Transcript Slide 1

Housing First Glasgow
Evaluation and Findings
Dr Sarah Johnsen
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
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Project Aims
• Main aim to reduce re-occurring homelessness
• Specific objectives:
1. Improvement in personal living situation
2. Reduction, or no increase, in substance misuse (as per users’
personal goals)
3. Reduction, or no increase, in injecting or associated risk
behaviours
4. Reduction in involvement with criminal activity
5. Improved psychological wellbeing
6. Improvement in overall physical health
7. Improved capacity to participate in and be valued by society
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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)
5. Respect for consumer choice (insofar as supply allows)
6. Holistic support 24/7 (assertive outreach and motivational
interviewing; staff on-call outside office hours)
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Project Details
• Eligibility criteria:
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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
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Service coordinator
Assistant service coordinators
Peer support workers
Pilot Evaluation
• Independently evaluated by Heriot-Watt University
• Longitudinal study involving:
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Interviews with TPS staff and key stakeholders (x2)
Interviews with pilot service users (x2)
Case file analysis
Fieldwork phase
Wave 1
Wave 2
Total
Type of interviewee
Stakeholder
Staff
Service user
Stakeholder
Staff
Service user
No. of interviews
9
4
22
12
5
21*
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Service User Profile at Recruitment
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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
Outcomes: Housing Stability
Outcome
Housed and retained tenancy:
(…of whom housed for 24+ months)
(…of whom housed for 12-23 months)
(…of whom housed for 6-11 months)
(…of whom housed for < 6 months)
No. of service
users
15
(9)
(2)
(3)
(1)
Housed but subsequently lost/gave up tenancy
2
Not housed
4
Deceased
1
Total
22
NB: no evictions
Outcomes: Health
• Physical health improved for majority
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Less substance misuse and better diet
…but some still in poor health
• Mental health outcomes also good on balance
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Stable housing and ‘stickability’ of support = ↑ psychological
wellbeing
But, ‘dip in mood’ not uncommon after being housed (often
accompanied by ↑ substance misuse / relapse)
Outcomes: Substance Misuse
• Outcomes mixed, but positive on balance
• Drugs:
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↓ 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:
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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
Outcomes: Criminal Activity &
Financial Wellbeing
• Criminality and street culture
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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
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Improved for most (due to ↓ in drug misuse)
But, majority still find it difficult to cope financially
Outcomes: Social Support
• Family support important for some; a few have
(re)established contact with estranged children
• Friendship/ peer networks complicated:
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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
Outcomes: Meaningful Activity &
Community Integration
• Employment and meaningful activity
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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
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Know neighbours ‘well enough to say hello to’
Instances of neighbourhood disturbance rare
Neighbour complaints resolved without resorting to eviction
Trajectories
Three general trajectories re direction and extent of
behaviour change / ‘distance travelled’ on recovery
journey
1. Sustained positive change – outcomes largely or uniformly
positive overall and sustained; c.½ service users (n=11)
2. Fluctuating experiences – periods of relative stability
punctuated by ‘slips’ on recovery journey; c.¼ service users
(n=6)
3. Little observable change – housing stability achieved, but
little evidence of change re other outcomes; c.¼ service users
(n=5)
Service User & Stakeholder Views
• Very high levels of service user satisfaction; esp. re:
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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:
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High rates of tenancy sustainment for ‘serial disengagers’
Far fewer instances of neighbourhood disturbance than
anticipated
‘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
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