Ending Chronic Homelessness

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Ending ChronicHomelessness
Liz Giles Manager Homelessness Unit City of
Sydney
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Ending Chronic Homelessness

• OUTLINE
• Who are the chronically homeless
• Why target them
• Proven models that work

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Ending Chronic Homelessness

• Who are the Chronically Homeless?
• People who have been consistently homeless for 12
  months or longer
• Or who have experienced episodic homelessness
• Generally around 10-20 of the homeless
  population
• More likely to suffer increased vulnerability due
  to chronic or acute health conditions
• Smaller percentage with multiple and complex
  needs

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Ending Chronic Homelessness

• Why target the chronically homeless
• 1. The costs argument
• Its more expensive to maintain it than to solve
  it.
• Alternative is repeat episodes of service with no
  outcome
• 2. The moral argument
• Chronically homeless people are particularly
  vulnerable
• Because access to somewhere secure to live is
  everyones right
• 3. The results argument
• Evidence of models that work at the individual
  level
• Evidence of programs that work at the population
  level

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Ending Chronic Homelessness

• Proven Models that Work!
• Doing the research , understanding the costs
• Assertive Outreach focused on outcomes
• Vulnerability Index
• Housing First and Street to Home
• Access to Supportive Housing
• Assertive Community Treatment Teams
• Coordination of Services
• Servicing the need not the diagnosis

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Complex Needs Coordination Project

• MODELS THAT WORK

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OBJECTIVES OF CNCP

• To resolve the needs of chronically homeless
  people with complex needs through the provision
  of coordinated and sustainable support and
  housing across Inner Sydney
• To enhance the capacity of homelessness services
  as an interdependent group, to respond
  collaboratively within a framework of best
  practice

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• SYNERGY n
• from Greek word sunergia
• working together
•  the interaction or cooperation of two or more
  drugs, agents, organisations etc to produce a new
  or enhanced effect compared to their separate
  effects

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Coordination pulling it all together

• The difference between
• responding to a single need with a single outcome
  at a single point in time.
• And ensuring synergy between all interventions to
  realise one common goal identified by consumer

   
Parts Coordinator
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CNCP Project Structure
COMPLEX NEEDS MANAGEMENT GROUP
Care Coordination
Housing First
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CNCP Care Coordination Group

• Assessment and referral provided by a panel of
  experts
• Their Role is to provide
• Assessment and advice in the context of all
  issues not limited to single or dominant issue.
• Recommendations for ongoing treatment
• Regular review of care plans, ongoing support and
  advice if necessary
• Philosophy of return to the drawing board

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CNCP Housing First

• A pilot initiative of the NSW Housing and Human
  Services Accord
• Based on proven models overseas. Long term
  homeless with significant disabilities were
  housed and remained housed
• No pre-requisites for treatment before housing
• Holistic support provided to people before and in
  housing
• Client goal orientated
• Bad tenancy history did not preclude people from
  housing

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Results

• Total no. of referrals since beginning 38
• 58 (22) in housing or other long term supported
  accommodation
• 10 (4) Approved and waiting for a tenancy
• 24 (9) Going through the CCG process
• 8 (3) Approved but not housed due to external
  factors (jail, hospitalisation etc)
• All those housed remain housed

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Challenges

• Access to Housing has been slow
• Coordination is challenging in a diverse service
  sector
• CCG model takes time.
• Those old chestnuts!
• Diagnostic issues
• Eligibility issues
• Service Gaps

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Complex Needs Coordination Project

• First we started the project
• Then the resources arrived
• Housing x 30 tenancies
• A Project Coordinator
• Money for brokerage and an evaluation
• 22 people housed in 18 months, another 4 about to
  be.

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Vulnerability Index

• MODELS THAT WORK

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Vulnerability Index

• Administered as a survey to rough sleepers.
• Ranks individuals by mortality risk and length of
  homelessness
• Used to identify, target and house the most
  vulnerable
• Saves lives and reduces overall costs
• Builds a strong support base rough sleepers and
  other.

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Vulnerability Index

• More than 6 months street homeless AND at least
  one of the following
• End Stage Renal Disease
• History of Cold Weather Injuries
• Liver Disease or Cirrhosis
• HIV/AIDS
• Over 60 years old
• Three of more emergency room visits in prior
  three months
• Three or more ER or hospitalizations in prior
  year
• Tri-morbid (mentally ill abusing substances
  medical problem)
• Takes the guess work out of outreach and offers a
  rational system for prioritising the most in need.

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Assertive Outreach

• MODELS THAT WORK

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Assertive Outreach successful elements

• Focus on outcomes not relationships
• Give Outreach Workers access to Housing
• Coordinate the involvement of all partners
• Target anchors
• Vulnerability index directing resources to most
  vulnerable persons.
• ACTs / Hubs focus on taking the services to the
  client and providing as many services in one
  place at one time as possible.

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Planning your Outreach Strategy

• Street counts
• Identify hotspots and focus resources there
• Intensive days service saturation
• Ensure necessary services are in place/available
• Work with councils, other land holders the
  police
• Consult and negotiate with the rough sleepers
• Protocol for Homeless People in Public Space

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Assertive Community Treatment Teams (ACTs)

• MODELS THAT WORK

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Assertive Community Treatment Teams

• Key Elements
• Multi-disciplinary teams take services to clients
• Targeted at the high needs end of the population
• Team Approach to service delivery
• Low staff to consumer ratio
• Services are provided where they are needed
• Services are provided when they are needed
• Uninterrupted care
• Services are provided as long as they are needed.

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Assertive Community Treatment Teams

• ACT is an evidence based practice that has proven
  results over more mainstream approaches
• The Results
• Better control of psychiatric symptoms
• Lower use of inpatient services
• Better quality of life
• More independent living
• Better substance abuse outcomes
• Higher rates of community re-engagement
• Greater consumer satisfaction!!

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Theres no place like home

• My life has improved
• leaps bounds
• since getting my house
• Mr. B housed through CNCP

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Thank you

• Liz Giles
• Manager Homelessness Unit, City of Sydney
• Ph 02 9246 7676
• egiles_at_cityofsydney.nsw.gov.au