oh canada! lessons on housing first from the canadian response to homelessness stephen gaetz...
TRANSCRIPT
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OhCANADA!
Lessons on Housing First from the Canadian Response to Homelessness
Stephen Gaetz Canadian Observatory on HomelessnessProfessor, Faculty of Education, York University, Toronto, Canada
National Housing First
DayJune 7, 2015
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Housing FirstThe context …
Part 1
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A short history of Housing First in Canada
• Pathways to Housing – New York, Sam Tsemberis
• Toronto – Streets to Homes 2004
• Calgary, Edmonton, Lethbridge, Medicine Hat, Red Deer, Province of Alberta – 2008 - Present
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PreventionEmergency Response
Housing and
Supports
Paradign shift from MANAGING the crisis, to
ENDING HOMELESSNESS
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The emergency response is EXPENSIVE!!!!
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PreventionEmergency Response
Can we move from THIS . . .
Housing and
Supports
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PreventionHousing
and
Supports
Emergency Response
. . . to This!
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2013 – Government of Canada renews Homelessness Partnering Strategy
for 5 years
Prioritizes
Housing First
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Prioritizing needs in terms of
• Transitional - 88-94%• Episodic – 3-11%• Chronic – 2-4%
Chronicity
Aubry et al., 2013
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The EVIDENCE
Part 2
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Does it work?• Huge body of evidence that says it does
work.
• Between 80-90% of those who receive Housing First are still housed after a year
• The At Home / Chez Soi project has ended more than 6000 person years of chronic homelessness
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Does it lead to less use of homeless related services?
Significant differences between Housing First and Treatment as Usual (TAU) in 12 months of service use (per 1,000 people)
• 7,497 fewer nights in institutions (largely residential addiction treatment).
• 42,078 fewer nights in shelters.• 6,904 fewer nights in transitional housing or group homes.• 732 fewer emergency department visits.• 460 fewer police detentions.• 1,260 fewer outpatient visits.• 34,178 fewer drop-in centre visits.
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Does it cost more?• On average the HF intervention cost $22,257 per
person per year for ACT participants and $14,177 per person per year for ICM participants.
• For every $10, an average savings of $9.60 for high needs/ACT participants and $3.42 for moderate needs/ICM participants.
• For the highest needs clients (top 10%) every $10 invested in HF services resulted in an average savings of $21.72.
(Goering, et al., 2014 National At Home / Chez Soi Final Report)
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Success in Alberta• Edmonton – 30% reduction in
homelessness
• Lethbridge – 65% reduction
• Medicine Hat – poised to be first community to end homelessness in Canada
• Province of Alberta – over 9000 individuals housed.
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Implementation Challenges
Part 3
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Community RESISTANCE
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Matching supports to client acuity
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The first three months are a crucial transition period
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Nurturing effective
working relations
with landlords
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The importance of
rent supplements
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How do we consider the needs of the fifteen percent for whom housing stability continues to be a challenge.
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How do we support social interaction and meaningful engagement?
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Where does ASSESSMENT fit in?
Clinical Assessments
Community Priorities
Intake
Assessment Tool
Interventions
Case Management
Data Management Systems (HMIS, HIFIS)
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A word of caution:
Assessment tools are one source of information to guide decision making.
Avoid SCIENTISM!
They are not magic, and they cannot make decisions for you. Trust your own knowledge as well.
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Housing FirstWhat’s Next?
Part 4
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1 Reframe
the Problem
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PreventionHousing
and
Supports
Emergency Response
Where does PREVENTION fit in?
2
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A Framework for
Thinking About Prevention
TertiaryPrevention
PrimaryPrevention
TertiaryPrevention
SecondaryPrevention
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Working upstream to prevent new cases
Primary Prevention1
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Early intervention strategies to stop people from becoming homeless or to help them exit quickly
SecondaryPrevention 2
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Stopping homelessnessfrom happeningagain!
TertiaryPrevention3
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Addressing the lack of Affordable
Housing
3
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The Grand Experiment…
DECLINEIn direct Federal expenditures on affordable housing
INCREASEIncrease in tax expenditures / Subsidies for home ownership
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Decline in Federal spending over 25 years
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The OUTCOME?
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Shrinking investment in affordable rental housing
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18% of low income Canadians are in “Extreme Housing Need”
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Six key recommendations
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The need to address Aboriginal homelessness in Canada
4
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Aboriginal Homelessness in Canada
Belanger, et al. 2012
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Population Profile based on AgeAboriginal vs. Aboriginal in Canada
0-14 years 15-24 years
25-34 years
35-44 years
45-54 years
55-64 years
over 650
5
10
15
20
25
30
AboriginalNon-Aboriginal
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Addressing
YOUTH HOMELESSNESS 5
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Does HOUSING FIRST work for youth?
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COMING SOON!
More on this in the afternoon
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Resources andSupports
Part 4
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TOOLKIT
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Book on Housing First
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www.homelesshub.ca/housingfirstyouth
Housing FirstFramework for Youth
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Questions or comments?