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Reflections on Lessons Learned from a Housing First Researcher

Tim Aubry, Ph.D., C.Psych. Third Research Symposium Calgary, Alberta April 23, 2015. Reflections on Lessons Learned from a Housing First Researcher. #1 Housing First is Equally Effective in Cities of Different Sizes and Composition Across Canada. Montreal Pop: 1,621,000. Toronto

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Reflections on Lessons Learned from a Housing First Researcher

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  1. Tim Aubry, Ph.D., C.Psych. Third Research Symposium Calgary, Alberta April 23, 2015 Reflections on Lessons Learned from a Housing First Researcher

  2. #1 Housing First is Equally Effective in Cities of Different Sizes and Composition Across Canada. Montreal Pop: 1,621,000 Toronto Pop: 2,503,000 Winnipeg Pop: 633, 000 Vancouver Pop: 578, 000 Moncton Pop: 107,000

  3. #2 People with Severe Addictions Can Also Achieve Housing Stability with Housing First. Percentage of Time Spent in Housing in the Past Year

  4. #3 It is Virtually Impossible to Predict Who Will Not Be Successful in Housing First Programs.

  5. Redesigning the System: Housing First Approach Permanent housing (scatter-site, off site services) Permanent Single Site (on-site services) Community-based, Residential Treatment (on-site clinical staff) Longer term Institutional Care Least Restrictive Setting Most Restrictive Setting

  6. #4 Housing First Programs Achieve Only Modest Non-Housing Outcomes. Differences in Quality of Life Differences in Community Functioning

  7. Logic Model of Housing First Recovery = Functioning + Community Integration + Quality of Life Engagement + Stable Housing + Health and Social Services Housing First

  8. #5 There is No Evidence That Housing First Impacts Employment, Vocational, or Educational Outcomes. % of Participants with Moderate Needs Obtaining Some Form of Employment Housing First 25% Treatment as Usual 28%

  9. #6 Housing First is a Modest Investment with Modest Cost Offsets.

  10. #6 Housing First is a Modest Investment with Modest Cost Offsets. Cost Analysis – Based on Service Use (Top 10% Users) $10 invested in Housing for Top Decile (TD) group : Average  savings of $21.72

  11. #6 Housing First is a Modest Investment with Modest Cost Offsets. Cost Analysis – based on Service use (High Users) Major cost offsets are hospitals, home visits, jail/prison office visits

  12. #7 Programs Must Stay True to Core Housing First Standards to Achieve the Best Outcomes. Maintaining a Balance between Fidelity and Adaptation adaptation fidelity

  13. #7 Programs Must Stay True to Core Housing First Standards to Achieve the Best Outcomes. “When Fidelity Goes Out the Window” adaptation fidelity

  14. Fidelity Standards for Housing First Approach

  15. Consumer Narrative Sub-Sample (N = 195) Positive life change – “This is the first time, you know, that I’ve had a home… like I’ve had supportive housing before, but I didn’t feel like I was safe. And, this is the first place like I… feel like I love to go home…I feel so safe. Mixed/neutral life change – “That’s what life is, cause it’s just like I said, like picking up, losing it all, picking up, losing it all, picking up, losing it all.” Negative life change – “They discharged me to a hotel. I left the next day. It was noisy, bug-infested, full of drugs.” #8 Qualitative Findings of Housing First Studies are More Impressive than Quantitative Findings.

  16. #8 Qualitative Findings of Housing First Studies are More Impressive than Quantitative Findings. Participant Feedback about Life Course

  17. #9 Landlords Who Partner with Housing First Programs Are Business People with Prosocial Motives.

  18. #9 Landlords who Partner with Housing First Programs are Business People with Prosocial Motives.

  19. #10 Social Isolation and Poverty are Ongoing Challenges Faced by Many Successful Tenants in Housing First Programs. “Housing is First. What’s next?”

  20. Future Directions 1. Achieving recovery outcomes 2. Integrating addictions treatment into HF 3. Improving employment outcomes • Adopting a strengths-based approach 5. Adapting HF for youth & families • Accommodating people with additional needs who are not succeeding in HF

  21. Acknowledgements The national At Home/Chez Soi project team: Jayne Barker, PHD (2008-11) and Cameron Keller, MHCC National Project Leads; Paula Goering, RN, PhD, Research Lead and over 50 investigators from across Canada and the US. In addition there are 5 site coordinators and numerous service and housing providers as well as persons with lived experience. The research has been made possible through a financial contribution from Health Canada to the Mental Health Commission of CanadaThe views expressed herein solely represent the authors. The Supportive Housing Addictions Recovery Program – Evaluation was funded through a contract with the Ottawa Branch of the Canadian Mental Health Association. The evaluation team gratefully acknowledges the assistance and participation of the staff and clients of the Ottawa Supportive Housing for People with Problematic Substance Use program for their involvement in this evaluation. The evaluation team also thanks managers of CMHA Ottawa and the Oasis program for technical support in conducting of the evaluation. We also thank the Mental Health Commission of Canada for providing the research protocol of the At Home / Chez soi Demonstration Project.

  22. Thank You! Questions?

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