Coordinating Housing, Health and Social Supports in Manitoba to Address Homelessness

1
Coordinating Housing, Health and Social Supports
in Manitoba to Address Homelessness

• Cross-Department Coordination Initiatives
• September 9, 2008

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Purpose of the Presentation

• Making the case for coordination
• Reducing homelessness through public,
  not-for-profit and private sectors partnerships
• Mandate of the Cross-Department Coordination
  Initiatives (CDCI)
• Update on current projects and outcomes of CDCI
  activities

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Why a Housing Focus?

• Affordable housing issues
• High housing costs
• Decline in affordable housing stock
• Housing in a key determinant of health
• Limitation to income and rental supports
• Lack of appropriate housing with health and
  social service supports
• Increasingly visible homeless population

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Manitobans Increasingly at Risk of Homelessness

• Mental illness and/or substance use
• Physical disability or ill health
• Aboriginal descent
• Large families
• Single parents
• History of abuse/family violence
• History of institutionalization
• Poverty
• Lack of life skills

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Human Costs of Homelessness

• Those at-risk of housing insecurity and
  homelessness have poor health outcomes
• 2007 Street Health Report (Toronto)
• 20 X epilepsy
• 5 X heart disease
• 4 X have cancer
• 2 X diabetes
• 30 X Hepatitis C
• Emergency housing and current social housing
  models have difficulty supporting
  health/wellbeing

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Financial Cost of Homelessness

• Band-Aid solutions are expensive
• High cost emergency shelter 2X more costly than
  social housing
• Emergency and transitional housing used as
  long-term housing, creates a backlog
• High cost of evictions (Legal fees, Court
  attendance, Rent arrears, Property refurbishment,
  Unit turnovers)

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Financial Cost of Homelessness

• 35 of visits to emergency rooms in Canada are by
  homeless people (CIHI)
• 38 street people in Winnipeg cost the
  emergency, health and justice systems millions of
  dollars (Project Breakaway)
• Over 16 month the 38 generated
• 570 IPDA calls
• 447 calls for service (e.g. medics)
• 49 arrests
• Multiple costs for ambulance, hospital and detox
  services

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Current Situation

• Some efforts to coordinate policy and service
  delivery in housing, health and social services
• Dominant trend for systems to work in isolation
• More tenancies considered high risk
• Housing providers have conflicting roles
  (property management versus addressing the needs
  of complex tenancies)

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Benefits of Coordinating Housing, Health and
Social Services

• Development of range housing models and support
  services
• Cost saving to the justice and health systems
• Increase familiarity with services and supports
  in other sectors
• Integrated research, policy and planning among
  various sectors
• Policy development informed by front line
• Common understanding needs of at-risk populations
• Better ability to provide a wide range of
  services
• Full range of services housing and communities
  safer
• Expectation confirmed between housing and service
  providers

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Challenges

• Perception that demand often exceeds available
  resources
• Challenge of pressing old systems into more
  collaborative ones seems insurmountable
• Turf protection
• Creation of mechanisms to coordinate services
• Contrasting mandates, responsibilities, cultures
• Health/social services view housing
  finance/development as inaccessible and
  profit-driven
• Housing systems view human services as
  inaccessible, imprecise, subjective, inconclusive
  and beyond mandate

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Current Examples of Coordination

• Housing First
• Outreach Urban Health/ Partners In Community Care
• Program of Assertive Community Treatment (PACT)
• Community Wellness Initiative (CWI)
• Winnipeg Integrated Service (WIS)
• Cross-Department Coordination Initiatives (CDCI)

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Housing First

• Best practice approach
• Housing with wraparound case management services
• Key component of long-term housing and homeless
  plans
• Alternative to the emergency shelter response and
  continuum of care model
• Examples
• New Yorks Pathways to Housing
• Torontos Street to Homes Project

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Outreach Urban Health (OUHKelowna) BC

• Primary Health Care Centre that provides low
  barrier access and full scope outreach services
  to homeless individuals
• Based on principles of primary health care
• Access to health care
• Health promotion (includes housing)
• Intersectoral collaboration
• Partners In Community Collaboration (PICC)
  coordinated inter agency case management
  includes housing providers
• Formal agreements enable collaboration
• Over 60 reduction in Emergency Department visits

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Program of Assertive Community Treatment (PACT)
Manitoba

• Multi-disciplinary team of mental health
  professionals, addiction specialists and
  vocational rehabilitation specialists (2 teams in
  Manitoba)
• Low staff to client ratio, using a team approach
  and shared caseloads
• Services include medication management,
  therapeutic counseling, substance use
  intervention, primary health care, crisis
  response 24/7
• Support with daily living activities such as
  maintaining housing

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Community Wellness Initiative (CWI)

• Partnership between Winnipeg Regional Health
  Authority (WHRA) and the Manitoba Housing
  Authority (MHA)
• CWI supports the overall mental health and
  wellness of tenants, and to build stronger
  communities
• Community activities, presentations, workshops,
  annual Health Fair build awareness of programs
  and supports
• Current CWI is located in 5 MHA sites

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Winnipeg Integrated Services (WIS)

• Developed in 2001, Winnipeg Regional Health
  Authority (WRHA) and Manitoba Family Services and
  Housing (FSH)
• Integrated community-based health and social
  service delivery model
• Provides efficient, effective and holistic
  services
• Objective
• Improve access to services
• Improve efficiency
• Reduce duplication
• Simplify coordination
• Opportunities for Housing Providers to engage in
  health/social services providers

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Housing for Seniors

• In October 2005, Central Government endorsed
  Aging in Place to be used as a central principle
  in the planning of all provincial government
  housing and Long Term Care initiatives
• The principles of Aging in Place addresses the
  need for affordable option for housing with
  supports, as alternative to premature personal
  care home placement
• The long Term Care strategy addresses the gap
  between an individual living in their home and
  Personal Care Homes
• The strategy focuses on three community models of
  support, Supports to Seniors in Group Living
  (SSGL), Supportive Housing program and
  Specialized Supports

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Supports to Seniors in Group Living (SSGL)

• Target Population
• Seniors in existing community congregate
  settings.
• Do not require 24-hour support and supervision
• Model
• Enhanced support services
• Health promotion
• Focus on Instrumental Activities of Daily Living
  (IADLs) (telephone, banking, appointments)
• Tenants pay their own rent
• Regional Health Authority funds services

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Supportive Housing

• Target Population
• Primarily cognitively impaired, frail elderly
• Require 24-hour support and supervision
• Model
• Community, congregate setting
• Personal support/supervision (24/7)
• Secure environment
• Resident responsible for rent and service package
• Service package includes meals, laundry and light
  housekeeping
• RHA funds care component

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Where Are We Now?

• Since the introduction of Aging in Place in
  January 2006
• 2,760 units of Support to Seniors in Group Living
  have been implemented
• Over 358 units of Supportive Housing have been
  developed
• 83 spaces for Specialized Supports are active

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Cross-Department Coordination Initiatives (CDCI)

• June 2007 - Division of FSH and MHHL in
  partnership with WHRA
• Mandate to identify and review existing
  housing-related policies, programs and services
  that require coordination, and propose
  enhancements or alternatives to improve policy
  coordination and service delivery
• Initial focus on housing and supports for the
  homeless, seniors and individuals with mental
  health issues

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(No Transcript)
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Work to Date

• Regional Forums with frontline FS, Housing, MHHL
  and RHA staff
• Key stakeholder consultations/interviews
• Inventory of existing housing, health and social
  services
• Review of government/community and
  research/planning documents
• Better coordination of funding allocation
  opportunities (e.g. WHHI, MHCC, HPS, WPS, UAS)
• Best practice re current housing, health and
  social service policy, program and funding models
• Continuation and implementation of existing
  homeless, metal health and seniors housing
  projects

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Next Steps

• Work with multi-sector stakeholders to promote
  coordinated resource allocation
• Assist in the development of strategy to end
  homelessness
• Support the Mental Health Commission of Canada
• Developing housing and support options for target
  populations
• Increase awareness of best practice in
  coordinating housing, health and social services
• Provide recommendations to government on
  mechanisms to coordinate policy/program
  development, funding allocation and service
  delivery