Healthier, happier, and more positive:

Transcription

1 Healthier, happier, and more positive: What housing first means to people housed under Toronto s Streets to Homes program Results of 2007 post-occupancy research National Alliance to End Homelessness Conference, Washington, DC, July 10, 2007 Iain De Jong, City of Toronto Shelter, Support and Housing Administration Division

2 Contents Homelessness in Toronto Toronto s strategy to end street homelessness Post-occupancy survey results Overall satisfaction Overall life changes Quality of life Service use Housing security Follow-up supports Future outlook Policy and program implications 2

3 Toronto, Canada Fifth largest city in North America (2.5 million in a region of 7+ million) High rents; low vacancy rates for affordable housing Dense urban core, large public spaces, considerable green space 3

4 Homelessness in Toronto Toronto Street Needs Assessment (April 19, 2006) revealed: 9 out of 10 homeless people want permanent housing Minimum of 5,052 homeless on any given night 72% in shelters 16% outdoors 5% in hospitals and treatment facilities 3% in correctional facilities 3% in assaulted women s shelters Shelter, Support and Housing Administration 95,000 units of social housing 65 shelters accommodating 4,000+ nightly 45 drop-ins (day centres) 67 homelessness and eviction prevention projects 10 organizations providing street outreach services 4

5 Toronto s strategy to end street homelessness Toronto City Council s commitment to end street homelessness: February ,200+ in permanent housing, directly from the street 87% remain housed, mostly in private rentals Predominately a scattered-site approach Implementation of various innovations Mobile Multi-Disciplinary Street Outreach Team Post-incarceration housing supports Employment supports Rapid housing Centralized and consistent follow-up support model Furniture bank and moving service Housing-first plan 5

6 Post occupancy survey Commitment to continuous improvement Use of data for program refinement Designed survey to be replicable One on one interviews lasting 45 minutes to 3 hours, November 2006-April 2007 Opportunity to better understand client views on the program and its benefits Ensured results would be accurate 19 times out of 20, +/- 10% 6

7 Happy with housing Very Happy Mostly Satisfied What they liked the most Somewhat Unsatisfied Very Unhappy 50% 37% 8% 5% Size Specific amenity such as a balcony or air conditioning Privacy The fact that they were off the street and had a roof over their head Location 7

8 Housing changes lives Improved a lot Somewhat improved Stayed the same Gotten worse 61% 30% 7% 2% Most spoke about improved security and privacy, and overall improved mental outlook Those saying it had stayed the same or gotten worse spoke about missing living outdoors or were unhappy with their current housing 8

9 Quality of life improves Improved Stayed the Same Gotten Worse Health 70% 17% 13% Mental Health 57% 31% 12% Food Quality 63% 22% 15% Sleeping 69% 18% 13% Personal Safety 72% 22% 6% Social Interaction 40% 35% 26% Increased Stayed the Same Decreased Stress Level 16% 24% 60% Food Eaten 65% 18% 17% 9

10 Changes in quality of life for those homeless 2+ years More likely to report improvements in the amount of food they ate (68% vs. 57%) Less likely to report improvements in general health (71% vs. 87%) More likely to report improvements in mental health (63% vs. 44%) Less likely to report improvements in sleeping habits (62% vs. 83%) 10

11 Less alcohol and drug use Increased Stayed the Same Decreased or Quit Alcohol 10% 41% 49% Drugs 8% 18% 73% 17% reported no drinking since being in housing Homeless 2+ years much more likely to report decrease in alcohol use (59% vs. 27%) 31% reported they had quit using drugs completely since being in housing Those homeless 2+ years most likely to report decrease in drug use (78% vs. 62%) 11

12 Use of health services Of those who used hospitals when homeless 21% said they had been admitted at least once just to get off the streets Of those who used the ER when homeless 40% had gone once in the past year, 35% went between 2 and 5 times, 25% (12% of all surveyed) went from at least once every two months to several times per week Of these frequent users 20% had not been to the ER once since being housed; 80% reported a decrease in the frequency of visits Up Family Doctors 32% Psychiatrists 71% Dentist 5% Optometrist 143% Specialists 233% Clinics ER Hospital Down - 28% - 40% - 25% 12

13 Less use of emergency services % Ambulance - 38% Fire - 71% Police detox ( Drunk Tank ) - 75% Getting arrested - 56% Jail - 68% Court - 58% Probation - 38% For those who still had interaction, frequency decreased E.g. for those who had been arrested when homeless, 52% reported being arrested multiple times per year. Only 25% of people who had been arrested since being housed reported this had happened more than once. While 63% of those who used police detox when homeless reported using it more than twice a year (some several times per month), the maximum any individual reported being in police detox since being housed was twice. 13

14 Use of services UP Food bank +55% Education +57% Drug/ alcohol treatment +50% Mental health programs +20% Job training +175% Down Drop-ins (day centres) -38% Identification clinics -44% OOTC meals (faith-based) -67% Harm reduction services -32% Legal services -32% Health bus -77% Detox -62% 14

15 Statistically significant changes in use of emergency and homeless services Family doctor YES Health bus YES Clinics YES Identification clinics YES ER YES Job training NO Hospital NO Legal services NO Psychiatrist NO Mental health programs NO Dentist NO OOTC (faith-based) meals YES Optometrist YES 911 NO Specialists YES Ambulance NO Detox YES Fire NO Drop-ins YES Police detox YES Drug/ alcohol treatment NO Get arrested YES Education YES Jail YES Food bank YES Court YES Harm reduction services YES Probation NO 15

16 Housing security 85% say they felt their housing is secure 39% say they thought about leaving their housing at least once since being housed Most often immediately after moving in Most often they stayed because their follow-up (after care) worker resolved the issue Those homeless 2+ years more likely to report thinking about leaving housing (51% vs. 28%) Same for those with mental health issues (48% vs. 33%) 32% moved at least once since being housed Most often moving from shared to independent units 16

17 Housing satisfaction linked to choice in type of housing Those who felt they had the greatest choice in type of housing were likely to report highest housing satisfaction Housing Choice Yes Somewhat No Very happy 63% 42% 32% Mostly satisfied 34% 26% 52% Somewhat unsatisfied 2% 26% 4% Very unhappy 0% 5% 12% 17

18 Living alone better than sharing Shared: Those in shared accommodation were most likely to say they had no choice in the type of housing (45% vs. 19%) Of the 32% who had moved at least once since being housed, almost one-third blamed roommate problems in shared accommodation Independent: Those living alone more likely to be very happy or mostly satisfied than those sharing Even when respondents said they had no choice in type of housing, 100% of those in independent units were very happy or mostly satisfied 18

19 Shared accommodation blamed for problems People in shared accommodation frequently reported issues with roommates/housemates that made it difficult to keep their housing. People in shared accommodation were more likely to report food security issues or say their eating had stayed the same or gotten worse Only 56% reported improvement (68% in independent units) This was often attributed to small fridges and lack of secure food storage areas Several people complained of housemates stealing their food. 19

20 Follow-up supports deemed most valuable Clients identified the following as the most valuable components of followup supports: 1. Discussion/ Decision-making 2. General support/ Makes me feel better 3. Information/ Referrals 4. Advocacy on their Behalf 5. Help with Appointments 20

21 Frequency of follow-up Once a week 41% Several times per week 17% Once every two weeks 15% Once every few months 12% Once a month 8% Once a day 6% Once every six months 1% Since being housed, 33% report a decrease in the frequency of follow-up, 51% said it stayed the same, 16% said it had increased Of those who said it had increased, several mention starting to deal with other life issues When asked about need for supports in the future, respondents generally had difficulty answering the question 56% saw it staying the same and 11% thought it would increase 21

22 After housing, less panhandling 54% panhandled when homeless 23% reported panhandling once housed Panhandling and drugs and alcohol 66% of those who panhandled used drugs, compared to 32% of non-panhandlers Once in housing, of those who stopped panhandling, 70% had also quit or decreased their alcohol use Those who decreased drug use were still likely to panhandle Those who quit drug use were less likely to panhandle 22

23 Housing makes the future look better More positive Not really changed Gotten worse 82% 18% <1% Higher self-esteem Starting to set goals Looking for volunteer positions Beginning to plan to go back to school or work 23

24 Client perspectives on housing first Friendliness and persistence of outreach workers was key to accepting service Being housed especially the first few months is a difficult adjustment and many people think about leaving Despite all the difficulties and adjustments, clients are inclined to want to stay housed 24

25 What housing first means Better quality of life Substantially less alcohol and drug use Less use of emergency services More use of appropriate health services Less panhandling The need to rebuild social networks 25

26 Policy and program implications Choice in housing leads to greater housing satisfaction, which in turn leads to greater housing stability Those sharing have less housing satisfaction More likely to have food security issues More likely to relocate Assistance with decision making is the most valuable support clients receive from their follow-up worker Reduction in emergency service use 26

27 Thank you 27

28 Contact us Phil Brown, General Manager, Shelter, Support and Housing Administration Division, City of Toronto, Iain De Jong, Manager, Streets to Homes, City of Toronto,