Finding the Way Home Two counterarguments can be made in response to these • CHF places people who are long-term homeless and who criticisms. First, that other service models do not stop the unique have high support needs alongside one another. There are distress of homelessness among vulnerable people, i.e. concerns that CHF services may be an environment in which sustainably end physical homelessness, at the rate achieved by many people use drugs and drink alcohol, and thus less than PHF. Second, expecting a homelessness service - of any sort - to ideal places to overcome problematic drinking or drug use. fully address all support needs, end social isolation and end CHF services might also be difficult places to manage54. economic exclusion simply may not be realistic, given that no form It is possible to argue against these criticisms. The belief that of homelessness service has ever managed to completely address inconsistency in the design of CHF services makes them difficult the poverty, worklessness, exclusion, poor health and low levels of to replicate and compare can be balanced against evidence that well-being that are associated with long term homelessness, for it is the general philosophy of housing-led services not the the bulk of the people whom it works with46. 55. Theevitceffemehtsekamtahtnoitareporiehtfoscificeps arguments against people who are formerly homeless with high ‘Communal’ Housing First support needs living together can be countered by looking at US Evidence of success evidence that people who are homeless do seem to choose to stay within CHF services, and while that choice may be The evidence base for CHF services is less developed than for constrained (i.e. there may be nowhere else to go), an PHF, but there is American and Finnish evidence that this apparently very similar population did tend to abandon staircase approach can sustainably end homelessness for people with long 56. Finally, it might be argued that if CHFetarhgihatasecivres term experience of homelessness who have high support needs47. services are correctly resourced there is no reason to assume Recent Finnish figures suggest a 32% fall in long-term they are inherently likely to make it more difficult to cease using homelessness48 from 3,600 in 2008 to 2,730 in 2011, the result of drugs or alcohol or be difficult to manage environments. There is a national programme using several forms of housing-led service, American evidence that CHF can manage groups of people with in which CHF services are particularly prominent49. very high needs who are long-term homeless (chronically homeless people in US terms), though also some Finnish Some work on the cost effectiveness of CHF has been done in the evidence suggesting that challenges can exist in managing a USA. One study estimated that there was an annual gross saving group of high need formerly long-term homeless individuals of $12 million for emergency and criminal justice services by living together57. stably housing 95 very ‘high cost’ people who were long term homeless and had very high support needs. The initial net saving was much less high, because the CHF project had cost close to $11 million to develop, but there were also the benefits of having 46 Busch-Geertsema, V. (2005) ‘Does re-housing lead to reintegration? Follow-up studies of re- taken a very high need population away from the emergency housed homeless people’ Innovation Vol. 18, Part 2, pp. 202-226. shelters and streets50. There is also some evidence that CHF 47 Larimer, M.E, et al (2009) op cit; Collins, S.E.; Malone, D.K.; Clifasefi, S.L. et al (2012) ‘Project-Based Housing First for Chronically Homeless Individuals with Alcohol Problems: services can reduce the level of problematic drinking among Within-Subjects Analyses of 2-year Alcohol Trajectories’ American Journal of Public Health people who were formerly homeless who become resident within 102, 3, pp.511-518; Busch-Geertsema, V. (2010) op cit; Kaakinen, J (2012) ‘Long term perspectives: From Housing First to Ending Homelessness’ Housing First: A Key Element of these services51, alongside the benefits to these individuals, this European Homelessness Strategies, 23rd March 2012 Unpublished conference proceedings. should over time reduce health service expenditure. French Permanent Representation, Brussels. http://feantsa.horus.be/code/EN/pg.asp?Page=1409 Evidence of limitations 48 proeloFngnidshndfcinirtoininc,ofo‘rloisgthtreeratehnoimgelteosb’ecsomeecrhsroonniwh(cherohnoic hoemeneessssnhss meecaonmesbsaelsslemsocpaisnmnohedaenihT Criticisms of the CHF model are threefold: sociraolnaendehealfthopmoeblleesmnse).ss or repeated homelessness during the last three years due tosrhorayevo • It is possible to argue that CHF is not a clear and consistent 49 Kaakinen, J (2012) Ibid. model in the way that PHF is, i.e. CHF services vary in 50 Larimer, M.E, et al (2009) op cit structure and operation, which means care has to be taken to 51 Collins, S.E. et al (2012) op cit. understand what it is about a specific CHF model that makes it 52 housil,nC:.;ADcominge,hCe.nasnvdeRrevieenweofkmRdel2009criSttuodnissaonfd“muepapsourrteem”entn’dEvauupaptoonivaend”trils“adseip‘)sed(.o,chsoirpbergobaT effective before a decision is made to replicate the approach Program Planning 33 pp. 446-456; Pleace, N. (2011) op cit. and which also makes cross comparison of CHF service 53 Tsemberis, S. (2011) Observations and Recommendations on Finland’s “Name on the Door outcomes more difficult52. Project” From a Housing First Perspective Housing First Finland www.asuntoensin.fi/files/1242/Tsemberis_2011_-Observations_and_Recommendations.pdf • People using CHF services have no choice over where they live, 54 Kettunen, M. and Granfelt, R. (2011) Observations from the first year of the Finnish Name on whereas PHF and HFL services may offer at least a restricted tyherso2012-2e0c15Rwwwmhmusidnatfiiornts.ffi/en/holusingt_frimsth/oeaedliensg_reososm/genetrion_preogriam/me forgndarlacudernsmrre-gnoehtrosgneo.oce:tjorprodae choice. If someone cannot choose where to live and who to live observations_and_conclusions/ alongside (at least to some degree) it might be argued that their 55 Pleace, N. (2012) op cit. capacity to exit homelessness may be undermined. By 56 Pleace, N. (2008) op cit. keeping people who were homeless in one block of clustered 57 Pleace, N. and Bretherton, J. (2012) ‘Will paradigm drift stop Housing First from ending flats, CHF services also arguably isolate their residents from the sociallepsoslnceysperCpeecgiovreis.ingpenrdgcivetncatlly‘Saoscsialssiolgcyhie HouUinnegquiarlstWmrold’emointt arnnualamofneJvoFsnantinPeaiiraaP’ttas?siemoh wider community and again it can be argued that this might conference of the EasJoint annual conference of the East Asian Social Policy Research Network limit possibilities for reintegration into society53. and the UK Social Policy Association, University of York 16-18 July. http://cms.york.ac.uk/terminalfour/SiteManager?ctfn=download&fnno=60&ceid=316902685 14
Finding the Way Home
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