properties were self-contained, usually a one bed flat if someone is living alone, not in immediate proximity to other Housing First tenants. In the European model, congregate models (using self-contained flats with tenancies) and properties in which two or three people had a shared tenancy were sometimes used. Sometimes this was as a result of individual needs and preferences; often it was driven by the nature of housing markets and welfare benefits systems. Also, in the original model, mental health support models, assertive community treatment (ACT) and intensive case management (ICM), were specified, which involves considerable direct provision of services by Housing First when supplying ACT (used for homeless people with the very highest needs). Thus far, UK Housing First experiments have been a case-management only
version of Housing First. Here, as in the original model, there is a relatively high amount of contact between workers and Housing First service users, but health, drug, alcohol, mental health and other support needs are handled primarily through referral and support with using external
services23. In other words, UK Housing
First services have, thus far, ensured someone has a doctor, makes sure they attend appointments and get the treatment they need, works to get any help wanted with drugs and alcohol from specialist services and arranges other treatment and support on the same basis, connecting people with services, rather than providing those services directly.
Broadly speaking, while the trials of ‘high fidelity’ Housing First in Canada
23 Bretherton, J. and Pleace, N. (2015) Op. Cit. (74% of service users housed for 1 year or more) 24 Busch-Geertsema, V. (2013) Housing First Europe: Final Report http://housingfirstguide.eu/website/
wp-content/uploads/2016/03/FinalReportHousingFirstEurope.pdf 25 Bretherton, J. and Pleace, N. (2015) Op. Cit.
26 Johnson, G., Parkinson, S. and Parsell, C. (2012) Policy shift or program drift? Implementing Housing First in Australia, AHURI Final Report No. 184, AHURI: Melbourne; Pleace, N. and Quilgars, D. (2013) Improving Health and Social Integration through Housing First: A Review DIHAL.
27 Quilgars, D. and Pleace, N. (2016) Housing First and Social Integration: A Realistic Aim? Social Inclusion, 4 (4), pp. 5–15
28 Bretherton, J. and Pleace, N. (2015) Op. Cit.
and in France, using the original ACT/ICM model have proven highly successful, there are reports of very strong results from Housing First services using a case management approach24. In England, seven out of
every 10 service users were housed at one year by five Housing First pilots25, in the Netherlands, Finland,
Portugal and Ireland, similar or better results were achieved by Housing First services that followed a case management model.
Outcomes from Housing First
The clearest measure for success in the use of Housing First lies in the evidence that it sustainably ends homelessness. The evidence in respect of improvements to health, well-being and social integration is more mixed26, but there is evidence of
positive outcomes in these respects as well27.
The evaluation of Housing First pilots in England completed in 201528 found
that, among 60 users of Housing First services:
• 43% reported bad or very bad physical health a year before using a Housing First service, with 28% reporting the same poor levels of health as Housing First service users (i.e. a 15% drop in reports of bad or very bad physical health).
• 52% reported bad or very bad mental health a year before using a Housing First service, dropping to 18% when surveyed as Housing First service users.
• Uneven results in respect of drug and alcohol use, but some evidence of improvement for individuals. • 25% of Housing First service users
39
Housing First
reporting daily, weekly or monthly contact with family one year before using Housing First, compared to 75% reporting these levels of familial contact as Housing First service users, a 50% improvement. • Falls in involvement in anti-social
behaviour, from 78% reporting involvement a year before using Housing First to 53% as Housing First service users.
The international evidence shows that: • Finnish experience in using Housing
First as an approach to long-term and recurrent homelessness, has been extremely positive and lain at the core of a sustained national strategy that has brought Finland to a point where homelessness is becoming a functional zero. The concept of functional zero can be summarised as a state in which experience of homelessness is rare and, where it does occur, short- term, with Finland having levels of homelessness that are extremely low by UK standards29. Housing First
is successful in Finland because it is a part of an integral homelessness strategy which includes a strong emphasis on prevention and an array of lower intensity services: a point to which we return below.
• The first stage of the Danish
Homelessness Strategy from 2009- 2013 was one of the first large-scale Housing First programmes in Europe and housed more than 1,000 people, the intensive case management versions of Housing First reported a 74% housing retention rate, with a 95% rate being achieved by assertive community treatment models of Housing First (Benjaminsen, L (2013)30.
29 For further details, see: Pleace, N.; Knutagård, M.; Culhane, D.P. and Granfelt, R. (2016) ‘The Strategic Response to Homelessness in Finland: Exploring Innovation and Coordination within a National Plan to Reduce and Prevent Homelessness’ in Nichols, N. Doberstein, C. (eds) Exploring Efective Systems Responses to Homelessness Toronto: Canadian Observatory on Homelessness.
30 Benjaminsen, L (2013) Policy Review Up-date: Results from the Housing First based Danish Homelessness Strategy European Journal of Homelessness 7.2, pp. 109-131
31 Source: ARA http://www.ara.fi/en-US
32 Goering, P. et al (2014) National At Home/Chez Soi Final Report Mental Health Commission of Canada 33 http://www.home-eu.org/85-percent-homeless-persons-france-keep-home-two-years/)
• The Finnish use of Housing First within an integrated homelessness strategy is directly linked to the reduction in long-term homelessness. Finland recorded 2,628 long-term homeless people in 2012 and 2,047 in 2016, a drop of 23%31.
• The major Canadian national pilot, the At Home/Chez Soi programme, has been determined to be a major success. In the last 6 months of a study which compared Housing First service users with a ‘Treatment as usual’ group32, the following results
were obtained:
Table 3.1. Outcomes of national Canadian Housing First pilot
Housing status in last 6 months of trial
Treatment as Usual
Housing First
Housed all of the time 6% 62% Housed some of the time 23% 22% Housed none of the time 46% 16% In France, the pilot of Housing First
(Un Chez-Soi d’abord programme (2011-2016)) in four cities was led at a national level by the inter-ministerial body responsible for the national homelessness strategy. Overall, 85% of Housing First service users retained housing over the course of two years and the programme was extended to 16 cities33.
Health, Well-Being and Social Integration
The core goal of Housing First, what it seeks to achieve as a model, is to use housing as a basis from which to pursue integration into mainstream social and economic life. What this means in practice is that Housing First seeks to improve the following aspects of an individual’s life: