Leading the Way Together - Housing First June 2018 - Depaul Ireland

Leading the Way Together - Housing First June 2018 - Depaul Ireland
Housing First
          Leading the Way
             Report on Fidelity Assessment of Depaul
Belfast and Derry/Londonderry Housing First Services
                                              June 2018

                                 Housing First
                              Housing First
Leading the Way Together - Housing First June 2018 - Depaul Ireland
   Word from our CEO						04
   Introduction							05
   Executive Summary						06
   Housing First - International Model				                   08
   Core Principles of Housing First Service			               09
   Depaul Housing First - History of the Service		           10
   Case Management Model					11
   What is a Fidelity Assessment of a Housing First Service? 12
   Methodology of Assessment Process			                      13
   Outcome of Fidelity Assessment				                        14
   Statutory Funder and Stakeholder Feedback		               18
   Key Findings of the Assessment				                        20
   Our Recommendations to Improve the Housing First          23
    Service in Northern Ireland
   Service User Feedback					24
   Housing First Service User Case Studies			                26


                                             Housing First
Leading the Way Together - Housing First June 2018 - Depaul Ireland
word from                                                                                          introduction
our CEO
In all the work we do to support those                                                             Depaul works with the most vulnerable          This approach is in line with the Northern
experiencing homelessness, Depaul is driven                                                        and marginalised people in our society.        Ireland Housing Executive (NIHE) Homeless
by its values, and an example of these values                                                      The organisation helps those with complex      Strategy and its housing led approach. The
in practice is the work of our Housing First                                                       support needs by providing them with           NIHE is currently leading on the development
team.                                                                                              supported accommodation, resettlement          of a new Chronic Homelessness Strategy
                                                                                                   and tenancy sustainment interventions and      which will incorporate Belfast and Derry/
Our Housing First services are founded on                                                          a route out of homelessness. We believe        Londonderry Rough Sleeper Strategy. One
the belief in the potential of people to exit                                                      that everyone should have a place to call      of the key objectives of this strategy is to
homelessness, to cast off this label and live,                                                     home. Depaul’s considerable experience in      ensure appropriate housing models for those
with support, in the community. This model                                                         working with service users from a variety of   experiencing chronic homelessness. Depaul
recognises that those we work with have                                                            backgrounds equips us to provide services      advocates that the Housing First model
rights; the right to housing even if they do not                                                   aimed at ensuring vulnerable people are        should play a pivotal role within the Chronic
wish to engage with services and our teams                                                         provided with the most appropriate supports    Homelessness Strategy.
work hard to support them to understand                                                            to ensure a long term sustained exit from
their responsibilities in the community.                                                           homelessness while also ensuring community
                                                                                                   resettlement and tenancy sustainment is
These services demonstrate Depaul’s                                                                achieved.
commitment in playing an active role in wider      vital model of service delivery through the
civil society, recognising that a Housing First    Supporting People budget. We are committed
approach requires collaboration and support        to doing more together to ensure people are
from others. This is not a service that can be     supported to exit homelessness.
owned solely by Depaul, it requires a wide
range of interventions and support in order to     Thank you to the large range of partner
make a tenancy successful.                         agencies who have played a pivotal role in
                                                   making Housing First in Northern Ireland a
The Housing First teams, small as they are,        success.
demonstrate Depaul’s value of action over
words. The teams work on an ongoing basis,         Finally, thank you to Depaul’s Housing First
to meet people ‘where they are at’, take risks     teams in Derry/Londonderry and Belfast for
when necessary and do all they can to support      their commitment and passion. This invaluable
individuals with very complex needs towards        work encourages people to achieve their goal
the very best outcome - leaving the stigma         of ending their homelessness and supports
and label of homelessness behind and having        them to change their lives.
a key to their own front door and a place to
call home.

Thank you to the Northern Ireland Housing          Kerry Anthony MBE
Executive for the funding we receive for this      CEO, Depaul

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                                                                                                                                                                     Housing First
Leading the Way Together - Housing First June 2018 - Depaul Ireland
As an organisation committed to a housing          Outcomes of the report show that;                     Our recommendations for the next steps in        •   Development of methods in which social
led approach to solving homelessness, the                                                                Housing First in Northern Ireland include;           isolation and community integration is
Housing First model was adopted by Depaul          •   Depaul Housing First services operate with                                                             addressed for the Housing First cohort. A
as the best in practice to achieve this goal for       a high level of fidelity to the internationally   •   A regional Housing First development             development opportunity in this area is
its service users.                                     recognised standards for Housing First.               strategy within the NIHE Homelessness            for peer involvement in the staffing model
                                                       However, the lack of housing supply has               Strategy 2017-2022 that assists in dealing       of Housing First services.
Housing First is an internationally recognised         a considerable impact on the capacity of              specifically with chronic homelessness.
model of combatting long-term homelessness             each of the Housing First services.
for people with complex needs that has shown                                                             •   Further investment in Housing First as
very positive results. A Housing First service     •   There were 87 successful placements                   part of the solution to homelessness
prioritises permanent housing for people               made by the 2 teams from 2015 to 2017.                for a cohort of people with long-term
experiencing homelessness from the outset              This equates to 74% of service users                  homelessness and chronic health issues.
that is entirely separated from any treatment          worked with in the same period of time.
supports that they might need. The intention                                                             •   A regional strategy to be developed
is that housing should be available even if a      •   Depaul Housing First teams have                       by the Department for Communities in
person experiencing homelessness refuses               developed strong working relationships                partnership with NIHE to improve housing
treatment for their substance use or mental            with statutory and community based                    supply for Housing First tenancies.
health issues and then a flexible support              services to support the work of wrap
package covering mental health, substance              around services for service users in              •   A strategic and financial commitment
use, employment and other issues is provided           their tenancies, however the lack of                  towards Housing First services by health
for the service users in their new home by a           formal agreements with these services is              and social services. This should be
multi-disciplinary team. This is done with a           restrictive.                                          integrated with the NIHE homelessness
view to reconnecting them to their community                                                                 strategy and action plan.
and ensuring stability in their accommodation.     •   The social isolation and ability of service
                                                       users to establish roots and to integrate         •   Development of formal protocols for
The following report is the outcome of a               within their new communities is a                     local health and community services in
Fidelity Assessment that was carried out               prevalent feature that affects the fidelity           providing support to Housing First service
on two Depaul Housing First Services (in               of the service delivery model.                        users in the community, moving away
Belfast and Derry/Londonderry). It assesses                                                                  from the successful but informal working
how closely both of these services remain                                                                    arrangements that are in place at present.
compliant to the original model of a Housing
First service as originally developed by
Dr Sam Tsemberis and colleagues at the
Pathways to Housing National Organisation in
New York, USA.

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                                                                                                                                                                              Housing First
housing first -                                                                                     8 core principles
international                                                                                       of housing first
Pathways Housing First is a model of              This approach challenges the conventional
                                                                                                                                      Housing is a Human Right
housing provision developed in the early          approaches to homelessness of shelter
1990’s by Dr Sam Tsemberis in New York            accommodation such as hostels for people                                  Choice and Control for service users
with his colleagues at the Pathways to            with complex issues until they have addressed
Housing National Organisation. This model         their support needs (such as addictions or
has proven extremely successful in ending         mental health for example).
                                                                                                                           Separation of Housing and Treatment
homelessness for people with high support
                                                  A harm reduction approach is adopted in
needs in the USA, Canada and in several                                                                                                   Recovery Orientation
European cities since then. This approach is      Housing First, rather than a requirement of
based on the principle that housing is a basic    abstinence as a condition of tenancy, which
human right and that there should be respect      is common in many homeless services. This                                          Harm Reduction Approach
and compassion for those experiencing             approach is seen as respecting the individual’s
homelessness. The provision of housing is         right to a home and to a personal and private
                                                                                                                           Active Engagement without coercion
not conditional on accepting treatment or on      life. The Housing First model of provision is
abstaining from drugs or alcohol.                 designed as a way vulnerable people with
                                                  substance use and/or mental health issues can                                        Person Centred Planning
A Housing First service prioritises permanent     gain access to permanent housing with the
housing from the outset, this is entirely         support, social care and health services they
                                                                                                                          Flexible Support as long as is required
separated from any treatment supports             need.
that they might need. The intention is that
housing should be available even someone          In the USA, Canada and Europe, research
experiencing homelessness refuses treatment       shows that the Housing First model generally
for their substance use or mental health          ends homelessness for at least eight out of
issues. Ideally, the housing is independent       every ten people who avail of the service,
units dispersed within the community with a       nearly twice the success rates of more
flexible support package. This package covers     traditional homeless services.
mental health, substance use, employment
and other issues provided for the service users
in their new home by a multi-disciplinary team
– such as an Assertive Community treatment
                                                                                                    (Tsemberis, S.J. (2010) Housing First: The Pathways Model to End Homelessness
team and/or Intensive Case Management
                                                                                                    for People with Mental Illness and Addiction Minneapolis: Hazelden.)

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                                                                                                                                                                                    Housing First
depaul housing                                                                                     case management
first; history of                                                                                  model
the service
In 2013 Depaul, in collaboration with             The Housing First NI service proposed to                 Case co-ordination & tenant engagement
Supporting People, a programme from the           work with service uses aged 18+, with multiple
Housing Executive to fund housing related         presenting needs, by supporting them to
support services, proposed an initiative to       access independent accommodation with
the Northern Ireland Housing Executive to         a permanent tenancy, either in the private
establish a Housing First pilot project in        rented or social housing sector and by                      Support needs and risk assessment
Belfast. The aim of this initiative was “to       adopting a case management approach to co-
identify, assess, place and support individuals   ordinate the services that each tenant needed
into permanent housing from a range of            from external agencies.
temporary accommodation sources and to co-
ordinate support and care packages to these       In 2014 a revised contract was agreed with the
                                                                                                             Tenancy identification and matching
individuals”.                                     NIHE which allowed for the further expansion
                                                  of the Belfast Housing First service and the
The need for such a service had been              extension of the service to include Derry/
identified through the work of Depaul in its      Londonderry.
low threshold services Stella Maris in Belfast
and Sundial House in Dublin as well as in
                                                                                                    Formal agreement of support/care package with partners
evidence published in the Housing Rights
sponsored study “Meeting the Housing Needs
of Vulnerable Homeless People in the private
Rented Sector in Northern Ireland”.
                                                                                                     Co-ordination/monitoring and adjustment of package

                                                                                                              Ongoing evaluation of programme

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                                                                                                                                              Housing First
what is a fidelity                                                                                   methodology of
assessment?                                                                                          assessment process
In response to an increasingly diverse use of the Housing First approach in the USA, the             The mechanism used to carry out this               Alongside this self-assessment process, we
Pathways to Housing National Organisation developed a Fidelity Scale to encourage                    assessment is the self assessment tool of          engaged with our service users and asked
consistency in the adoption of the Pathways to Housing First model. The Fidelity Scale provides      the Fidelity Scale designed for the Pathways       for their feedback in many of the areas of
a series of tests in a scale against which to examine the provision of Housing First services        Housing First Programme (Stefanic et al, 2013      the assessment – level of contact with the
to help avoid situations in which providers re-labelled traditional approaches to housing the        and Gilmer et al, 2013) and further validated in   service, what choices they had, what (if any)
homeless as ‘Housing First’.                                                                         2016 (Goering et al, 2016.).                       requirements were made of them in order to
                                                                                                                                                        access the service and consistency of staffing.
This scale considers the activity of Housing First services in 5 Key Areas:                          The internal Assessment Survey was                 Sample feedback comments from the service
                                                                                                     completed by all Depaul staff involved in the      users on these issues are provided throughout
1. Housing Process & Structure                     4. Service Array                                  delivery of the Housing First services in both     this report.
focusing on how decisions are made                 considering the range of supports and             sites. Initially, it was completed individually
about where the service user will live, who        opportunities available to the service users      without consultation with colleagues. This         We also engaged with external agencies and
determines this, the affordability of housing      for social integration – i.e. resettlement into   was followed by meetings with each team to         statutory funders and asked their opinion of
provided/sourced, length of time it takes to       community, access to treatment, physical          arrive at group consensus through discussion       how Housing First worked for their service
access housing and the type of housing the         health support or employment, education           on each of the items in the survey and final       users. Their feedback is detailed on page 18.
service user lives in.                             and volunteering. This section also considers     fidelity ratings for each item were agreed.
                                                   the engagement of peer activity within the
2. How Housing and Services are related            Housing First Service.                            The assessment took place during April 2018
looking to what conditions (if any) are                                                              and covered three years of Housing First
required of service users in order to access       5. Team Structure and Human Resources             service provision in both sites, 2015 – 2017
and stay in accommodation, the level of            this area considers how the team has been         inclusive.
sharing required, security of tenure and what      resourced to work with the service user group,
happens if a service user loses their housing.     what the caseloads are, the level of contact      The ratings agreed were inputted to the
                                                   staff have with service users on an ongoing       scoring system which was designed to assess
3. Service Philosophy                              basis, planning and management capacity           the 5 key areas. Scores were then achieved in
assessing the approach taken by a team             and opportunities for service users to provide    each area with each score brought together
when service users lose their housing, the         input to the service.                             to arrive at an overall score for the service.
intensity and level of support provided on an                                                        An overall score of 3.5 is considered as a
ongoing basis, what demands are made of                                                              high fidelity score and 1-3 are considered low
service users to access mental health supports                                                       fidelity scores.
                                                   This scale is considered the best practice
or addictions support (if any) and how
                                                   model of Assessment of Fidelity to the
support plans are developed and the level of
                                                   Housing First model in USA, Canada and
autonomy of the service user.
                                                   Europe and hence this is the process we
                                                   applied to our assessment of Housing First
                                                   Services in Belfast and Derry/Londonderry.

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                                                                                                                                                                            Housing First
outcome of fidelity
                                                                                                                                       Score per Domain

                                                                                                                                   Maximum Score     Domain Score

assessment                                                                                                                                    41     40

Both Derry/Londonderry Housing First and          per agreed schedule whilst they continue to
                                                                                                              28              28     28
                                                  access the service as well as committing to
Belfast Housing First sites returned very
                                                  meet the responsibilities of their lease once
similar scores, each achieving an overall score
                                                  they access accommodation.
of 3.2 out of 4.                                                                                                     20
                                                  All of the accommodation accessed by service
Both sites showed very strong returns for
                                                  users has a lease attached and therefore
How Housing and Services are Related.
                                                  service users have reasonable security of
Service users can self-refer and the services
have strong referral processes in place with
external agencies that ensure their services
                                                  If service users lose their accommodation, the
reach as many service users as possible. There
                                                  Housing First service will continue to work to
are no requirements for service users to be in
                                                  re-house them with no preconditions other
active treatment. Service users have only to
                                                  than to meet with staff on a regular basis.
commit to meeting the Housing First staff as                                                               Housing Process Housing &          Service          Service      Team Structure/
                                                                                                             & Structure    Services         Philosophy         Array      Human Resources

                        Extent of Fidelity to Housing First Model                                  Services Philosophy also scored positively.      environment and the ever increasing costs
                                                                                                   Both teams are very clear on the need for        of private rented accommodation it is very
                               Average Domain Rating on 4 Point Scale                              the service to be led and directed by the        difficult for Housing First staff to support
                                                                                                   service user, with service user choice being     service users to achieve their choice of
                                       Housing & Services                                          paramount. They describe their role as           accommodation and location.
                                              4.0                                                  informing and encouraging service users to
                                                   4.0                                             ensure that they are making informed choices     This presents a significant challenge for
                                                   3.5                                             about their accommodation and support            the Housing First teams in that they do
                                                                                                   needs. Support Plans are driven by the service   not have access to a stock of units that are
                                                                                                   users’ own goals and are based on the service    dedicated specifically for Housing First
                                                                                                   users’ strengths as well as on addressing the    service users that would allow for the rapid
       Housing Process                             1.5
                                                                         Service                   barriers to achieving goals identified.          access to accommodation required. Sourcing
            & Structure                            0.5
                                                                         Philosophy                                                                 accommodation is reliant on the same market
                    2.9                                                  3.9                       Each site acknowledged challenges in the area    as the general population – private landlords,
                                                                                                   of Housing Process and Structures. This area     social housing associations and the Northern
                                                                                                   covers the range of housing options available    Ireland Housing Executive are the primary
                                                                                                   to service users and the speedy access to        providers of units.
                                                                                                   accommodation. A key component of a
               Team Structure                                                                      successful Housing First model is swift access   Timelines from referral to move in can take
                                                                  Service Array
            /Human Resources                                                                       to appropriate housing for service users who     up to 6 months for some service users. This
                          3.0                                                                      have experience of long-term homelessness        results in longer stays in
                                                                                                   and multiple, complex support needs. In light
                                                                                                   of the housing supply crisis in the external

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                                                                                                                                                                         Housing First
outcome of fidelity
                                                                                                                     total Housing First Fidelity
                                                                                                                Maximum Score       Derry Site Score

hostel accommodation than is considered best       provide these essential wrap around supports
practice for Housing First service users.          to Housing First service users are not as
                                                   efficient as they would ideally be.
On a positive note, 64% of current service
users are living in independent units provided     This section also looks at the involvement
by social housing providers, the Housing           of people with personal experience of
Executive, the private rented sector or            homelessness, addiction and mental health
have returned to family homes and of the           as peer support workers as this has proven
accommodation that has been sourced, all           internationally to contribute to the success
service users are paying rent at a rate of less    of a Housing First model. Neither site has any
                                                   paid peer specialists on the staff team – this is
                                                                                                       Site Score                      137
than 30% of their income.
                                                   definitely an important area of development
In the area of Service Array there is a very       for each site.
high level of support being provided but                                                                            05       0       100        150      200
there are significant challenges also. Practical   Team Structure displayed positive results in
supports regarding moving in, community            this assessment. Each site team is working
orientation, dealing with landlords, budgeting     with the appropriate service user group-
and shopping, for example, are provided            those who have experience of significant                                   Belfast
by the Housing First team directly and as          periods of homelessness and with a wide                           total Housing First Fidelity
such can be delivered with certainty and           variety of support needs. Levels of support
as required by the service user. Supports          for social integration activities with service              Maximum Score        Belfast Site Score
for service users with mental health issues,       users was also high, with activities such as
substance use, education or physical health        problem solving, leisure activities, family
issues can vary radically. The Housing First       reconnections and community activities being
teams are structured as Intensive Case             routinely provided by the Housing First teams.
Management teams and as such do not have
medical professionals on the team. They rely
                                                   Caseloads of up to 15 per staff member scored
                                                   positively as did an average of 6-10 face-to-
on accessing medical professionals through         face contacts with service users each month.
existing community based services. Both            The level of planning and review of cases
teams have been very successful in building        scored very highly with daily reviews of cases
up links with multiple community services that     ongoing.
can provide support to their service users and
as a result service users are benefitting from     There were low scores for both teams on

the referrals that the team make. However,         the opportunities for service user input – a
                                                                                                       Site Score
most of these links are based on informal          grievance/complaints process is in place, as
relationships i.e. there are no formal contracts   are formal participant feedback opportunities
in place to work with Housing First service        however this could be developed further
users and no dedicated places for our service      to involve service users in planning and                         05       0       100        150      200
user group. This means the opportunities to        development of services and inclusion of
                                                   people with lived experience on the team and
16                                                 the governing body of the organisation.                                                                                     17

                                                                                                                                                               Housing First
statutory funder
& stakeholder
We consulted our statutory partners and a         All agreed the service provided service users      We asked if stakeholders believe that
number of stakeholders, such as Floating          with personal choices and supports them in         engagement with Depaul Housing First
Support services, health professionals, the       acquiring and sustaining tenancies.                services has a direct connection to the
Police Service of Northern Ireland (PSNI) and                                                        following areas for service users and
voluntary organisations to get feedback on         “They reduce the risk of these people             everyone said ‘yes’ and cited some of the
their experience of the Housing First services.    becoming homeless and help them improve           following outcomes:
Those consulted confirmed the following:           the quality of their life.”
                                                                                                     •     Reduction in criminal behaviour
They all felt the service has a positive impact    “They provide a lifeline to hard to reach
                                                                                                     •     Improved health outcomes
on their service delivery:                         people and as a result reduce the risk of
                                                   harm.”                                            •     Reduction in Accident and Emergency
 “Housing First is a beneficial referral source                                                            admissions
 for our service. They provide our staff           “{…}and this is witnessed first-hand on a         •     Improved engagement levels
 with sufficient background knowledge of           daily basis. Housing First provide support
                                                                                                     •     Decrease in homeless presentations
 particular service users and their needs,         through whatever means possible, but
 which aids staff in putting robust support        ultimately service users are empowered to         •     Decrease in use of emergency services
 structures in place. Staff from both services     make their own decisions and encouraged
                                                                                                     •     Increased stability for service users
 work exceptionally well together which is         to take responsibility for different aspects of
 complimentary to the aims of each service.”       their life”.
                                                                                                     Recommendations for improvements
 “The Concern Hub works with some of the          They all rate the communication and
 most vulnerable in our community and             engagement of the Housing First teams as
                                                                                                         “Additional resources such as staff and
 Depaul Housing First have been an integral       excellent.
                                                                                                         housing stock. Greater awareness needs
 community partner in helping keep these
                                                                                                         to be raised in the area for potential
 people safe. The referral process works both
                                                                                                         private landlords to build up a portfolio of
 ways both into and out of the Hub.”
                                                                                                         properties. This would in turn have an impact
                                                                                                         on the number of homeless referrals into
 “{They} Advocate on behalf of customers
                                                                                                         temporary accommodation until a property
 regarding their housing and the sustainment
                                                                                                         becomes available”
 of tenancies and placements.”

                                                                                                         “If they had more resources they could
                                                                                                         provide a service to more people in a city
                                                                                                         where alcohol abuse and mental health are a
                                                                                                         predominant problem”.

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                                                                                                                                                         Housing First
key findings of
the assessment
•    This evaluation has demonstrated that                 have sustained their placements for 2          Gender and Age Profile (All Referrals 2015-2017)               Belfast   L’Derry
     Depaul Housing First services operate with            years or more (allowing for those who
                                                                                                          Male                                                           78%       79%
     a high level of fidelity to the internationally       passed away or returned to prison). In
                                                                                                          Female                                                         22%       21%
     recognised standards for Housing First.               Derry/Londonderry 72% of service users
                                                                                                          Age 20+                                                        29%       25%
     This builds upon the findings from the                are still in accommodation after 12 months.
                                                                                                          Age 30+                                                        32%       32%
     independent 2015 evaluation of the                    Between both services an average of 23%
     NIHE funded pilot programme and has                   of service users returned to homelessness      Age 40+                                                        26%       24%
     established it as a critical part of the              over the 2015-2017 timeline.                   Age 50+                                                        13%       19%
     response to chronic homelessness.
                                                                                                          Belfast Service (commenced 2013):                                        Total/
                                                       •   At an operational level both the Belfast       Data covers 2015-2017                                                    Avg
•    The lack of suitable housing supply has               and Derry/Londonderry Housing First            No of service users supported through HF Interventions 2015-2017         64
     a considerable impact on the capacity                 teams have developed strong working            No of service users placed in permanent accommodation 2015-2017          49
     of each of the Housing First services                 relationships with statutory and
                                                                                                          % of service users placed 2015-2017                                      75%
     to support service users achieve                      community based services to support
                                                                                                          Of those placed: total number who died 2015-2017                         7
     their potential to permanently exit                   the work of wrap around services for
                                                                                                          Of those placed: number who returned to prison 2015-2017                 5
     homelessness. There is a high demand                  service users. However, this is restricted
     on the existing small amount of housing               by the lack of formal agreements between       % of service users still in accommodation 2 years later (cumulative)     78%

     supply that is of a suitable size and tenure          existing partners and specifically funded      Total No of service users placed who subsequently returned to            11
                                                                                                          homelessness 2015-2017
     appropriate for the Housing First cohort.             functions within related services such as
                                                                                                          Total No of service users who successfully exited programme/case         24
     In a high percentage of cases it takes 6              health and social services.
                                                                                                          closed 2015-2017
     months to identify suitable housing for
     referred individuals. The result of this is       •   Social isolation and the ability of service    Derry/Londonderry Service (commenced 2015):                              Total/
     there is little or no capacity to identify            users to establish roots and to integrate      Data covers 2015-2017                                                    Avg
     and allocate the necessary stock of units             within their new communities is a              No of service users supported through HF Interventions 2015-2017         51
     specifically for Housing First service                prevalent feature that affects the fidelity    No of service users placed in permanent accommodation 2015-2017          38
     users to access quickly. It is critical and           of the Depaul service delivery model.          % of Service users placed 2015-2017                                      74%
     necessary that this issue is addressed if a           There is considerable potential for internal   Of those placed: total number who died 2015-2017                         2
     Housing First Strategy is to succeed in the           developments that will improve the             Of those placed: number who returned to prison 2015-2017                 4
     way it was designed to operate.                       outcomes of the service in this area.          % of service users still in accommodation 12 months later                72%
                                                                                                          Total No of service users placed who subsequently returned to            9
•    There were 87 successful placements into                                                             homelessness 2015-2017
     independent, permanent accommodation                                                                 Total No of service users who successfully exited programme/case         3
     made by the two teams over the period                                                                closed 2015-2017
     2015-2017. This equates to 74.5% of the
     service users worked with in the same
     period. In Belfast 78% of service users

20                                                                                                                                                                                                  21

                                                                                                                                                                                    Housing First
     for improvement
     Our recommendations to improve Housing           •   Development of formal protocols for
     First services in Northern Ireland:                  local health and community services in
                                                          providing support to Housing First service
     •   A regional Housing First development             users in the community, moving away
         strategy within the NIHE Homelessness            from the successful but informal working
         Strategy 2017-2022 that assists in dealing       arrangements that are in place at present.
         specifically with chronic homelessness.
                                                      •   Development of methods in which social
     •   Further investment in Housing First as           isolation and community integration is
         part of the solution to homelessness             addressed for the Housing First cohort. A
         for a cohort of people with long-term            development opportunity in this area is
         homelessness and chronic health issues.          for peer involvement in the staffing model
                                                          of Housing First services.
     •   A regional strategy to be developed
         by the Department for Communities in
         partnership with NIHE to improve housing
         supply for Housing First tenancies.

     •   A strategic and financial commitment
         towards Housing First Services by health
         and social services. This should be
         integrated with the NIHE homelessness
         strategy and action plan.

22                                                                                              23

                                                                          Housing First
service user
Male, 46 years old, had been a Housing First       Housing First helped me when I moved             Female, 32 years old, had been a Housing          Housing First referred me on to the Harm
service user for 2 years. Service user was         into my accommodation and helped me to           First service user for 10 months and housed       Reduction service which has been helping
accommodated for 2 years in a series of 3          apply for a Community Grant. Housing First       for one week.                                     me with my anxiety, depression and a couple
different properties - 2 private rental & 1        work with the landlord and help with any                                                           of physical health issues. I have felt involved
housing association, had been residing in          problems that arise. Housing First help me to     “Housing First helped me to talk with the        in making decisions for my future and how
current Housing Association property for 10        get to my appointments and have referred          Housing Executive about re-registering with      best I could move forward positively in my
months.                                            me to other agencies, for support.                them and getting the succession of tenancy       life. I’ve never felt coerced into engaging
                                                                                                     of my father’s house. Housing First also         with support or abstaining from drink or
 “Housing First helped me to facilitate and        I meet regularly with staff about my utility      helped me deal with the Housing Executive        drugs was a condition of the service.
 secure accommodation with Apex and                for the coming week, and any appointments         when I was squatting in the house post my
 worked together as a team. I had a choice         that I need facilitated or accompanied to.        father passing away. During this stressful       I have only just got my home but Housing
 of area that I wanted to live in but there        The meetings consist of what is happening         time staff listened to me and they made sure     First are already helping with discretionary
 weren’t many free accommodations in the           in my life, and what support I need and           I got the counselling I needed and helped        funds for furniture etc., registering for
 city as new builds weren’t ready. Housing         how they can provide support around this.         me with my physical and mental health.           universal credits and my housing benefits.
 First helped me to apply for a Community          Housing First meet with me at least once a                                                         They are also going to help to support me
 Care Grant to help me with money, I think         week and when I have appointments that I          I was waiting to get accommodated for 10         with my substance use.
 I was waiting over a year before I got this       need lifts to. I usually have the same support    months and now that I am housed, Housing
 current accommodation.                            workers that come visit me and I usually am       First are going to help me with getting a        They are still going to talk with the Housing
                                                   key worked by the same staff member.”             discretionary fund and dealing with universal    Executive for me and help me with
 I don’t feel like there were any requirements                                                       credit and all the other stuff they had been     education, training & employment, (help me
 put on me, it was all very relaxed. Yes, I fear                                                     previously helping me with.                      get back in to hair dressing training and my
 I could lose my tenancy with adhering to my                                                                                                          GCSE maths and English), when I’m ready.
 tenancy lease, and drink and drug taking and                                                        At no time did I think that I would be
 offending behaviour resulting in me to losing                                                       removed from the service if I didn’t do          I also recently got contact with my daughter
 my accommodation but I know that Housing                                                            certain things. If Housing First hadn’t helped   again so I’ll probably get help with that.
 First would be there and would still work                                                           me and sign post me to counselling and
 with me to find another accommodation.                                                              helped me out with housing and physical/         I meet with Depaul staff about twice weekly
                                                                                                     mental health I would not be here today          once with John Housing First and once
 Housing First helps provide support to me                                                           and I wouldn’t have been able to keep my         with Eileen, a Harm Reduction worker. In
 with my addiction and helps to facilitate                                                           father’s house. I’d be worse on the drugs and    these meetings we discuss pretty much any
 me to appointments and remind me of                                                                 alcohol.                                         problems that are going on in my life I need
 these. I get to set my own goals, and decide                                                                                                         help with. Lately it’s been mainly my housing
 where I want to go for help and support and                                                         I am happy that you have put me on to all        issues and mental and physical health
 Housing First helps and refers me.                                                                  the support that I am getting and I’ve never     issues.”
                                                                                                     felt put under pressure to do it.

24                                                                                                                                                                                              25

                                                                                                                                                                         Housing First
service user
case studies

Case Study 1                                        Stephen had the maximum level of support and        Case Study 2                                                  Upon joining us in 2017, Frank linked in with
                                                    access to the additional statutory mental health                                                                  the Addiction Treatment Unit, where he had
Stephen* is a 35-year-old male with entrenched                                                          Frank* is a 33-year-old single male, who self-
                                                    services that enabled him to stabilise his mental                                                                 been taking part in a Suboxone programme &
alcohol, substance use and mental health issues.                                                        referred to the Housing First service in June
                                                    health.                                                                                                           receiving counselling for his addictions.
Prior to working with Housing First he had a                                                            2017. At the point of referral, Frank had been
history of stays in homeless hostels, prison,       In addition, Stephen was supported to engage        sleeping on the sofa at his parents’ home for a               Frank was also referred to Depaul’s Harm
care, physiatrist facilities and periods of rough   with his housing provider to avoid being asked      period of 3 months.                                           Reduction service who worked with him on
sleeping. Over the years, he had also secured a     to leave his property because of anti-social                                                                      specific needs pertaining to physical & mental
                                                                                                        Frank had a history of failed tenancies, both
number of tenancies that had failed.                behaviour and rent arrears. This was achieved                                                                     health. Through the interventions of his harm
                                                                                                        private rental and housing authority and this was
                                                    by addressing these issues through the case                                                                       reduction worker, Frank was referred to the
One of Depaul’s Housing First support workers                                                           mainly due to antisocial behaviour related to
                                                    management process. Previous tenancies would                                                                      community mental health team for, anxiety,
supported Stephen to find a social housing                                                              his alcohol and drug use and ongoing offending
                                                    have broken down because of these issues but                                                                      insomnia and anger issues. A referral was also
flat. Following his assessment, a number of                                                             behaviour.
                                                    Stephen currently remains in his property.                                                                        made to the Recovery College for enrolment
referrals were made in order to support him with
                                                                                                        Frank had been a service user of the Housing                  in the following courses: Introduction to
his multiple complex needs and to ensure his        The long-term vision is that Stephen will be able
                                                                                                        First service briefly in 2016 when they worked                Mindfulness; Living with Psychosis & Exploring
tenancy was sustained. He received support from     to overcome his alcohol addiction, become more
                                                                                                        with him to secure a one-bedroom flat in private              your options. Frank is willing to fully engage
an intensive floating support service, a harm       independent and maintain positive relationships
                                                                                                        rented accommodation. Unfortunately, this lasted              with these courses in order to work towards
reduction service and statutory mental health       with his family. By empowering him to achieve
                                                                                                        for just one night due to anti-social behaviour in            continued stabilisation of his emotional & mental
services.                                           these goals it is hoped that they will only
                                                                                                        a settled community and as a result the landlord              health.
                                                    continue to improve his independence and long
Housing First provided a high level of support                                                          evicted him. Following his eviction Frank floated
                                                    term health outcomes.                                                                                             In August 2017 Frank received a housing
during the interim period when no other services                                                        between family and friends, while Housing
                                                                                                                                                                      offer from a local housing association and
were in place. Once the referrals were accepted,                                                        First worked tirelessly in trying to secure him
                                                                                                                                                                      after accepting moved into his new home in
a case management approach was adopted with                                                             permanent accommodation. Unfortunately, Frank
                                                                                                                                                                      November 2017. Since then he has been in
Housing First coordinating all of the services                                                          returned to prison approximately 6 weeks later
                                                                                                                                                                      sustained accommodation with Housing First
involved. Regular review meetings were held to                                                          to serve a 6-month sentence. Upon release from
                                                                                                                                                                      coordinated support.
ensure that appropriate levels of support were                                                          prison Frank re-joined Housing First again in
offered and the services involved were clear on                                                         2017 via a self-referral.                                     Frank continues to remain drug free and
their roles and responsibilities. Communication                                                                                                                       currently only consumes alcohol on occasion. He
                                                                                                        At the time of the initial assessment Frank had
protocols were established to ensure that                                                                                                                             has fully engaged with all the supports that were
                                                                                                        52 convictions, a history of alcohol and drugs
concerns could be escalated and addressed as                                                                                                                          offered to him through the Housing First service
                                                                                                        use- he had been an active heroin user with a
quickly as possible.                                                                                                                                                  and he is very happy with the progress he has
                                                                                                        history of using ecstasy, amphetamines and LSD
                                                                                                                                                                      made and continues to make, in order to live as
Stephen’s first year in his accommodation was                                                           (Lysergic Acid Diethylamide), mental health
                                                                                                                                                                      independently as possible, in his own home.
a difficult one due to his substance use and                                                            issues included schizophrenia, anxiety and
declining mental health. Housing First were                                                             depression and physical health issues including
able to support him through this crisis period                                                          epilepsy, perfuse sweating, undiagnosed chest
by coordinating the services involved to ensure                                                         issues and a previous case of pneumonia.

26                                                                                                      *Names have been changed to protect service user’s identity                                                    27

                                                                                                                                                                                             Housing First
Dublin Head Office     Belfast Office
         Holy Cross College,    449 Antrim Road,
              Clonliffe Road,   Belfast,
         Dublin 3, D03 P2E7     BT15 3BJ
e. depaul@depaulcharity.net     e. depaulni@depaulcharity.net
            t. +353 1 4537111   t. +44 2890 647755
 Charity Reg. No. 20048938      Charity Reg. No. NIC102995
                 (CHY14753)     (XR87991)
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