HARM REDUCTION AND
HOUSING FIRST AT SHOW
National Conference on Ending
Homelessness 2013
Lindsay Klassen, B.A., M.S.W.
HOUSING FIRST
• The Housing First approach
• Housing First and recovery
• The Housing First model is simple
• Housing First and Housing Stability
THE CASE FOR HOUSING FIRST
• An estimated 150,000 to 300,000 people are
homeless across the country
• $1.4 billion each year in health care, justice and
social services costs
• 25 to 50 per cent of homeless people live with a
mental health disorder
• Social Determinants of Health
A PLACE TO CALL HOME
A PLACE TO LIVE
• Affordable
• Safe and secure
• Physical structure
A HOME
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Affordable
Appropriate
Permanent
Belonging and Community
Relationships
Choice and Control
Working and living
Self determination
Freedom
CORE PRINCIPLES OF HOUSING FIRST
Relationships
Tenant
Screening
and
Selection
Harm
Reduction
Housing First
Support
Services
Referrals
Finances
TENANT SELECTION AT SHOW
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Relationships with community partners
Eligibility criteria
Acceptance
Relationships with prospective tenants
SUPPORT SERVICES AT SHOW
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Engagement and problem-solving
Collaborative support plans
External supports
Additional Support Services
Harm Reduction Counselling and Supplies
HARM REDUCTION AND
UNDERSTANDING CHANGE
“Individuals are also likely to not want to change
when they perceive other people as trying to
pressure them or coerce them into changing. The
desire to be in control of ourselves and our
environment can cause us to resist changes that
might otherwise be to our advantage.”
From “Why Don’t Continents Move? Why Don’t People Change?”
Prochaska and Prochaska
STAGES OF CHANGE
• Pre-contemplation
“I don’t have a problem!”
• Contemplation
“Do I have a problem?”
• Preparation
“What can I do about this problem?
• Action
“I am currently doing something to
address the problem.”
• Maintenance
“I have managed to stick to the
changes I made for 6 months or
more.”
WHAT DOES HARM REDUCTION IN
HOUSING FIRST LOOK LIKE AT SHOW?
EXAMPLES OF HARM REDUCTION IN
HOUSING CONTEXT
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Wellness checks
A place to call home
Secure entry
Problem solving
Assistance
Planning
Food stability
Rent assistance and flexibility
Community and relationship building
WHAT ARE THE RISKS AND REWARDS?
Risks
• Risk of accidental injury, physical health decline etc. due
to substance use
• Risk of injury due to violence
• High staff turnover due to challenges of the work
• Risk of increased stigmatization of housing first participants
from the community
Rewards
• Witnessing and walking alongside recovery journeys
• Increased sense of community
• Lots of fun with inspiring people
• Enhanced collaboration with other community agencies
• De-stigmatization of housing first through stability
HARM REDUCTION
IN OPERATIONAL POLICY
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Identify primary purpose of program
Acknowledge substance use
Acknowledge diversity
Understand change and Reduce harm
Be clear about the problem
Be clear about expectations, triggers for staff
action, and consequences
Traditional Risk Management
Approach:
Housing First Risk Management
Approach:
• Implement practices that
reduce probabilities of high
impact risks.
• Implement practices that embrace
and minimize risks in order to reduce
the probability of something bad
happening
• Can’t be true to Housing First
principles without taking risks.
• Can’t control all of the factors that
increase risk
• Have to accept risk as part of doing
Housing First
• Therefore, programs must
• Take responsibility and
• prepare for risks
• Plan for appropriate supports to
minimize risks
HARM REDUCTION IN POLICY:
RISK MANAGEMENT IN HOUSING FIRST
WHAT FACTORS INCREASE RISK FOR
HOUSING FIRST PROGRAMS?
External Factors
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Difficulty Accessing
Needed MH/SU
treatment
Reliance on external
partners for support
Location
Internal Factors
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Housing First
Principles/tenant
selection
Staffing Model
RISK MANAGEMENT THROUGH
THERAPEUTIC RAPPORT
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Mutuality in relationship, trust, and respect
Empathy and understanding
Enhancing community, participant, and staff safety
Increasing tenant housing and wellness stability
Improving housing longevity
Increasing tenant engagement and ownership
Educate staff and the community
HARM REDUCTION ORIENTED
DECISION MAKING
RESPONDING TO ISSUES.
• Conflict Resolution
• Complaint Management
DOES HARM REDUCTION IN
HOUSING FIRST WORK?
• Tsembaris and Eisenberg - Pathways to Housing program
• Housing stability, fewer days in hospital, less expensive
interventions.
• The Here At Home/Ici Chez Soi Project
• The Story of SHOW
• The Village where Anything is Possible
THE VILLAGE
WHERE ANYTHING IS POSSIBLE