This is the PDF version of the PowerPoint used during the housing First webinar on February 13, 2010, sponsored by the National Council for Community Behavioral Healthcare and Hazelden.

1. Housing First:
Ending Homelessness for People
with Mental Illness and Addiction
Brought to you by:
January 12, 2011
3:00 CST/2:00 CST

2. Housing First:
Ending Homelessness for People
with Mental Illness and Addiction
PRESENTER
Sam Tsemberis, PhD
Founder and CEO Pathways to Housing
Email: stsemberis@pathwaystohousing.org
Website: www.pathwaystohousing.org

3. Housing First:
Ending Homelessness for People
with Mental Illness and Addiction
SPEAKER
Tim Sheehan, Ph.D.
Professor and Director of Institutional Effectiveness
Hazelden Graduate School of Addiction Studies

4. Presentation Objectives
Participants will be able to describe:
• the essential ingredients of operating a
g p g
Housing First program
• core values and program components of
p g p
Housing First: services, treatment and housing
• steps in starting a Housing First program
p g g p g
• available resources, including the Housing First
manual, training, and consultation
, g,

5. Poll Question
ll i
In what profession do you currently practice?
A. Mental health, substance abuse, or
, ,
co-occurring treatment
B. Supportive housing
C. Research
D. Policy development, government, or
administration
E. Other

6. Poll Question
ll i
Does your organization currently p
y g y provide
any form of supportive housing ?
1. Yes
2. No

7. Housing First
Introduction
The Origins of the
Pathways Program
Program Principles
Program Operations
Program Effectiveness

8. People who are homeless with
p
mental health and substance
abuse problems
p
Chronically homeless
Psychiatric disabilities
y
Addiction and abuse
Health problems
p
Poverty
Isolation
Stigma
Trauma
GINI (Social Disparity)

9. Are they the homeless mentally
ill or the mentally ill homeless?
Why are people with psychiatric
disabilities over-represented among
the homeless?

10. Traditional Treatment and
Sobriety then Housing programs
$$$$ $$$$ $$$$$$$$ $$$$
there are cost implications PERMANENT
Housing
TRANSITIONAL H
Housing
i
SHELTER (housing readiness)
Outreach
O t h Challenges:
Ch ll Dx is l t d to
D i related t
1)Housing readiness is not needed ability to function
Drop-in 2)Clinical assumptions are not 3) Cost
substantiated implications

11. Single Site
g
(congregate housing)
New or rehab building
Tenants are people with
special needs
Property management and
social services are on site
Psychiatric treatment and
sobriety usually required
(can have harm reduction
models as single-site
programs )
Rules, regulations, and
shared housing

12. Single Site
Effectiveness (cont’d)
About half stayed 3 years or more
Only one-third of leavers went to stable alternative
one third
housing (“positive leavers”)
“Negative leavers” had more severe levels of mental
g
illness, greater incidence of substance abuse, higher
supportive service needs
(O’Hara, 2007)

13. When people cannot access
or keep housing
• Shelters: 10% of the chronically homeless
utilize 50% of the system resources
• Hospitals/Detoxes: 3% of clients use 28% of
all Medicaid funding for these services
g
• Jail/Prison: High rates of incarceration and
recidivism rates: poverty and drug related
p y g
charges for people who are mentally ill and
homeless. 25% of prison population have
mental health problems
problems.

14. Pathways
Housing First
Scatter site
apartments
Immediate access
Treatment 0r
sobriety are not
required
Admission it i
Ad i i criteria
is inclusive, not
restrictive

15. What is H
Wh i Housing First?
i Fi ?
An evidence-based, consumer-
driven program, rooted in the
principles of:
Psychiatric rehabilitation
Harm reduction
H d ti
Consumer movement
Recovery oriented practice

16. What is H
Wh i Housing First?
i Fi ?
A clinical and housing
intervention that provides
immediate access to
permanent housing and
support and treatment services
d i
for people with mental health
and addiction problems

17. Four Essential Ingredients of
Pathways’ Housing First
1. Consumer Choice Philosophy
2. Separation of Housing and Services
3 Recovery Oriented Services
3.
4. Community Integration

18. 1. Client Choice is the
Foundation of the Pathways’
Housing First Program
Choice drives both housing and clinical
services
Clients choose among housing options:
location, size floor neighborhood,
location size, floor, neighborhood
furnishings and other household items
o their apartments
of t e apa t e ts
Clients choose among the services: type,
frequency and intensity
q y y

19. Top choice: Independent
apartments i community
in i
settings (Scatter Site Housing)
Given the choice -- most consumers
prefer own place in normal settings
Creates sense of home
Privacy, safety, security
Integrated housing (rented from
community landlords and rent l
i l dl d d less
than 20% of units in any one building)

20. Top choice: Independent
apartments i community
in i
settings (Scatter Site Housing)
Tenants rights - housing is
permanent, client holds lease
Tenants have the same rights and
responsibilities as any other tenant in
the building
Social services are off site
Visits are required
Treatment is offered not mandated

21. Landlords as program
p g
partners
Landlord, program and participants have a common
goal - All want safe, decent, well managed housing
1.Agency ensures rent is paid on time
2.Agency and landlord communication – responsive to
landlord concerns
3.Agency responsible for tenant damages
4.Advantages of using rental market: quick start up,
relocation, expansion as needs change, others.

22. SERVICES: Clinical and support
services provided by ACT
i id d b
or ICM Teams
• M hi the l
Matching h level of services to the person’s needs
l f i h ’ d
• Hi Need: ACT is a multidisciplinary team and
provides support and services directly
• Moderate Need: ICM case management team provides
support and brokers services
pp b
• Services provided in the participant’s home or
community (group meetings offered at offices or other
community settings)
• ACT and ICM – Off site and call services 7-24
• All teams use a recovery orientation

23. LIMITS to consumer choice:
clinical, legal, economic &
li i l l l i
practical issues
There are clinical, legal and practical limits to choice:
1 Must agree to weekly apartment visit by team
1.
2. Danger to self or others may lead to involuntary hospitalization
3 Other legal social issues (abuse, violence illegal activity, etc.)
3. (abuse violence, activity etc )
Limits on housing choice
4. Economic constraints on h
E i t i t housing choice
i h i
5. Must sign lease, pay 30% of income towards rent and observe
responsibilities of standard lease

24. 2.
2 Separation of
Housing and Services
The home visit
isit

25. 2. Separation of Housing
p g
and Treatment Services
Use different criteria for success in housing and success
in treatment services
Relapse i anticipated; relapse i clinical i
R l is i i d l is li i l issue, not a
housing problem
Relapse does not mean eviction or loss of housing
It means obtaining treatment and returning home
Similarly, eviction from housing does not mean
discharge from the program (it usually means
relocation)
Program commitment i to the person not the h
i is h h housing
i

26. Relationship
l i hi
True caring and honest concern
“See” the individual and treat as a whole person
See
“Can do!” messages
Facilitative partnership
Collaborative relationship, Non-judgmental
p, j g
Person as the driver of his or her own life and
recovery
y

28. Some Core R
S C Research
h
World Health Organization studies
(Whitaker)
The Vermont Study (Harding)
What Helps What Hinders Recovery?
(Onken, Ridgway et al.)
Exploration f Process & St
E l ti of P Stages of
f
Recovery

29. Key Elements of the
y
Paradigm Shift
What helps/what hinders:
Change in view of those served
Change in goals of the system
Change in power relationships
Change in focus and locus of care
g
Change in treatment culture

30. Recovery Focused
y
Treatment
People need self-directed approaches e.g., supported
employment, wellness self-management, IDDT,
supported education
Other Evidence-Based Practices (EBPs) are
incorporated into treatment services
They also need knowledge and skills to self-manage
their condition
An emphasis on holistic wellness and positive lifestyle
is healing (address emotional, physical, social, cultural,
emotional physical social cultural
and spiritual needs)

31. Recovery Extends Beyond
the Mental Health Field

32. M
Meaningful S i l R l
i f l Social Roles

33. Peer Support and Recovery
pp y
Role Models Are of
Primary Importance

34. Opportunities/
Choices/Options
Choices really matter!
People have often been stuck in programs
with few options and opportunities that
perpetuated dependence and helplessness
Benefits so low as to be life-stealing
Meeting basic needs—housing, income,
transportation, health care
Opening doors to community integration

35. 4.
4 Community Integration
i l l i
Social Inclusion

36. 4. Community I t
4 C it Integration
ti
Housing that is normal housing provides (l
i h i lh i id (least
restrictive setting – (Olmstead Decision)
Provide opportunities f social integration
d for l
Building community supports in integrated
neighborhoods (self-help, spiritual, cultural,
personal skills and interests)
Services assist participants with community
integration activities – orientation to building
Mapping of their neighborhood and community

37. Community Integration
and Graduation
Services can be reduced over time or stopped
altogether when the person no longer needs
them. This makes for smooth graduation.
In Housing First model, the service providers
d l h d
walk away and the person stays home

38. Graduation, services
,
walk away and the
person stays home!

39. Program Effectiveness
ff i
Studies f
St di of
Program
g
Effectiveness

40. Evaluating Housing First
Highly effective program for the ‘hard to house’
85% housing retention rates across many cities and
programs
Access problems eliminated, retention increased
Reduction in acute care services and significant cost
savings (pre=post)
(pre post)
Improves quality of life Tsemberis effectiveness (2004);
HUD Pearson 6 cities (2007);
VA Rosenheck 11 cities (2007);
Larimer, cost (2009).

41. High Choice PSH
g
Programs, Choice &
Psychiatric Symptoms
reduction
Program
P
Assignment
Personal reduction Psychiatric
Choice
Mastery Symptoms
Proportion
increase
of time
homeless
Adapted from Greenwood et al, 2005.

42. Research E id
R h Evidence
• Residential stability (85%)
• Reductions service tili ation
Red ctions in ser ice utilization
• Improved mental health status
p
• Reduction in drug & alcohol consumption
• Cost effectiveness (over 35 studies)

43. Research Evidence:
Pathways’ Housing First is
an evidence based practice

44. Housing First in
U.S. & Canada

45. Housing First
in Europe
p

46. Studies in Progress
St di i P
• Mental Health Commission of Canada
• ($110 M; 5 city longitudinal rct)
• European Union (10 cities hf compared to tau)
p p
• France (4 city implementation)
• Fi l d ( city i
Finland (4 it implementation)
l t ti )

47. For more information
about Pathways to
H i
Housing
Please visit our website at
pathwaystohousing.org
Or send email to
stsemberis@pathwaystohousing.org

48. About Housing First
Ab t H i Fi t
The manual includes:
information about the program's
philosophy, operations, and
administration
Staffing patterns and day-to-day
operations of the clinical and support
services
property management and housing
services
protocols for assisting clients with the
search for housing building
housing,
relationships with landlords, and the Cost: $49.95
overall community integration process for the manual alone
the research evidence for the With a 30% discount =
effectiveness of the Pathways model $34.97

49. About Housing First
Ab t H i Fi t
About the DVD:
The
Th DVD ill t t th
illustrates the
concepts presented in the
manual, offering client
success stories helpful tips,
stories, tips
and model teams in action.
See a preview of the DVD at
www.bhevolution.org Cost: $265.00 for the
manual and the DVD
With a 30% discount =
$185.50

50. www.BHEVOLUTION.org
g
Sign up for Funding Alerts and
N l tt
our e-Newsletter

51. This presentation
p
covered:
• the essential ingredients of operating a
Housing First program
• core values and program components of
Housing First: services, treatment and housing
services
• steps in starting a Housing First program
• available resources, including the Housing First
manual, training, and consultation

52. The Series Continues!
Join
J i us th second Wednesday of every month for more
the dW d d f th f
information about treating co-occurring disorders…
February 9:
Applying the Individual Placement and
Support Model with Supported
Employment

53. Time for Discussion
Ti f Di i
For more information about
Housing First materials or to order
call 1-800-328-9000
You will receive a follow-up e-mail
with information about receiving
credit for Continuing Education
g
through NAADAC or APA
Participants in this web
conference will receive
f ill i
a 30% discount on Housing First
Use this d to d
U thi code t order:
SMIREWARD

54. Six Steps to Obtain Continuing
Education credit through
NAADAC and APA
1) Go to www.hazelden.org/professionaled
2) Click on “Course Catalogue
Course Catalogue”
3) Search for the course: Housing First Learner
Assessment
4) Pay the administrative fee ($10.00) for the
assessment
5) T k the assessment
) Take th t
6) Print your certificate!