Housing First in the world
Organized by Pathways to Housing and DESC, central players experiments Housing First USA, a conference was held from March 20 to 24, in New Orleans. Sylvaine Villeneuve was there for Aurore. This post provides a first analysis of these exchanges, which will be supported later.
Housing First USA
In the U.S., the approach "Housing First" is experienced for 20 years, but it is still considered a pioneering approach which goes against traditional practices of care for the homeless. From March 20 to 24, a conference, for the first time, met at The New Orleans, nearly 700 researchers and practitioners in the medical and social sector, from all states. What is striking is that many questions are asked in the same terms in France and the United States, when questioning the concept of Housing First.
Developed a practice for twenty years
Experimentation "Housing First" began in 1990 in New York with the team of Sam Tsemberis that ensured medical marauding in the streets with the homeless. To believe Bill Hobson, DESC president, major NGOs of Seattle, operator manager of shelters, and co-organizer of the conference, "Housing First the term has become incredibly popular in recent years in the U.S., especially in the administration who is responsible for housing issues and homelessness. Local authorities and the federal government, distributing tens of millions of dollars to operators to implement it. "
Since 2009, the Obama administration has committed a federal policy to fight against homelessness and access to housing (Homeless Emergency & Rapid Transition to Housing Act). She created a fund to prevent eviction (Homeless Prevention Fund). She supports the model of Housing First for homeless chronicisés. In early March, the Secretary of State for Planning and Housing, Shaun Donovan, said the Housing First Model in an interview on a major TV station: "It is not only better for people but it is also much cheaper, and it resolves homelessness instead of putting a bandage on it "... As in France, the idea of Housing First - housing without any preconditions - was of course very controversial for many years. He objected that drug addicts and people with mental disorders, but also all the people on the street, had become "housing ready" home loans - weaned, followed medically and employment - before being "rewarded "accessing the housing.
Those on the street for some time [...] have much more chance to stabilize if we start by offering them a home
But in recent years, a series of studies and academic research came undermine these principles and have shown that the homeless, including the most vulnerable - those on the street for a long time, drug or undergoing mental disorders severe - were far more likely to stabilize if we start by offering them a home, before any proposed medical care and social. First, a series of assessments "costs-benefits" showed it was cheaper to install people in housing.
One study was a landmark in the ‘90s showed that chronically homeless most severely in the street could cost the federal finances between 35,000 and 150,000 dollars / year, if we accounted stays in emergency shelters, to hospital (or psychiatric emergencies), in prison, etc.. And this, with no monitoring, no treatment, no hope of tangible social inclusion and improving their health. Other studies have been conducted since, going in the same direction.
Second, research has shown that the implementation of Housing First had better outcomes for the people themselves, especially those who are black-listed and rejected by the emergency reception centers.
The generalization of the model after Katrina : After Hurricane Katrina in 2005, the Greater New Orleans led a special policy to try to reduce the number of homeless in the streets (12,000 in 2005, and there are still 6000). UNITY federation which brings together 60 associations throughout the city, has widely applied the Housing First model for the homeless remained in town, in generalized far beyond the few people suffering from addiction or serious mental disorders . In several states, the Housing First model is now applied as of inadequate housing and non-housing, and is no longer reserved exclusively for homeless very désociabilisés.
Points of convergence USA / France
There is a set of rather striking similarities between the two countries, the issue of homelessness.
Like actors: Operators of "shelters" (emergency shelter) are associations ("Communities"), almost always charitable, who work together social workers and volunteers. Actions of transition to housing and social housing are also carried by associative operators ("Community").
Relations with the central government rather similar "It's great what you do, but we will have trouble keeping the 2011 budget ...", Mark Johnston (federal Housing & Homeless). Centralized funding The federal government provides partial funding policies against homelessness, supporting actors and charitable foundations (the Bill Gates Foundation spends as much money as the federal state ...).
Similar debates: Instead of "shelters"?
In advance, we must keep in mind that there is no equivalent model CHRS, that people are either emergency shelter or housing, or anywhere ... The support services may be provided by the organization that hosts, but they are offered separately in resource centers. The idea of separation instead of living / support services is not in debate. However, the idea that there might see a failure of coaching, people once installed in their homes, is under debate (see below, chp. "Queries").
The question of the role of "shelters" across the continuum towards the housing is placed in much the same way as in France, and carried by the operators who manage the centers:
- There will always be situations of emergency, to shelter, it will take over.
- There are people for whom the "housing first" is not appropriate immediately, for which the group plays a role.
Housing together or dispersed?
The subject was very present. Operators of shelters, because of their history, are often grouped together housing advocates, as they manage social landlords, with acquisition of real estate assets and management of the frame (the CHRS with self-contained units ...) The teams from psychiatry argue instead renting apartments placed in the grounds of common law (a kind of intermediation rental). To harmonize the practices of Housing First, the founders asked seven principles of social support and medical intensive:
- People out of the streets and emergency shelters to be installed in a home without preconditions acceptance of treatment or support;
- The operator must be able to provide intensive support services ("robust support services"), which are proposed but not imposed;
- The retention of housing does not depend on the commitment of the person in a care process or integration;
- The teams target the most vulnerable and do not let them aside;
- Teams carry a risk reduction approach, not an approach of abstinence;
- Tenants have a lease and rights;
- The model "Housing First" can be developed in a public housing grouped or scattered in homes.
Ideally, it is proposed to the person two or three different homes, so she can choose. And a new home when she brought out ... The application of these principles is a big challenge. There was a workshop which was entitled: "Housing First, for the Tenth Time ..." = "Housing first, for the tenth time ..."
A real difference: the evaluation
The study found that housing stability also allowed savings, millions dollars L'évaluation allowed the generalization of this model in progress. Earlier this year, a study conducted by researchers at the University of Washington has reinforced the advocates of radical reform of the management of people homeless. This study involved a group of one hundred homeless extremely desocialized, followed for two years.
These people on the street were offered accommodation, without any precondition of withdrawal. We do not ask them to stop drinking or taking drugs or engaging in a psychiatric or other conditions that are usually asked. They were given the keys to their homes and were provided an intensive social support. The study showed that once installed in their homes, they had reduced their drinking in half, they were significantly better, they were engaged in therapeutic treatments, they were using a lot less often to hospital emergency departments ... and that it had made an annual saving of $ 4 million to aid programs for the homeless in Seattle! These are the initial feedback from the application of the principle of "Housing First".
The experimental Housing First Montreal
In Montreal, the research project receives $ 20 million + a dedicated team of social workers + a coordinator.
- As noted by the founder of Pathways to housing and Housing First, Sam Tsemberis, it's "Housing First, not Housing Only! "=" Housing First, not only housing! "
- Positionings associations / operators of transitional housing, social housing, are the same as in France. On the issue of social support ("intensive support").
- Similar fears: "Stay true to the spirit" does not skimp on the "wrap-around service" (the "envelope"), condition for success.
- What role for housing operators?
- Bill Hobson: "Many operators of housing accessible to low-income households are financially asphyxiated. They seek money desperately. They are committed to Housing First programs, but in reality they are like before ... And the State which finances controls nothing, requires no return. That's why we want a general dialogue on the subject. What conditions implemented? What principles? What obligations for operators? "
- Grouped housing? Dispersed settlement? Managers of nursing homes should they become social landlords?
- The "wrap-around services" = the overall support, 7/7, 24/24. How?
- What "contract" with the person, if any prerequisite is fixed?
- On what people give priority when resources are limited?
- Housing First and social landlords: a relationship "love / hate."
- How to improve relations with neighbors?
- Home visits. Intrusive?
- How to manage crises? Violence?
- How to combine the "peers"?
- How Housing First applied to families?