After Demonstrating that Housing First Works in Canada, What’s Next?

EUROPEAN RESEARCH CONFERENCE

Housing First. What’s Second?

Berlin, 20th September 2013

After Identifying that Housing First

Works in Canada, What’s Next?

Cameron Keller, Vice President, Programs and Priorities,

Mental Health Commission of Canada

Paula Goering, RN, PhD, National Research Lead,

At Home/Chez Soi (regrets)




At Home/Chez Soi Project Overview

In 2008 the Federal government allocated $110million

At Home/Chez Soi is:

the largest study of its kind in the world

providing evidence about what services and systems best help people experiencing serious mental health issues and homelessness

Housing First model

implemented in: Vancouver, Winnipeg, Toronto, Montreal, Moncton

Funding – 85% services / 15% research




Research Demonstration

Objectives

Policy shift – Evidence-informed investments in Housing

First to address chronic homelessness among people

with serious mental illness

Opportunity to create lasting system change

Federal/provincial/territorial/municipal collaborations

Scalable investment opportunities for all levels of

government moving forward




Integrated Knowledge Translation

Research involves exchange and linkage with decision-

makers throughout the process

Requires allegiance to both scientific and participatory

principles

“evidence of effectiveness alone is rarely enough to

ensure adoption of interventions” (Leff & Mulkern, 2002)

Science requires orderly, phased process of scientific

investigation

Participation requires that the interests and values of

various groups in public systems be reflected.




Research Design

Pragmatic, multi-site, randomized, mixed methods field trial

Effectiveness and cost effectiveness of Housing First Model in

Canadian contexts

Model being tested at two levels of intensity – ACT and ICM

Randomized to Housing First (HF) or TAU + third arm

Comparisons to care as usual in all cities

Outcome data collected at baseline, 6, 12, 18, & 21 months

Two fidelity assessments and formative evaluations

Qualitative data collected on subgroup of participants at baseline

and 18 months




Project Timeline

March 2008-Funding announced

Fall 2008-Request for Proposals posted

March 2009-Grants and Contracts Awarded

Fall 2009-Data collection begins

Summer 2012-One year data collection complete

September 2012-Interim report released

Spring/summer 2013-One year scientific papers submitted

March 2013-Program funding ends and data collection ends

December 2013-Final report due

2014-Two year scientific papers submitted




Program Sustainability

What happens to demonstration projects after their initial limited time

funding ends.

Continued benefits for individuals, continued activities for programs and

continued capacity for communities.

Theoretically the stage after implementation and before dissemination

to other sites. In reality….overlapping, non-linear and continuously

evolving)

Multi-factors influence outcomes (innovation, context, capacity,

processes and interactions)

Evaluation has limited utility although perceived benefits often cited

positive influence.

Scheirer, MA 2005




A common problem

The project “should include rigorous evaluation and

enough time after the results of the evaluation are known

to plan for the sustainability of program interventions

shown to be effective”

“The timing of evaluation findings is often too late in the

project life cycle to be useful in promoting sustainability;

evaluation could be more useful if interim data about

outcomes would be available before the initial funding

ends.”

Scheirer, M 2005




Interim report results Over 900 people currently housed in adequate, affordable,

suitable settings

Stable living conditions contribute to a shift from the frequent use

of inappropriate and expensive services

• At Home/Chez Soi saved the system a net average of $9,390 for those

who had a high use of services “High Users”

Housing First has the potential to provide system-wide cost

offsets.

Individuals receiving Housing First saved the system a yearly average of

$2,184 per person in costs related to inpatient stays – this savings was

even greater for the “high user” sub-group

Canada can (and is) implementing Housing First

Benefits cross a range of sectors (health, social services,

criminal justice)




Review of efforts to solve the

sustainability problem

Comprehensive government relations efforts – January 2012

through September 2012

Interim results presented to senior leaders in multiple briefing

sessions

Request to federal government for two years of post project housing

Formal request to Health Canada for transition funding from four of

five provinces – August 2012

Interim report released in September, extensive media coverage

Federal government response communicated to MHCC – October

2012

Federal/provincial/MHCC negotiations – November 2012 to present




Sustainability outcomes The federal government contributed to the housing

component for one year in all of the sites

Manitoba, New Brunswick, BC and Quebec are

all finalizing plans to provide clinical services to

participants.

Ontario made a public announcement outlining

ongoing funding for housing subsidies and Housing First

services and supports.

Mixed picture re continuation or modification of Housing

First program components.




Current Priorities

Facilitation of transition in five cities

Final data cleaning and analysis

Formulation of policy recommendations – policy forum –

October 2013

Final report December 2013

Ongoing dissemination of findings through MHCC’s

Knowledge Exchange Center and ongoing publications

and local KE activities




What’s Next?

Thinking beyond immediate sustainability:

Rich knowledge base still under creation

Health & social innovation potential based on evidence

Capacity built in regions across the country to deliver Housing First

Long term opportunity for all levels of government to invest with

confidence in a cost-effective intervention to reduce chronic

homelessness

Opportunity to build on the investment to date, and leverage the

partnerships created to date (existing P/T & private sector)




Scaling Up-Definition

“deliberate efforts to increase the impact of

successfully tested pilot, demonstration or

experimental projects to benefit more people and

to foster policy and programme development on a

lasting basis”

ExpandNet/WHO www.expandnet.net

http://www.expandnet.net/




Further Scaling up Activities Development of a HF toolkit

Partnership with Provincial and National Housing and

Homelessness Organizations (thinktanks, PHSI and

SHERC grant applications)

Consultations to jurisdictions interested in implementing

or scaling-up of Housing First approaches;

Ongoing engagement with local and national media

Continued development of Here at Home an interactive

website in partnership with NFB.

Applications for further funding to follow up participants

post project.




A Major Policy Shift

Federal budget announcement of renewal of Homelessness

Partnering Secretariat funding of $600M for 5 years

Shift towards Housing First

Mental Health Commission of Canada a “trusted advisor” invited to

assist in shaping policy shift as well as implementation support

including training and technical assistance

What advice do you have for us regarding how to do

this i.e. tension between advisor role and advocacy?

What key considerations must we not forget?




Role of Research Evidence

One of many factors that influence decision making-

politics, personalities, financial cycles

Interim results and experiential knowledge both influence

governments

Strong governmental relations and communications

supports are an asset

Pressure to release findings in timely manner creates

risks re consistency. e.g. economic results will change




Thank you!

Contact Us:

Cameron Keller: [email protected]

Paula Goering: [email protected]

Visit: www.mentalhealthcommission.ca

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The views represented herein solely represent the views of the presenters. Production of this document is made possible through a financial contribution from Health Canada.

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http://www.mentalhealthcommission.ca/

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After Demonstrating that Housing First Works in Canada, What’s Next?