Complexity of need among men entering a ‘housing first’ model in Sydney

1. Complexity of need among men entering a ‘housing first’ model in Sydney Elizabeth Conroy, Centre for Health Research UWS Mat Flynn, Service Manager, MISHA

2. MISHA model • Permanent housing • Support period 2-3 years • (Aspirational) multidisciplinary team (nurse, occupational therapist etc.)

3. Fidelity to ‘housing first’ • ‘Housing first’ model (as described by Tsemberis 2010) • Rapid access to permanent housing (2 weeks for Pathways) • Consumer choice • Separation of housing and services • Recovery as an ongoing process • Community integration • (Having a multi-disciplinary team)

4. Recruitment & housing of clients • Eligibility criteria: • History of homelessness (any kind) • 25 years or older • Wanted support • Connection to Western Sydney • Tried to get a mix of low and high needs: • Rough sleepers (assumed to have high needs) – target of 30-35% • Mix of low and medium need • Time lapsed between recruitment of clients and when they were housed • Case management commenced immediately (or co-case managed) • Not necessarily housed straight away

5. Number of participants housed per month since start of support period (n=64)

6. Research question • Anecdotal feedback: intensity of case management was similar for rough sleepers and clients from accommodation services • Unexpected • Impact on case loads • Employed team leader • Does the survey data reflect this?

7. Complex needs • Rankin and Regan (2004) • Breadth – multiple needs, interconnected • Depth of need – severe, intense • Often equated with: • sleeping rough • substance use • mental disorder • But no ‘generic’ complex needs case (Rankin & Regan, 2004)

8. Analysis model

9. The Research Sample

10. The research evaluation

11. Demographic profile of clients

12. Age categories

13. Income

14. Complex needs results

15. Accommodation immediately prior to MISHA

16. Lifetime experience of homelessness

17. Past 12 months homelessness • Chronic rough sleepers – 20% (n=15) • Defined as 6 months continuous episode of sleeping rough OR four or more separate episodes of sleeping rough

18. Psychological distress

19. Lifetime & past month substance use

20. Top 10 problems in the past month

21. Self-efficacy

22. Results • No differences found between the two groups • Regardless of definition used • Breadth & depth of problems • OR substance use & mental health • Issue of small sample size • Replicated on the Michael Project sample (n=250) • Same results • Confirms what MISHA staff noticed anecdotally • Amount of time spent on case management was similar for those recruited from the streets and accommodation services • Where they come from bears little relation to their level of need when housed

23. Discussion & conclusions • What does this mean for ‘housing first’? • Identifying the right balance of complex and non-complex clients  impact on case management workloads • What does this mean for accommodation services? • Expectation that those coming from services would cope better  ‘housing ready’ • Our findings confirm that the two groups are similar in terms of complexity of need • Being housed is stressful even if you come from an accommodation service

24. Discussion & conclusions (cont.) • Learning and practising life skills • Accommodation services – • safe, structured environments • limit exposure to circumstances or situations that case management can perhaps have the most benefit with • ‘Housing first’ models • Allow complexity to unfold • Learn ‘in situ’ (i.e. managing emotions and stress etc)

25. Acknowledgements • MISHA clients • MISHA staff • Claudia, Wally, Adam, Belinda, Rachel, Amber, Jeff, Carmel • Mission Australia • Lesley Butt • Philanthropic donor • Research team • UWS: Marina Athanassios, Danielle Lacey • UNSW: Lucy Burns, Tony Eardley • UWA: Paul Flatau • Mission Australia: Bronwen Dalton