Leading the Way Together - Housing First June 2018 - Depaul Ireland
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Housing First
Leading the Way
Together
Report on Fidelity Assessment of Depaul
Belfast and Derry/Londonderry Housing First Services
June 2018
Depaul
Depaul
Housing First
Housing First
contents
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
3
Depaul
Housing First
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
4 5
Depaul
Housing First
executive
summary
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.
6 7
Depaul
Housing Firsthousing first - 8 core principles
international of housing first
model
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.)
team.
8 9
Depaul
Housing Firstdepaul 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
10 11
Depaul
Housing Firstwhat 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.
12 13
Depaul
Housing Firstoutcome of fidelity
50
Score per Domain
Maximum Score Domain Score
assessment 41 40
42
30
Both Derry/Londonderry Housing First and per agreed schedule whilst they continue to
28 28 28
access the service as well as committing to
26
Belfast Housing First sites returned very
meet the responsibilities of their lease once
similar scores, each achieving an overall score
they access accommodation.
22
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
tenure.
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
3.0
needs. Support Plans are driven by the service not have access to a stock of units that are
2.5
users’ own goals and are based on the service dedicated specifically for Housing First
2.0
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
1.0
& 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
2.4
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
14 15
Depaul
Housing Firstoutcome of fidelity
assessment
Derry/Londonderry
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.
Maximum
Score
169
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
Derry
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-
Maximum
Score
169
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
135
Belfast
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
Depaul
Housing Firststatutory funder
& stakeholder
feedback
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
included:
“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”.
18 19
Depaul
Housing Firstkey 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
Depaul
Housing Firstrecommendations
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
Depaul
Housing Firstservice user
feedback
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
Depaul
Housing Firstservice 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
Depaul
Housing FirstDublin 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)
ie.depaulcharity.orgYou can also read
