After Demonstrating that Housing First Works in Canada, What’s Next?
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This document summarizes a research conference on Housing First programs for the homeless with mental illness. It discusses the At Home/Chez Soi project, the largest Housing First study in the world conducted across 5 Canadian cities. Interim results found Housing First reduced health system costs and increased housing stability. Efforts were made to promote sustainability after funding ended through negotiations. Current priorities are the project transition and disseminating findings to scale up Housing First nationally through toolkits and partnerships. Housing First is now a major policy shift in Canada with renewed homelessness funding and the Mental Health Commission's advisory role on implementation.
After Demonstrating that Housing First Works in Canada, What’s Next?
- 1. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 After Identifying that Housing First Works in Canada, What’s Next? Cameron Keller, Vice President, Programs and Priorities, Mental Health Commission of Canada Paula Goering, RN, PhD, National Research Lead, At Home/Chez Soi (regrets)
- 2. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 At Home/Chez Soi Project Overview In 2008 the Federal government allocated $110million At Home/Chez Soi is: the largest study of its kind in the world providing evidence about what services and systems best help people experiencing serious mental health issues and homelessness Housing First model implemented in: Vancouver, Winnipeg, Toronto, Montreal, Moncton Funding – 85% services / 15% research
- 3. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Research Demonstration Objectives Policy shift – Evidence-informed investments in Housing First to address chronic homelessness among people with serious mental illness Opportunity to create lasting system change Federal/provincial/territorial/municipal collaborations Scalable investment opportunities for all levels of government moving forward
- 4. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Integrated Knowledge Translation Research involves exchange and linkage with decision- makers throughout the process Requires allegiance to both scientific and participatory principles “evidence of effectiveness alone is rarely enough to ensure adoption of interventions” (Leff & Mulkern, 2002) Science requires orderly, phased process of scientific investigation Participation requires that the interests and values of various groups in public systems be reflected.
- 5. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Research Design Pragmatic, multi-site, randomized, mixed methods field trial Effectiveness and cost effectiveness of Housing First Model in Canadian contexts Model being tested at two levels of intensity – ACT and ICM Randomized to Housing First (HF) or TAU + third arm Comparisons to care as usual in all cities Outcome data collected at baseline, 6, 12, 18, & 21 months Two fidelity assessments and formative evaluations Qualitative data collected on subgroup of participants at baseline and 18 months
- 6. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Project Timeline March 2008-Funding announced Fall 2008-Request for Proposals posted March 2009-Grants and Contracts Awarded Fall 2009-Data collection begins Summer 2012-One year data collection complete September 2012-Interim report released Spring/summer 2013-One year scientific papers submitted March 2013-Program funding ends and data collection ends December 2013-Final report due 2014-Two year scientific papers submitted
- 7. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Program Sustainability What happens to demonstration projects after their initial limited time funding ends. Continued benefits for individuals, continued activities for programs and continued capacity for communities. Theoretically the stage after implementation and before dissemination to other sites. In reality….overlapping, non-linear and continuously evolving) Multi-factors influence outcomes (innovation, context, capacity, processes and interactions) Evaluation has limited utility although perceived benefits often cited positive influence. Scheirer, MA 2005
- 8. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 A common problem The project “should include rigorous evaluation and enough time after the results of the evaluation are known to plan for the sustainability of program interventions shown to be effective” “The timing of evaluation findings is often too late in the project life cycle to be useful in promoting sustainability; evaluation could be more useful if interim data about outcomes would be available before the initial funding ends.” Scheirer, M 2005
- 9. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Interim report results Over 900 people currently housed in adequate, affordable, suitable settings Stable living conditions contribute to a shift from the frequent use of inappropriate and expensive services • At Home/Chez Soi saved the system a net average of $9,390 for those who had a high use of services “High Users” Housing First has the potential to provide system-wide cost offsets. Individuals receiving Housing First saved the system a yearly average of $2,184 per person in costs related to inpatient stays – this savings was even greater for the “high user” sub-group Canada can (and is) implementing Housing First Benefits cross a range of sectors (health, social services, criminal justice)
- 10. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Review of efforts to solve the sustainability problem Comprehensive government relations efforts – January 2012 through September 2012 Interim results presented to senior leaders in multiple briefing sessions Request to federal government for two years of post project housing Formal request to Health Canada for transition funding from four of five provinces – August 2012 Interim report released in September, extensive media coverage Federal government response communicated to MHCC – October 2012 Federal/provincial/MHCC negotiations – November 2012 to present
- 11. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Sustainability outcomes The federal government contributed to the housing component for one year in all of the sites Manitoba, New Brunswick, BC and Quebec are all finalizing plans to provide clinical services to participants. Ontario made a public announcement outlining ongoing funding for housing subsidies and Housing First services and supports. Mixed picture re continuation or modification of Housing First program components.
- 12. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Current Priorities Facilitation of transition in five cities Final data cleaning and analysis Formulation of policy recommendations – policy forum – October 2013 Final report December 2013 Ongoing dissemination of findings through MHCC’s Knowledge Exchange Center and ongoing publications and local KE activities
- 13. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 What’s Next? Thinking beyond immediate sustainability: Rich knowledge base still under creation Health & social innovation potential based on evidence Capacity built in regions across the country to deliver Housing First Long term opportunity for all levels of government to invest with confidence in a cost-effective intervention to reduce chronic homelessness Opportunity to build on the investment to date, and leverage the partnerships created to date (existing P/T & private sector)
- 14. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Scaling Up-Definition “deliberate efforts to increase the impact of successfully tested pilot, demonstration or experimental projects to benefit more people and to foster policy and programme development on a lasting basis” ExpandNet/WHO www.expandnet.net
- 15. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Further Scaling up Activities Development of a HF toolkit Partnership with Provincial and National Housing and Homelessness Organizations (thinktanks, PHSI and SHERC grant applications) Consultations to jurisdictions interested in implementing or scaling-up of Housing First approaches; Ongoing engagement with local and national media Continued development of Here at Home an interactive website in partnership with NFB. Applications for further funding to follow up participants post project.
- 16. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 A Major Policy Shift Federal budget announcement of renewal of Homelessness Partnering Secretariat funding of $600M for 5 years Shift towards Housing First Mental Health Commission of Canada a “trusted advisor” invited to assist in shaping policy shift as well as implementation support including training and technical assistance What advice do you have for us regarding how to do this i.e. tension between advisor role and advocacy? What key considerations must we not forget?
- 17. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Role of Research Evidence One of many factors that influence decision making- politics, personalities, financial cycles Interim results and experiential knowledge both influence governments Strong governmental relations and communications supports are an asset Pressure to release findings in timely manner creates risks re consistency. e.g. economic results will change
- 18. EUROPEAN RESEARCH CONFERENCE Housing First. What’s Second? Berlin, 20th September 2013 Thank you! Contact Us: Cameron Keller: ckeller@mentalhealthcommission.ca Paula Goering: paula.goering@camh.ca Visit: www.mentalhealthcommission.ca Follow us on: The views represented herein solely represent the views of the presenters. Production of this document is made possible through a financial contribution from Health Canada.