III. Integrating Supports and Housing First: Approaches and Practices
Lorraine Bently, Executive Director, Options Bytown Non-Profit Housing Corporation (ON)
Options Bytown is a non-profit organization that since 1989 has provided permanent housing and supportive services for those who need help to live independently. Options Bytown operates three apartment buildings in central Ottawa housing 128 men and women, and also supports hundred of tenants living in the two largest social housing providers in the city, being Ottawa Community Housing and Centretown Citizens Ottawa Corporation. Combining affordable housing with on-site counseling, training and other services, the organization helps individuals facing social isolation and other complex challenges such as low incomes, a history of homelessness or special needs, mental illness, HIV/AIDS or substance use.
Options Bytown has evolved over its twenty-seven year history to adapt to changing policies on how homelessness is addressed at the municipal level, and have as a result developed a locally grown supportive housing approach known as HousingPlus into their service delivery model. Ottawa sees upwards of 1,300 individuals on the city-wide supportive housing waiting list, living precariously, and not stably housed. HousingPlus brings into stark focus the often times simple solutions that are needed to solve the complex problems of homelessness. The HousingPlus model, also known as supportive housing, reduces reliance on costly emergency, health and social services and helps people to become strong, successful members of the community. Housing coupled with on-site supports and elimination of barriers to the terms and conditions of access to housing, such as sobriety, means that more people are more quickly and stably housed.16
The on-site supports and services offered by Options Bytown consist of first and foremost access to housing support workers to assist tenants to maintain stable housing. They also offer crisis intervention, life skills training, informal counseling and referrals to addictions, mental health and other social and supportive services. Supporting tenants to set personal goals to acquire the skills they need to live independently is key to the success of the HousingPlus model, and is providing a variety of housing options so that tenants needing more or less supports may be re-housed quickly. With over 1,300 on the waiting list for supportive housing in the community17, Options Bytown provides a vital service in terms of successfully transitioning individuals from the social housing waitlist and shelters into permanent supportive housing.
16 Options Bytown, http://www.optionsbytown.com/index.php/about/housing-plus. Accessed June 2016.
17 Options Bytown 2015 Annual Report. CANADIAN HOUSING AND RENEWAL ASSOCIATION 8
The HousingPlus model is more cost effective than other responses to homelessness such as emergency shelters and hospital care, policing and detention. Supportive housing shares with Housing First a client centered model focused on recovery and individualized care. Yet it also takes a step beyond in that it combines affordable housing with on-site counseling, training and other services, as well as to place an emphasis on community building between residents and the broader neighbourhood. Social isolation can interfere with the ability to sustain independent living. Building strong communities through peer support, social events, common spaces in buildings, leadership opportunities and tenant engagement programs such as gardening and collective kitchens, goes a long way to eliminating the precarious nature of housing for many of the individuals Options Bytown serves.
What does integrating supports and Housing First mean?
A case in point – Meet Cindy:
Cindy is 23. She spent most of her first eighteen years in the foster care system and group homes. She has been diagnosed with a mental illness and has a developmental delay. Cindy also spent the last three years homeless, couch surfing, staying in shelters and has been hospitalized for various periods. She is involved in the criminal justice system, and was first referred to Options Bytown Housing First Case Management service. At that time there were a total of seven agencies involved in supporting her.
Options Bytown’s Housing First Case Management supports are portable and include finding housing in the community with a rent supplement, weekly home visits once the client is housed, as well as attending appointments with clients, coordinating services and regular case conferences. Cindy needs these services as well as on-site daily supports due to her developmental delay and her high risk for unit takeovers. She is a vulnerable person who needs support to say “no” to visitors.
Cindy and her case manager came to the conclusion that the best housing choice for Cindy would be an Options Bytown supportive housing apartment building. The on-site housing supports offered by Options Bytown, including cuing and prompting for appointments, have helped Cindy to say “no” to guests”, barring predators such as those involved with drug dealing or the sex trade, educating Cindy on the role and responsibilities of being a tenant, life skills training, dealing with isolation and finding meaningful community activities both within the apartment building and in the broader community.
What Does Success Look Like for Cindy?: Cindy’s goal is to “graduate” from case management and to achieve a successful tenancy living in supportive housing. She will always need supportive housing because of her developmental delay. As of now however, she has maintained her housing for six months, which is the longest she has lived in any one place for the last six years. Cindy is an active member of the community choir, goes to the library and to a nearby swimming pool. She has reduced her substance use and improved her independent living skills (cooking and cleaning). The number of agencies involved in supporting Cindy has been reduced from seven to three. The overall results of the first six months of incorporating the Housing First component within the supportive service model at Options Bytown has shown positive outcomes and results:
• 33 clients supported by 4 case managers in first 6 months; • Females – 3; Males – 30; • Stably housed for past 6 months 25 out of 33; • 7 moved to supportive housing, 18 to private market (with rent supplement) or social housing; • 1 deceased and 1 in hospital; • 1 waiting for nursing home and living in special care unit at shelter; CANADIAN HOUSING AND RENEWAL ASSOCIATION 9 • 1 housed in supportive housing and then returned to shelter; • 2 on waiting list for supportive housing/in programs at shelter and 2 refused, 2 offers each of rent supplements and housing or social housing.
Outcomes do indicate that there is a disconnect between shelter services and Housing First, as there are services available within shelters that individuals do not want to leave, delaying their transition to permanent housing. This system disconnect is important moving forward in helping to situate how to better align supports and housing for vulnerable populations. A tool currently being used by the team at Options Bytown to better align services, supports and programs with outcomes for tenants is the UK based tool Outcomes Star for Homelessness Support. The Outcomes Star is an online tool designed to enable services to take an overview of their achievements by providing valuable data on the outcomes of service users. It opens the possibility of comparing outcomes for different types of service user (e.g. men and women) or different services or interventions.
For individual service users, the Star gives a snapshot of where they were on each outcome area when they joined the project and at each review – the difference between starting point and review shows the progress made in that time. This monitoring and evaluation tool focuses on the gradual increases in confidence, improved behaviours, reduced self harm and so on, that are all part of the journey from homelessness to finding stability and a lasting home, and traces client’s progress and achievements in a way that is meaningful to the client.
With such a diverse population accessing the resources offered by Options Bytown it is clear that there is not just one approach to supporting and providing stable housing for vulnerable individuals working through complex issues. Options Bytown follows an eclectic approach, matching what works with the individual needs of clients and tenants. Next steps include sharing the resources and lessons learned with other local Ottawa social and supportive housing providers on HousingPlus and Outcome Star through the strong Ottawa Supportive Housing Network of nineteen supportive housing providers that already exists.
In conclusion, many lessons were shared throughout the session, including the continued need for more coordination between agencies, and more robust data collection on service users and providers. Furthermore, it was agreed that increased investment in the Housing First program is needed, both in terms of further defining program directives as well as increasing financial investment.
In terms of federal leadership, The Homelessness Partnering Strategy has been an incredibly supportive program through which financial assets have been leveraged to deliver valuable supports and services. Yet it can be very difficult to achieve consistent success rates while project funding is delivered yearly, meaning there is no flexibility to manage long-term projects or plan for resource management or staffing needs.
Sustainable program funding and delivery is key to eliminating homelessness and keeping vulnerable individuals stably housed. While Housing First is an important part of the solution to delivering effective programs with this goal, strict funding targets can limit resources from being delivered to the most vulnerable in ways that best support their most immediate needs. Policy and implementation must go hand in hand, while the pairing of a case management supportive approach with services onsite for tenants has proven to deliver the best outcomes and results – being a decrease in reliance on social supports and systems, more community focused solutions, and increased personal well being for tenants.