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?