Finding the Way Home Using case management or service brokering to ensure Housing-led services emphasize treating people who are someone who is homeless has all the support they need to live homeless with compassion, warmth and respect and on independently in their home. Rather than directly providing recognising that access to suitable housing is a human right. treatment, personal care, practical support or advice, this model functions by arranging access to services provided by Housing-led services seek to promote what can be termed other agencies to ensure a person who is homeless is ‘ontological security’ and social and economic engagement by supported in accessing all the treatment, support and practical rapidly re-housing people who are homeless into their own help and assistance they may need to live as independently as settled accommodation in which they can live as independently possible. as possible. ‘Ontological security’ refers to the sense of safety, security and predictability that having somewhere you think of Using a combination of direct provision of support services and as your own home can give to people. In the housing-led case management to enable people who were formerly model, a home both functions as a place of security and safety homeless to live as independently as possible in ordinary and also as the base on which to re-connect with society. A housing. home means one can register to vote, sign up with a doctor, open a bank account and look for education, training or a job Some models of supported housing, for example staircase in the way anyone else would. Rapid housing is intended to services, can be highly regulated environments. For example, move people away from the unique distress of homelessness staircase services can insist on total abstinence from drugs and and back into society, improving their well-being by restoring a alcohol and on treatment compliance for mental health sense of safety and predictability and enhancing life by giving problems and might prevent people who are homeless from them a secure base from which to engage with normal social progressing from one ‘step’ to another, and sometimes evict and economic life13. them, for breaking these rules. In these forms of supported housing, housing is a ‘reward’ for following rules, for behaving Housing-led services do however have an expectation that ‘correctly’ and for compliance with treatment10. service users will have regular contact with a support worker or mobile support team who will work with them towards It is important to note that not all supported housing services sustaining as independent a life as possible. work by setting expected standards of behaviour and goals for people who are homeless to comply with. The balance between The importance of housing-led services seeking compliance with rules and providing flexible support Housing-led services have become globally important. The that seeks to follow the preferences of people who are reasons for this centre on a detailed longitudinal study that homeless can vary considerably across different forms of compared the outcomes of the New York Pathways model with supported housing11. those for staircase-based supported housing services and a The Pathways approach series of subsequent studies. The Pathways model was been found to be significantly more effective at delivering sustained Housing-led services generally follow or at least reflect what exits from homelessness for people who are long-term can be referred to as a ‘Housing First’ approach. This approach homeless and who have multiple needs, including problematic is based on the ideas and philosophy of the ‘Pathways Housing drug and alcohol use and severe mental illness, than staircase First’ model of housing-led service which was originally models. The staircase models used in the US do have developed in New York12. Housing-led services that either successes, but Pathways has stopped long-term homelessness entirely or broadly reflect this approach have the following at an unprecedentedly high rate, compared to other US service characteristics: models14. Service users choose for themselves whether or not to use drug/alcohol and mental health services without it affecting either their access to permanent or settled accommodation or being allowed to remain in permanent or settled accommodation. This ‘separation’ of housing from support is 10 TseentalerIlilsn,eSs.s(2010Aad)dHctuionnHaFzieldenhe Pnnesoata. Model to End Homelessness for People withsywhtaiM:T:tsrgisoidnabmM central to the housing-led model. 11 Pleace, N. (2008) Effective interventions for homeless people with a history of substance abuse: Lessons from a review of Housing-led services follow a harm reduction approach with a the Global evidence base for Scotland Edinburgh: Scottish Government. recovery orientation, i.e. they seek to support an end to drug 12 Tsemberis, S. (2010a) op cit. and alcohol use and encourage compliance with treatment for 13 Padgett, D. (2007) ‘There’s no place like (a) home: Ontological security among persons with a serious mental illness in the United States’ Social Science and Medicine 64, pp. 1925-1936; mental health problems through providing support within a Johnson, G. and Wylie, N. (2010) This is not living: The lived experience of chronic framework that gives people choice and control over what homelessness, Sacred Heart Mission, St.Kilda. services they use and when they use them, i.e. facilitating and 14 Tsemberis, S. and Asmussen, S. (1999) ‘From Streets to Homes: The Pathways to Housing Consumer Preference Supported Housing Model’ Alcoholism Treatment Quarterly 17,1-2, encouraging rather than requiring treatment compliance. pp.113-131; Tsemberis, S. (2010b) ‘Housing First: Ending Homelessness, Promoting Recovery and Reducing Costs’ in I. Gould Ellen and B. O’Flaherty (eds) How to House the Homeless Russell Sage Foundation: New York. 9
Finding the Way Home
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