Types of Supports

Information about the Housing First Types of Supports

The aim of this page is to provide guidelines on Housing First (HF) service delivery approaches in the context of the renewed Homelessness Partnering Strategy (HPS). This page also includes information on the types of supports needed for an HF approach and how to organize them. To see how these approaches have been adapted based on the local setting and the self-determined needs of clients, see Case studies.

It should be noted that this is a broad framework only and will be updated periodically to reflect new information. Other supporting information will be provided to communities as it becomes available. As well, the HF approach adopted should be informed by the community-level analysis of chronically and episodically homeless populations.

HF is a specific evidence-based approach to reduce homelessness. It involves moving homeless individuals—particularly the chronically and episodically homeless—rapidly from the street or emergency shelters into stable and long-term housing, with supports. Stable housing provides a platform to deliver services to address issues frequently faced among the chronically and episodically homeless. The goal is to encourage housing stability and improved quality of life for persons served by HF and, to the extent possible, foster self-sufficiency.

The delivery of these supports is based on a number of HF fidelity criteria, the most primary of which is the principle of client choice. It is expected that services would be organized and provided based upon meeting these fidelity criteria to the extent possible. For example, communities should make every effort to tailor their HF services to meet the self-determined needs of each client.

Community Advisory Boards and Community Entities

It is expected that each community will adapt their HF approach to fit their local situation. Communities would need to consider who is required to deliver HF effectively.

The HPS and the HF Fidelity Scale

A Fidelity Scale is intended to inform communities of what is expected in an HF approach. It indicates the criteria by which the HPS would gauge the extent to which communities are implementing an HF approach. More information on these criteria is provided in the tool: HPS HF Fidelity Scale.

Three types of supports

HF involves three kinds of service supports:

  1. housing with supports to help clients find housing, move in and maintain that housing;
  2. clinical supports providing or facilitating access to health and social care to clients to help them achieve housing stability and encourage well-being; and
  3. complementary supports, such as assistance with finding employment, volunteer work and accessing training offered on a case-by-case basis to help clients improve their quality of life, integrate into the community and, to the extent possible, achieve self-sufficiency.

Collaborative service delivery

The collaboration of service providers who provide these supports is strongly encouraged and expected. The HF approach requires collaborative service delivery to ensure that persons who are chronically and episodically homeless receive the supports they need at the right moment and by the appropriate service. Housing, clinical and complementary service providers would work together to serve all of the needs of the individual.

Collaboration is also necessary to avoid the duplication of services within the community and to ensure the creation of a program that is sustainable.

1. Housing with supports

Under HF, the initial intervention is to provide clients with housing. Housing supports are also required to help clients stabilize and maintain their housing. Communities would therefore need to ensure that they have the capacity to provide housing with supports.

Housing and housing supports can be delivered using the services of existing housing service providers. In addition, communities may need to create supplementary housing teams or housing outreach workers to leverage or provide housing with supports. These teams would work with those who provide the clinical supports and complementary supports.

The main activities of those who provide housing and housing supports under HF could include:

  • working with shelters and individuals living on the street to identify and locate HF clients;
  • securing housing for clients by working with groups like private and public local real estate and landlord associations to identify housing units;
  • determining clients' preferences and needs for housing and type of supports;
  • building and maintaining relationships with landlords;
  • providing apartment set-up assistance;
  • managing short-term, time-limited rent subsidies with the objective of transitioning clients either to provincial/municipal system of supports or other sustainable solutions for the long-term (e.g. self-sufficiency);
  • applying for or negotiating access to social housing, non-profit housing, provincial rent supplements and the like;
  • providing landlord mediation;
  • assisting with money management;
  • providing access to grants to cover utility bills;
  • assisting with repairs and cleaning to ensure general maintenance and to cover damages as needed; and
  • providing other supports requested by the client (for example, obtaining legal advice).

All of the above activities are eligible for HPS funding.

2. Clinical supports

Recovery-oriented clinical supports are required for most clients to maintain housing stability, improve quality of life and, to the extent possible, foster self-sufficiency. Clinical services based upon client self-determination are provided by a case management approach, which either provides or links the client to needed mental health and addictions services.

The clinical case management approach includes support services from outreach/referral to existing treatment in communities or health services offered by provinces and territories, to more intensive coordination with multi-professional specialists. In all cases, the types of services offered through case management reflect the clients' self-determined needs assessment and would be carried out in the community setting. This approach ensures that clients receive the necessary support to maintain their housing. Case managers would also coordinate with the Housing Team and complementary service providers that are needed.

Only specific activities under clinical supports would be eligible for funding under HPS. For more information, see the section that outlines Intensive Case Management and Assertive Community Treatment.

Linking to existing services

The direct provision of clinical supports (such as psychiatrists, doctors, addiction counsellors) is not eligible for funding under the HPS. From the HPS perspective, direct provision of clinical supports creates client dependencies that may not be sustainable in the long-term. Communities are therefore strongly encouraged to link up with existing clinical services. This could take the form of accessing existing clinical teams or linking up with main-stream services. A coordinator/case manager/peer support worker could be engaged for this purpose.

It is of note that provinces and territories have well-established local health and social services that might have the available skill sets required to deliver clinical services. HF service providers would be expected to coordinate supports for clients without duplicating existing services.

It may be possible for the HPS to fund clinical supports that are indirect, namely where the clinician explicitly supports the work of a housing supports team. In this role, the clinician would not have a caseload of clients but would assist with the tasks of the housing/outreach team. For example, a private psychiatric nurse could be engaged as a member of an outreach team to conduct initial street assessments and assist with referrals to suitable housing and supports. Where such expertise is needed, communities could work with local health authorities to offer such services as an in-kind contribution.

3. Complementary supports

Access to supports other than housing and clinical is often a priority for HF services. Although not necessarily the initial focus for an HF approach or intervention, they can help to foster the longer-term goals of community integration and autonomy.

These supports include providing access to:

  • income supports to those who are entitled to them;
  • life skills (budgeting, meal preparation);
  • pre-employment support and bridging to the labour market;
  • services to support educational opportunities (tutors); and
  • supports to reduce isolation (volunteer work).

One factor in improving clients' long-term housing stability and autonomy is to provide supports that help them to integrate within the community. For example, employment supports would help clients to take part in the labour market, where practical. Education supports and supports that promote volunteering in the community would help clients to learn skills to participate in the labour market or in the community as a whole.

Note that the direct provision of skills or labour market training is not eligible for funding under the HPS.

Partnering with provincial/territorial programs

Service providers would be expected to provide access to existing provincial or territorial programs to the extent possible, and avoid creating new services where current supports already exist. Access to these programs could be provided by housing or complementary support teams, or by existing clinical support teams. Examples of existing programs include those that remove barriers to employment and those that provide skills enhancement to facilitate labour market readiness among HF clients who are capable of workforce attachment. There are also programs available in many communities that promote broader participation in the community.

Definitions

Chronically homeless

This term refers to individuals, often with disabling conditions (e.g. chronic physical or mental illness, substance abuse problems), who are currently homeless and have been homeless for six months or more in the past year (i.e. have spent more than 180 nights in a shelter or place not fit for human habitation). **To the extent possible, communities should prioritize those chronic homeless who have been homeless the longest.

Episodically homeless

This term refers to individuals, often with disabling conditions, who are currently homeless and have experienced three or more episodes of homelessness in the past year (of note, episodes are defined as periods when a person would be in a shelter or place not fit for human habitation for a certain period, and after at least 30 days, would be back in the shelter or place).

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