Housing First Glasgow Evaluation and Findings

1. Housing First Glasgow Evaluation and Findings Dr Sarah Johnsen

2. Introducing the Pilot Project • Background: response to high levels of repeat homelessness amongst people with substance misuse issues in Glasgow • Client group: 22 homeless people involved in active substance misuse • 3 year pilot (Oct 2010 – Sept 2013) • First project of its kind in UK 2

3. Project Aims • Main aim to reduce re-occurring homelessness • Specific objectives: • Improvement in personal living situation • Reduction, or no increase, in substance misuse (as per users’ personal goals) • Reduction, or no increase, in injecting or associated risk behaviours • Reduction in involvement with criminal activity • Improved psychological wellbeing • Improvement in overall physical health • Improved capacity to participate in and be valued by society 3

4. Project Principles • Founded on belief that security of own home + support = better position to begin journey toward recovery from addiction • Key principles: • Provision of scatter-site housing (‘ordinary’ social housing) • No ‘housing readiness’ prerequisites • Harm reduction approach • No time limits on duration of support or length of tenancy (standard Scottish Secure Tenancy) • Respect for consumer choice (insofar as supply allows) • Holistic support 24/7 (assertive outreach and motivational interviewing; staff on-call outside office hours)

5. Project Details • Eligibility criteria: • 18+ years • Homeless (statutorily and eligible for s.5 referral) • Current drug, alcohol or polysubstance problem • Needs not being met by current services • Desire to sustain a tenancy • Staff team • Service coordinator • Assistant service coordinators • Peer support workers

6. Pilot Evaluation • Independently evaluated by Heriot-Watt University • Longitudinal study involving: • Interviews with TPS staff and key stakeholders (x2) • Interviews with pilot service users (x2) • Case file analysis

7. Service User Profile at Recruitment • Most aged 25-44; 18 male/ 4 female; all White British • Backgrounds of revolving door of homelessness / institutional care • Substance misuse problems typically date back to early teens • For many, drug addictions severe; alcohol dependencies less so • Almost all been involved with criminal justice system (mostly minor acquisitive offences, some more serious/violent) • Weak (and often damaging) social support networks, but some benefited from positive family support • Approx half had never had paid work

8. Outcomes: Housing Stability NB: no evictions

9. Outcomes: Health • Physical health improved for majority • Less substance misuse and better diet • …but some still in poor health • Mental health outcomes also good on balance • Stable housing and ‘stickability’ of support = ↑ psychological wellbeing • But, ‘dip in mood’ not uncommon after being housed (often accompanied by ↑ substance misuse / relapse)

10. Outcomes: SubstanceMisuse • Outcomes mixed, but positive on balance • Drugs: • ↓ in severity of drug misuse for majority • 10 abstinent at end of pilot period • …but minority still reported high level of dependence at wave 2 • Alcohol: • less change in severity of alcohol dependence • 2 former problematic drinkers abstinent at end of pilot period • some substitution of alcohol for drugs • Most met / closer to meeting substance misuse goals

11. Outcomes: Criminal Activity & Financial Wellbeing • Criminality and street culture • Overall↓ in concert with ↓ in substance (esp. drug) misuse • Similarly, general ↓ in street culture activities (e.g. begging, sex work), but minority continue to beg regularly • Financial wellbeing • Improved for most (due to ↓ in drug misuse) • But, majority still find it difficult to cope financially

12. Outcomes: Social Support • Family support important for some; a few have (re)established contact with estranged children • Friendship/ peer networks complicated: • Some cut ties with other users; vulnerable to isolation and very reliant on staff for social/emotional support • Others still in contact; less likely to be lonely but had greater difficulty ‘managing the door’ and higher risk of relapse

13. Outcomes: Meaningful Activity & Community Integration • Employment and meaningful activity • Outcomes better than anticipated: 7 in training/education; 5 attending day services (e.g. NA); 2 voluntary work • Majority view paid employment as long-term goal • Community integration • Know neighbours ‘well enough to say hello to’ • Instances of neighbourhood disturbance rare • Neighbour complaints resolved without resorting to eviction

14. Trajectories Three general trajectories re direction and extent of behaviour change / ‘distance travelled’ on recovery journey Sustained positive change – outcomes largely or uniformly positive overall and sustained; c.½ service users (n=11) Fluctuating experiences – periods of relative stability punctuated by ‘slips’ on recovery journey; c.¼ service users (n=6) Little observable change – housing stability achieved, but little evidence of change re other outcomes; c.¼ service users (n=5)

15. Service User & Stakeholder Views • Very high levels of service user satisfaction; esp. re: • Flexibility and ‘stickability’ of support • Understanding and non-judgemental approach of staff • Ability to be able to be ‘honest’ about their addiction • Generally viewed as highly successful by stakeholders; ‘conversion’ of ‘sceptics’, in large part due to: • High rates of tenancy sustainment for ‘serial disengagers’ • Far fewer instances of neighbourhood disturbance than anticipated

16. ‘Lessons Learned’ • Critical importance of communication with police and housing officers • Delays in accessing flats/furnishings demotivating • ‘Making house a home’ mitigates against ‘dips in mood’ • Peer support workers ‘add value’ • Value of informal/ unstructured recreational activities

17. Conclusion • Housing First ‘works’ with people involved in active substance (esp. illicit drug) misuse … • … and the Glasgow pilot is already informing the development of other projects throughout the UK and beyond