innovation in homeless services: the social, economic and community value of tackling homelessness...
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Sam Tsemberis, PhD
Founder and CEO Pathways to Housing, Inc.
JUNE 12, 2013
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Who is served by Housing First?
Homeless
Mental health problems Addiction and abuse
Health problems
Poverty
Isolation
Stigma
PTSD/Trauma
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Frequent users of acute care services
Jail
Shelter
Hospital/
Detox
Streets Institutional Circuit
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Housing and Support Services: Rearranged (Housing first) and Redesigned (consumer driven)
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Levels of Program Fidelity
consumers Hundreds of choices, change over time & have tradeoffs r
Management issues include team-consumer, landlord-tenant, landlord-team, and team-agency interactions
Operations Variety of services and
housing options
Decisions about housing status and consumer
engagement
Principles
Consumer choice Separation of housing and treatment
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Homeless
Shelter placement
Transitional housing
Permanent housing
Ongoing, flexible support
Harm Reduction
Housing First Model
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MHCC At Home / Chez Soi 5 Cities RCT N=2,257
Moncton, Montreal, Toronto, Winnipeg, Vancouver
Housing First
(n=1267)
Interviews every 3 months: Residential stability, mental health, addiction, quality of
life, social integration
Treatment as Usual (n=990)
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
3M 6M 9M 12M
Time Spent in Stable Housing Over Year One
HF TAU
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/ 9
Housing First shows cost offsets
Annualized costs: Total sample Annualized costs: High Service Users (defined as
those in top 10% of prior service costs
TAU Intervention Difference TAU Intervention Difference
Est. annual cost:
Non-study services$23,849 $14,599 $ (9,250) $ 56,431 $30,216 $ (26,215)
Est. annual
intervention cost$17,160 $ 17,160 $16,825 $16,825
Total $ 23,849 $ 31,759 $ 7,910 $ 56,431 $ 47,041 $ (9,390)
High Service Users:• There is an overall savings of $9,390 per person per year• Every dollar spent on Housing First for these participants saves $1.56 through reduced
use of other shelter, health and justice services
Total Sample: • An investment in Housing First requires only an additional investment of $7910 per year• For every dollar spent 54 cents is saved through reduced use of other shelter and
health are services after only one year
Table 1 – Costs of Housing First versus use of other health, justice and social services after one year
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Peer Support: Recovery Focused Mental Health Services
Hope-instilling practice Socially supported wellness
knowledge and
skills to self-
manage
Emphasis on
holistic wellness
and positive
lifestyle as healing
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Son returns from tour in Afghanistan and stays with (formerly homeless) dad in his apartment.
Social connections are key and
and housing should adjusts accordingly
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Community-based, Residential Treatment (on-site clinical staff)
Permanent Single Site (on-site services)
Permanent housing
(scatter-site, off site services)
Redesigning the System: System Transformation
Longer term Institutional Care
Least restrictive to more restrictive setting
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• People are much more capable than we imagined possible.
Capabilities
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For Additional Information
Web sites:
www.pathwaystohousing.org
Or send an email to