What is Housing First?
Housing First provides a comprehensive and holistic approach to addressing homelessness for people experiencing mental health, physical health, substance misuse, social, behavioural, and other challenges. The programme consists of three major components:
- Permanent, affordable housing;
- Mobile case management and treatment services (mental health, health, and addiction services); and
- A programme philosophy based on client choice and recovery.
Ireland’s national Housing First programme is based on the Pathways Housing First programme, which is the model that has produced the research evidence for the effectiveness of Housing First.
The ‘Housing First National Implementation Plan 2018-2021’ launched by the Minister for Housing, Planning and Local Government and the Minister for Health in 2018, describes how the Government’s goal to extend Housing First to every county in Ireland is to be delivered. This plan specifies the number of Housing First tenancies for each local authority to achieve by the end of 2021. The post of National Director of Housing First was established in early 2018 to drive national implementation; and a Housing First National Implementation Committee oversees delivery nationwide.
“The key successes I’ve had would be finally moving from the hostel into my new apartment. Getting back in touch with my family; getting more support to reduce my drinking and most recently finally addressing my health concerns.”
- Housing First Tenant
Why Housing First?
Housing First provides an effective solution for individuals who have repeatedly tried and failed to exit homelessness, who have given up on the treatment-then- housing ‘staircase’ approach, or who have been given up on by systems that regard them as ‘treatment resistant’, ‘hard to reach’, ‘not housing ready’, or ‘homeless / rough sleeping by choice’.
Housing First successfully engages these individuals by offering and providing immediate access to an apartment of their own, as well as access to person-centred, community-based, recovery-oriented visiting supports.
By providing a person with a home, Housing First offers dignity and ignites hope in individuals who have often been treated in an undignified manner, who have remained homeless and who have felt hopeless for years. The transformation of moving out of homelessness into a home of one’s own begins a process of physical and psychological healing and instantly changes that person’s social status from an outcast on the streets to a member of a community.
“I could not be happier and that’s the gospel truth. Staff keyworkers have helped me amazingly, they are always there to have my back which is a great thing to know. I did not think I would be able to live on my own because I never had to live on my own, but I am doing fine.”
- Housing First Tenant
Purpose of the Housing First Manual
The aim of the Housing First manual is to define, and support implementation of, a core set of principles and practices to create well-organised, multi-agency Housing First team structures that collaborate to provide housing and support services which aid recovery and community integration for the programme’s participants. The expectation is that Housing First services across Ireland will adhere to the principles and practices of Housing First internationally – to provide a uniform quality of supports across all regions.
The Housing First Manual is broken down into ten chapters and covers issues such as prioritisation of clients, housing selection, the process for home visits, and how to ensure clients are at the centre of decision-making. Below there is a breakdown of what each chapter entails, this will be a useful resource for Housing First Practitioners to consult the chapters which are most beneficial to them:
“Housing First is the only service that has treated me like a human being and I feel listened to. They provided me with a house that I turned into a home for me and my son. I can finally put the years of sleeping rough in tents behind me and move on with my life.”
-Housing First Tenant
This presents an overview of the values and principles of the Housing First programme, and a description of the core practices and skills that are an integral part of Housing First case management, treatment, and housing services.
The goal of the Housing First programme is to prioritise and engage those who have remained outside the existing service system by providing a different type of programme. This chapter provides detailed information on how local services select and prioritise clients for Housing First.
This section describes how community based, mobile support and treatment services are provided by Housing First. It details Community Based Care, No Discharge Policy, Specialist Supports, and Clinical Governance.
Housing First services consist of multi- disciplinary teams and staff from at least three different agencies (the local service- provider NGO, the HSE, and the relevant local authority). There is further information outlined on Team Culture; Communication; Staff Wellbeing; and Recovery Focused Services.
Home visits are among the most crucial interventions of Housing First. The client’s home is the stage where many of the team services are provided. On any given day, Housing First team members make many home visits, so they need to be efficient, prepared, and organised. Details are further outlined on how to arrange a Home Visit; Locations; and Staff Roles and Responsibilities.
It is essential that all Housing First programmes provide housing and tenancy support services to clients, landlords and Housing First team members in a way that is consistent with the programme’s principles and evidence-based practice.
The manual further outlines the approach to housing and tenancy support and focuses on a number of key areas including; the role of the housing case manager, housing retention and eviction, property management challenges, social relations and guest management and eviction prevention.
The vast majority of properties for Housing First programmes are social housing units provided by either local authorities or AHBs, with some regions also securing a number of units from landlords in the private rented sector. Housing First practitioners can find more information on Tenancy Agreements; Housing Options; Emergency Accommodation; and Housing Quality Standards.
Housing First programmes should have a peer specialist as one of the staff members of the support services team. The peer specialist or peer support worker should have personal experience in having sought assistance in overcoming their obstacles and should be currently in recovery from substance use, mental health problems, homelessness, or have overcome other obstacles for a period of at least one year. Here you will find information on the role of the Peer Specialist, Training and Supervision and Supports required.
This chapter provides suggestions about how to modify the Housing First programme to operate effectively in rural areas, including suburban communities, small towns and villages. It outlines information on rural health and treatment supports; identifying community stakeholders and challenges for Housing First Teams.
Fidelity’ refers to the degree to which individual, local Housing First services effectively adhere to the programme practices described in the manual.
Programme fidelity includes an assessment of programme content – staff composition, staff practices, services provided, and programme dosage – the duration, intensity, and frequency of services.
In the Housing First Manual the full Pathways Housing First Programme Fidelity Scale is provided which can serve as a review to help staff consider how they are applying the Housing First programme principles across the many complex client situations they encounter.