Finding the Way Home Housing First Light services • Questions have been raised about whether ongoing support from HFL services is actually necessary if this approach is Evidence of success used for lower need groups, i.e. whether people with lower While there have been evaluations of individual HFL services, support needs, for whom suitable housing has been arranged, systematically collected evidence on the effectiveness of these might actually tend to be able to live sustainably and services is quite unusual and some of what is available is rather independently in the community without any further support63. out of date58. The HFL approach, or services which are close to it, • HFL service outcomes can also be questioned in some of the is quite widely used in the UK but research on these services same ways in which PHF service outcomes can be tends to be small scale and not to monitor how sustained any questioned, i.e. homelessness may be stopped, but needs successes are. In one systematic US study, an HFL model around isolation, boredom and productive/work related activity achieved a 65% housing sustainment rate59 among military for service users may remain. The capacity of HFL services to veterans with support needs who had become homeless, a level support high risk individuals using mobile support might also of housing sustainment that, while lower than that achieved by be questioned64. PHF and CHF services, was still higher than for staircase services. Questions around the financial ‘pay off’ from using HFL services can be counteracted by considering the wider costs of Little work has been done on the costs of HFL services, although homelessness to individuals and society. Costs and benefits are it is generally the case that these services, using a small, mobile not simply about savings to emergency medical, criminal justice support team to provide low intensity case management to people and emergency accommodation services. Keeping people who who were formerly homeless, are quite low cost. One difficulty are vulnerable and homeless off the streets and out of emergency lies in calculating the ‘entire’ cost of an HFL service, because shelters and re-housing them is both a humanitarian policy these services do not cost that much in themselves, but bring response and also one that can change how a city like Dublin together more expensive packages of support through case feels to its residents and presents itself to potential investors65. management. If HFL services work well, they have the potential to While HFL is not a single, cohesive, approach like PHF, evidence connect people who were homeless with support needs with suggests that, as with CHF services, following a ‘housing-led’ health, personal care and welfare systems they may have not philosophy appears to make HFL services relatively more been previously using, even if at the same time HFL may reduce effective at ending homelessness than some other forms of costs for emergency health services and the criminal justice homelessness service66. system60. As with PHF, it is possible to criticise HFL services on the basis Evidence of limitations that they may not fully address other needs. The same response There are four sets of criticisms of HFL services: can be made to these criticisms about these services not addressing all needs as for PHF, which is that it is not realistic to • When HFL is used by people who are homeless with lower expect any one homelessness service model to fully address all level support needs, the ‘savings’ on health, personal care and aspects of need associated with long-term or chronic criminal justice budgets may be less significant. This is homelessness. HFL services are primarily designed to sustainably because it is people who are homeless who have high support address the unique distress of homelessness, which is lacking needs and sustained experience of homelessness that are adequate and settled housing. likely to cost emergency medical and criminal justice services the most. There is a less obvious and extensive financial benefit when housing and supporting people who, while they were homeless, did not have very high support needs and 58 Pleace, N. (1997) ‘Rehousing single homeless people’ in Burrows, R.; Pleace, N. and Quilgars, D. (eds) Homelessness and Social Policy London: Routledge, pp. 159-171; Goldfinger, S. M., R. K. were thus not making extensive use of expensive emergency Schutt, et al. (1999). “Housing placement and subsequent days homeless among formerly services61. homeless adults with mental illness.” Psychiatric Services 50, 5 pp. 674-9; Lipton, F.R.; Siegel, C.; Hannigan, A.; Samuels, J. and Baker, S. (2000) ‘Tenure in Supportive Housing for Homeless Persons • As is the case with CHF services, while HFL service models with Severe Mental Illness’ Psychiatric Services 51, 4, pp. 479-486 follow or reflect a broad housing-led philosophy, the 59 Based on a specific measure of staying in their housing for 65% of the nights covered by a longitudinal evaluation, a higher rate than for comparison groups getting time limited case operational detail of these services can vary significantly. As is management. the case with CHF, it can be argued that HFL services are 60 Culhane, D.P. (2008) ‘The Cost of Homelessness: A Perspective from the United States’ European inconsistent in design, which means care has to be taken to Journal of Homelessness, Vol. 2, Part 1, pp. 97-114. understand what it is about a specific HFL model that is 61 Kertesez, S.G. and Weiner, S.J. (2009) ‘Housing the Chronically Homeless: High Hopes, Complex Realities’ Journal of the American Medical Association 301, 17, pp. 1822-1824; Stanhope, V. and effective, if this approach is to be successfully replicated. Dunn, K. (2011) op cit. Again as with CHF cross comparison of service outcomes for 62 Tabol, C et al (2010) op cit; Pleace, N. (2011) op cit. HFL services is more difficult because of variations in the 63 Rosenheck, R. (2010) ‘Service Models and Mental Health Problems: Cost Effectiveness and Policy detail of the operation of services62. Relevance’ in Ellen, I.G. and O’Flaherty, B. How to House the Homeless Russell Sage Foundation: New York, pp. 17-36. 64 Pleace, N. (2012) op cit. 65 Culhane, D.P. (2008) op cit. 66 Pleace, N. (2012) op cit. 15
Finding the Way Home
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