innovation in homeless services: the social, economic and community value of tackling homelessness...
TRANSCRIPT
Sam Tsemberis, PhD
Founder and CEO Pathways to Housing, Inc.
JUNE 12, 2013
Who is served by Housing First?
Homeless
Mental health problems Addiction and abuse
Health problems
Poverty
Isolation
Stigma
PTSD/Trauma
Frequent users of acute care services
Jail
Shelter
Hospital/
Detox
Streets Institutional Circuit
Housing and Support Services: Rearranged (Housing first) and Redesigned (consumer driven)
Levels of Program Fidelity
consumers Hundreds of choices, change over time & have tradeoffs r
Management issues include team-consumer, landlord-tenant, landlord-team, and team-agency interactions
Operations Variety of services and
housing options
Decisions about housing status and consumer
engagement
Principles
Consumer choice Separation of housing and treatment
Homeless
Shelter placement
Transitional housing
Permanent housing
Ongoing, flexible support
Harm Reduction
Housing First Model
MHCC At Home / Chez Soi 5 Cities RCT N=2,257
Moncton, Montreal, Toronto, Winnipeg, Vancouver
Housing First
(n=1267)
Interviews every 3 months: Residential stability, mental health, addiction, quality of
life, social integration
Treatment as Usual (n=990)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
3M 6M 9M 12M
Time Spent in Stable Housing Over Year One
HF TAU
/ 9
Housing First shows cost offsets
Annualized costs: Total sample Annualized costs: High Service Users (defined as
those in top 10% of prior service costs
TAU Intervention Difference TAU Intervention Difference
Est. annual cost:
Non-study services$23,849 $14,599 $ (9,250) $ 56,431 $30,216 $ (26,215)
Est. annual
intervention cost$17,160 $ 17,160 $16,825 $16,825
Total $ 23,849 $ 31,759 $ 7,910 $ 56,431 $ 47,041 $ (9,390)
High Service Users:• There is an overall savings of $9,390 per person per year• Every dollar spent on Housing First for these participants saves $1.56 through reduced
use of other shelter, health and justice services
Total Sample: • An investment in Housing First requires only an additional investment of $7910 per year• For every dollar spent 54 cents is saved through reduced use of other shelter and
health are services after only one year
Table 1 – Costs of Housing First versus use of other health, justice and social services after one year
Peer Support: Recovery Focused Mental Health Services
Hope-instilling practice Socially supported wellness
knowledge and
skills to self-
manage
Emphasis on
holistic wellness
and positive
lifestyle as healing
Son returns from tour in Afghanistan and stays with (formerly homeless) dad in his apartment.
Social connections are key and
and housing should adjusts accordingly
Community-based, Residential Treatment (on-site clinical staff)
Permanent Single Site (on-site services)
Permanent housing
(scatter-site, off site services)
Redesigning the System: System Transformation
Longer term Institutional Care
Least restrictive to more restrictive setting
• People are much more capable than we imagined possible.
Capabilities
For Additional Information
Web sites:
www.pathwaystohousing.org
Or send an email to