Housing Needs Assessment for DrugAlcohol Users in the LBL

1
Housing Needs Assessment for Drug/Alcohol Users
in the LBL

• August 2006
• Summary Findings

2
Background

• Commissioned by Lewisham Community Safety and
  Drug Action Partnership (CSDAP)
• Objectives
• To determine the nature, extent and pattern of
  homelessness among problematic substance users in
  Lewisham
• To examine the pattern of tenancy and supported
  housing for problematic substance users in
  Lewisham
• To examine age, gender and ethnicity variation in
  homelessness in the target group
• To determine the gap in housing provision for
  problematic substance users.

3
Methods

• The project adopted various methods including
• (i) systematic literature analysis
• (ii) use of inferential indicators and
  multipliers
• (iii) secondary analyses of data from substance
  misuse services, probation, Drug Intervention
  Programmes and housing providers
• (iv) a semi-structured interview survey of
  people in supported housing and those currently
  homeless a semi-structured interview of
  supported housing providers and
• (v) gap and risk analysis

4
Operational Definition of Homelessness

• Adopting the Charity Shelters definition
  homelessness, the following parameters were
  applied to cases
• You should be considered homeless if
• you have no home in the UK or anywhere else in
  the world
• you have no home where you can live together with
  your immediate family
• you can only stay where you are on a very
  temporary basis
• you dont have permission to live where you are
• you have been locked out of home and you arent
  allowed back
• you cant live at home because of violence or
  threats of violence which are likely to be
  carried out against you or someone else in your
  household
• it isnt reasonable for you to stay in your home
  for any reason (for example, if your home is in
  very poor condition)
• you cant afford to stay where you are
• you live in a vehicle or boat and you have
  nowhere to put it.

5
Current Capacity

• Supporting People Programme (temporary)
• Provides funding for 4,500 units of
  accommodation managed by 70 different providers,
  of which 166 units are designated specifically to
  support people with drug (52) and alcohol (114)
  problems.
• General Housing (permanent tenancy)
• Council housing stock is 27,545
• In 2005 the number of people on the Housing
  Register was 17,000 and the number of lettings
  that became available was 1,800

6
Challenges

• No readily available, comprehensive and robust
  source of information on the numbers of single
  homeless people in UK
• Varying definitions of homelessness
• hidden and mobile nature of many peoples
  homelessness

7
Extent of Statutory Homelessness in the UK

• 2005 LAs in England accepted that 100,170
  households as unintentionally homeless and in
  priority need
• 48,990 were considered homeless but not in
  priority need
• 13,830 were considered intentionally homeless
  and in priority need (ODPM, 2006)
• Crisis (2003) estimates that there are 380,000
  single homeless people in Great Britain

8
Extent of homelessness in London

• London has the highest number of households in
  temporary accommodation (63,800) on 31 Dec 05,
  accounting for 65 of the England total (98,730).
• Figures from the ODPM (2005) report 459 people
  sleeping outdoors (rough sleepers) on any one
  night in England, 221 in Greater London.

9
Extent of Homelessness in Lewisham

• End of April 2006, LBL reported to ODPM that they
  had 2284 homeless households from the Borough in
  temporary accommodation
• Between March 05 and April 06 1449 lettings
  became available
• The number of rough sleepers varies from 1 to 6
  according to official point-in-time counts. Up to
  17 in unofficial count.

10
Evidence linking substance misuse and homelessness

• Share common risk factors
• No evidence of a causal relationship together
  homelessness and substance misuse may result in,
  or make more intractable, other problems or
  disadvantages
• Chronically homeless individuals tend to
  attribute their continued homelessness to a
  substance abuse problem

11
Pathways to Housing in Lewisham

• Main Sources of support
• Housing Options Centre (HOC) main gateway
• Lewisham Supporting People Programme -
• (offering hostels, shared houses, floating
  supporting etc)
• Probation/DIP employ specific housing support
  staff who offer direct and indirect support to
  clients and colleagues

12
Procedures for Re-Housing and Banding System

• LBL Homesearch Team (choice based lettings scheme
  active cases run at 10,000 at any one time)
• To access Homesearch a person has to be accepted
  onto the register and needs to maintain their
  place on the register
• Housing assessment results in being banded i.e.
  priority level of need
• Four bands AA, A, B, C, and NB

13

• Lettings that become available are weighted
  against the priority bands, for example
• 70 are assigned to Band A,
• 20 are assigned to Band B,
• 9 are assigned to Band C
• 1 is assigned to the No Band

14
Supporting Vulnerable Groups

• Housing allocate a number of nominations to
  agencies in the Borough including those working
  with drug and alcohol. These quotas offer
  agencies the opportunity to access band A.
  Quotas for 06/07 e.g.
• ARP- 5 DIP -3 TRB 15 St Mungos 30

15
Supply ???(Drug/Alcohol)
16
Extent of Illicit Drug Use and Chronic Drinking
in LBL

• Estimated number of illicit drug users in LBL in
  the last year is 21,187 (males 14,894, females
  6,293)
• Estimated rate is 13.2 compared to England and
  Wales (11.3) and London (12.2)
• Estimated number of chronic drinkers in LBL
  31,342 (males 19,127, females 12,215)
• First national alcohol needs assessment estimated
  that 23.5 of chronic drinkers engage in harmful
  drinking, who are also considered the group at
  high risk of homelessness. Hence applying this
  multiplier, estimated number of chronic drinkers
  at risk of homelessness is 7,365 (male 4495
  female 2870)

17
Prevalence rates and multipliers of homelessness
in this study

• Drawing on the literature there are various rates
  of homelessness some applying to general
  population, others to clinical populations, this
  study proposed that the estimate rate of
  homelessness would be the median value of
  published rates i.e. 20

18
Estimated Number of Problem Drug Users and
chronic drinkers (harmful use) that are homeless

• Using the 20 multiplier
• Drug 423 (Male 296 Female 126)
• Alcohol 1,473 (Male 899 Female 574)

19
Extent of Homeless among problem drug users and
harmful alcohol users in treatment

• CDP (196 clients records 1 April 04 March
  31 05) information on housing available on 182
  cases homeless rate was 49
• DIP (576 clients records 1 Dec 04 Nov 30 05)
  information on housing available on 138 cases
  homeless rate was 54
• Dual Team (86 clients records 1 April 04
  March 31 05) information on housing available
  on 69 cases homeless rate was 73
• ARP (120 clients records 1 April 05 to March
  31 06) information on housing available on all
  cases homeless rate was 28

20
Demand for Housing among probation clients

• Total of 135 probation clients with a range of
  housing needs were referred over an 8 mth period
  June 05 to Feb 06.
• Information on housing available on 133 cases. -
  82 of cases were homeless
• 19 of homeless cases had been involved in drugs
  (offence), 4 in alcohol and 2 in both drugs
  and alcohol

21
Demand for housing to LBL HOC

• Secondary analysis of data on clients
  applications to HOC (n2,236)
• 27 cited homelessness
• No information on drug/alcohol hence applying
  multipliers from estimates
• Problem drug users 29
• Chronic drinkers 105

22
Users Perspectives

• Summary Issues (In-Treatment and Homeless Group)
• Majority male, British Born with ties to
  Lewisham. Poly drug history, initiation in their
  teens, extensive forensic history, numerous
  treatment episodes (none however in residential
  rehabs). Factors precipitating homelessness
  include chaotic drug use, mounting debts,
  involvement in criminal activities and breakdown
  in family support. Domestic violence is
  indicated for female clients. Male clients tend
  to experience homelessness at an earlier age to
  females, and do not have experience of having
  their own tenancies. Majority currently sofa
  surf among friends and family, and main
  obstacles in accessing housing support are linked
  to negative attitudes of housing staff towards
  drug users and lack of accurate information.

23
Users Perspectives

• Summary Issues (In Supported Housing Group)
• Majority male, British born with ties to
  Lewisham. Similar profiles to the In Treatment
  group with respect to drug use. Respondents
  described long and serious criminal histories.
  For the majority of the sample access to housing
  support was via assistance received as a result
  of being engaged with the criminal justice
  system. With the exception of one person all
  respondents were satisfied with their
  accommodation, and regarded their key worker as
  an important source of support. Maintaining
  their supported housing was facilitated by being
  drug free and/or remaining engaged in treatment.
  All respondents were engaged in some form of
  meaningful daily activity e.g. voluntary work or
  college. Key concerns regarding long term
  tenancies was having access to choice in where
  they were to live and support services being
  maintained once longer term tenancy was in place.

24
Summary

• The estimated rate of homelessness among problem
  substance users in Lewisham is 20. The rates of
  homelessness among users of substance misuse
  services and associated agencies in Lewisham are
  diverse as follows CDP (49) DIP (54) Dual
  Team (73) ARP (28). The majority (93) of
  Probation clients referred for housing support
  were homeless.
• Given that these rates are higher than the
  overall rate, it may well mean that the overall
  rate was a conservative estimate.
• However, the rates in services could be elevated
  because of missing data on housing status in some
  of the agency data used. In addition, the
  estimates provided are not exact. There are
  assumptions that the margin of error is less than
  5 percent of the estimates.
• It must be remembered that clients applying for
  housing may well conceal drug and alcohol
  problems fearing that such information would have
  a negative impact on their application.

25

• The profile of homeless problem drug users in
  treatment was consistent across agencies. The age
  group most at risk were those aged 25-34 years
  accounting for between 32 and 48 of homeless
  persons in treatment.
• In most agencies studied, the predominant ethnic
  group among the homeless was White. However, in
  the probation and housing department samples, as
  well as the TRB cohort, the largest ethnic group
  was Black. The proportion of homeless Asian
  clients was relatively small.

26

• Altogether, 1,896 problem substance users (493
  problem drug users and 1,473 problem drinkers)
  are in need of housing. The current HHUs
  provision is 12 of that required to meet the
  need of problem drug users and 7.7 of that for
  problem drinkers.
• However, the gap between demand and current
  provision is optimal for problem drinkers where
  78 of demand is being met. Conversely, only 18
  of demand for housing is being met in the case of
  problem drug users.

27

• Risk analysis revealed that current housing
  provision is most suited to male and female
  problem drinkers, and female problem drug users,
  but less so for male problem drug users.
  Furthermore, problem drug users aged 16-24 and
  35-44 years are at risk of poor access to
  supported housing. So also are problem drinkers
  aged 25-44 years. It would seem that current
  provision is somewhat favourable towards the
  earlier identified 25-34 year-old problem drug
  users at the expense of other age groups.

28
Recommendations

• The JCM should explore the introduction of
  common assessment frameworks which would
  include sufficient detail on clients past and
  current housing status. In the first instance the
  DST may wish to consider undertaking a review of
  current datasets. Such practice should assist in
  effective monitoring of the Treatment Plan and
  identify areas for improvement.
• Furthermore consideration should be given to
  encouraging housing providers and the HOC in
  recording drug and alcohol use as part of their
  routine datasets. Clearly, training particularly
  on attitudes will need to be addressed to ensure
  data collected does not result in a barrier to
  engagement.
• The DST may wish to further examine the
  heightened risk of homelessness in those aged
  25-34 years given that this is also the age group
  most at risk of drug-related deaths. This
  activity could be incorporated into the DSTs
  proposed harm reduction audit and strategy.

29
Recommendations

• It may prove useful to examine the pathway to
  homelessness in the different ethnic groups and
  communities in Lewisham, identifying any
  potential protective factors in specific ethnic
  groups and communities that can be disseminated
  widely.
• Given the gap between need, demand and housing
  provision, there is a need to increase the number
  of HHUs stipulated in the Lewisham Supported
  Peoples Strategy for 2005.
• The DST, Supporting People and YOT jointly may
  wish to examine the barrier to access for those
  problem drug users aged 16-24 and 35-44 years
  and problem drinkers aged 25-44 years.

30
Recommendations

• In view of the clients negative perception of
  the HOC, the CSDAP may wish to consider
  undertaking a training needs analysis (TNA) of
  HOC and associated agencies. The outcome of the
  TNA should be employed to develop a continuing
  professional development (CPD) module, which
  should be included both in new staff induction
  programmes, and as part of CPD training within
  the organisation. To ensure that this training
  and workforce support is given the necessary
  priority, CSDAP should ensure that this
  recommendation is taken forward within the LBL
  Substance Misuse Training and Workforce Strategy.
• The CSDAP may wish to invite the HOC to develop a
  collaborative working partnership to address the
  gap in information identified by clients as
  part of an information dissemination strategy.

31
Recommendations

• Given clients anxiety about losing support once
  they are settled into housing Supporting People
  may need to re examine the current policy
  regarding ongoing support and consider
  introducing additional steps as part of a longer
  term disengagement programme.
• In keeping with this review and in view of the
  priority groups identified in the Housing Needs
  Assessment, Supporting People may wish to
  introduce a screening panel to manage the block
  quotas for marginalised groups. The panel should
  consider establishing criteria which would ensure
  that nominations which may have alternative
  routes into housing are screened out.

32
Recommendations

• Supporting People may wish to undertake a review
  with their Housing Providers on admission
  criteria and exclusion policies, with the
  recommendation that Housing Providers should not
  exclude clients purely based on the fact that
  they are in treatment for substance misuse.
• Furthermore the DAAT Substance Misuse Training
  and Workforce Strategy, in collaboration with DIP
  and Supporting People target Supporting People
  Housing Providers around working with drug and
  alcohol clients. In particular the training
  programme should incorporate a module on Risk
  Assessment associated with offending.

33
Recommendations

• To ensure that the issues and gaps identified by
  this report are addressed the CSDAP may wish to
  repeat this exercise in the future, employing the
  data from this review as its baseline measurement
  by which to bench mark progress.

34
Action Plan

• The JCM should explore the introduction of
  common assessment frameworks which would
  include sufficient detail on clients past and
  current housing status. In the first instance the
  DST/commissioning team may wish to consider
  undertaking a review of current datasets. Such
  practice should assist in effective monitoring of
  the Treatment Plan and identify areas for
  improvement.
• This works fits in with the models of care work
  that has been started in the borough covering
  standard assessment tools.
• Liaison with DIP housing lead re nature of data
  needed.
• Include housing data in new commissioning team
  database design.
• Una Carnochan Joint commissioning manager.
  Lorna Thomas - DST data officer

35
Action Plan

• Furthermore, consideration should be given
  to encouraging housing providers and the HOC in
  recording drug and alcohol use as part of their
  routine datasets. Clearly training particularly
  on attitudes, will need to be addressed to ensure
  data collected does not result in a barrier to
  engagement.
• Supporting people could carry this recommendation
  out fairly easily with supported housing
  providers.
• Housing options centre may be more difficult. It
  may be more realistic in the first instance to
  carry out a sample survey for a fixed period of
  time, provide training, then roll out further.
• Supporting people team, DST data officer HOC
  management to work jointly on this. DST training
  workforce development manager

36
Action Plan

• The DST may wish to further examine the
  heightened risk of homelessness in those aged
  25-34 years given that this is also the age group
  mostly at risk of drug-related deaths. This
  activity could be incorporated into the DAATs
  proposed harm reduction audit and strategy.
• This area of risk has been highlighted in the
  current harm reduction audit/strategy work.
• Use of rent deposit schemes widen the remit of
  HOC scheme.
• Explore funding options for extending rent
  deposits schemes
• Una Carnochan Joint commissioning manager
  Supporting people, HOC DIP housing lead

37
Action Plan

• It may prove useful to examine the pathway to
  homelessness in the different ethnic groups and
  communities in Lewisham, identifying any
  potential protective factors in specific ethnic
  groups and communities that can be disseminated
  widely.
• Research future priority.
• Ensure DIP DST have input into HOC research re
  BME access to housing.
• Need to ensure the Supporting people diversity
  plan links in with this work.
• DST and DIP housing lead, Supporting people team

38
Action Plan

• In view of this finding, there is a need to
  increase the number of HHUs stipulated in the
  Lewisham Supporting Peoples Strategy for
  2005-2010.
• Supporting people to explore options for
  increased or more targeted use of existing units.
  Balance commissioning decisions based on
  evidence of gaps.
• Supporting people

39
Action Plan

• SP may wish to examine the barrier to access
  for those problem drug users aged 16-24 and 35-44
  years and problem drinkers aged 25-44 years. The
  following are two suggestions that could be
  pursued immediately
• a. as there already exists two Supporting
  People workers within HOC targeting 16-17 years
  old, the supporting people team may wish to
  consider expanding the remit of the SP workers,
  with an emphasis on facilitating sign posting
  to services that offer appropriate support.
• b. CSDAP may wish to explore undertaking,
  with the Substance Misuse Worker attached to YOT
  and ACAPS and the Supporting Peoples Young
  Peoples Worker, a survey of young peoples views
  on the specific barriers they encounter in
  accessing housing services.

40
Action Plan

• SP investigate the coverage of the current posts
  and ensure adequate training around drug
  alcohol issues.
• Make use of substance misuse link worker at HOC
  to provide info and advice to other HOC workers
  and signposting.
• Survey to be carried out by partners
  co-ordinated by DST
• Supporting people team, HOC , DST YP co-ordinator
  

41
Action Plan

• In view of the clients negative perception
  of the HOC, the DST/HOC may wish to consider
  undertaking a training needs analysis (TNA) of
  HOC and associated agencies. The outcome of the
  TNA should be employed to develop a continuing
  professional development (CPD) module, which
  should be included both in new staff induction
  programmes, and as part of CPD training within
  the organisation. To ensure that this training
  and workforce support is given the necessary
  priority, DST/HOC should ensure that this
  recommendation is taken forward within the LBL
  Substance Misuse Training and Workforce Strategy.

42
Action Plan

• Training needs assessment to be carried out by
  DST TWDM. HOC will need to commit to meeting the
  assessed need.
• Training programme to be discussed negotiated
  between HOC, DIP housing lead and training and
  workforce development manager.
• DST training workforce development manager, DIP
  housing lead and HOC

43
Action Plan

• The Safer Lewisham partnership DST/SP team
  may wish to invite the HOC to develop a
  collaborative working partnership to address the
  gap in information identified by clients as
  part of an information dissemination strategy.
• This could link in with the training programme.
  Information re drug alcohol treatment, housing
  advice and local support is available in DST
  directory.
• DST training workforce development manager, DIP
  housing lead and HOC

44
Action Plan

• Supporting people may need to re examine the
  current policy regarding ongoing support and
  consider introducing additional steps as part of
  a longer term disengagement programme.
• S.P. team to explore policies and links to
  support agencies and referral routes to floating
  support. Waiting times into floating support
  services to be examined as part of this.
• The SP floating support contracts are currently
  being re-commissioned. Therefore design of the
  spec will include targeting substance misusers
  and include waiting times targets.
• Supporting people team

45
Action Plan

• In keeping with this review and in view of
  the priority groups identified in the Housing
  Needs Assessment, the supporting people team may
  wish to introduce a screening panel to manage
  the block quotas for marginalised groups. The
  panel should consider establishing criteria which
  would ensure that nominations, which may have
  alternative routes into housing, are screened
  out.
• To ensure non-priority clients have other
  routes into housing. Use of a panel to allocate
  supporting people spaces. Design of panel and
  criteria led by S.P.
• Supporting people to lead.

46
Action Plan

• Supporting People may wish to undertake a
  review with their Housing Providers on admission
  criteria and exclusion policies, with the
  recommendation that Housing Providers should not
  exclude clients purely based on the fact that
  they are in treatment for substance misuse.
  Furthermore the DST Substance Misuse Training and
  Workforce Strategy, in collaboration with DIP and
  Supporting People target Supporting People
  Housing Providers around working with drug and
  alcohol clients. In particular the training
  programme should incorporate a module on Risk
  Assessment associated with offending.
• S.P team to conduct review of policies.
• Training to include risk assessment associated
  with offending. This work should make use of the
  DIP housing lead given the offending issues
• Supporting people, Training workforce
  development manager in conjunction with DIP.

47
Action Plan

• Currently refuge policies can exclude
  substance using clients. It may be useful for the
  DV co-ordinator to investigate which policies are
  in existence, and ensure that refuge staff have
  access substance use training and support from
  substance use services.
• Joint work between SP/DV co-ordinator
• DV co-ordinator to lead Supporting people team,
  Training and workforce development manager

48
Action Plan

• To ensure that the issues and gaps identified
  by this report are addressed the CSDAP may wish
  to repeat this exercise in the future, employing
  the data from this review as its baseline
  measurement by which to bench mark progress.
• DST to organise any further research after review
  of initial action plan March 2008
• DST manager