Which Way Home? 27 needs at very high rates across different unemployment follow successful housing by a countries and within various welfare systems. housing-led service (Atherton and Earlier service models, notably the staircase or McNaughton, 2008). These criticisms centre step-based models that tried to make people on whether or not other aspects of life improve ‘housing ready,’ had sometimes housed less once chronic homelessness has come to an than 50 per cent of the people who were end. Evidence is, at the moment, mixed, there chronically homeless they worked with. is some evidence that living independently in Housing-led services working across a range their own home with access to support of countries were ending chronic services over which they exercise control has homelessness among 80 per cent or more of generally beneficial effects on the health and the people they worked with. A large scale well-being of people who were formerly multi-site evaluation in Canada (Mental Health chronically homeless, but, equally, that these Commission of Canada, 2012), the initial positive effects are not always present (Busch- results of a large scale four site trial in France Geertsema, 2013; Pleace, 2012). (DIHAL,2012) and the Housing First Europe project, which reported on housing-led l Some questions about the limitations of housing-led models, particularly centred on the services in five countries (Busch-Geertsema, 2013), all had very similar results. Housing-led 5-15 per cent of people who are homeless for approaches are generally successful at ending whom a housing-led service has not brought chronic forms of homelessness and providing an end to their homelessness (Pleace and sustained housing for people who were Bretherton, 2013b). Advocates of housing-led formerly chronically, i.e. long term homeless. services have responded to these criticisms by arguing that it is not possible for one service model to suit everyone, and that housing-led Debates about housing-led services need to be one of a mix of services, approaches shoutldhae,tihetheifaviewesponsngt-o chservic escinordeleisuoh,rtluredntbtiebla homelessness (Tsemberis, 2013). Criticism of housing-led services has come from two main sources. The first of these are academics, A debate about the most effective forms of Housing service providers and policymakers who have First is also on-going. This is centred on the extent raised the following questions about the to which housing-led services should replicate the effectiveness of housing-led services: original Pathways Housing First model used in New York. This debate centres on the assertion that l Questions about the strength of the evidence base for housing-led services, particularly housing-led services that do not closely follow, i.e. criticism of the evidence supporting the have high fidelity with, the Pathways Housing First Housing First service model in the USA model are less effective, with that effectiveness (Kertesz et al, 2009; Rosenheck, 2010; lessening the more the service differs from the Groton, 2013). These criticisms, which original model (Tsemberis, 2011). centred on methodological limitations, have lost some credence as evidence of success from These criticisms centre on the idea of ontological multiple international evaluations of housing-led security, which can be broadly described as the services have produced very similar results to difference between a living situation in which the original American research on Pathways someone is merely accommodated and a living Housing First and other Housing First services situation in which someone has a home (Padgett, (Busch-Geertsema, 2013). 2007; Tsemberis, 2010; Johnson and Wylie, 2010). l Questions about the other outcomes achieved The original Pathways Housing First model places following the successful housing of people great emphasis on normalisation of life through who were formerly experiencing chronic or normalisation of housing, in that people who were long term homelessness, i.e. whether formerly chronically or long term homeless are improvements in mental and physical health, intended to live surrounded by ordinary citizens social support, community integration and who have no experience of homelessness.
Which Way Home?
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