Housing and
homelessness
service integration:
Literature review
March 2016
About QCOSS
The Queensland Council of Social Service (QCOSS) is the state-wide peak
body representing the interests of individuals experiencing or at risk of
experiencing poverty and disadvantage, and organisations working in the
social and community service sector.
For more than 50 years, QCOSS has been a leading force for social change
to build social and economic wellbeing for all. With members across the state,
QCOSS supports a strong community service sector.
QCOSS, together with our members continues to play a crucial lobbying and
advocacy role in a broad number of areas including:



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sector capacity building and support
homelessness and housing issues
early intervention and prevention
cost of living pressures including low income energy concessions and
improved consumer protections in the electricity, gas and water markets
energy efficiency support for culturally and linguistically diverse people
early childhood support for Aboriginal and Torres Strait Islander and
culturally and linguistically diverse peoples.
QCOSS is part of the national network of Councils of Social Service lending
support and gaining essential insight to national and other state issues.
QCOSS is supported by the vice-regal patronage of His Excellency the
Honourable Paul de Jersey AC, Governor of Queensland.
Lend your voice and your organisation’s voice to this vision by joining
QCOSS. To join visit the QCOSS website (www.QCOSS.org.au).
ISBN – 978-1-876025-85-4
© 2016 Queensland Council of Social Service Ltd. This publication is copyright. Non-profit
groups have permission to reproduce part of this book as long as the original meaning is
retained and proper credit is given to the Queensland Council of Social Service. All other
persons and organisations wanting to reproduce material from this book should obtain
permission from the publishers.
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Housing and homelessness service integration literature review
Contents
About QCOSS................................................................................................. 2
Introduction ..................................................................................................... 4
What is service integration? ......................................................................... 4
Definitions of integration ........................................................................... 4
Reasons for integration ............................................................................. 6
Challenges for integration ......................................................................... 6
Conditions for success .............................................................................. 7
Housing and homelessness service integration ........................................... 8
The Australian experience ........................................................................ 8
The international experience ................................................................... 13
Summary ...................................................................................................... 18
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Introduction
The term ‘service integration’ means some form of ‘joint working’. This can
range from loose collaborative arrangements, such as referral of clients and
good communication between staff in different organisations to full integration
where the resources of different organisational units are pooled in order to
create a new organisationi. Service integration is increasingly being applied in
the housing and homelessness sector. This is because people who
experience homelessness also often concurrently experience mental health,
drug, alcohol or other issues and they need assistance from more than one
service at once. Service integration has the ultimate aim of providing a
seamless service for clients.
This report reviews peer-reviewed and grey literature on what service
integration is, what are the challenges of implementation and the conditions
for success, and how it can be applied in the housing and homelessness
arena. Different approaches to integrated housing and homelessness
responses in the United States, Canada, Europe, and Australia are also
considered.
What is service integration?
Definitions of integration
Service integration has been defined as the bringing together of previously
dispersed and independent services into a more comprehensive service
delivery systemii; or a process by which two or more entities establish
linkages for the purpose of improving outcomes for needy peopleiii. The term
has been used in a variety of contexts including in relation to coordinating,
collocating, or restructuring services or programsiv.
Crucially, integration is about creating more client-centred services. The
following definition comes from the health sector, which has been operating
using integrated approaches for some time:
Achieving integrated care requires those involved with planning and
providing services to impose the patient’s perspective as the
organising principle of service deliveryv
The terms ‘bottom up’ and ‘top down’ are frequently used to describe the
distinction between service level integration and system level integrationvi.
Top down approaches typically involve government or departmental service
design and implementation through contract management. Decentralised
bottom up approaches stem from the services or communities themselves
and tend to allow for greater local community roles in program administration
and managementvii.
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In fact, integration of services and service systems can occur at any of four
levels:
1. Government/policy integration which occurs across portfolios. This
requires political commitment and continued high level support.
2. Regional and local planning integration which involves the formation of
local partnerships to drive integration, map community assets and
need, and develop a local integration plan.
3. Service integration which could occur anywhere along a five-point
continuum from coexistent independence through to full of services
integration through mergers.
4. Teamwork integration where team members with specialist expertise
support a range of client needs or multidisciplinary teams attend to
several needsviii.
As noted, service integration may be thought of in terms of a continuum
rather than just the end point of full integrationix. Figure 1 below illustrates one
conceptualisation of this continuum.
Figure 1: Continuum of service integration x
Another way of thinking about the continuum of service integration is from
cooperative to coordinated to collaborative integration. Cooperative
arrangements link autonomous agencies with individual priorities through
information sharing. Coordinated integration links independent accountable
agencies with complimentary goals through formalised project related
information and resource sharing. Collaborative integration is characterised
by higher levels of information sharing and communication, systemic change,
power sharing, collective funding arrangements, and service integration
network accountabilityxi.
Agronoff identifies three interdependent public management activities that are
essential to integration:

Policy and strategy development at program implementation level

An operating plan that contemplates external support

Local systems that are developed at the client levelxii.
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Reasons for integration
The move towards integration is based upon the opinion of service
professionals, policy makers, and researchers that by integrating services
clients will gain the benefits of reduced fragmentation and greater
coordination of services, leading to a more effective system. Social services
systems with complex, inter-connected service pathways are said to offer the
biggest opportunities for gains through integrationxiii.
Integration can be driven by an impetus to create a new service to fill existing
gaps, to improve the functioning of existing services, or by a combination of
both factorsxiv. Within the health, substance use, and human services arenas,
there is general support for a community-centred approach to integration that
decentralises the relationship with the client, or patient, and brings the
influence of community and personal supports to bearxv.
Service integration is seen to offer both efficacy and efficiencyxvi. Efficacy
relates to improved outcomes; that is the intervention is more likely to
produce the desired result. Efficiency is about reduced cost per-service. In a
housing and homelessness context, this often results in the substitution of
lower priced or community based services for high cost government-delivered
programs and resources.
Collaborative strategies, such as service integration, are supported by the
bulk of the literature as being the most effective in dealing with complex or
‘wicked’ social problems because they allow power to be dispersed across
many stakeholders. The result is a win-win approach to problem-solvingxvii.
Challenges for integration
Integration efforts face a number of challenges. Research indicates that
initiatives are likely to fail if they are overly ambitious in level and scope;
lacking in incremental achievable goals; driven by ideologies rather than
policy analysisxviii, or limited geographically or politically and thus cannot
encompass the full range of required servicesxix. Initiatives also tend to fail if
there is inadequate time for implementation; unclear definitions and starting
points; or a shortage of data on cost benefitsxx.
Barriers cited in the literature to the successful planning, implementation, and
management of integration initiatives include: lack of leadership; lack of
support in decision making; poor delivery system design, and lack of effective
information systemsxxi.
Garnering support at a policy level that corresponds with service level uptake
can be another stumbling block, along with service funding and outputs that
do not match with the complex needs of clients. Outcomes may take some
time to achieve and integration partners may need to commit to continuing
integration activities after funding has ceased if funding arrangements are not
based on realistic timeframes.
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Conditions for success
The New Zealand Government notes that integrated services models are best
applied with people who find accessing the services they want, in the form
they want, very difficult and experience consistently poor outcomes across a
range of domains. See Figure 2xxii.
Figure 2: Relationship between integrated social services and other models.
For locally-based integration activities, it is important to build on the
community’s priorities rather than external concerns and to work with, rather
than for, community members. This means identifying and supporting
leaders within the community and encouraging accountability among leaders.
It is also about encouraging collective work, knowledge sharing and
participatory decision-makingxxiii.
Leadership, clear and shared understandings of the approach, supportive funding
and governance systems are key success factors that are repeatedly cited in the
literature.
Ouwens et al. highlight the following key enablers for success:

supportive service information systems

agreement between personnel involved on the nature of the integration

leaders with a clear vision

resources for the implementation and maintenance of the approaches

management commitment and support
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
clients capable of, and motivated for, self-management, and

a culture of quality improvementxxiv.
A review of the integration of homelessness, mental health and drug and alcohol
services in Australia noted the following conditions need to be present:

A clear understanding of the cost/benefit of integration

Goodwill among staff to mesh different cultures and ways of working and
willingness to adapt
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Leadership and good management
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Funding and governance arrangements that support integrated
programsxxv.
Housing and homelessness service integration
The Australian experience
Service integration has been a major plank of Australian policy frameworks
related to housing and homelessness in all jurisdictions in Australia in recent
years. The Federal Government’s White Paper, The Road Home, and
subsequent homelessness plans implemented around the country refer to the
importance of service integration in achieving an end to homelessness for
clients. A similar focus on service integration is evident in the mental health
and drug and alcohol domainsxxvi.
An Australian literature review on the effectiveness of integration in the
homelessness context found systems that are better integrated have
significantly better housing outcomes, but that beyond housing, extensive and
targeted efforts to promote systems integration do not produce desired social
and clinical outcomes at the individual client levelxxvii. Earlier analyses of
integrated approaches trialled in Townsville, the Gold Coast and Brisbane
found that the combination of increased funding and a focus on integrated
approaches precipitated a shift from disparate uncoordinated responses that
compete for available long term and temporary housing options towards
approaches that harness a range of agencies’ knowledge, resources, and
expertise in order to achieve sustainable housing outcomes for clientsxxviii.
A report on homelessness service integration in regional areas identifies five
realistic integrated models. These are: integrated case management, service
hubs, networks, project-based working groups, and integrated Aboriginal and
mainstream services. These integration strategies have been shown to be
transferable to other regional as well as metropolitan areasxxix.
Creating an integrated system model in the homelessness area is a complex,
time consuming and resource intensive endeavour.
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An integrated model must focus on the three key components of prevention,
outreach, and recovery, combined with intensive case management for
people with acute, complex, and interconnected issues. Importantly,
integrated support should not cease once a person leaves crisis or
transitional accommodationxxx. A best practice model would be
comprehensive and include accommodation and mainstream support
services across the housing employment, health and mental health, training,
education, and social spheresxxxi.
A 2013 review of the level of integration of homelessness, mental health and
drug and alcohol services in Australia found there were still a number of
policy challenges to overcome:

While close collaborative relationships and formal partnerships are
producing positive net benefits for clients, there was a greater likelihood
of collaboration within the same service domain than with services in
different domains.

Services do want to increase integration but they also want to retain their
independence. That is, there are limits to the desired level of integration
and these limits need to be recognised.

There are resource implications in supporting integration in terms of
governance and coordination support that need to be considered.

In some cases, relationships between staff in different services and
protocols for sharing information need to be strengthened before
integration functions effectivelyxxxii.
Summaries of three successful Australian housing and homelessness
integrated service initiatives are:
1. Under One Roof, Brisbane
2. Common Ground, Brisbane
3. Housing Connect, Tasmania
Under One Roof
The Brisbane Under One Roof coalition is a consortium of homelessness,
housing and community services located in the inner city that offer a city-wide
range of services. The program employs a ‘housing first’ approach; it
provides assertive outreach from primary homelessness through to tenancy
sustainment once people are housed.
Funding for an Under One Roof coordinator position has been provided by
the Rotary Club of Fortitude Valley with additional funding provided during the
integration phase by the Department of Social Services, Queensland Health,
and the Departments of Communities, Health and Housing and Public Works.
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Under One Roof ran leadership and professional development sessions
throughout the establishment phase, and cite leadership at a front line worker
and board level as key factors contributing to the successful collaboration of
multiple large agencies.
Under One Roof’s multi-agency response provides coordinated case
conferencing meetings, a managers’ forum to constantly improve service
delivery and inter-agency cooperation and communication, a board of
management, and professional development opportunities. By combining
resources the coalition can coordinate all components of a support plan
including:

specialised case management

wrap around support

short, transitional and long term supported housing options

multiple information, assessment and referral points

a common assessment tool

mental and physical health supports
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respite from trauma and abuse

street outreach and multiple entry points to a single coordinated
system
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harm minimisation information
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help with substance dependency, and
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assistance with food and mealsxxxiii.
In addition to 12 core partnering agencies, Under One Roof has developed
partnerships with legal, homelessness, social, and health support agencies,
which are engaged in support provision when appropriate.
In 2013, Under One Roof moved towards a sustainable model which could be
replicated in other locations. It wound down project establishment costs and
quantified resourcing for continuing case coordination at just over $18,000
per annum above the costs of frontline staff and managers attendance,
housing provision and support, with Brisbane City Council providing 2013-14
case coordination funding.
The Under One Roof model has reported increasingly strong housing
outcomes during the past five years with 74 per cent of clients reporting an
improved housing outcome in 2013-14.
Learnings from the model include:

A learning and development approach is important

Quality improves through integrated service delivery: better ideas and
more persistence emerge
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
Structure is important to support relationships between agencies: case
coordination meetings, learning events, the board: minimal structure
for the task

While resources and systems issues are very real, there is also a lot
that can be done with practice to improve outcomes

Leadership makes a difference: leadership at every level xxxiv.
Under One Roof cite the strong focus on clients and client outcomes as
important in terms of lending meaning to the consortia’s work, enabling the
development of concrete practical objectives, and helping sustain agency and
worker commitments.
Common Ground
Common Ground Australia won the support of governments and the nongovernment sector through the efforts and influence of policy entrepreneurs
and advocacy coalitions rather than by directly influencing government policy
through evidence based researchxxxv. Looking for a new approach, key
Australian homelessness sector stakeholders travelled to the United States to
visit the Times Square New York Common Ground Congregate Living
Project. The New York project harnessed the financial support and goodwill
of the Times Square business development community in supporting the
conversion of a disused hotel into a supported housing residence for former
Times Square rough sleepers. Characteristics of the Times Square
development included an onsite concierge, tolerance of alcohol and
substance use in situ, and the provision of resident support as needed.
These characteristics have now been reproduced in Australian Common
Ground projects.
Four key factors influencing the adoption of Common Ground in Australia’s
congregated housing model in preference to the usual scatter site housing
models widely adopted internationally have been identifiedxxxvi:
1. Common Ground galvanised support because it anticipated an exciting
radical response to homelessness.
2. Large scale building that attracted private developers willing to build at
cost was considered an advantageous method of adding social
housing stock.
3. Undertaking a scatter site approach to housing and support provision
in Australia’s high cost public and private rental markets was
considered unfeasible.
4. Common Ground aligned with broader policy objectives including
offering measurable targets, promoting social inclusion and coincided
with a shift in Commonwealth Government homelessness policy with
the election of the Rudd Government and championing of Common
Ground by the then Prime Minister’s wife Therese Rein.
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Common Ground featured prominently in sector-led integration initiatives
including the 50 Lives 50 Homes (2010) and 500 Lives 500 homes (2014)
campaigns. Both campaigns adapted U.S. methodologies including use of the
Vulnerability Index Service Prioritisation Decision Assistance Tool (VISPDAT) to triage interviewees and build an evidence base for support
provision and housing placements. The campaigns engaged local and state
government support; enlisted community and volunteer supports for public
space outreach engagement with people experiencing homelessness; and
applied a collective impact approach to a housing first framework. Collective
impact approaches have a common agenda, shared measurement, mutually
reinforcing activities, continuous communication, and backbone (dedicated
team) supportxxxvii. Common Ground Brisbane’s adaptation of the New York
model with onsite concierges, independent tenancy management, and
external supports provided by MICAH, complimented the campaign’s
methodology.
The independent evaluation of the Brisbane Common Ground initiative is
soon to be completed. This will provide solid evidence of the nature,
experiences and effectiveness of its approach. In the meantime debates
continue about the appropriateness of integrated models that involve
congregate housing, such as Common Ground, versus scattered site
housing. In the end, it may come down to the individual needs and
preferences of the consumer. Some individuals prefer the support and
company that congregate housing may offer, but for some the associated
stigma with the identified status as a ‘homeless person’ or a ‘mentally ill
person’ is of greater concern than the tenants need for supportxxxviii.
Housing Connect Tasmania
Housing Connect Tasmania is a one-stop shop for all housing and support
needs for people on low incomes and in crisis, from emergency
accommodation to long-term homes.
In 2013, the Tasmanian Government partnered with five organisations:
Anglicare, Centacare, Colony 47, Hobart City Mission, and the Salvation
Army, to establish a series of Housing Connect front doors to the housing and
homelessness system. Five Tasmanian Housing Connect front doors
consolidate all housing and homelessness information, advice, and referrals
into single shopfronts staffed with highly skilled generalists obviating the need
for people to approach multiple services. A common assessment framework
and use of the ‘ASK’ database allow front door staff to undertake initial
assessment, case planning, and referrals to support services.
Housing Connect offices administer private rental assistance funding
(including assistance with arrears, removals and relocation assistance), as
well as crisis and early intervention brokerage that may be used to purchase
short term private rental accommodation, maintain an existing tenancy, or
purchase white goods, household security, child care, counselling, or
transport to support services.
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Social housing assessments are also completed at front door offices.
Housing Connect also serves as a triage point for youth clients and people
experiencing or escaping domestic violence. Additional intake options
include outreach appointments for vulnerable people, or those exiting
institutional care into homelessness. A free after-hours phone service
provides emergency accommodation advice, information, and referral.
All specialist homelessness support service accommodation providers will
transition into the Housing Connect system by 1 July 2016xxxix. The Housing
Connect model has experienced high demand since opening its doors in
2013, with more than 11,000 Tasmanians receiving housing assistance in the
nine month period of its first year (Oct 2013 - June 2014)xl.
The international experience
The move towards service integration in housing and homelessness services
has taken hold around the world. This section summarises examples of
approaches taken in various countries including:

U.S. legislative reforms that mark a foundational shift from Federal
system-level regulation to bespoke regional responses delivered by
autonomous self-regulating consortia.

Canadian services that, in the absence of system level reforms, have
created service-level localised responses built upon memoranda of
understanding, inter-service agreements, formal and informal
partnerships, and

Eurozone place-based strategies that situate cities as lead agencies,
primary service providers, significant funders, and coordinators of nongovernment services.
United States of America
American housing and homelessness service integration initiatives arose
from public competition for homelessness grants in 1995, and were codified
as a system level reform through passage of the Homelessness Emergency
Assistance and Rapid Transition to Housing Act in 2009. Under the Act,
service systems are integrated through the Continuum of Care (CoC)
framework, in which the Federal Department of Housing and Urban
Development (HUD) devolves housing and homelessness responses to
locally formed and governed state, local government, and not for profit
provider CoC consortiaxli.
CoCs are local networks that develop and manage plans, and coordinate
funding, for local services that support people experiencing homelessnessxlii.
CoCs are governed by a Board comprised of stakeholders who apply for HUD
funding, oversee grant acquittal, and are accountable to HUD for the CoC’s
activities. CoCs may be comprised of, but are not limited to, non-government
specialist homelessness support agencies, domestic violence organisations,
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charitable and private sectors including churches and businesses, schools,
public and community housing providers, mental health services, hospitals,
tertiary education facilities, police and corrective services, veteran supports,
and peer supporters.
COCs are designed to foster a community-wide commitment to addressing
homelessness, administer funding for rapid rehousing work by CoC
members, facilitate access to and use of mainstream services, and enhance
self-sufficiency and independence among people experiencing
homelessness. HUD awards funds based on CoC planning group assessed
and demonstrated need. All participating agencies cooperate through the
submission of a single consolidated applicationxliii.
Three key components of the CoC service model are:
1. Outreach, intake, and assessment with use of a common assessment
tool to link people with the appropriate service
2. Transitional housing with support services that develop peoples’
ability to maintain permanent housing and live independently
3. Permanent long-term community based supported housing that
supports high acuity people with complex needs.
CoCs use considerable brokerage funding and discretion for client debt
remedy; financing education and vocational training; and purchasing health,
mental health, drug and alcohol and psychological services. CoCs use both
scatter site and congregate housing approaches intended to transition
primary homeless into independence. The more successful CoC approaches
attach up to six months support to transitional tenancies.
Figure 3: Continuum of Care Homelessness Response Model United Statesxliv
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People assessed as requiring long term intensive support and subsidised
housing through use of the VI-SPDAT benefit from integrated housing and
mental health programs combining a scatter-site housing-first approach with
in-home mental and physical health, substance use, education, and
employment supports for people with severe psychiatric disorders and
substance abuse issues. Combining housing with in-home health and social
supports has resulted in 85 to 90 per cent housing retention rates thereby
reducing health system costs associated with treating rough sleepersxlv.
Rapid-Rehousing models that form a centrepiece of CoC strategies have
been shown to be effective provided that:

people housed are assessed as having moderate needs

home visits continue for six months

households have reasonable locational choice

connections to mainstream and community supports commence as of
move in

employment is a case management cornerstone wherein interactions
progress towards a goal that relates to housing sustainment in a
sequenced manner, and

contingency planning is in place for cessation of supports and
subsidiesxlvi.
Canada
In 2003, the Canada Mortgage and Housing Corporation (CMHC) reviewed
the applicability of the US CoC model for domestic implementation. Positive
aspects cited by Canadian stakeholders included collaborative planning
requirements, competitive applications, service integration, focus on high
needs demographics, and the recognition that support is required to assist a
persons’ transit through the homelessness to housing continuumxlvii.
Stakeholders also identified challenges with the model including the lack of
planning resourcing, triage and assessment workloads, and the lack of long
term affordable housing. Valuable CoC components that could be included in
the Canadian system included mandatory locally coordinated action plans,
best practice identification and sharing, development of a national
standardised individual tracking and statistics toolxlviii.
CoCs have now been established in Canada in several locations, on a
smaller scale than their American counterparts. For instance, in British
Columbia three housing emergency shelter program services have
established a collaborative CoC model that provides a continuum of supports
across three agencies ranging from food and laundry drop-in services to full
service shelter with links to housing and community based resourcesxlix.
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Observing the example set by North American initiatives, the Canadian
Homeless Hub assisted with the development of Calgary’s 10 Year Plan to
End Homelessness 2008-2018. The plan provides a template for
communities interested in adopting local action plans to end homelessnessl.
The plan operates within a housing first framework in which the most
disadvantaged clients are prioritised for housing with supports to promote
housing stability and sustainability. The system is characterised by use of a
common assessment tool, region or city wide coordinated case management,
and a data management system that supports consistency and coordination
of responses. The housing first philosophy underpins several chronic
homelessness response programs across Canadian provinces.
Europe
The Eurocities Working Group on Homelessness developed a transferable
integrated service model known as the “Integrated Chain” in which services
and cities work together under a common strategyli. Key links in the
integrated chain include:

Independent housing

Accommodation with floating support or ongoing residential support

Night shelters and/or emergency response accommodation

Specialist crisis and support centres

Non-accommodation services

Intake to homelessness services

Support to avoid homelessness/ prevention.
Members of the Eurocities meet regularly to analyse policies and practices to
prevent homelessness and support those who are homeless. Some of the
integrated approaches being implemented under the framework include the
followinglii.
Newcastle
Newcastle’s Housing Advice Centre helps people to remain in their
accommodation and helps people in crisis to access stable accommodation,
through a network of more than 60 agencies that work to a range of
prevention protocols and procedures. The Centre’s housing management
team monitors people who were homeless or were at risk of homelessness
but are now living independently in public housing to check that they do not
relapse into homelessness and re-establish support services if necessary.
Barcelona
Barcelona has established a network of agencies under its “Municipal Care
for the Homeless” program featuring a network of public agencies and NGOs
working collaboratively. The program is co-funded by services and local
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government, includes street outreach services, accommodation, day centres,
and specific care, and is framed by inter-organisational agreements.
Bergen
Bergen has eight social services centres which assist people who are at risk
of eviction and ensure that people who were homeless can retain their flats.
In addition, all the relevant services play a part in preventing eviction through
the local strategy against homelessness.
On top of these services, an outreach team of social workers is active on the
streets, seeking out vulnerable young people who may be homeless or in
danger of eviction. Young people are encouraged to get in touch with the
appropriate services (for example, social services, mental health services,
doctor, and addiction treatment) so that they can avoid losing their home. The
centres also provide assistance in finding jobs, support for people with drug
addiction, and help in contacting other relevant support services.
Munich
Each of Munich’s 13 regions has a social services and benefits office with a
homelessness prevention service (FaSt). The FaSt offices are drop-in
centres, staffed by social workers who offer advice and assistance to people
at imminent risk of homelessness, and can intervene on their behalf. In
addition, under a cooperation agreement with landlords, FaSt services are
notified of households who are in rent arrears. Under German law, FaSt
services are informed of notices for repossession and eviction.
Oslo
Until recently, Oslo’s homelessness system was comprised of a myriad of
disparate competing services offering supports to the homeless in an
uncoordinated manner. Oslo’s Social Services Department now have primary
responsibility for homelessness assistance provided through a single entry
point where services can be delivered directly or brokered. Housing with
support is provided for people with mental illness or dual diagnosis. Tenancy
sustainment and homelessness prevention services are provided by 15 city
run district services – which also provide food, social engagement, and a
range of support and advocacy services as well as a 24-hour emergency
medical centre. There are 32 rehabilitation centres which house people for an
average of two years with many tolerating drug and alcohol use. Permanent
supported housing for people with substance use issues is provided by the
city in conjunction with medical support. People can move between
rehabilitation centres as needed. The city provides subsidised housing with
five-year leases for vulnerable people.
Rotterdam
The first stage of the Netherlands plan to address homelessness focused on
the provision of individual plans for nearly 3,000 people experiencing
homelessness effectively reducing levels of anti-social behaviour and criminal
offences by 25 per cent
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Stage two of the strategic plan focuses on prevention empowerment. A
homelessness integration strategy will involve a scatter site approach to
housing of people with anti-social behaviours. Progression through the
integrated chain model is non-linear, circumstance determined. Rotterdam’s
Department of Health chairs networks comprised of housing corporation
managers, doctors, teachers, and social workers who provide early
intervention by identifying people at risk of homelessness.
Stockholm
Stockholm uses housing and support within a coordinated chain approach
with eviction prevention a priority. The majority of people using Stockholm’s
homelessness services have substance use issues. Fourteen districts design
strategies to prevent evictions locally, within national and city guidelines.
Each district has its own intake and assessment point. Services are funded
either completely or in large part by the city and are delivered by a
combination of NGOs, private companies, and the city.
Summary
There is a consensus that service integration for complex clients such as
people experiencing homelessness makes practical sense in terms of
reducing fragmentation in the service system and creating more clientfocused and streamlined responses.
There are many examples of integration occurring at the coordination and
collaboration end of the spectrum. The challenge is in garnering the political
and funding support and strong service provider relationships required for
deep integration that allows homeless clients to more readily access the full
range of services they require.
More evidence is required on the client experience and outcomes to fully
understand the impact of housing and homelessness integration initiatives in
Australia and what models work best.
Page 18 / March 2016
Housing and homelessness service integration literature review
Endnotes
i
Flateau, P. (2013). Homelessness and services and system integration. AHURI positioning
paper. http://www.ahuri.edu.au/publications/projects/p82013
ii
ibid.
iii
Konrad in Service integration in a Regional Homelessness Service System- Final report
November 2011.
iv
Hassett and Austin in Fisher, P. and Elnitsky, C. (2012). Health and Social Service
Integration: A review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
v
Shaw S., Rosen R., Rumbold B. (2011). What is integrated care? London: Nuffield Trust.
vi
Voyandanoff in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A
review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468.
vii
Hassett, S., & Austin, M. J. (1997). Service integration: Something old and something new.
Administration in Social Work, 21(3/4), 9–29.
viii
Lewis in Moore, T.G, and Fry, R. (2011). Placed based approaches to child and family
services: A literature review. Parkville, Victoria: Murdoch Children’s Research Institute and
The Royal Children’s Hospital Centre for Community Child Health.
ix
Ibid
x
Hilton in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A review
of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xi
Ibid
xii
Agranoff in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A
review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xiii
NZ Productivity Commission (2015). More Effective Social Services: draft report.
http://www.productivity.govt.nz/sites/default/files/social-services-draft-report.pdf
xiv
Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A review of
Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xiv
Ibid
xv
Adams and Nelson in Fisher, P. and Elnitsky, C. (2012). Health and Social Service
Integration: A review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xv
Ibid
xvi
Capitman in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A
review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xvi
Ibid
Page 19 / March 2016
Housing and homelessness service integration literature review
xvii
Moore, T.G, and Fry, R. (2011) Placed based approaches to child and family services: A
literature review. Parkville, Victoria: Murdoch Children’s Research Institute and The Royal
Children’s Hospital Centre for Community Child Health
xviii
Lago and Zarit in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration:
A review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xix
Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A review of
Concepts and Models, Social Work in Public Health, 27:5, 441- 468
O’Looney in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration: A
review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xx
xxi
Kilbourne et al in Fisher, P. and Elnitsky, C. (2012). Health and Social Service Integration:
A review of Concepts and Models, Social Work in Public Health, 27:5, 441- 468
xxii
New Zealand Social Policy Evaluation and Research Unit. (2015). What Works: Integrated
Social Services for Vulnerable People Families Commission.
http://www.superu.govt.nz/what-works-integrated-social-services-vulnerable-people
xxiii
Katz in Moore, T.G, and Fry, R. (2011) Placed based approaches to child and family
services: A literature review. Parkville, Victoria: Murdoch Children’s Research Institute and
The Royal Children’s Hospital Centre for Community Child Health.
xxiv
Flatau, P., Conroy, E., Clear, A. & Burns, L. (2010) The integration of homelessness,
mental health and drug and alcohol services in Australia. AHURI positioning paper no. 32.
xxv
ibid.
xxvi
Flatau, P., Conroy, E., Thielking, M., Clear, A., Hall, S., Bauskis, A., Farrugia, M. & Burns,
L. (2013). How integrated are homelessness, mental health and drug and alcohol services in
Australia? AHURI Final Report no 206.
xxvii
Flatau et. al (2010). op.cit.
xxviii
Keast R., Waterhouse, J., Brown, K., Murphy, G. (2008) Closing Gaps and Opening
Doors: the function of an integrated homelessness service system, Place based network
analysis and case studies - Final Report
xxix
Evans, T. (2011). Service Integration in a Regional Homelessness Service System,
Northern Rivers Social Development Council, Regional Futures Institute, Southern Cross
University
xxx
Cameron C. (2009). Tackling youth homelessness with integrated service delivery: The
case for integration in addressing the needs of young people who are homeless,
disadvantaged and at risk, Melbourne Citymission, Melbourne.
Urbis. (2009). Quality Frameworks for Homelessness and Related Services – Literature
Review and Environmental Scan.
xxxi
xxxii
Flatau et. al (2013). op. cit.
xxxiii
Under 1 Roof. (2013). Our Approach. http://www.under1roof.org.au/our-approach/
Page 20 / March 2016
Housing and homelessness service integration literature review
xxxiv
Under 1 Roof: community in action. (2015). Celebrating five years.
http://www.under1roof.org.au/elements/2013/12/Presentation-of-client-outcomes-final.pdf
xxxv
Parsell, C., Fitzpatrick, S., Busch-Geertsema, V. (2014). Common Ground in Australia: An
Object Lesson in Evidence Hierarchies and Policy Transfer, Housing Studies, 29:1, 69-87
xxxvi
Ibid.
xxxvii
Collective Impact Forum. (2014). What is collective impact.
https://collectiveimpactforum.org/what-collective-impact
xxxviii
Parsell et. al. (2014). op. cit.
Tasmanian Government (2015) Tasmania’s Affordable Housing Action Plan 2015-2019
http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0003/203691/150596_TAH_Action_Plan_
WCAG_d1.pdf
xxxix
xl
Housing Tasmania (2015) Tasmania’s affordable housing strategy 2015-2025
xli
US Department of Housing and Urban Development. (2014). HUD Exchange
https://www.hudexchange.info/programs/coc/
xlii
US Department of Housing and Urban Development. (2014). Continuum of Care Program.
https://www.hudexchange.info/resources/documents/EstablishingandOperatingaCoC_CoCPr
ogram.pdf
xliii
Canada Mortgage and Housing Corporation. (2003). Applicability of a Continuum of Care
Model to Address Homelessness, Socio Economic Series 03-015, Sept 2003.
xliv
US Department of Housing and Urban Development. (2013). Rapid rehousing: ESG vs
COC guilde. https://www.hudexchange.info/resource/2889/rapid-rehousing-esg-vs-coc/
xlv
Pathways to Housing. (2016). Housing First Model. https://pathwaystohousing.org/housingfirst-model
xlvi
Org Code Consulting Inc. (2015). Does Rapid Re-housing Work: Well it Depends?
http://www.orgcode.com/2015/07/08/does-rapid-rehousing-work-well-it-depends/
xlvii
Canada Mortgage and Housing Corporation. (2003). op. cit.
xlviii
Ibid
xlix
Efry, Keys Housing and Health Solutions and Options Community Services. (2013).
Partnering Towards a Continuum of Care for the Homeless in Surrey.
https://www.elizabethfry.com/publications/docs/Case-planning-collaboration-v7.pdf
The Homeless Hub. (2007). Calgary’s 10 Year Plan to End Homelessness 2008 - 2018.
http://homelesshub.ca/resource/calgary%E2%80%99s-10-year-plan-end-homelessness2008-2018
l
Eurocities. (2012). Report on Cities’ Strategies Against Homelessness: The integrated chain
approach. http://www.fiopsd.org/wp-content/uploads/2012/12/City-responses-tohomelessness.pdf
li
lii
ibid
Page 21 / March 2016
Housing and homelessness service integration literature review
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