Streets to Homes and Housing FirstStreets to Homes and Housing First

St. John’s NewfoundlandGordon Tanner and Katie Keating

City of Toronto, Streets to Homes ProgramFebruary 23, 2011

OutlineOutline

1.1. Shelter, Support and Housing Shelter, Support and Housing Administration PrioritiesAdministration Priorities

2.2. Setting the Context Setting the Context 3.3. Housing First and Streets to HomesHousing First and Streets to Homes4.4. Outcomes to dateOutcomes to date5.5. What’s next What’s next 6.6. Critical success factors and future / Critical success factors and future /

ongoing challenges ongoing challenges

Shelter Support and Housing DivisionShelter Support and Housing Division

What we doWhat we do

Fund and coordinate services for homeless and Fund and coordinate services for homeless and vulnerably housed people, including:vulnerably housed people, including:• Streets to HomesStreets to Homes• Emergency sheltersEmergency shelters• Pre-employment support servicesPre-employment support services• Housing help and eviction preventionHousing help and eviction prevention• Drop-in servicesDrop-in services

Administer the social housing portfolioAdminister the social housing portfolio

Coordinate emergency human servicesCoordinate emergency human services

Service delivery in partnership with about 346 Service delivery in partnership with about 346 community agenciescommunity agencies

Top PrioritiesTop Priorities

End street homelessnessEnd street homelessness Help prevent homelessnessHelp prevent homelessness Provide emergency shelter servicesProvide emergency shelter services Sustain and revitalize social housingSustain and revitalize social housing Create more affordable and transitional Create more affordable and transitional

housinghousing

Early learning – Tent City 2002Early learning – Tent City 2002

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Early learning – Bathurst Bridge 2004Early learning – Bathurst Bridge 2004

Bathurst Bridge

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“ “ City Council make a commitment to ending City Council make a commitment to ending street homelessnessstreet homelessness by working with other by working with other orders of government, private sector orders of government, private sector landlords, such as the Greater Toronto landlords, such as the Greater Toronto Apartment Association, and community Apartment Association, and community partners to implementpartners to implement an outreach-based and an outreach-based and rent support-based Homelessness Strategy to rent support-based Homelessness Strategy to assist homeless persons find permanent assist homeless persons find permanent housing.”housing.”

February 2005February 2005

Streets to Homes – How did it start?Streets to Homes – How did it start?

Hire a City staff led team – 10 peopleHire a City staff led team – 10 people

Lead change management in the sector (9 agencies Lead change management in the sector (9 agencies funded to do street outreach)funded to do street outreach)

Re-focus from managing street homelessness to Re-focus from managing street homelessness to ending street homelessnessending street homelessness

Conduct a needs assessment and count of people Conduct a needs assessment and count of people experiencing homelessness in Torontoexperiencing homelessness in Toronto

Develop a strategy to serve people with significant Develop a strategy to serve people with significant mental health and concurrent disorders mental health and concurrent disorders

Street Needs Assessment, 2006Street Needs Assessment, 2006

Estimated 5,052 homeless peopleEstimated 5,052 homeless people

• 72% staying in emergency shelters72% staying in emergency shelters• 16.2% sleeping outside16.2% sleeping outside• Remainder in health and treatment facilities, Remainder in health and treatment facilities,

corrections and VAW shelterscorrections and VAW shelters

818 estimated to be living outside818 estimated to be living outside 24% of all people living outside were Aboriginal24% of all people living outside were Aboriginal 9 out of 10 homeless people surveyed said they 9 out of 10 homeless people surveyed said they

wanted permanent housingwanted permanent housing

Where did our clients live?Where did our clients live?

Street Outreach: Street Outreach: ThenThen and and NowNow People have a right to People have a right to

sleep outsidesleep outside

Focused on meeting Focused on meeting immediate needsimmediate needs

Getting people into Getting people into sheltershelter

Many volunteer led Many volunteer led initiativesinitiatives

Report on activities and Report on activities and contacts in an aggregate contacts in an aggregate formform

No central administration No central administration

Anecdote drivenAnecdote driven

Not okay for people to Not okay for people to sleep outsidesleep outside

Intensive case Intensive case management focus around management focus around housing (no survival housing (no survival supports)supports)

Focus on getting people Focus on getting people into housing as quickly as into housing as quickly as possiblepossible

Professionalized staff led Professionalized staff led service with increased service with increased training and accountabilitytraining and accountability

Report on outcomes on a Report on outcomes on a client by client basisclient by client basis

Central administrationCentral administration

Evidence drivenEvidence driven

What is Housing First?What is Housing First? A client-driven strategy that provides options A client-driven strategy that provides options

and rapid access to a home without requiring and rapid access to a home without requiring initial participation in treatmentinitial participation in treatment

Based on a belief that housing is a basic Based on a belief that housing is a basic human right, not a reward for clinical successhuman right, not a reward for clinical success

Don’t need to be “housing ready”Don’t need to be “housing ready”

Two models for implementation :Two models for implementation :• Assertive Community Treatment Team Assertive Community Treatment Team

(ACT) – eg, Pathways to Housing(ACT) – eg, Pathways to Housing• Intensive Case Management (ICM) – eg, Intensive Case Management (ICM) – eg,

Streets to HomesStreets to Homes

Why Housing First?Why Housing First? People who experience homelessness want People who experience homelessness want

permanent housingpermanent housing

The best place to learn the skills necessary for The best place to learn the skills necessary for housing stability is while in housinghousing stability is while in housing

More cost effective to focus on long term More cost effective to focus on long term housing solutions than emergency measureshousing solutions than emergency measures

Quality of life improves for people housedQuality of life improves for people housed

Separates housing (homelessness) issues from Separates housing (homelessness) issues from other life issuesother life issues

““Treatment first” is not needed to achieve Treatment first” is not needed to achieve stable, independent livingstable, independent living

Decreases demand and costs of other health, Decreases demand and costs of other health, emergency and criminal justice servicesemergency and criminal justice services

Taking services to the streetTaking services to the street

Street outreach helps with:Street outreach helps with:

Obtaining IDObtaining ID Accessing income supportsAccessing income supports Accompaniment and Accompaniment and

referrals to servicesreferrals to services Looking for an apartmentLooking for an apartment Negotiating the lease with Negotiating the lease with

the landlordthe landlord Acquiring furnitureAcquiring furniture Moving InMoving In Connecting with follow-up Connecting with follow-up

supportssupports

Clients Choose Where They LiveClients Choose Where They Live Three requirements for serviceThree requirements for service

1.1. Must agree to have Must agree to have rent paid directly to rent paid directly to landlordlandlord

2.2. Must agree to have Must agree to have follow-up supportsfollow-up supports

3.3. Must agree to Must agree to complete an complete an application to be on application to be on the centralized waiting the centralized waiting list for subsidized list for subsidized housinghousing

Housing OptionsHousing Options Private market partnershipsPrivate market partnerships

Toronto Community HousingToronto Community Housing

Priority access because Priority access because clients come with supportsclients come with supports

New supportive & affordable New supportive & affordable housing projects provide housing projects provide direct access to unitsdirect access to units

Specialized ServicesSpecialized Services

Aboriginal specific outreach and follow upAboriginal specific outreach and follow up

Youth outreach and housing teamYouth outreach and housing team

New comers, refugees and people with New comers, refugees and people with settlement issuessettlement issues

Post Incarceration support for people Post Incarceration support for people leaving detentionleaving detention

Mobile Multi-Disciplinary Outreach Team (MDOT)Mobile Multi-Disciplinary Outreach Team (MDOT)

Multi organizational team of specialists (nurse, concurrent Multi organizational team of specialists (nurse, concurrent disorders therapist, case manager, housing worker, disorders therapist, case manager, housing worker, psychiatrists) provide outreach to individuals with severe psychiatrists) provide outreach to individuals with severe mental illnessmental illness

Provide comprehensive assessment to clients on the Provide comprehensive assessment to clients on the streetstreet

Focused on linking to appropriate Focused on linking to appropriate services within the mental health, services within the mental health, primary care and addiction sectorsprimary care and addiction sectors

Consultation to outreach teams is Consultation to outreach teams is also provided.also provided.

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Housing First but not Housing onlyHousing First but not Housing onlyFollow up Support ProgramFollow up Support Program

Individualized service Individualized service planning and goal setting planning and goal setting

Landlord support and Landlord support and mediationmediation

Monthly rent checksMonthly rent checks Linking clients with new Linking clients with new

communitiescommunities Harm reduction strategies Harm reduction strategies Eviction prevention and Eviction prevention and

crisis interventioncrisis intervention Exit strategy, and re-Exit strategy, and re-

housing if applicablehousing if applicable

Streets to Homes: Building on successStreets to Homes: Building on success Post-occupancy survey of people Post-occupancy survey of people

housed through Streets to Homes housed through Streets to Homes

49% decreased or quit alcohol49% decreased or quit alcohol 73% decreased or quit other drugs73% decreased or quit other drugs Less use of 911, ambulance, fire, Less use of 911, ambulance, fire,

court and police detox servicescourt and police detox services 54% panhandled when homeless54% panhandled when homeless 23% reported panhandling once 23% reported panhandling once

housedhoused

Housing makes the future look better – Housing makes the future look better – 82% more positive.82% more positive.

Client Perspective on Housing FirstClient Perspective on Housing First Friendliness and persistence of outreach workers Friendliness and persistence of outreach workers

was key to accepting servicewas key to accepting service

Being housed – especially the first few months – Being housed – especially the first few months – is a difficult adjustment and many people think is a difficult adjustment and many people think about leavingabout leaving

Despite all the difficulties and adjustments, Despite all the difficulties and adjustments, clients are inclined to want to stay housedclients are inclined to want to stay housed

“…“…to leave would screw everything up. I would go back to square to leave would screw everything up. I would go back to square one. I’m walking a fine line right now and I don’t want to go that one. I’m walking a fine line right now and I don’t want to go that way.”way.”

Expansion of Streets to HomesExpansion of Streets to Homes

Increase of 48 FTE staffIncrease of 48 FTE staff 24/7 service24/7 service Specialized supports for Specialized supports for

individuals who are housed and individuals who are housed and panhandle panhandle

Expansion of pre-employment Expansion of pre-employment work preparation programwork preparation program

May 2008, Council approved an enhancement to May 2008, Council approved an enhancement to Streets to Homes services, to address the needs of Streets to Homes services, to address the needs of people who panhandle or are otherwise street people who panhandle or are otherwise street involvedinvolved

Outcomes to dateOutcomes to date

3,000 people housed in 5 years3,000 people housed in 5 years Most in the private marketMost in the private market In housing of their choiceIn housing of their choice Spend an average 41% of monthly income on Spend an average 41% of monthly income on

rentrent

More than 80% remain in housing at 12 More than 80% remain in housing at 12 monthsmonthsMost in the first apartment they choseMost in the first apartment they choseIntensive monitoring and supportIntensive monitoring and support

Evidence that Housing First is working Evidence that Housing First is working in Torontoin Toronto

2009 Street Needs 2009 Street Needs Assessment Assessment

51% reduction in 51% reduction in street street homelessness in homelessness in TorontoToronto

What’s New – Fall 2010What’s New – Fall 2010

Streets to Homes Assessment & Referral CentreStreets to Homes Assessment & Referral Centre

Street RespiteStreet Respite Walk-in Housing AccessWalk-in Housing Access Overnight ProgramOvernight Program Walk-in Referral to ShelterWalk-in Referral to Shelter Dedicated Local Outreach Services Dedicated Local Outreach Services

Critical success factorsCritical success factors

Partnership, Partnership, PartnershipPartnership, Partnership, Partnership

Council commitment to end street homelessnessCouncil commitment to end street homelessness

Opportunity to pilot projects and innovate under Federal Opportunity to pilot projects and innovate under Federal Homelessness Partnership StrategyHomelessness Partnership Strategy

Committed and innovative staff who believe in making a Committed and innovative staff who believe in making a difference, one person at a timedifference, one person at a time

Client-centred thinking; listening to clientsClient-centred thinking; listening to clients

Tracking outcomes and evaluationTracking outcomes and evaluation

Future / ongoing challengesFuture / ongoing challenges Sustainable follow up supportsSustainable follow up supports

Need to re-housing clientsNeed to re-housing clients

Access to affordable and supportive Access to affordable and supportive housinghousing

Maintaining a healthy staff teamMaintaining a healthy staff team

Tracking outcomes and evaluationTracking outcomes and evaluation

Integrating health services with social Integrating health services with social (homeless) services(homeless) services

Ongoing sustainable funding from Ongoing sustainable funding from provincial and federal governmentsprovincial and federal governments

Ongoing impact of extreme poverty on Ongoing impact of extreme poverty on our clientsour clients

James and MauriceJames and Maurice

James2007web.lnk Maurice2007web.lnk

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Contact us:Contact us:

Gord TannerGord TannerManager, Streets to HomesManager, Streets to Homes

416-397-4210416-397-4210gtanner@toronto.cagtanner@toronto.ca

Katie KeatingKatie KeatingSupervisor, Social Assistance, Streets to HomesSupervisor, Social Assistance, Streets to Homes

416-397-5182416-397-5182kkeatin2@toronto.cakkeatin2@toronto.ca

www.toronto.ca/housingwww.toronto.ca/housing