Transcript Housing Needs Assessment for Drug/Alcohol Users in the LBL

Housing Needs Assessment for
Drug/Alcohol Users in the LBL
August 2006
Summary Findings
Background

Commissioned by Lewisham Community
Safety and Drug Action Partnership (CSDAP)
Objectives:
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1.
2.
3.
4.
To determine the nature, extent and pattern of
homelessness among problematic substance users
in Lewisham
To examine the pattern of tenancy and supported
housing for problematic substance users in
Lewisham
To examine age, gender and ethnicity variation in
homelessness in the target group
To determine the gap in housing provision for
problematic substance users.
Methods
The project adopted various methods including
(i) systematic literature analysis;
(ii) use of inferential indicators and multipliers
(iii) secondary analyses of data from substance
misuse services, probation, Drug Intervention
Programmes and housing providers;
(iv) a semi-structured interview survey of people in
supported housing and those currently
homeless; a semi-structured interview of
supported housing providers; and
(v) gap and risk analysis
Operational Definition of
Homelessness
Adopting the Charity Shelter’s definition homelessness, the following
parameters were applied to cases
“You should be considered homeless if:
 you have no home in the UK or anywhere else in the world
 you have no home where you can live together with your immediate family
 you can only stay where you are on a very temporary basis
 you don’t have permission to live where you are
 you have been locked out of home and you aren’t allowed back
 you can’t live at home because of violence or threats of violence which are
likely to be carried out against you or someone else in your household
 it isn’t reasonable for you to stay in your home for any reason (for example,
if your home is in very poor condition)
 you can’t afford to stay where you are
 you live in a vehicle or boat and you have nowhere to put it.”
Current Capacity
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Supporting People Programme (temporary)
Provides funding for 4,500 units of accommodation
managed by 70 different providers, of which 166 units
are designated specifically to support people with
drug (52) and alcohol (114) problems.
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General Housing (permanent tenancy)
Council housing stock is 27,545
In 2005 the number of people on the Housing
Register was 17,000 and the number of lettings that
became available was 1,800
Challenges
 No
readily available, comprehensive and
robust source of information on the
numbers of single homeless people in UK
 Varying definitions of homelessness
 ‘hidden’ and ‘mobile’ nature of many
people’s homelessness
Extent of Statutory Homelessness
in the UK

2005 LAs in England accepted that 100,170
households as ‘unintentionally homeless’ and in
priority need
 48,990 were considered ‘homeless’ but not in
priority need
 13,830 were considered ‘intentionally homeless’
and in priority need (ODPM, 2006)
 Crisis (2003) estimates that there are 380,000
single homeless people in Great Britain
Extent of homelessness in London
 London
has the highest number of
households in temporary accommodation
(63,800) on 31 Dec 05, accounting for
65% of the England total (98,730).
 Figures from the ODPM (2005) report 459
people sleeping outdoors (rough sleepers)
on any one night in England, 221 in
Greater London.
Extent of Homelessness in
Lewisham
 End
of April 2006, LBL reported to ODPM
that they had 2284 homeless households
from the Borough in temporary
accommodation
 Between March 05 and April 06 1449
lettings became available
 The number of rough sleepers varies from
1 to 6 according to official point-in-time
counts. Up to 17 in ‘unofficial’ count.
Evidence linking substance misuse
and homelessness
 Share
common risk factors
 No evidence of a causal relationship –
together homelessness and substance
misuse may result in, or make more
intractable, other problems or
disadvantages
 Chronically homeless individuals tend to
attribute their continued homelessness to
a substance abuse problem
Pathways to Housing in Lewisham
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Main Sources of support
Housing Options Centre (HOC) – main
gateway
Lewisham Supporting People Programme (offering hostels, shared houses, floating
supporting etc)
Probation/DIP – employ specific ‘housing
support staff’ who offer direct and indirect
support to clients and colleagues
Procedures for Re-Housing and
Banding System
 LBL Homesearch
Team (choice based
lettings scheme active cases run at 10,000
at any one time)
 To access Homesearch a person has to be
accepted onto the register and needs to
maintain their place on the register
 Housing assessment results in being
‘banded’ i.e. priority level of need
 Four bands AA, A, B, C, and NB
 Lettings
that become available are
weighted against the priority bands, for
example
70% are assigned to Band A,
20% are assigned to Band B,
9% are assigned to Band C
1% is assigned to the No Band
Supporting Vulnerable Groups
 Housing
allocate a number of
‘nominations’ to agencies in the Borough
including those working with drug and
alcohol. These ‘quotas’ offer agencies the
opportunity to access ‘band A’. Quotas for
06/07 e.g.
 ARP- 5; DIP -3; TRB – 15; St Mungos 30
Supply ???(Drug/Alcohol)
HHUs per 100,000 population
People with Alcohol
Problems
People with Drug
Problems
Lewisham
45
20
London Average
16
6
Inner London Average
33
11
LSL Average
48
21
National Average
7
7
Extent of Illicit Drug Use and
Chronic Drinking in LBL
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Estimated number of illicit drug users in LBL in the last
year is 21,187 (males 14,894, females 6,293)
Estimated rate is 13.2% compared to England and
Wales (11.3%) and London (12.2%)
Estimated number of chronic drinkers in LBL 31,342
(males 19,127, females 12,215)
First national alcohol needs assessment estimated that
23.5% of chronic drinkers engage in harmful drinking,
who are also considered the group at high risk of
homelessness. Hence applying this multiplier, estimated
number of chronic drinkers at risk of homelessness is
7,365 (male 4495; female 2870)
Prevalence rates and multipliers of
homelessness in this study
 Drawing
on the literature there are various
rates of homelessness – some applying to
general population, others to clinical
populations, this study proposed that the
estimate rate of homelessness would be
the median value of published rates i.e.
20%
Estimated Number of Problem Drug Users and chronic
drinkers (harmful use) that are homeless
 Using
the 20% multiplier
Drug= 423 (Male 296; Female 126)
Alcohol = 1,473 (Male 899; Female 574)
Extent of Homeless among problem drug users
and harmful alcohol users in treatment
CDP = (196 clients records – 1 April 04 – March
31 05) – information on housing available on
182 cases homeless rate was 49%
 DIP = (576 clients records 1 Dec 04 – Nov 30
05) – information on housing available on 138
cases – homeless rate was 54%
 Dual Team = (86 clients records – 1 April 04 –
March 31 05) – information on housing available
on 69 cases – homeless rate was 73%
 ARP = (120 clients records – 1 April 05 to March
31 06) – information on housing available on all
cases – homeless rate was 28%
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Demand for Housing among
probation clients
 Total
of 135 probation clients with a range
of housing needs were referred over an 8
mth period June 05 to Feb 06.
 Information on housing available on 133
cases. - 82% of cases were homeless
 19% of homeless cases had been involved
in drugs (offence), 4% in alcohol and 2 %
in both drugs and alcohol
Demand for housing to LBL HOC
 Secondary
analysis of data on clients
applications to HOC (n=2,236)
 27% cited homelessness
 No information on drug/alcohol hence
applying multipliers from estimates
 Problem drug users = 29
 Chronic drinkers = 105
Users Perspectives
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Summary Issues (In-Treatment and Homeless Group)
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Majority male, British Born with ties to Lewisham. Poly drug history,
initiation in their teens, extensive forensic history, numerous
treatment episodes (none however in residential rehabs). Factors
precipitating homelessness include chaotic drug use, mounting
debts, involvement in criminal activities and breakdown in family
support. Domestic violence is indicated for female clients. Male
clients tend to experience homelessness at an earlier age to
females, and do not have experience of having their own tenancies.
Majority currently ‘sofa surf’ among friends and family, and main
obstacles in accessing housing support are linked to negative
attitudes of housing staff towards drug users and lack of accurate
information.
Users Perspectives
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Summary Issues (In Supported Housing Group)
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Majority male, British born with ties to Lewisham. Similar profiles to
the ‘In Treatment group’ with respect to drug use. Respondents
described long and serious criminal histories. For the majority of the
sample access to housing support was via assistance received as a
result of being engaged with the criminal justice system. With the
exception of one person all respondents were satisfied with their
accommodation, and regarded their key worker as an important
source of support. Maintaining their supported housing was
facilitated by being drug free and/or remaining engaged in treatment.
All respondents were engaged in some form of meaningful daily
activity e.g. voluntary work or college. Key concerns regarding long
term tenancies was having access to choice in where they were to
live and support services being maintained once longer term
tenancy was in place.
Summary
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The estimated rate of homelessness among problem substance
users in Lewisham is 20%. The rates of homelessness among users
of substance misuse services and associated agencies in Lewisham
are diverse as follows: CDP (49%); DIP (54%); Dual Team (73%);
ARP (28%). The majority (93%) of Probation clients referred for
housing support were homeless.
Given that these rates are higher than the overall rate, it may well
mean that the overall rate was a conservative estimate.
However, the rates in services could be elevated because of missing
data on housing status in some of the agency data used. In addition,
the estimates provided are not exact. There are assumptions that
the margin of error is less than ± 5 percent of the estimates.
It must be remembered that clients applying for housing may well
conceal drug and alcohol problems fearing that such information
would have a negative impact on their application.
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The profile of homeless problem drug users in
treatment was consistent across agencies. The
age group most at risk were those aged 25-34
years accounting for between 32% and 48% of
homeless persons in treatment.
 In most agencies studied, the predominant
ethnic group among the homeless was White.
However, in the probation and housing
department samples, as well as the TRB cohort,
the largest ethnic group was Black. The
proportion of homeless Asian clients was
relatively small.
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Altogether, 1,896 problem substance users (493
problem drug users and 1,473 problem drinkers)
are in need of housing. The current HHUs
provision is 12% of that required to meet the
need of problem drug users and 7.7% of that for
problem drinkers.
 However, the gap between demand and current
provision is optimal for problem drinkers where
78% of demand is being met. Conversely, only
18% of demand for housing is being met in the
case of problem drug users.
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Risk analysis revealed that current housing
provision is most suited to male and female
problem drinkers, and female problem drug
users, but less so for male problem drug users.
Furthermore, problem drug users aged 16-24
and 35-44 years are at risk of poor access to
supported housing. So also are problem drinkers
aged 25-44 years. It would seem that current
provision is somewhat favourable towards the
earlier identified 25-34 year-old problem drug
users at the expense of other age groups.
Recommendations
The JCM should explore the introduction of ‘common
assessment frameworks’ which would include sufficient
detail on clients past and current housing status. In the
first instance the DST may wish to consider undertaking
a review of current datasets. Such practice should assist
in effective monitoring of the Treatment Plan and identify
areas for improvement.
 Furthermore consideration should be given to
encouraging housing providers and the HOC in
recording ‘drug and alcohol use’ as part of their routine
datasets. Clearly, training particularly on attitudes will
need to be addressed to ensure data collected does not
result in a barrier to engagement.
 The DST may wish to further examine the heightened
risk of homelessness in those aged 25-34 years given
that this is also the age group most at risk of drug-related
deaths. This activity could be incorporated into the DST’s
proposed harm reduction audit and strategy.
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Recommendations
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It may prove useful to examine the pathway to
homelessness in the different ethnic groups and
communities in Lewisham, identifying any potential
protective factors in specific ethnic groups and
communities that can be disseminated widely.
Given the gap between need, demand and housing
provision, there is a need to increase the number of
HHUs stipulated in the Lewisham Supported People’s
Strategy for 2005.
The DST, Supporting People and YOT jointly may wish
to examine the barrier to access for those problem drug
users aged 16-24 and 35-44 years; and problem drinkers
aged 25-44 years.
Recommendations
In view of the client’s negative perception of the HOC,
the CSDAP may wish to consider undertaking a training
needs analysis (TNA) of HOC and associated agencies.
The outcome of the TNA should be employed to develop
a continuing professional development (CPD) module,
which should be included both in new staff induction
programmes, and as part of CPD training within the
organisation. To ensure that this training and workforce
support is given the necessary priority, CSDAP should
ensure that this recommendation is taken forward within
the LBL Substance Misuse Training and Workforce
Strategy.
 The CSDAP may wish to invite the HOC to develop a
collaborative working partnership to address the ‘gap in
information’ identified by clients as part of an information
dissemination strategy.
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Recommendations
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Given clients anxiety about losing support once they are
settled into housing Supporting People may need to re
examine the current policy regarding ongoing support
and consider introducing additional steps as part of a
longer term disengagement programme.
In keeping with this review and in view of the priority
groups identified in the Housing Needs Assessment,
Supporting People may wish to introduce a ‘screening
panel’ to manage the block quotas for marginalised
groups. The panel should consider establishing criteria
which would ensure that nominations which may have
alternative routes into housing are screened out.
Recommendations
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Supporting People may wish to undertake a review with
their Housing Providers on admission criteria and
exclusion policies, with the recommendation that
Housing Providers should not exclude clients purely
based on the fact that they are in treatment for
substance misuse.
Furthermore the DAAT Substance Misuse Training and
Workforce Strategy, in collaboration with DIP and
Supporting People target Supporting People Housing
Providers around working with drug and alcohol clients.
In particular the training programme should incorporate a
module on Risk Assessment associated with offending.
Recommendations
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To ensure that the issues and gaps identified by this
report are addressed the CSDAP may wish to repeat this
exercise in the future, employing the data from this
review as its baseline measurement by which to bench
mark progress.
Action Plan
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The JCM should explore the introduction of ‘common assessment
frameworks’ which would include sufficient detail on clients past and
current housing status. In the first instance the DST/commissioning team
may wish to consider undertaking a review of current datasets. Such
practice should assist in effective monitoring of the Treatment Plan and
identify areas for improvement.
This works fits in with the ‘models of care’ work that has been started in
the borough covering standard assessment tools.
Liaison with DIP housing lead re nature of data needed.
Include housing data in new commissioning team database design.
Una Carnochan – Joint commissioning manager. Lorna Thomas - DST
data officer
Action Plan
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Furthermore, consideration should be given to encouraging housing
providers and the HOC in recording ‘drug and alcohol use’ as part of
their routine datasets. Clearly training particularly on attitudes, will
need to be addressed to ensure data collected does not result in a
barrier to engagement.
Supporting people could carry this recommendation out fairly easily
with supported housing providers.
Housing options centre may be more difficult. It may be more
realistic in the first instance to carry out a sample survey for a fixed
period of time, provide training, then roll out further.
Supporting people team, DST data officer & HOC management to
work jointly on this. DST training & workforce development manager
Action Plan
The DST may wish to further examine the heightened
risk of homelessness in those aged 25-34 years given
that this is also the age group mostly at risk of drugrelated deaths. This activity could be incorporated into
the DAAT’s proposed harm reduction audit and strategy.
 This area of risk has been highlighted in the current
harm reduction audit/strategy work.
 Use of rent deposit schemes – widen the remit of HOC
scheme.
 Explore funding options for extending rent deposits
schemes
 Una Carnochan – Joint commissioning manager
Supporting people, HOC & DIP housing lead
Action Plan
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It may prove useful to examine the pathway to
homelessness in the different ethnic groups and
communities in Lewisham, identifying any potential
protective factors in specific ethnic groups and
communities that can be disseminated widely.
Research – future priority.
Ensure DIP & DST have input into HOC research re
BME access to housing.
Need to ensure the Supporting people diversity plan
links in with this work.
DST and DIP housing lead, Supporting people team
Action Plan
In view of this finding, there is a need to
increase the number of HHUs stipulated in
the Lewisham Supporting People’s
Strategy for 2005-2010.
 Supporting people to explore options for
increased or more targeted use of existing
units. Balance commissioning decisions
based on evidence of gaps.
 Supporting people
Action Plan
SP may wish to examine the barrier to access for those problem
drug users aged 16-24 and 35-44 years; and problem drinkers aged
25-44 years. The following are two suggestions that could be
pursued immediately:
a. as there already exists two Supporting People workers within
HOC targeting 16-17 years old, the supporting people team may
wish to consider expanding the remit of the SP workers, with an
emphasis on facilitating ‘sign posting’ to services that offer
appropriate support.
b. CSDAP may wish to explore undertaking, with the Substance
Misuse Worker attached to YOT and ACAPS and the Supporting
People’s Young People’s Worker, a survey of young people’s views
on the specific barriers they encounter in accessing housing
services.
Action Plan
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SP investigate the coverage of the current posts and ensure
adequate training around drug & alcohol issues.
Make use of substance misuse link worker at HOC to provide info
and advice to other HOC workers and signposting.
Survey to be carried out by partners – co-ordinated by DST
Supporting people team, HOC , DST YP co-ordinator
Action Plan
In view of the client’s negative perception of the HOC,
the DST/HOC may wish to consider undertaking a
training needs analysis (TNA) of HOC and associated
agencies. The outcome of the TNA should be employed
to develop a continuing professional development (CPD)
module, which should be included both in new staff
induction programmes, and as part of CPD training
within the organisation. To ensure that this training and
workforce support is given the necessary priority,
DST/HOC should ensure that this recommendation is
taken forward within the LBL Substance Misuse Training
and Workforce Strategy.
Action Plan
 Training
needs assessment to be carried
out by DST TWDM. HOC will need to
commit to meeting the assessed need.
 Training programme to be discussed &
negotiated between HOC, DIP housing
lead and training and workforce
development manager.
 DST training & workforce development
manager, DIP housing lead and HOC
Action Plan
The Safer Lewisham partnership & DST/SP team
may wish to invite the HOC to develop a
collaborative working partnership to address the
‘gap in information’ identified by clients as part of
an information dissemination strategy.
 This could link in with the training programme.
Information re drug & alcohol treatment, housing
advice and local support is available in DST
directory.
 DST training & workforce development manager,
DIP housing lead and HOC
Action Plan
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Supporting people may need to re examine the current
policy regarding ongoing support and consider
introducing additional steps as part of a longer term
disengagement programme.
S.P. team to explore policies and links to support
agencies and referral routes to floating support. Waiting
times into floating support services to be examined as
part of this.
The SP floating support contracts are currently being recommissioned. Therefore design of the spec will include
targeting substance misusers and include waiting times
targets.
Supporting people team
Action Plan
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In keeping with this review and in view of the priority
groups identified in the Housing Needs Assessment, the
supporting people team may wish to introduce a
‘screening panel’ to manage the block quotas for
marginalised groups. The panel should consider
establishing criteria which would ensure that
nominations, which may have alternative routes into
housing, are screened out.
To ensure ‘non-priority’ clients have other routes into
housing. Use of a panel to allocate ‘supporting people’
spaces. Design of panel and criteria led by S.P.
Supporting people to lead.
Action Plan
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Supporting People may wish to undertake a review with their
Housing Providers on admission criteria and exclusion policies, with
the recommendation that Housing Providers should not exclude
clients purely based on the fact that they are in treatment for
substance misuse. Furthermore the DST Substance Misuse Training
and Workforce Strategy, in collaboration with DIP and Supporting
People target Supporting People Housing Providers around working
with drug and alcohol clients. In particular the training programme
should incorporate a module on Risk Assessment associated with
offending.
S.P team to conduct review of policies.
Training to include risk assessment associated with offending. This
work should make use of the DIP housing lead given the offending
issues
Supporting people, Training & workforce development manager in
conjunction with DIP.
Action Plan
Currently refuge policies can exclude substance
using clients. It may be useful for the DV coordinator to investigate which policies are in
existence, and ensure that refuge staff have
access substance use training and support from
substance use services.
 Joint work between SP/DV co-ordinator
 DV co-ordinator to lead & Supporting people
team, Training and workforce development
manager
Action Plan
To ensure that the issues and gaps
identified by this report are addressed the
CSDAP may wish to repeat this exercise in
the future, employing the data from this
review as its baseline measurement by
which to bench mark progress.
 DST to organise any further research after
review of initial action plan March 2008
 DST manager