© 2013 Canadian Homelessness Research Network

ISBN 978-1-55014-637-0

Gaetz, Stephen; Scott, Fiona; & Gulliver, Tanya (Eds.), Housing First in Canada: Supporting Communities to End Homelessness. Toronto: Canadian Homelessness Research Network Press.

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This book is protected under a Creative Commons license that allows you to share, copy, distribute, and transmit the work for non-commercial purposes, provided you attribute it to the original source.

The editors wish to acknowledge the work of Sarah Jean Harrison and KC Santo who provided excellent copy-editing services. We would also like to thank the key informants who contributed to the development of each case study: Tim Richter, Katrina Milaney & Alina Turner (Calgary – Calgary Homeless Foundation), Kim Wirth/Katie Davies (Infinity Project), Brad Crewson (Victoria), Amanda DiFalco (Hamilton), John Sharpe & Timothy Ross (Fredericton), Amelia Ridgway (Vancouver), Wally Czech (Lethbridge) and Susan McGee & Alex Abboud (Edmonton).

The Canadian Homelessness Research Network (CHRN) acknowledges with thanks the financial support of the Government of Canada’s Homelessness Partnering Strategy (Employment and Social Development Canada) and the Social Sciences and Humanities Research Council of Canada. The analysis and interpretations contained in the chapters are those of individual contributors and do not necessarily represent the views of the financial contributors of the CHRN. The views expressed in this book are those of the Canadian Homelessness Research Network and do not necessarily reflect the views of the Government of Canada.

City of Lethbridge &

Social Housing in Action

Lethbridge ALBERTA

Fiona Scott & Stephen Gaetz

Key Messages

• The staff team has been documenting the key lessons learned in the implementation of a Housing First program. A set of 10 lessons are included in this case study.

• Several experts in Housing First – from Canada and the U.S. – have informed the development and adaptation of the model in Lethbridge.

• Lethbridge was one of the first cities in Canada to develop a Plan to End Homelessness in 2009 and is coming up to the end of the initial 5 Year Plan.

• As an early adopter of a Plan to End Homelessness Lethbridge has seen a significant decrease in absolute homelessness, as well as a decrease in shelter usage.

In 2008 Alberta became the first province in Canada to develop a 10 Year Plan to End Homelessness. Upon receiving provincial funding, the City of Lethbridge developed Bringing Lethbridge Home − the 5 Year Plan to End Homelessness (2009-2014), a community plan fully aligned and integrated with Alberta’s 10 Year Plan and augmented the Community Plan developed for Human Resources and Skills Development Canada. Bringing Lethbridge Home is based on a Housing First approach that addresses the root causes of homelessness through participant-focused support and service, prevention, rapid re-housing, diversion and integrated community support services.

Seven guiding principles frame Bringing Lethbridge Home:

1. Ending homelessness depends on visionary, innovative and brave leadership from all orders of government.

2. Housing is a basic human right. An adequate stock of housing must be accessible, safe and affordable.

3. All responses to ending homelessness are based on the Housing First approach.

4. Our community is strengthened socially and economically when all people are safely and securely housed.

5. Creation of opportunities for self-reliance, social integration and community participation supports people in successfully sustaining their housing.

6. Continuous learning and improvement, which includes evidence based practice, is necessary.

7. Strong collaborative partnerships are essential to best serve the community.

Since the city’s implementation of Bringing Lethbridge Home and the sixth annual homelessness census in 2008, Lethbridge has seen a progressive decrease in its rate of homelessness including a 93% decrease in absolute (street) homelessness. The latest homelessness census in 2012 showed a 27% decrease in the total number of people experiencing homelessness since the previous year (136 people in 2011 to 99 in 2012), a 25% decrease in the sheltered population and a 50% decrease in the number of people categorized as experiencing absolute homelessness (SHIA, 2012).

Responses to the 2012 census indicated that 22% of respondents declared “their health-related issues” as the main barrier in obtaining permanent affordable housing. An additional 21% of respondents indicated that their inability to pay rent prevented them from accessing housing. More than half (54%) of respondents reported that they had experienced homelessness for a year or more, suggesting that chronic homelessness is still an issue that needs addressing in Lethbridge.

The City of Lethbridge is one of the seven community-based organizations in Alberta that work with the provincial Ministry of Human Services to implement the strategies established in Alberta’s 10 Year Plan to End Homelessness. The Social Housing in Action (SHIA) group functions as the community advisory board. In 2009 the City of Lethbridge began introducing Housing First teams into the community. This case study provides an overview of Lethbridge’s experience of planning, implementing and sustaining a Housing First approach including ten embedded principal lessons, as well as some of the barriers faced and how they were overcome. The data from Lethbridge demonstrates that Housing First is an effective means of supporting people experiencing homelessness in securing and maintaining housing.

GETTING STARTED: FRAMING THE ISSUE

Securing community support for a Housing First approach is an ongoing process in Lethbridge that focuses on education. Many people have heard of the Housing First concept, but few understand what it really entails.

Lesson #1: Housing First versus housing first

Lethbridge as a community, both people and organizations, has widely embraced the Housing First philosophy. However, in terms of delivery it is important to identify the Housing First agencies that have both the required mandate and the necessary expertise. Housing First is not a simple task, particularly because it goes beyond just housing; case management is equally important.

In order to be considered a Housing First team in Lethbridge, an agency must be actively establishing relationships with landlords, providing Intensive Case Management (ICM) that includes stringent follow-up support and continually working with clients in developing the skills and relationships necessary to maintain their housing. Lethbridge’s qualifying teams are grounded in research-based evidence that has identified effective Housing First strategies and policies, such as maintaining a consistent focus on program orientation, client criteria and core principles.

An important component in implementing Housing First in Lethbridge is the continued effort to educate the community around the differences between case management and ICM. These differences are most clearly seen in the level of support provided to clients around skill development and barrier elimination. Wally Czech, Housing First Specialist with the City of Lethbridge, explains why ensuring that the community knows the difference between Housing First and ‘housing, first’ can avoid having teams develop bad reputations for incidents unrelated to their work:

“We received some feedback from a housing organization, that they were getting damage to property from our Housing First clients. We found out that it wasn’t us who facilitated the housing but instead it was people referred by the homeless shelter. They believe in Housing First and try to support it, but they aren’t funded to do it and intense follow is not part of their mandate. You need to know who is funded to do it and who has the skills and the training to do the follow-up”.

In Lethbridge, the process of educating people about Housing First has included consultations with experts and the community, public workshops and meetings with landlords in the community to explain the program and its benefits.

The Housing First team is now in the process of planning and preparing a complete education and social marketing community-wide campaign to further educate the community.

Lesson #2: Tell the Community about Homelessness: People Experiencing Homelessness are Human Too

Lethbridge believes that helping people understand the realities of homelessness is an important part of increasing the public’s understanding of what is required to end homelessness. Homelessness results from a variety of intersecting personal and systemic issues including lack of income, lack of supports and lack of access to supportive housing. As Czech explains, there is never one singular event that causes homelessness:

“People don’t snap. All kinds of things happen in a person’s environment that accumulate and contribute to the choices people make. All of these negative things can make it easy for people to become homeless. There is no one who wakes up and says, ‘I want to be homeless for a while’. If people learn to see the homeless as real people, ‘human beings’, then they have more empathy and more willingness to join in the efforts to assist them”.

When the public understands that people experiencing homelessness are humans too, they are more committed to providing those experiencing homelessness with housing. Housing First teams in Lethbridge continue to talk to community members around the basic human right to housing, as recognized under the Universal Declaration of Human Rights1. They work to dismantle the belief that people experiencing homelessness have to prove themselves before they are provided with housing.

Challenges in addressing homelessness in Lethbridge exist in many aspects. ‘Not in my back yard’ or NIMBYism continues to be a barrier to implementing effective solutions, as is achieving complete community support. However, Lethbridge is working hard to educate the community about its teams and benefits. Through community outreach and media campaigns, combined with engaging municipal council, landlords and community members, the teams are raising awareness about Housing First.

MOVING FORWARD: PLANNING

Lesson #3: Understand Your Community

Understanding Lethbridge’s demographics and trends was important in identifying the specialized supports and interventions that would be required to make the Housing First model effective. According to Lethbridge Census: Count Yourself In, Lethbridge has a population of 90,417 people and a 5.9% vacancy rate. It is bordered by two large Aboriginal reserves: Blood Indian Reserve No. 148 and Pikani No. 147. Students represent a significant portion of the population for a city of its size. It is also an economic hub, with a high level of transiency as people move around for work.

Approximately 50% of jobs in Lethbridge are in health, retail, hospitality and education including the university and college level. With such a large population of the workforce employed in education, Lethbridge has developed a strong community education focus.

Understanding the cultural make-up of Lethbridge was also crucial to program development. Lethbridge is a diverse city made up of many different cultures with a recent influx of Bhutanese refugees. In order to provide appropriate services, Housing First teams have created partnerships with different cultural organizations in the city (such as the Aboriginal Council of Lethbridge and Lethbridge Immigrant Services) and calls upon the Inclusion Consultant at the City of Lethbridge for advice on cultural matters. Partnerships with outside organizations allow workers to draw upon these organizations’ expertise when identifying the cultural needs of a client within a service plan. Professional development for staff has also been provided regarding how to work respectively with other cultures.

As with many other communities, Lethbridge’s population experiencing homelessness has a disproportionate number of Aboriginal persons. Housing First staff recently met with leaders of nearby reserves to discuss things like housing, employment, education and others reasons that lead people to migrate from the reserves to the city. It has been important for both staff and clients to understand the differences between reserve and city life in order to best support those wanting to move. For example, income assistance rules can be different for those living on reserve – there are sometimes different expectations from those living in the city compared to the reserve – which many are not aware of until they arrive in Lethbridge. This includes stricter guidelines for receiving income support, landlords not allowing long-term guests based on lease agreements or no tolerance in the city for multiple guests or overcrowding. Housing First teams have been educating on-reserve communities before they move to the city, making sure individuals have all of the information required for a successful transition. Lethbridge found that a transition period between leaving the reserve and being housed completely independent in the city is often helpful for Aboriginal people making the shift. This provides time to learn and understand how life in the city works and to make appropriate connections. It is important to note however, that this transition time only occurs when it is possible and if the individual chooses that option.

Racism is an ongoing issue for Aboriginal people in Lethbridge. The situation is so difficult that when Aboriginal people contact a landlord that have been forced to make it part of their process to ask the landlord if they ‘rent to natives.’ Lethbridge Housing First teams want to change that. Ongoing public education about the causes of homelessness and the effectiveness of solutions like Housing First are crucial in dismantling this racism.

Lesson #4: Identify Who Your Champions Are

Taking Housing First from a concept to creation requires commitment and leadership from diverse sectors in the community. The involvement of key individuals from diverse sectors in the community keeps the projects moving forward, providing stability and strength in the effort to end homelessness. In Lethbridge these champions include Dr. Gary Bowie, Chair of the SHIA and Diane Randell, Manager of Community & Social Development at the City of Lethbridge. Both were instrumental leaders in developing Housing First programming. Francis First Charger, Blackfoot Elder, has been heavily involved in program development as well as making connections between the City of Lethbridge and its neighbouring reserves. Several other members of the public sector, service providers, community leaders, as well as business and real estate leaders and have all contributed and support the plan to end homelessness in Lethbridge.

Lethbridge also has a champion on the inside. Wally Czech, the Housing First Specialist, oversees all Housing First teams funded by the City of Lethbridge. Czech is responsible for ensuring fidelity to the Housing First model, as well as ensuring that clinical best practices are used. Having one staff member who specializes in Housing First and is responsible for all of the teams has been critical in guiding the development of programs in Lethbridge, identifying gaps and programming needs and promoting continuity among Housing First teams in Lethbridge.

Lesson #5: Get Help

When implementing a new approach to ending homelessness, quickly building community capacity and asking for outside help are essential tasks. Drawing upon the knowledge of earlier programs and perspectives and bringing in expertise from outside of the community on programming and implementation were valuable strategies in Lethbridge’s Housing First development.

A number of experts came to Lethbridge to talk about Housing First and its related components. Sam Tsemberis, Pathways to Housing in New York City, provided education on Housing First, including its framework, strategies and procedures. Tsemberis helped solidify the necessary steps in successfully planning and implementing Housing First teams. Iain de Jong, Consultant on Housing First with OrgCode, was also brought in to discuss Housing First implementation.

Outside expertise in support services provided professional development in areas such as motivational interviewing, trauma and addictions. While some similar resources were available within Lethbridge, particularly around motivational interviewing, existing resources did not focus on the homelessness sector or within a framework for Housing First. They are now seeking to take advantage of experts like people from t3 in Seattle and others to have training such as motivational interviewing to be more applicable to working with the homeless population. Dr. Gabor Mate, who specializes in trauma, mental health and addictions, instructed other community partners and professionals on effective ways of supporting clients experiencing these issues. Ongoing collaboration occurs with the other six cities in Alberta to develop and share training including the development of an online training site available to all seven cities.

Finally, staff were assisted with ‘systems thinking’ by David Stroh and John McGah from Bridgeway Partners in Massachusetts. Stroh and McGah specialize in helping organizations solve complex social problems through planning, change management and systems thinking; an area identified as needing additional support within Lethbridge’s Housing First teams.

HOUSING FIRST MODEL IN LETHBRIDGE

Housing First in Lethbridge is directed and monitored by The City of Lethbridge with SHIA acting as an advisory board. Housing First teams are funded both provincially through Human Services and the Outreach Support Services Initiative (OSS) as well as from the federal government through the Homelessness Partnering Strategy (HPS). All Housing First teams in Lethbridge share the following critical elements:

• A prioritization of the most complex cases being served first.

• A focus on helping individuals and families access and sustain permanent housing as quickly as possible. The housing is not time-limited.

• A variety of services including objective-based ICM are delivered following a housing placement to promote housing stability and individual well-being.

• Services are time-limited or long-term depending upon individual need and complexity.

• Supports or services from Housing First Teams are not contingent on compliance to such conditions as treatment or abstinence. Instead, participants will be subject to a standard lease agreement and are provided with the services and supports that are necessary to help them be successful.

The following Housing First agencies and support programs are funded by SHIA to provide Housing First activities in Lethbridge. In order to avoid duplication, each one has a specific mandate.

Community Outreach is the original Housing First team established in Lethbridge and is based out of the Canadian Mental Health Association (CMHA). The agency focuses on people experiencing chronic homelessness with complex, multiple-barriers to housing. They work with both men and women in an ICM model providing housing and supports in market housing. They also have a team specific to working with complex youth ages 18-24.

Diversion is located within the Lethbridge Emergency Shelter with the mandate to connect immediately with new to shelter clients. If deemed to likely be Housing First eligible they will connect them to centralized intake for assessment. If they are not Housing First they will work with that individual to create an action plan in effort to divert them from the shelter as quickly as possible. Lastly, they provide ICM supports to individuals or families needing eviction prevention support.

The Aboriginal Housing First Team provides interim supportive housing in a residence setting for Aboriginal women with our without children. They also provide Housing First supports including outreach and ICM to Aboriginal women, men, and families with our without children transitioning from the Reserve to urban life.

YWCA Residence is a 30 unit permanent supportive housing facility for women, with or without children (depending upon age and gender), who have complex needs. This facility can be an individual’s permanent home and includes Residence Counsellors. They provide day-to-day support through ICM, as well as continued support if an individual leaves the residence. They make it a priority to reserve vacant units for Housing First eligible clients.

HESTIA Homes is permanent supportive living for youth ages 18-24 who are homeless, or at risk of being homeless, as they transition to adulthood. HESTIA is a type of foyer model with three homes each having three rooms available for the youth with a live in mentor to help with life skills and daily living. They also each have a follow-up worker providing ICM.

Woods Youth Shelter is an emergency youth shelter designed for youth 13-18 years of age. The shelter can house 8 youth, each with separate sleeping quarters and a shared kitchen and facilities. Twenty-four hour staff includes a new daytime staff position. The shelter works regularly with Children’s Services and other community organizations to assist youth in family mediation, referrals, onsite support and housing (SHIA, 2012). In cooperation with the Housing First Specialist, Woods has now developed a Housing First team for youth under 18. With a motto of ‘Family First then Housing First’, and incorporating ICM, the Housing First team are housing these youth in market rentals and providing intense follow-up supports.

The Intake Process

All Housing First teams take their referrals from HomeBASE – a new centralized intake, triage and referral team in Lethbridge. Clients are referred to HomeBASE where they undertake initial screening using the Service Prioritization Decision Assistance Tool (SPDAT). SPDAT determines a client’s eligibility and identifies their major barriers to maintaining housing, which allows clients with the most complex cases to be served first. Once a client’s eligibility is determined, additional in-depth screening and intake determines the most appropriate housing avenue based on housing and caseload availability. The information collected with SPDAT also informs the nature of a client’s comprehensive service plan once they are housed. A Universal Intake form eliminates the need for a client to repeat the intake process when they are referred to a program; instead the information collected with Universal Intake, SPDAT summary accompanies them to the appropriate agency. This is all transferred through a warm transfer process which includes the HomeBASE intake worker, the new agency, and the client and guardian if applicable.

The HomeBASE Universal Intake was created based on intake best practices research. Intake forms from each agency were combined to create a universal and centralized intake form. Czech explains the benefits of this new centralized intake:

“We have a variety of teams all with different mandates and we did not like the idea of people bouncing around the community from agency to agency telling and retelling their story only because they did not know the most appropriate agency to serve them. We also wanted to eliminate the potential and already occurring problem of agencies veering away from their mandates which made things complicated later on when justifying why certain individuals were being served and others were not. We also knew it would provide a great venue for gathering data centrally and discovering gaps in our services. So HomeBASE helps us to determine Housing First eligibility and then if they are eligible they can be immediately referred to the appropriate agency to serve them. If they are not Housing First, they still receive a referral to the most appropriate place in the community to help them. We try to not let them leave empty handed.”

Each agency has its own team of outreach and follow-up workers which helps lower case loads. After intake and referral to the appropriate agency an Outreach Worker is assigned to the client, helping them find housing and stabilize income. Once a client accesses housing they are connected to a Follow-Up Workers (FUW) from the Housing First team that provides SPDAT based and objective based ICM. The FUW spends up to three months helping the client stabilize their housing, orienting to their surroundings and learning how to take care of their responsibilities including rent and utilities.

The FUW then works with the client to create a service plan, identifying barriers to maintaining their housing and discussing ways that the worker can support the client in addressing those barriers. The FUW assists the client in accessing additional supports and services, as well as learning skills necessary to maintain permanent housing. Czech explains the importance of FUWs:

“This follow-up support is key to the long-term success of the participant. First, they obtain a sense of security and safety by getting a roof over their head. Then, they increase their level of self-esteem and confidence by having a home. Lastly, they maintain that home by having consistent, intensive, long-term support to assist them in becoming self-sustaining. This Housing First recipe is the foundation to Bringing Lethbridge Home. We house them and then we wrap them up with what they need to stay housed.”

Meaningful Daily Activity

Lethbridge believes that meaningful daily activity and social connections are essential in helping clients maintain housing. People often lose housing because they are not used to the rules and regulations that come with permanent housing. For example, newly housed clients may try to help others who are experiencing homelessness, or are precariously housed, by giving them a place to stay; unfortunately this can put the client at risk of losing their housing. It is important to help clients find ways to stay socially connected in a manner that does not jeopardize their housing. FUWs advocate for the client and stay connected with the landlord to deal with any such issues. In an effort to assist teams and help clients with options for meaningful daily activity, other programs have been created. These would include Clean Sweep which is a downtown workforce for Housing First participants and Real Artists at Work (RAW), which is Housing First art/dance program.

A follow-up assessment and the SPDAT are completed every three months to assess progress. The goal is to keep the client active in the program and help them reach graduation. Clients graduate from the program when they have fulfilled the following three criteria:

1. They have been active for a year or more and have maintained housing for six consecutive months of the year while in the program.

2. SPDAT scores have consistently gone down.

3. The client and case manager mutually determine that supports are no longer needed.

If these criteria are not all fulfilled work with the client continues.

MAKING IT HAPPEN: IMPLEMENTATION

Lesson #6: Collaboration, Collaboration, Collaboration

Implementing an effective Housing First team requires drawing upon all the ideas, connections and networks available in the community. Lethbridge has benefited from high levels of collaboration, as well as connections with organizations that have not historically been a part of the solution to end homelessness. Relationships have been developed with the Aboriginal Council of Lethbridge, Children’s Services, Persons with Developmental Disabilities (PDD), Mental Health, Seniors Mental Health, Covenant Health and many more. Funding has been provided to Lethbridge Legal Guidance to provide specific support to Housing First clients and landlords to educate and assist with landlord tenancy issues.

Peter Block, expert on community development, speaks of the need to bring together key stakeholders to resolve complex community issues. This means including program users; people experiencing homelessness know what they need and what will help. There is often concern that such collaborative processes are too slow, however in Lethbridge bringing people together has actually sped up the process rather than slowing it down.

An example of this collaboration in Lethbridge is Project Connect. Project Connect serves as an annual trade fair for people experiencing homelessness or other issues in their lives that have kept them from being connected to services and programs. Individuals and families who are struggling can come together and meet service providers in the areas of employment, counselling, health services, youth services, government information, legal advice, housing outreach and tax advice.

Housing First in Lethbridge has also developed partnerships with the following key organizations in the community:

Police Services

Collaboration with Lethbridge Police Services has resulted in several positive changes. After providing education on Housing First for the police, a relationship was established with Police Services Sergeant Tiffany Housworth of the Downtown Policing Unit who has spearheaded initiatives in collaboration with the Housing First teams. This new department was created to address the issues causing problems for the police and community in Lethbridge’s downtown core. Since the partnership began, the police have nearly stopped issuing tickets to people experiencing homelessness and are instead working with Housing First staff.

An innovative example of this collaboration between the police and Housing First staff is the Housing First ID Card, and a Housing First data base created by the police which allows them to flag Housing First participants for the entire police force which potentially will create alternative courses of actions when dealing with these individuals. Many officers found it difficult to know how to handle people experiencing homelessness they encountered on the streets. To address this issue a Housing First Card was created for clients. The card will contain the clients name, photo, the agency they work with and their key worker and contact information. So if an officer see this ID card, it will trigger them to look up the client in their data base and they will be able to see if this person is housed, what their address is and any other pertinent information they need to assist this client and possibly avoid more punitive alternatives.

If a client is involved in a situation with police presence, the card can be presented to the officer who is then able to contact a client’s FUW and help the client get home.

Income Support Programs

From the outset of Lethbridge’s relationships with income support programs such as Alberta Works Income Support (IS), Assured Income for the Severely Handicapped (AISH) and Persons with Developmental Disabilities (PDD) were developed. Many clients experiencing homelessness have spent considerable time living on the street and may have been exposed to trauma and/or brain damage; two situations that may qualify a client for income support. In order to streamline the eligibility process, which includes undergoing neuropsychological testing, the P12 Lethbridge Homeless Outreach Support Services Test Centre was created as a partnership between the Common Access Service Implementation Office (CASIO), the Family Violence Prevention and Homeless Supports Division and the City of Lethbridge. The P12 Test Centre also supports two of the strategies highlighted in Alberta’s 10 Year Plan to End Homelessness: 1) reformulate Alberta’s government assistance programs to ensure they achieve the coordinated objective of providing Albertans with housing stability and 2) make it easier for clients to connect with Alberta’s government programs and services.

Developing The P12 Test Centre provided an opportunity to work collaboratively with several partners on improving outcomes for individuals experiencing homelessness in the Lethbridge area. While the original intention was to streamline applications and eligibility determination for income support services, the initiative has since been expanded to include eligibility determination for the Office of the Public Guardian (OPG) and the Office of the Public Trustee (OPT).

Landlords

Partnerships with landlords are crucial for the teams’ ability to maintain and increase housing availability. Housing First in Lethbridge provides training on landlord relations for its agencies. Czech explains how they work with landlords:

“We support the landlords by keeping them informed about what they need to know regarding the status and progress of the client. With landlords you need to be honest with them, let them know what is going to happen, but also that you will be there to provide supports for them and the individual living in their apartment. They need to see that you are working for the benefit of all involved and that you will be there to help with issues as they arise. But it is always a work in progress.”

Alberta Health Services

Collaborating with Alberta Health Services is an essential part of supporting existing teams and developing new ones. SHIA meets with Alberta Health Services monthly to discuss programming issues and solutions. Alberta Health Services is also a funder of Housing First projects including the new Brassard House, a 12 bed permanent supportive housing facility through Covenant House and based out of St. Michael’s hospital. Using a harm reduction approach, Brassard House provides health care through St. Michael’s to seniors and those who are functionally geriatric due to chronic disease and other health issues, and chronic addictions and mental health issues who as a result would not be successful in market housing.

Mental Health

Staff from the Alberta Health Services (AHS) mental health clinic are a part of ongoing meetings with Housing First staff where working with clients experiencing both mental health issues and homelessness is discussed.

Complex Case Consultations

A number of partners from Housing First and other agencies, including AHS addiction and mental health, meet weekly to discuss complex cases that FUWs are handling. Alberta Works, AISH, Downtown Policing Unit, and Lethbridge Emergency Shelter are also included. Others will be added as desired.

Workers present a client’s comprehensive story using a formalized consultation template, which is followed by discussion and brainstorming of ways to assist the client. The last portion of this meeting is a round table for all Housing First agencies and partners discuss other questions and concerns around common clients, processes, and other ways to improve the work with this population Czech describes the process:

“So we get everybody and anybody together. If you aren’t sure whether they should be involved, invite them anyway. One of the greatest advantages of collaboration, especially in the early stages, but is important throughout, is that those at the table and part of the discussion now have a vested interest, when they feel like they are part of something bigger than they are and have influence they become supporters instead of antagonists. But I would suggest even involving the naysayers. Most of the time they are the way they are because they care about their community. Get them involved in a way that shows that their opinions and ideas matter to you.”

Lesson # 7: Housing First Must be Evolutionary

A constant theme in Housing First programming is the need to adapt. Learning from process – ideas will be tried, some will work and some will not – is essential to a team’s success. Even successful implementations will need ongoing modifications in order to best serve clients.

Additionally, the broader social context within which a Housing First team is operating may change as a result of a variety of factors. The economy may weaken, housing prices may shift or there may be important demographic changes that require adaptation. As learning continues and grows, so too may the need for new program options. In Lethbridge, the following changes and developments have occurred since Housing First began there in 2009:

Adapting to a Changing Demographic

During the last several years the demographic of Aboriginal people migrating from reserves changed from mostly women with or without children to an increasing number of men and families with or with out children. Housing First staff adapted funding and shifted the focus and mandate of a Housing First team in order to better address this emerging demographic. In addition, housing units for Aboriginal men and their families are currently being developed that will be made available to Aboriginal tenants who are transitioning off of reserve.

Creating a Furniture Bank

Most people who are experiencing homelessness do not have furniture or the funds to buy furniture. Lethbridge has created a furniture bank dedicated solely for Housing First clients. When first housed they are able to pick out furnishings and other items to make their house a home at no cost.

Centralized Intake

Centralized Intake evolved from the need to better assess and monitor eligibility for Housing First supports and streamline entrance into the appropriate Housing First team. The centralized Intake prevents clients from bouncing around the community looking for the appropriate connection and becomes information gatekeepers, which in turn allows gaps to be identified.

It has also benefited agencies and funders and was an important development in enabling Housing First to be information gatekeepers, which in turn allowed for gaps in service to be identified.

Stabilization Units

A number of permanently leased units are allocated to the Housing First teams in order to provide clients with a short-term transitional home where they can complete some of the final pieces of stabilization necessary before being ready to be independent. This might include final efforts to establish income, or take care of some legal matters and so forth. If the transitional unit suits the client well, they will be able to take over the lease. Another unit will be acquired to keep a constant stock of stabilization units.

Post-Release Housing First Team

The Post-Release/Discharge Housing First Team is specifically designed to house and support individuals being released from corrections and hospital psychiatric and acute care units. Such individuals often do not qualify for ‘traditional’ Housing First teams because they would be seen as transient due to their short time in the community. The Post-Release Housing First Team will address these barriers by working on the process of release when a client enters one of these facilities and begin discharge planning and assessing as soon as possible. The Team will also conduct both outreach and ICM.

St. Joan’s Haven

St Joan’s Haven will be a 40-bed harm reduction based facility that will provide housing and health care for people who have extreme mental health, addictions, and/or physical needs, require 24-hour support and are not appropriate for market housing (regardless of support level) due to these chronic conditions. Brassard House is the interim program set up until the complete project is completed. It houses 12.

Castle Apartments

One floor of the Castle Apartments building will be strictly for Housing First clients experiencing complex needs, are looking to transition away from the influences of addictions, mental health and homelessness and would benefit from intense on-site support.

Lesson #8: Develop Housing First Fidelity

Adhering to the principles of Housing First is an important consideration in Lethbridge’s Housing First teams. Housing First was designed to address the needs of the most vulnerable population – people experiencing chronic homelessness with high levels of acuity. In addition to the core principles, Lethbridge has identified the following factors as important prerequisites for effective programming:

Caseload Numbers

In Lethbridge, staff have a client load of 10 – 15 people (outreach is higher at 20) that contains a balanced mix of complexities. It is recognized that case loads that exceed these levels compromise the effectiveness of a staff person’s work.

Remain True to Staffing Roles

Outreach and FUW staff must only be responsible for their specific tasks. Outreach is strictly about stabilizing income and finding housing, whereas FUW involves ICM and wrap-around supports.

Follow-up is Objective-based

In order to move clients toward self-sufficiency, a case plan must include specific goals and avenues for achieving these goals, informed by the challenges and successes of the client’s SPDAT analysis.

Follow-ups are Planned, Purposeful and Based on Tasks Set Out in Service Plan

The activities and services that a client is referred to should relate to the goals and barriers identified by the SPDAT.

Tool for Measuring Acuity

A reliable, valid and consistent tool is important for measuring acuity in order to guide and prioritize clients, as well as to develop goals that can be achieved by the client. In Lethbridge the use of the SPDAT is crucial in monitoring improvement. ICM is also based on and driven by the SPDAT.

Affordable Housing

Access to affordable housing continues to be a priority in the City of Lethbridge’s Social Policy (2008) and Affordable Housing Policy (2008). The need for affordable housing is demonstrated by the 623 households that are currently on waiting lists for subsidy services. Community trends suggest that more rental properties will be needed in the community, based on number of retirees and others that face challenges in managing their own property. Even when affordable housing is available, NIMBYism attitudes present a significant barrier, particularly for the Aboriginal population.

Although Lethbridge has the highest vacancy rate amongst Alberta’s major cities at 8.8%, the properties that are available are not affordable for everyone. Because of the city’s high number of students, the number of people becoming landlords as a side business has grown. Rental properties generate income for landlords and there is no incentive to reduce their rents. It is therefore essential to continue finding ways to encourage private landlords to work with Housing First teams in Lethbridge.

Sustainability

Integrated Approach

Lethbridge’s Community Plan and Bringing Lethbridge Home: The Plan to End Homelessness 2009-2014 will only be possible with support from a variety of stakeholders including all levels of government, the public and private sectors and the community.

Prove it With Data

Continuing to collect data and disseminate information about the outcomes for Housing First clients is crucial in validating the work. Housing First staff continue to inform funders about the numbers of people housed, maintaining housing, and other areas such as improvement in quality of life, as well as reduction in the use of emergency services.through all of their funded agencies.

Creating Innovative Ways of Using the Cost-savings to Fund Housing First

Client’s reduced utilization of emergency services, reduced substance use and improved health status are the result of participating in Housing First which in turn produce cost savings. In the long term, Housing First staff in Lethbridge would like to see a method of using the money saved in the health, social and justice sectors by Housing First programming to be funneled back into supplementing program costs. This could include, for example, giving landlords reductions on property taxes for renting to Housing First clients. In order to achieve this, the City of Lethbridge needs a means of recuperating their costs and as of yet there is no plan in place to facilitate this goal.

Lobbying and Education

Sustaining Housing First also means making sure that community members continue to be aware of both the program and Lethbridge’s need for Housing First. Teams continue to educate and re-educate the community on these needs, as well as lobby at both the provincial and federal levels.

EVIDENCE OF EFFECTIVENESS

All of the Bringing Lethbridge Home teams use a specialized assessment tool called the Service Prioritization Decision Assistance Tool (SPDAT), which measures 15 specific items that have been identified in the research as indicators for maintaining permanent housing. The SPDAT is completed every three months in order to continually and consistently inform the needs and progress of each client. Data collected from the implementation of Housing First in 2009 show that:

• Over 864 households have been permanently housed and in 2012-2013 90% remain housed through Housing First.

In 2011-12:

• 199 households have ended their experience with homelessness and are now permanently housed.

• Over 205 people received intensive Follow-up Support.

• Overall, there was a 25% reduction in shelter occupancy and over 70% fewer people are living in absolute homelessness (SHIA, 2012a).

ADDITIONAL KEY MESSAGES

Lesson #9: Housing First: One Size Does Not Fit All

While there are core principles to Housing First, there is not a single program model that applies to every situation. Every community is different and what has worked in Lethbridge may not work in Regina. Flexibility is essential to building a program based on local needs.

For some communities core need and priority may be permanent, supportive housing. For others the priority may be subsidized housing or rapid rehousing. A strong community assessment completed with solid data and community-wide collaboration is essential to determining the specific set of needs required in each context.

Lesson #10: Build It and They Will Come

Paying attention to the service delivery model and how people access services is central in planning successful teams. An integrated service delivery model is essential, but is often misunderstood as a centralized service where all programs are run out of the same building. In fact, overly centralized service delivery can undermine efforts to move people out of homelessness. The separation of services is very important.

Czech describes the potential problems with centralizing services at shelters for people experiencing homelessness:

“In the movie Field of Dreams, there is the famous line ‘Build it and they will come’. At the shelter in Lethbridge the next line would more likely be ‘The problem is that I built it, you came, more keep coming and nobody wants to leave’. One of the things we thought years ago was to have a one-stop shop at the emergency shelter. Everything in one place. But this became a problem at a time when we were trying to eliminate shelters or shelter beds as opposed to building more of them. The problem, in our experience, is that when you create shelters as the central hubs for all services for people who are homeless, the shelter becomes like a vacuum. The longer people spend time at the shelter, the longer they stay homeless. One of our team’s ‘resource centre’ was in a shelter, and they brought in other resources and services. The Centre focused on rapid rehousing for people with low acuity, less complex cases. But here is the thing – individuals would get housed, and come back time to time to meet the worker or to access services. Then they meet old buddy Joe, and they decide to stay in the shelter to hang out. Then they stay for a week, then give up their housing, then stay for a month, then a year or more, they get sucked back in.”

As a result of this situation, all of the programming was moved out of the shelter and back into the community. The housing team began to be transitioned into a ‘Diversion Program’ based at the shelter, but with a mandate to create a connection with individuals as soon as they enter the shelter system for the first time. This helped divert clients away from the emergency shelter system. Clients were also connected to HomeBASE and other mainstream services in order to access the help they need.

REFERENCES

Social Housing in Action (2009). Bringing Lethbridge Home 5 Year Community Plan to End Homelessness (2009-2014). Retrieved from http://www.bringinglethbridgehome.ca/resources.cfm

Social Housing in Action. (2012a). “Until Everyone Has a Home”. Bringing Lethbridge Home: Our 5 Year Plan to End Homelessness. Annual Progress Report 2011-2012. Retrieved from http://www.bringinglethbridgehome.ca/resources.cfm

Social Housing in Action. (2012b). Bringing Lethbridge Home: 2012 Lethbridge Homeless Census. Retrieved from http://www.bringinglethbridgehome.ca/resources.cfm

ENDNOTES

1. The Universal Declaration of Human Rights, Article 25 1: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”