Sam Tsemberis, PhD

Founder and CEO Pathways to Housing, Inc.

JUNE 12, 2013

Who is served by Housing First?

Homeless

Mental health problems Addiction and abuse

Health problems

Poverty

Isolation

Stigma

PTSD/Trauma

Frequent users of acute care services

Jail

Shelter

Hospital/

Detox

Streets Institutional Circuit

Housing and Support Services: Rearranged (Housing first) and Redesigned (consumer driven)

Levels of Program Fidelity

consumers Hundreds of choices, change over time & have tradeoffs r

Management issues include team-consumer, landlord-tenant, landlord-team, and team-agency interactions

Operations Variety of services and

housing options

Decisions about housing status and consumer

engagement

Principles

Consumer choice Separation of housing and treatment

Homeless

Shelter placement

Transitional housing

Permanent housing

Ongoing, flexible support

Harm Reduction

Housing First Model

MHCC At Home / Chez Soi 5 Cities RCT N=2,257

Moncton, Montreal, Toronto, Winnipeg, Vancouver

Housing First

(n=1267)

Interviews every 3 months: Residential stability, mental health, addiction, quality of

life, social integration

Treatment as Usual (n=990)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

3M 6M 9M 12M

Time Spent in Stable Housing Over Year One

HF TAU

/ 9

Housing First shows cost offsets

Annualized costs: Total sample Annualized costs: High Service Users (defined as

those in top 10% of prior service costs

TAU Intervention Difference TAU Intervention Difference

Est. annual cost:

Non-study services$23,849 $14,599 $ (9,250) $ 56,431 $30,216 $ (26,215)

Est. annual

intervention cost$17,160 $ 17,160 $16,825 $16,825

Total $ 23,849 $ 31,759 $ 7,910 $ 56,431 $ 47,041 $ (9,390)

High Service Users:• There is an overall savings of $9,390 per person per year• Every dollar spent on Housing First for these participants saves $1.56 through reduced

use of other shelter, health and justice services

Total Sample: • An investment in Housing First requires only an additional investment of $7910 per year• For every dollar spent 54 cents is saved through reduced use of other shelter and

health are services after only one year

Table 1 – Costs of Housing First versus use of other health, justice and social services after one year

Peer Support: Recovery Focused Mental Health Services

Hope-instilling practice Socially supported wellness

knowledge and

skills to self-

manage

Emphasis on

holistic wellness

and positive

lifestyle as healing

Son returns from tour in Afghanistan and stays with (formerly homeless) dad in his apartment.

Social connections are key and

and housing should adjusts accordingly

Community-based, Residential Treatment (on-site clinical staff)

Permanent Single Site (on-site services)

Permanent housing

(scatter-site, off site services)

Redesigning the System: System Transformation

Longer term Institutional Care

Least restrictive to more restrictive setting

• People are much more capable than we imagined possible.

Capabilities

For Additional Information

Web sites:

www.pathwaystohousing.org

Or send an email to

stsemberis@pathwaystohousing.org