Findings from the At Home / Chez Soi Demonstration Project in Canada Paula Goering and Catharine Hume May 2, 2013
Outline for today Overview of Project Design Na8onal level findings re one year outcomes and implementa8on Iden8fica8on of cri8cal ingredients Report on End of Project Transi8ons Plans for scaling up of evidence based prac8ce / 3
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 / 4
Housing First Approach of At Home / Chez Soi Subsidized Housing + ACT or ICM / 5
Implementa8on of Housing First Na8onal and local training events Technical assistance visits Communi8es of prac8ce Fidelity measurement Quality assurance / 6
Research Design Pragma8c, mul8- site, randomized, mixed methods field trial Effec8veness and cost effec8veness of Housing First Model in Canadian contexts Model being tested at two levels of intensity High needs =ACT Moderate needs = ICM / 7
Target Popula8on Adults (age 18 (19 in Vancouver)) Homeless (absolutely or precariously housed) Presence of a serious mental health issue w/ or w/o co- occurring substance use disorder Over- sampling to ensure sufficient number of women (min. 20%) Total planned sample size 2205 (1255 exp and 1080 TAU) / 8
Key Findings from Interim Report Housing First makes becer use of public dollars, especially for those who are historically high users of service. Individuals who have not been well- served by our current approach, and who have remained homeless for years, are being successfully housed in adequate, affordable, and suitable seengs. People with mental health issues can live independently in the community with the right supports. There is strong support for con8nued investment. Rich pool of policy relevant knowledge will assist with decision making about future investments and scaling up. / 9
Early Project Findings Over 900 people currently housed in adequate, affordable, suitable seengs Stable living condi8ons contribute to a shif 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 poten8al 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 inpa8ent stays this savings was even greater for the high user sub- group Canada can (and is) implemen8ng Housing First Benefits cross a range of sectors (health, social services, criminal jus8ce) / 10
Residen8al status of par8cipants Homeless History Average life8me homeless=5 years First episode more than one year before study entry=77% Over 900 people housed in adequate, affordable seengs At 12 months, 8me spent in stable housing: Housing First (HF) = 80%; Treatment As Usual (TAU) = 33%. Over 65% of HF housed are s8ll in first apartment at end of year 3. Landlords as partners have helped us achieve this Have over 260 private landlords involved across five ci8es. Makes good business sense. Want to contribute to solving homelessness for their communi8es. / 11
Mixed methods implementa8on evalua8on External Quality Assurance team (20 fidelity reports) Round 1 ra8ngs:84 staff interviews, 10 consumer focus groups, and 100 chart reviews Round 2 ra8ngs: 89 staff interviews, 11 consumer focus groups, and 102 chart reviews QualitaUve implementauon (10 site & 2 cross- site reports) Round 1 ra8ngs: 72 key informant interviews, 35 focus groups with 211 par8cipants Round 2 data sources: 36 key informant interviews, 17 staff focus groups, and 57 interviews with landlords and caretakers. / 12
Summary of fidelity ra8ng results 10 programs rated on 38 fidelity items in 5 domains Early implementa8on and one year later Overall, strong fidelity to the Housing First model (program ingredients rated above 3 on a 4- point scale) 71% round one 78 % round two Varia8on at individual program level and by service delivery type, e.g. more challenges for ICM re service array domain / 13
Implemen8ng At Home/Chez Soi Strengths: partnerships, housing and re- housing par8cipants, and specialist staff providing valuable services. Challenges :staff turnover, the scacer- site model of housing not working for everyone, par8cipant isola8on, the need to further enhance peer support and consumer par8cipa8on, housing/re- housing issues, and the need to develop more voca8onal and educa8onal opportuni8es for par8cipants. / 14
Cri8cal Ingredients for Success Round 1 Barrier free housing Recovery philosophy High quality, mul8 faceted care delivered by well trained staff Round 2 Staff values re acceptance of par8cipants Team communica8on Consumer choice Re- housing Posi8ve Landlord and caretaker engagement / 15
/ 16 I think for many, many years we have not understood the lives of the clients in the system who, who really don t do well, we, we don t serve them well so they fall through the cracks everywhere, they re very hard to serve in the sense that we don t know what helps them. Quote from case worker
/ 17 For 5 years I have been homeless or living in shelters so just that whole thing lifted off my shoulders of being in a place and not having to worry about my rent and I can t even explain how huge that is, I mean I just broke down when I got accepted [into the project], it was, it s really a huge thing. I am starting school next month and because you know, I have a permanent place to live now. Quote from par8cipant
Research demonstra8on objec8ves Policy shif Evidence- informed investments in Housing First to address chronic homelessness among people with serious mental illness Opportunity to create las8ng system change Federal/provincial/territorial/municipal collabora8ons Scalable investment opportuni8es for all levels of government moving forward / 18
The Final Deliverable: Report and disseminauon At Home/Chez Soi ends March 31, 2013 Final data cleaning and analysis Formula8on of policy recommenda8ons policy forum October 2013 Final reports December 2013 Ongoing dissemina8on of findings through MHCC s Knowledge Exchange Center and ongoing publica8ons and local KE ac8vi8es / 19
Transi8on Status Federal and provincial government partnership on a transi8on year Local transi8on plans developed Transi8on from project to program MHCC role in the transi8on year Variability across sites opportuni8es and challenges / 20
Scaling Up- Defini8on deliberate efforts to increase the impact of successfully tested pilot, demonstra8on or experimental projects to benefit more people and to foster policy and programme development on a las8ng basis ExpandNet/WHO www.expandnet.net / 21
Thinking about sustainability and scaling up Rich knowledge base s8ll under crea8on Health & social innova8on poten8al 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- effec8ve interven8on to reduce chronic homelessness Opportunity to build on the investment to date, and leverage the partnerships created to date (exis8ng P/T & private sector) / 22
/ 23 Further Scaling up Ac8vi8es Development of a HF toolkit Partnership with Provincial and Na8onal Housing and Homelessness Organiza8ons (thinktanks, PHSI and SHERC grant applica8ons) Consulta8ons to jurisdic8ons interested in implemen8ng or scaling- up of Housing First approaches; Ongoing engagement with local and na8onal media and, Con8nued development of Here at Home an interac8ve website in partnership with NFB. Applica8ons for further funding to follow up par8cipants post project.
Acknowledgements / 24 The nauonal At Home/Chez Soi project team: Jayne Barker, PHD (2008-11) and Cameron Keller, MHCC Na8onal Project Leads; Paula Goering, RN, PhD, Research Lead and approximately 40 inves8gators from across Canada and the US. In addi8on there are 5 site coordinators and numerous service and housing providers as well as persons with lived experience. This research has been made possible through a financial contribu5on from Health Canada to the Mental Health Commission of CanadaThe views expressed herein solely represent the authors.
Thank you! Contact us: Paula Goering paula_goering@camh.net Catharine Hume: chume@mentalhealthcommission.ca Visit: www.mentalhealthcommission.ca Follow us on: The views represented herein solely represent the views of the presenters. ProducAon of this document is made possible through a financial contribuaon from Health Canada. / 25