incorporate social and cultural sensitivity and knowledge as part of their service delivery model.

The case study from The Vivian in Vancouver showcases the way in which the special needs of women can be addressed through the development of a program ‘for women, by women’. In Edmonton, the Nikihk Housing First team at Bent Arrow case study highlights how cultural sensitivity and cultural awareness to Aboriginal issues can help form an important part of the program development. These lessons can be modified to fit newcomer and racialized communities. The Infinity Project in Calgary describes how the unique needs of youth can be addressed in a Housing First Model. Each of these case studies provides lessons about developing a unique program to meet the needs of a distinct sub-population in their housing programs.

Additional questions that may become barriers to the adoption of Housing First include concerns about attracting landlords, funding arrangements that make the shift from ‘treatment as usual’ to Housing First problematic and locally-based resistance to change, both from mainstream services and ironically, from within the homelessness sector itself.

GETTING STARTED

In moving towards planning and implementing Housing First, where does one begin? The case studies carried out by the Canadian Homelessness Research Network, augmented by learnings from the At Home/Chez Soi project, identify many of the opportunities and challenges to promoting the adoption and adaptation of Housing First at the local, regional and national levels. The success of Housing First as a response to homelessness is well established. What is less understood is how communities can make the shift from ‘treatment as usual’ to this new approach. In the following section, key learnings from communities across Canada are discussed. These learnings provide a framework for adoption (and adaptation) of Housing First to different community contexts.

Establish the Context for Change

Adopting Housing First is an issue of change management. It requires leadership, community support, and conduciveness for change, evidence to address barriers and concerns, and resources to make it happen. In most instances where Housing First has been applied, there was local resistance to doing things differently. This was true even in the beginning of Housing First, as this story from Pathways to Housing illustrates:

“Sam’s team was originally told that implementing Housing First would be too risky, enabling, impossible, ineffective, delusional, and that they were fools to take on such a huge liability on behalf of their clients. Fighting past personal fears, professional prejudices, and staying true to the commitment of helping clients realize their own goals, Pathways to Housing housed 60 people in the first year” (Tsemberis, as quoted in Evans, 2012).

Creating an atmosphere for change includes disseminating knowledge so that it can be understood by service providers, the general public, politicians and policy makers. Each audience has different needs and uses for information. Communities should be prepared to share information about their programs or the need for Housing First to address all of the knowledge needs of the end-user.

Sharing research and the use of evidence-based practice is one key area for helping to create change. While communities may not have their own data to prove the effectiveness of implementing Housing First there is extensive research on successes stemming from the At Home/Chez Soi project as well as the different models outlined in case studies section of this book.

The use of pilot projects – as outlined in Victoria, Calgary, Vancouver and Hamilton – can also contribute to the development of data as well provide an example of how Housing First can work in a local community, thus building conduciveness for change. In Fredericton, this happened by happenstance when a project to rehouse people after a fire showed the community how feasible housing people experiencing homelessness actually was.

Partnerships are key

The importance of partnerships in enabling the success of Housing First cannot be underestimated. Addressing homelessness and implementing Housing First cannot be achieved solely through the efforts of the homelessness sector alone. The best examples of implementation of Housing First include strong collaboration between different sectors (including homelessness, health and housing). In some cases, drawing in the ‘unusual suspects,’ such as police, creates new models for outreach and support. Hamilton’s unique partnership with the EMS Navigator position provides a strong example of a community-police connection that enables the success of a Housing First program. The Vivian, in Vancouver, relies heavily on an extensive network of partnerships that are outlined in their case study.

The development of partnerships should occur early in the planning process.

“So we get everybody and anybody together. If you aren’t sure whether they should be involved, invite them anyway. One of the greatest advantages of collaboration, especially in the early stages, but is important throughout, is that those at the table and part of the development now have a vested interest, when they feel like they are part of something bigger than they are and have influence they become supporters instead of antagonists. But I would suggest even involving the naysayers. Most of the time they are the way they are because they care about their community. Get them involved in a way that shows that their opinions and ideas matter to you” (Wally Czech, as quoted in Scott & Gaetz, 2013:125).

Bring in the experts

Much can be learned from those who have gone before, and communities should avail themselves of technical support by those who have gone before them. The Calgary Homeless Foundation, in establishing its systems-based approach to Housing First, brought in individuals from a range of communities that had successfully implemented the model. These people provided local inspiration, convinced skeptics and addressed concerns that could become barriers to implementation. The other benefit of bringing in such experts is that relationships are established, and these individuals/communities can become a form of technical support during planning and implementation, when unforeseen challenges emerge. While early adopters of Housing First relied heavily on American experts such as Nan Roman from the National Alliance to End Homelessness and Sam Tsemberis from Pathways, later Housing First converts were able to use Canadian expertise. Tim Richter of the Canadian Alliance to End Homelessness (formerly with the Calgary Homeless Foundation), Brigitte Witowski, from Toronto’s Mainstay Housing, Toronto’s Streets to Homes project and Iain De Jong were all named in the case studies as innovators in Housing First whose expertise was relied upon.

One size doesn’t fit all

While there are core principles to Housing First, there is not a single program model that applies to every situation. Context always matters (city size, vacancy rate, local economy, demographics, etc.) and every community is different. What has worked in Lethbridge may not work in Regina and it is important to realize that flexibility is important to build a program based on local needs. This may mean programs have to be modified to suit the local context or the needs of a specific sub-population. For instance, the availability of low rent housing will have an impact on consumer choice. Providing rent supplements, partnerships with landlords or beginning to increase the supply of affordable housing are potential solutions to handling this in a tight housing market.

Embed Housing First in a broader planning framework

Housing First on its own will not end homelessness; rather, it must be embedded within a broader strategy. A thorough planning process is important to ensure the success of implementation and long term sustainability of the program. The places that seem to be making the most progress in reducing homelessness through Housing First tend to have an integrated systems plan. Communities in Alberta, such as Edmonton, Calgary and Lethbridge are all examples of this. Housing First is not simply a program offered in the community, but is part of a broader philosophy that all service providers are expected to support. This coordination becomes a key feature of integrated systems planning:

“Within a ‘system of care’ approach, all services and program elements within the homelessness sector – including many mainstream services – are guided by the principles of the model. As such, each program and service is expected to support and operationalize Housing First, each having a specific role to play in the larger system. While the service providers in the system are not Housing First programs on their own, they form different parts of a larger system that works towards achieving the goals of a Housing First program” (Gaetz, 2013:15).

Existing services can be retooled to be Housing First programs

New programs aren’t always needed. Existing support services – especially shelters, counselling and outreach services – can be redesigned to accommodate some of the needs of Housing First programming. In Hamilton, a decision was made to close one of the emergency shelters in order to dedicate resources to the Housing First program. This meant that other agencies needed to address the gap left by the closure of that shelter.

This re-tooling may need adjustments as the program evolves. In Lethbridge, one of the original goals was ‘one-stop shopping’; having all of the services available in one place; in this case, housing a resource center at a shelter. This centralization of services meant that Housing First clients were constantly returning to the shelter to meet with their worker or to participate in the program. Their familiarity with the shelter and companionship of other residents drew people back into the shelter system. In response, the programming transitioned back into the community from the shelter so that Housing First residents didn’t need to visit the shelter for their supports. Clients were also connected to mainstream services to further minimize their contact with the homelessness sector.

PROGRAM ISSUES

Fidelity to the core principles of Housing First is necessary

In a context where funders say they want to see more Housing First, it may be tempting to stretch the definition in order to access resources. For instance, programs that offer access to housing but provide little or no supports may be renamed Housing First. However, the provision of supports is absolutely key to the development of a Housing First program.

During program development key goals and a strong philosophy must be developed that fit with the guiding principles of Housing First. Without this it is hard to ascertain the degree to which a program really follows the core principles of Housing First (as outlined in the framework). Evidence of fidelity to the Housing First model is key to a program being an actual Housing First program or just a philosophy/program that shares a common goal with Housing First. While there are many different approaches how far you stray from the core principles really affects the ability of a program to be named Housing First. Fidelity to the core principles of Housing First is therefore important at all levels of the system. Providers of Housing First must be held accountable to demonstrate fidelity to these principles.

Housing First or housing, first?

It is not enough to just put people into housing and consider the job done, the other pieces must be in place, including necessary supports. The necessary skills of ICM and ACT teams cannot be replaced with minimal supports provided by untrained service providers.

Wally Czech, Housing First Specialist with the City of Lethbridge explains why ensuring that the community knows the difference between Housing First (as a program model) and housing first (a philosophy), can avoid having the entire program criticized for issues outside of their control:

“We received some feedback from a housing organization, that they were getting damage to property from our Housing First clients. We found out that it wasn’t us who facilitated the housing but instead it was people referred by the homeless shelter. They believe in Housing First and try to support it, but they aren’t funded to do it and intense follow-up is not part of their mandate. You need to know who is funded to do it, and who has the skills and the training to do the follow-up” (Czech, as quoted in Scott & Gaetz, 2013:114).

It is important to prioritize populations for Housing First. In many cases, it is people who are chronically homeless who should be prioritized. Research on homelessness in Canada and the U.S. has shown that while only a small percentage of the overall population of people experiencing homelessness are chronically homeless, they consume the majority of the resources. This includes not just use of shelter services but also health care, emergency services and the criminal justice system. Prioritizing people who are chronically homeless results in a faster cost-savings.

One of the lessons from case studies in Calgary and Edmonton is that it is also possible to adapt Housing First in prioritizing other sub-populations, including youth, Aboriginal people and families, for instance. While Housing First developed as a response to chronic homelessness and individuals with complex mental health and addictions issues, it clearly can and should work for other sub-populations as well.

Effective working relations with landlords are important

Whether a community is using a scattered site approach in which units are rented in the private sector or is housing people in social housing or permanent supportive housing, developing and nurturing effective relationships with landlords and housing providers is a critical component of success. In the Hamilton case study, they suggest that landlord relationships are just as important as relationships with program participants. Building trust with the landlords is key, and helping to strengthen relationships between landlord and client is important for both parties.

Bringing private landlords into the picture is a critical factor in a tight rental housing market, and perhaps not as challenging as people might imagine. Our case studies and the At Home/Chez Soi study identify that some landlords buy in because the funding and supports offered by the Housing First program offer a kind of guarantee of tenancy. In other cases, some landlords want to get involved because they are interested in making a contribution to solutions to homelessness. The key point is that even in tight housing markets, landlords can be persuaded to be partners in Housing First.

Quality Assurance matters

When implementing a new program, it is important to have standards for delivery of service, and expectations for program quality and outcomes. It is against these standards that the program is measured in order to ensure that it continues to meet the needs of clients. Communities adapting Housing First need to identify evaluation measures that will determine whether the program is being delivered as intended, and whether or not it is consistent with Housing First principles. Assessment of the success of a program needs to move beyond measurable outcomes – although use of data is critical in determining success – to include qualitative research that incorporates the perspectives of a variety of stakeholders including service users, community agency staff, landlords and the general public.

FINANCIAL CONSIDERATIONS

Budgeting must include a multiplicity of factors

In determining the cost of Housing First programs one needs to consider a comprehensive budget that includes:

• Program staff, including ICM and ACT teams, taking into account case loads.

• Rent supplements – for how many people, for how long, and when (and if) people can eventually be weaned off rent supplements.

• Cost of repairing units – One of the biggest surprises in Edmonton has been the cost of repairing damaged units, and Homeward Trust didn’t accurately forecast the amount that would need to be put aside.

Short term initial investments may be required

One of the promises of Housing First is that it will lead to a reconfiguring and eventual reduction in emergency services. This should be the case particularly if chronic and episodically homeless individuals are targeted, as they are the greatest users of emergency services. However, the savings (through the reduction of emergency services) will not be accrued immediately, so communities may have a challenge of ramping up new Housing First programs without being able to draw down other services at the same time. There may be a need for an initial investment, then, to ramp up the Housing First services.

Rent Supplements are important to Housing First success

Poverty is the common denominator among the homeless population and getting people out of poverty often means providing financial assistance to lower an individual’s costs. Rental assistance means that landlords get market rent for their apartments, and clients can afford to live in market properties. Some Housing First programs (following the Pathways model) ensure that no one pays more than 30% of their income on rent, and make rent subsidies available. If that is not in place, and clients pay a high percentage of their income on rent, other things are sacrificed, most notably food. Nutritional vulnerability is both a health and mental health risk factor, and can undermine social and community engagement.

Managing rent supplements is a challenge in many communities. Making a determination of how long an individual or family can or will need a rent supplement has an impact on program planning and resources. External bodies that fund rent supplements will have their own terms and conditions, and may jeopardise an individual’s housing if they are not able to maintain rent supplements for as long as they will need them (for some individuals this may be over their lifetime). In the Victoria case study (page 131), the original goal had been to reduce rent supplements through attrition but the lack of affordability in the housing market meant that cancellation of this aspect of the program would have a severe negative impact.

Rent supplements can also present a capacity issue, for over the years, as more and more individuals are housed through Housing First, the demand for rent supplements may eventually overtake the supply, unless some individuals can be weaned off. This circles back to the need for the development of affordable housing options to help meet demand and need.

Other material supports matter

People moving from homelessness into housing have few possessions if any. It therefore becomes important to help people furnish their apartments if possible. Inspired by the Toronto Streets to Homes program’s relationship with a furniture bank, Homeward Trust established FIND, a furniture market that is free for clients. In 2011 FIND became a social enterprise. It continues to serve clients, but also sells furniture to the public, re-investing the proceeds into housing and support programs.

SYSTEMS ISSUES

There is a real need for Affordable Housing

Housing First is not a magic wand that will solve homelessness. Effective implementation of the approach can be hampered by a lack of affordable housing. As such, implementation of Housing First must be linked to an affordable housing strategy. In order to continue to achieve the success that Housing First has seen, the availability of different types of housing will be crucial. The affordable housing supply can be expanded through a combination of direct investment (building new stock), zoning (inclusionary zoning, legalizing and regulating secondary suites), creative financing and incentives for the private sector. Communities need to work together to prioritize housing investment.

The homelessness sector and housing systems need to work in a collaborative manner

In the Hamilton case study (page 95), it was pointed out that many challenges that clients face are “as a result of the complexities within these systems rather than due to the complex situations of individual(s).” Community partners and stakeholders in housing and homelessness need to work together to ensure sustainable housing. This further strengthens the argument for integrated systems models when addressing homelessness.

Managing change helps build success

In order for Housing First to be successful and to take root, there must be buy-in to the Housing First philosophy by existing service providers and a willingness to do things differently. Housing First should not be seen as a threat, but as an opportunity, even if this means changing the mission and roles of existing services.

In the Calgary Homeless Foundation (CHF) case study (page 31), creating systems change was identified as a key challenge, yet one that was effectively managed.

Clarity of roles is important

A systems approach to Housing First, where all organizations are expected to support the philosophy of Housing First, does not necessarily mean that all providers actually do the work of Housing First. Within a partnership model each organization will deliver the services to the clients based on their functions. The Vivian program in Vancouver relies heavily on its partners to share the work. Vivian staff provide expertise housing clients and providing support to residents, but other partners address issues such as healthcare, harm reduction and food insecurity.

Several of the case studies indicated that it is critical to divide up landlord support/financial support to clients from those workers providing emotional or programmatic support to clients. It is challenging to be both the landlord and the counsellor. In order to develop trust with the clients it is best to separate these functions.

ACT and ICM teams possess a high level skill set and should therefore be responsible for delivering the intervention and providing the necessary supports for which they have the mandate and expertise. There are key skills and competencies associated with ICM and ACT teams, which other providers do not possess. Similarly, a needle exchange program or a food bank will provide supports to a client, not considered to be part of the services of an ACT or ICM team.

CLIENT ISSUES

The importance of matching supports to client needs and acuity is a key part of case management

The CHF found that acuity assessments are key in terms of ensuring resources are used appropriately. For instance, some clients with high needs were receiving inadequate supports, and should have an ACT team involved. Failure to do so leads to problems and can make housing stability precarious. Likewise, some clients who were assigned an ACT team really didn’t need that support in the long run – an ICM team may have been more appropriate to help them become stabilized. Susan McGee from Homeward Trust in Edmonton says,

“Sometimes when a client is housed their issues and support needs don’t present right away and someone that seems quite ‘stable’ may have significant mental health issues that become more clear once other things like housing and physical health improve. Or conversely someone may have been on the street a very long time and the assumption is they are complex but once the daily survival challenges of homelessness abate they do very well” (McGee, 2013).

Matching the type of housing to client need is also important

Some people do fine with the scattered site model, and prefer it to being in housing that is identified with homelessness, mental health problems or other marginalizing statuses. Other people may prefer institutional or congregate models and find them to be less stigmatizing. Again, it comes down to client choice, a core principle of Housing First.

The first three months is a crucial transitional period

For clients housed through Housing First, the first three months are often the most challenging as clients stabilize and adjust to a new mode of living. Many clients have become institutionalized after long-term shelter use and struggle with independent living. The At Home/Chez Soi team has found that this is often when housing stability is most fragile and then after that, things start to smooth out. This is a key time to ensure that the client is receiving regular support and that attempts are made to integrate the client into their new community. Providing both emotional support and access to community services and activities is key at this moment, especially if a client has moved into a new location. Susan McGee of Homeward Trust in Edmonton also remarked that it can take “several months to get the right match between client needs and appropriate supports” (McGee, 2013).

If evictions are a possibility, manage the process

Once again, effective partnerships with landlords and building managers are key. It is helpful to have a different person providing support to the client from the staff members who will deal with housing eviction, damage, later payments etc. Following the approach of Pathways in New York, and the Rapid Exit program in Hennepin County, the CHF was able to bring landlords and building managers on board through demonstrating that they could act as effective mediators between clients and landlords to reduce risk of eviction. Other key strategies that appeal to landlords and reduce the risk of eviction:

• The rent is guaranteed.

• If evictions are necessary, they will be done by the housing agency.

• Any damages will be covered by the housing agency.

Don’t give up on clients

A zero-discharge-into-homelessness policy is important. For all clients in the first three months, and for those with complex mental health and addictions issues, eviction or loss of housing is always a risk. Teams must be ready to engage in eviction prevention and to find people alternative forms of housing when staying in the current dwelling is no longer possible.

Some clients can be challenging

Some individuals, including those with histories of arson or who are violent, may prove to be challenging to house and to keep housed. They may also undermine relations with landlords. Finding appropriate housing and supports for such individuals is possible, but it may require extraordinary effort.

Consumer input in program development and implementation is essential

When you are making decisions about peoples’ lives, the most effective solutions require input from those very people. One size doesn’t fit all. What works for one won’t work for another so creating opportunities for clients to engage – from the planning through to implementation – is critical.

As demonstrated in the Edmonton case, if you are creating and delivering services for Aboriginal people, the manner in which they are engaged in decision-making and governance will impact the effectiveness of the program or service in engaging the population. It is important not to think about Aboriginal homelessness just in terms of service delivery but also to think about how they can be engaged with solutions to homelessness.

SUSTAINABILITY

The issue of sustainability must be addressed at both the programmatic and individual level in order for the program to succeed. A commitment to an increased investment is also necessary.

Program level sustainability

Funding for Housing First programs must be multi-year, as it becomes a disaster in waiting if a program is not able to guarantee longer term support for the people it houses. A three year Housing First project with no funding sustainability after that time leaves many people vulnerable who could otherwise be housed.

Individual level sustainability

The needs of clients in a Housing First program differ. Some will have low needs, and may only need help obtaining housing and support with rent in the short term. At the other extreme, others will need ACT team support or supportive housing for the rest of their lives. An effective Housing First program must identify how needs are met, who provides them and who pays for them. Rent supplements become an issue for some people, and so programs that provide support for a year only, for instance, will need to address how to maintain tenancy.

An initial investment will likely be required

Before savings are seen it will be necessary for an additional investment to be made into the homelessness sector. One of the challenges of Housing First is that it requires new money up front, with the promise that it will reduce the cost of emergency services in the long run. However, it may be several years before there is an impact on the numbers of people using emergency services, allowing for a draw down in those services and a reallocation of resources to Housing First. The decrease in expenditures will be dependent upon many factors including partnerships, an increase in affordable housing stock, the use of rent supplements and an effective homelessness prevention program.

DATA MANAGEMENT AND EVALUATION

Program evaluation should be part of any planning process

Program evaluation is not only important for demonstrating program effectiveness and social return on investment, but is a key to continuous program improvement. Program evaluation identifies where the program is experiencing challenges and helps increase understanding of the effectiveness of the program for different sub-populations. Evaluation must address what works and for whom, and under what conditions? It is important that funders recognize the need for evaluation and that tools and resources are built in to the funding model allow evaluation to occur.

Data systems with key indicators are important for measuring progress

Communities that have developed and implemented integrated systems typically have information management systems, whether the Homeless Individuals and Families Information System, the Service Prioritization Decision Assistance Tool, or the Homeless Management Information System (HMIS). Such systems can automatically track and record access to every client record by use, date, and time of access. One of the greatest benefits of HMIS is the ability to create reports describing client characteristics, outcomes of the services they receive, and general agency operating information. Communities should be mindful of key performance indicators and take the time to develop their own, based on their priorities and local circumstances. Data management systems also allow:

• The collection of system wide, standardized data.

• The ability to better understand longitudinal experiences, or experiences over time.

• Services to better meet client needs through service coordination.

Point in Time Counts should be adopted

Such counts allow for communities to develop accurate measurements of their progress as they implement their Housing First programs. Without having a baseline measurement it is very challenging, if not impossible, for communities to know whether or not their efforts are being effective. Point In Time Counts create the numbers, 10 Year Plans create the goals and Housing First is the answer to reducing homelessness.

REFERENCES

Evans, W. G. (2012). Housing First: An Interview with Sam Tsemberis. Rockville, Md. SAMSA

Gaetz, S., Fiona S., & Tanya G. (Eds.) (2013). Housing First in Canada: Supporting Communities to End Homelessness. Toronto: Canadian Homelessness Research Network Press.

McGee, S. (2013). Personal Communication.