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Framework’s Building Better Futures campaign to develop 200 units of accommodation over the next five years will support people with the greatest and most complex needs based on the principles of Housing First.

What is Housing First?

Housing First is a person-centred, evidence-based approach to supporting homeless people who have high needs and histories of entrenched or repeat homelessness, and especially rough sleeping, to live in their own homes. It has been widely adopted across the US and Europe and increasingly in the UK.

The approach of Housing First, initiated in the USA in the 1980s, is to provide a stable, independent home with intensive personalised support for homeless people with multiple and complex needs. Sam Tsemberis explains why and how the principles of Housing First were first applied in New York.

What are multiple and complex needs?

Multiple and complex needs are persistent and interrelated health and/or social care needs, which impact on an individual’s life and ability to function in society. These needs may include:

  • Entrenched street homelessness, repeat service use, or being otherwise vulnerably housed
  • Mental, psychological or emotional health needs
  • Drug and/or alcohol dependency
  • Contact with the criminal justice system
  • Physical health needs
  • Experience of domestic violence and abuse.

Mainstream services are often not equipped to support individuals with these overlapping needs. Housing First has been shown to be effective in supporting people with histories of street homelessness, or other types of homelessness where contact with services has been unsuccessful in breaking the cycle of instability.

The 7 Principles of Housing First

The following 7 Principles of Housing First were specified by Homeless Link and are summarised here with thanks.

1. People have a right to a home

Housing First prioritises access to housing as quickly as possible. Eligibility for housing is not contingent on any conditions other than willingness to maintain a tenancy. The housing provided is based on suitability (stability, choice, affordability, quality, community integration) rather than the type of housing, and the individual will not lose their housing if they disengage or no longer require the support. The individual will be given their own tenancy agreement.

2. Flexible support is provided for as long as it is needed

Providers commit to long-term offers of support with no end date: recovery takes time and varies according to individual needs, characteristics and experiences. The service is designed for flexibility of support with procedures in place for high/low intensity support provision and for cases that are ‘dormant’.

Support is provided for the individual to transition away from Housing First if this is a positive choice for them and the support provides links with relevant services across sectors that help to meet the full range of an individual’s needs. There are clear pathways into, and out of, the Housing First service.

3. Housing and support are separated

Support is available to help people maintain a tenancy and to address any other needs they identify however an individual’s housing is not conditional on them engaging with support.  The offer of support stays with the person, i.e. if the tenancy fails the individual is supported to acquire and maintain a new home.

4. People have choice and control

This means that people can choose the type of housing they have and its location within reason and have the choice, where possible, about where they live. People also have the option not to engage with other services as long as there is regular contact with the Housing First team and they can choose where, when and how support is provided. People are supported through person-centred planning and given the lead to shape the support they receive. Goals are not set by the service provider.

5. An active engagement approach is used

Staff are responsible for proactively engaging their clients and for making the service fit the individual rather than trying to make the individual fit the service. Caseloads are small which allows staff to be persistent and proactive – doing ‘whatever it takes’ and not giving up or closing the case when engagement is low.  Support is provided for as long as each client requires it and the team continues to engage and support the individual if they lose their home or leave their home temporarily.

6. The service is based on people’s strengths, goals and aspirations

Services are underpinned by a philosophy that there is always a possibility for positive change; for improvement in health, wellbeing and relationships; and for community and/or economic integration.

Individuals are supported to identify their strengths and goals; to develop the knowledge and skills they need to achieve their goals; to develop increased self-esteem, self-worth and confidence; and to integrate into their local community.

7. A harm reduction approach is used

People are supported holistically.  Staff support individuals who use substances to reduce immediate and ongoing harm to their health; they support individuals who self-harm to undertake practices which minimise risk of greater harm; and support individuals to reduce harm and promote recovery in other areas of physical and mental health and wellbeing.

How does Housing First differ from other models of support?

Traditional support workers may have caseloads of 20-40 people whereas Housing First workers will typically support an initial caseload of 5-7 people though this number may increase over time as people require less support.

Smaller caseloads enable more intensive, flexible and personalised support for a cohort of people who have not been successfully engaged and supported by other housing services due to the level and complexity of their needs. Evidence suggests that, over time, those housed by Housing First require less support from services and, in some cases, may no longer require support. However this is completely dependent on the individual and may take several months or years to achieve.

Housing First is a person-centred approach which fully respects the choices of each person and supports their self-determination. It employs active engagement, supporting individuals by recognising and emphasising their strengths and capacity for positive change, and links with relevant services that help to meet the full range of an individual’s needs. The Housing First approach also allows for people to be rapidly rehoused in instances of housing loss.

How have these principles been established?

The 7 Principles of Housing First outlined here are based on work by Homeless Link, the national membership body for agencies working with people experiencing homelessness in England, including Framework.

Homeless Link’s summary is in turn based on evidence initially gathered by Pathways to Housing in the USA and subsequent implementation of Housing First internationally.

To find out more about Housing First, please watch this video.

In the UK The Centre for Housing Policy at the University of York has undertaken several studies of Housing First’s effectiveness.

Housing First and Building Better Futures

To find out more about Framework’s Building Better Futures campaign, watch a video case study and make a donation please go here.

You can read the story of someone whose life was turned round by Opportunity Nottingham’s Housing First pilot here.

To talk to one of our fundraisers about Framework’s Building Better Futures campaign please email or call 0115 970 9558 during office hours.