Webinar recording: Housing First, the 10-20%

This session from April 29, 2021, explored the 10-20% of clients who are unsuccessful in ending their homelessness through participation in a HF program. Presenters highlighted the research, challenges, programs and supports for those who have had difficulty getting stably housed through Housing First; including an innovative model of housing first that blends scattered-site and permanent supported harm reduction housing models seamlessly to meet the needs of program participants.

Presenters

  • Tim Aubry, OHFRN-CoI co-lead, University of Ottawa, Canada
  • Susan Crouse, Executive Director, Horizon Health Network's Salvus Clinic, New Brunswick, Canada
  • Elina Liikanen, Sininauha OY, Finland
  • Jordan Mills, Director of Clinical Services, Saskatoon Crisis, Canada
  • Discussant: Michael Allen, Director of Advocacy, Focus Ireland

Webinar recording

International webinar series on Housing First: HF and the 10-20% (April 29, 2021) from EENet on Vimeo.

Resources from presenters

Questions and answers from the webinar

The following questions were submitted by webinar attendees during the presentation. Answers to their questions are included below. Response speakers are indicated as follows:

  • Tim Aubry (TA)
  • Susan Crouse (SC)
  • Jordan Mills (JM)

How do you explain the lower rate of housing instability for ethnoracial groups? Is it because few get access to HF? Are there similar findings for indigenous?

TA response: They represent 25% of the population with a disproportionate number in Toronto. It is a curious and unanticipated finding.  It’s possible that it’s related to the effectiveness of the anti-racist / anti-oppression HF program delivered by across boundaries.

I forgot to mention that we entered cities first into the regression and Winnipeg had more people in HF who were unstably housed and 70% of the participants in Winnipeg were Indigenous.  As a result, Indigenous identify doesn’t get picked up. 

Are people who move continuously because of issues with tenancy considered stably housed?

TA response: In study 1 , people unstably housed were in housing less than 50% of the first nine months in year 1 and not continuously housed in the last 3 months.   In study 2, people unstably housed were housed less than 90% of the time in the last 6 months. The definition does not take into account reasons behind the loss of housing and it is true that it could be because of tenancy issues tied to landlords.

Very interesting results regarding individual characteristics. Did you look at type of housing? E.g. private market vs. non profit housing?

TA response: All of the housing in Housing First programs were in private market rentals.  HF tenants in Montreal were given a choice of private market or social housing – all of them chose private market housing.

It puzzles me a bit. Chronic homelessness and addiction are the strongest predictors of housing instability, while at the same time the Housing First approach has been developed especially for that group and has led to previously unprecedented results for them.

TA response: True, but they are not really strong predictors. It just means that people with longer lifetime periods of homelessness and more severe substance use problems are at higher risk of being unstably housed.  The approach is successful 80-90% of the time for this population.

Wondering if you have any data on impact of ABI?  

TA response: We entered neuropsychology test scores picking up cognitive impairment in study 1 and it was not a significant predictor.  We have not done that yet for study 2.

Together, all predictors predict only 28% of variability, so actually, they are not really predicting' - important to keep this in mind! (Tim correct me if I'm wrong?)

TA response: What the 28% represents is the accuracy of the regression model in being able to identify someone will be unstably housed in Housing First.  It’s very low. Actually, the predictors only account for 17% of variabililty.

Tim - did you explore what individuals were incarcerated for when analyzing this?  I suspect incarceration among this population is directly related to one's substance use disorder.

TA reponse: No we only had their recent history of incarceration before coming into the study and not the reasons behind it.

I will send Angela a study we did in Toronto on the housing needs of justice involved people who are homeless. We analysed client characteristics on the supportive housing waitlist. Findings suggest need for support around SUD issues, using interventions such as DBT, CBT, and using correctional release planning tools, to support people involved in the justice system.

Resource from Steve Lurie: Justice-focused Mental Health Supportive Housing in Toronto (PDF) — Please note that this resource was created by a third party. While we are pleased to share this resource with you, we cannot guarantee its accessibility.

Participant comment: It did seem to me to be predictions that we shouldn't be too attached to because it's not strong, but it triggered this thought nonetheless. Thanks for your explanation Steven!

For Tim: did you look at the characteristics of the social network/quality of relationship with family and friends?

TA response: It gets captured in the quality of life measure as two of the life domains. However, we didn’t specifically look at perceived support.

Tim, you started by stating, "...this is an exceptional period we are going through."  What did you mean by that statement?   It appears that the 10 to 20% of individuals whom we are having a very hard time finding long term housing for are driving headlines across the country.   Can you speak to this issue?

TA response: I was referring to the pandemic.  Good point – I am assuming you’re talking about the encampments.  Actually, I would expect the people who are chronically homeless during the pandemic would be just as successful if there were Housing First available to them. We have not sufficiently scaled it up across the country.   

Following up on @Tom Greening's comment re "unprecedented times" and "the 10 to 20% of individuals whom we are having a very hard time finding long term housing" - this percentage has been relatively the same across various Housing FIrst studies over the past 15+ years. I'm wondering if these numbers have changed (e.g. gotten significantly higher) during this time of unprecedented housing instabillity, huge losses in private market affordable housing stock, and financialization of housing internationally? We know this crisis is hitting every renter in every social class. What is this doing to the scattered site private-market-reliant model as a whole?

TA reponse: There is no data that I am aware of that shows a change in housing outcomes of Housing First programs.  I think the more pressing issue is finding housing in some cities.  Curiously, the private rental market in our big cities did show a significant increase in vacancy rates and lowered rents as a result of the pandemic.

A lot of these solutions are housing-stock based. Can anyone provide more suggestions on how to best support participants to decrease the 10-20% number without a housing stock? Thank you.

TA response: From the data I presented, I would suggest provide more intensive support in the first year to people with longer lifetime histories of homelessness and recent histories of incarceration before entering Housing First. Related for the latter, Housing First program should work closely with probation services to support people in their new housing.  Also, we need to integrate into Housing First programs substance use treatment or link up with substance use treatment services in the community.  The lack of focus of Housing First programs is a real gap. 

Anecdotally, our observations suggest that SUD is becoming more prevalent - opioids, drug poisoning and specifically crystal seem to be increasingly associated with homeless lin shelters or, increasingly, living rough.    This sub-group has a VERY difficult time accessing private sector housing and existing supportive housing struggles to maintain tenancies. Substance use disorder.

TA response: Yes, so true.  We need to figure out how to address the special needs of this sub group.  The Moncton and Saskatoon programs are really innovative ways of doing that. 

I am interested who we count as 10-20 %? Tims definition was cleare, but for exemple in Czech republic we have problems to secure another housing in short time. I found out that it is quite common to count different groups here. Do we count people who need to be rehoused (how many times), people who are incarcerated, people who have serious health issues?

TA response: It refers to the group of people in Housing First programs who over a period of time move frequently often as a result of eviction and are not able to establish stable housing.

JM response: I don’t think ‘the 10-20%’ is a great descriptor. To me, this is a loose term that describes a subset of the population that despite being tried in scattered site housing first with good fidelity and true tenacity, it isn’t the right fit for them. Cyclical evictions despite high quality housing first. Generally, this amounts to 15% of the population or so….why it doesn’t work is less clear, as Tim pointed out, and less static.

Can rent not be paid direct?

SC response: In the case of the peer supported housing that we developed, we try if at all possible to have the rent paid directly from the source. This is not always successful as individuals may have money from a variety of sources or they may not have bank accounts. This is something we work on once we have them housed.

Maybe I missed this; but is PSH used for the 10% that do not make it within Housing First?

SC response: Yes PSH was developed to house those that were unsuccessful in the pure housing first model with scattered sites and regular market. It can be long term housing if the individual needs or wants it.

Susan, I'm curious if you are using a Home Unit Takeover framework for some of the illeagal activity and over-run with "friends"?

SC response: I am aware of some the work that has been done in this area and home unit takeover is a complicated issue for sure. Some of our clients are very vulnerable and in a small city it is often difficult to find units away from those who might prey on these vulnerabilities. Tenants often express that they don’t want these people in their apartment, but they fear for retaliation. The support team assists as much as possible but often “friends” just bother the other tenants in the building to gain access. In the PSH model, having quiet hours and secure entrances as well as a peer superintendent has all helped to keep guests under control.

Under the reasons individuals left, is eviction or being asked to leave under one of the four listed?

SC response: The five most common reasons that clients were asked to leave or were evicted from the Housing First Program are:

  • Causing problems with other tenants or superintendent
  • Apartment takeovers by friend
  • Substance use issues
  • Nonpayment of rent or utilities
  • Issues related to mental health

Does subletting the units allow you to enforce rules more easily? Does it avoid issues with the landlord tenant board (what it is here in Ontario) and get more private landlord buy in?

SC response: Originally, we had hoped that it would allow us to avoid issues, but in reality, a sublet is treated the same as a regular lease by the residential tenancy board. We have a sub agreement that they sign around the rules for the PSH and we can evict them if it is not working with proper notice. Most of our evictions have been more of a discussion with the tenants about why it isn’t working and then trying to help them see if anything else in the community would meet their needs better.

Susan, how is the decision way who is ready for HF or for PSH?

SC response: In the original PSH apartment unit we only placed those who had not been successful in scattered site housing with private landlords. Many of them had been housed 4-5 times in scattered apartments. As we have added new units to the program, we still like to give people the opportunity to be in a scattered site apartment first. From Tim’s presentation we learn that as providers we really can’t predict who will do well in a true Housing First model. Unfortunately in our community, there are people on the By Names List who routinely get skipped over by housing providers as the providers feels that their needs are too intensive for them to provide housing so we have taken these individuals into PSH. When they do well we move them to a more independent unit.

Susan, I am curious, Do the tenants have level of input relating to the building,  its day to day,  month to month organization and rules, in for lack of a better descriptor, "co-op" light. If so do you find that this can/does allow the tenants a feeling of empowerment and community?

SC response: Michael you make a wonderful point. One of the things that we are currently looking at is formalizing the way tenants can give input by creating a tenancy board or group. Most of the feedback we get presently is informal but certainly we have changed our rules as we have gone along based on this feedback. Having a peer superintendent on site helps with this input as they often bring tenant concerns to us. I didn’t speak too much about creating community, but we do host BBQ’s, community gardens, etc. at the buildings to help with this aspect.

Sorry, is the SCIS a hosptial program or a community agency?

JM response: The SCIS model is a Community Based Organization – not a hospital model.

How do you manage to get the housing stock to be able to house someone the day you meet them?

JM response: We have one staff on our team dedicated to working in a continuous loop with landlords. Because of this, we have landlords that trust our organization and will open spots to us so we often have several choices of spots in market rental housing. This hasn’t come easily, its taken years of work to establish these relationship to landlords.

Curious for these housing first programs what the length of time in program are on adverage? We are given key indicators of 12 to 18 months in a housing first program but sometimes find we are housing people muitple times in this period meaning that we don't get the chance to really dig into more long term supports as they remain in and out of housing crisis.

JM response: our program generally works with people between 2-12 yrs, sometimes longer.

What is the LOS @ Edwards Manor. When people move do they move to scatterred?

JM response: Edwards Manor is time unlimited. The participant can choose to move, or stay. If they move, it is sometimes to scattered site, but sometimes to residential settings such as group homes. In Saskatoon we have a mental health approved home system and this would be considered a step down from Edwards Manor. There are many pathways in and out of Edwards Manor – we try to offer the one that the client/participant wants.

Can anyone speak to how they actually secured funding for these types of housing units?  We are struggling to find funding to build supportive housing for youth - it seems no bank wants to touch a non-profit; funders want to see 'guarantees' around donations for the next 5-10 yrs so they can be assured their loans can be repaid.  Who can guarantee donations moving forward?  It's frustrating to know what is needed and not be able to find the funds to do it properly.

JM response: agreed, funding is a challenge. We try to develop core – multi year contracts with government and health funders for services, and then use that to build funding security to entice other funders (including Reaching Home funds) to give us money