1. THE EVIDENCE AND THE OPPORTUNITIES IN AUSTRALIA NOW APRIL 2009 Felicity Reynolds CEO, Mercy Foundation

2. Presentation overview

• Breaking the cycle focus

• Research agenda

• A very quick trip through the evidence for high cost of crisis responses, effectiveness of Housing First, Assertive Outreach, Permanent supportive housing, Low threshold services.

• Federal and State money now!

3. The White Paper Federal Policy

• Prevention Turning off the tap

• Doing things better Improving and expanding

• Ending homelessness Breaking the cycle

4. Research Agenda

• The White Paper also calls for further research to better evaluate current programs as well as build evidence for prevention and effective interventions.

• This will be an essential part of building on the current evidence, especially where there is limited Australian research in some areas.

• Think about this as we run through some of the evidence.

5.

• What works

• (and what doesnt)

• A very brief review of some of the evidence

6. High costs of not solving chronic homelessness

• We have already heard some of this today but here are references to some specific studies .

• It costs essentially the same amount to house people as it does to leave them homeless . ( Culhane, 2004)

• Providing stable housing for homeless people generated cost savings in a range of support areas. In some cases the savings paid for most, in not all, the housing expenditure. (Berry, 2003)

7. Housing First

• Again, we have heard about Housing First today there is now a body of research that shows:

• People can sustain housing straight from the streets but must have the right support (Tsemberis and others).

• People are more likely to become stable with mental health and other conditions once in stable housing (not the other way around).

• We need more Australian based research.

8.

• An example of the results of a study :

• Homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment.

• A drop-in centre approach. after 24 months only 38% of participants had moved to community housing.

• A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. (Tsemberis, Moran, Shinn, Asmussen, Shern, 2003)

9. Assertive outreach

• There is evidence that assertive outreach is effective in engaging and linking homeless persons with substance use disorders to substance abuse treatment services. ( Fisk, Rakfeldt, McCormack, 2006).

10. Another outreach study

• This evaluation showed that the impact of an integrated (mental health/substance abuse) assertive community treatment program on homeless persons with serious mental and substance use disorders. High rates of retention in treatment, housing stability, and community tenure were attained, and all but the most severe substance users appeared to gain these benefits.( Meisler, Blankertz, Santos, McKay, 2004).

11. Permanent low cost supportive housing

• HASI works (SPRC evaluation, 2007)

• Housing plus ongoing support (numerous international studies eg. Tsemberis, Culhane etc)

• After entering permanent supportive housing, those individuals each used less than $26,000, and that included the cost of housing. While making progress toward ending chronic homelessness, Portland Oregon is saving the public over $16,000 per chronically homeless person. (Moore. 2004).

12. Low threshold services

• A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters. (Podymow, 2006)

• Seaton House Annex Toronto (Report by Comeau, 2005).

• • However, limited longitudinal analysis or evaluation of other managed residential alcohol programs, although they are also implemented in the UK and Ireland.

13.

• Safe Havens limited formal evaluation but local reports indicate they work well for a particular sub-group of people who experience chronic homelessness. But more evidence needed.

• A priority to test this model in Australia and measure outcomes over time.

14. More low cost and affordable housing

• When people are forced to accept inappropriate accommodation their situations usually get worse (Johnson, Gronda, Coutts 2008).

• While refuge or transitional housing represents an effort to maximise limited resources, it frequently leads to the initiation of newly homeless people into the homeless subculture (Johnson et al 2008).

15.

• What are the opportunities now?

16. National initiatives

• In 2008, the Australian Government introduced new funding arrangements.

• The overarching framework for this new approach is set out in the Intergovernmental Agreement (IGA) on Federal Financial Relations. The National Affordable Housing Agreement (NAHA) is one of a number of new National Agreements agreed under the IGA.

• From 1January 2009, the NAHA incorporated and replaced the Commonwealth State Housing Agreement (CSHA) and the Supported Accommodation Assistance Program (SAAP).

17.

• The total funding provided by the Australian Government for housing and homelessness to all states and territories over the next five years under all the schemes add to:

• $6.20 billion for social housing and homelessness under the National Affordable Housing Agreement (NAHA)

• $0.40 billion under the Social Housing NP

• $0.40 billion for homelessness support services under the Homelessness NP

• $0.15 billion for capital construction under the Homelessness NP (A Place To Call Home initiative)

• $1.94 billion under the Remote Indigenous Housing NP

• $6.40 billion for social housing under the National Building and Jobs Plan NP

18. Matching funds from the States

• In addition, under the Homelessness NP, States and Territories will contribute matching funding of $0.40 billion for support services and $0.15 billion for A Place To Call Home. This brings the combined total of Australian, State and Territory Government funding for social housing and homelessness to $16.04 billion.

• The Nation Building and Jobs NP provides funding for capital construction and refurbishment of housing stock, with the dual aims of significantly increasing social housing stock, and rapidly delivering economic stimulus measures to support employment and growth.

19. Outputs and outcomes

• The Homelessness NP contains a number of agreed outputs aimed at reducing homelessness across Australia.

• States and Territories have responsibility for the allocation of funding for homelessness services within their jurisdiction, but must achieve agreed outputs.

• Mainstream services will be expected to improve their responses to clients to prevent or respond to homelessness and targeted homelessness services will be expected to build stronger links with mainstream services to ensure seamless service delivery.

20. A place to call home

• The A Place To Call Home program commenced in July 2008 and has now been incorporated as one of four core outputs of the Homelessness NP.

• A Place To Call Home differs from other capital construction funding arrangements because support for tenants is built into the funding model.

• Under the initiative, people who are at immediate risk of homelessness move directly into permanent housing. They receive tenancy and support services for up to 12 months

21. A place to call home a bit more

• People housed under the program will not have to leave their home at the end of the support period. The houses will be transferred to the public housing pool and their tenancy extended in accordance with normal arrangements for public housing. A Place To Call Home dwellings returning to social housing stock will be replaced by another property, ensuring a constant supply of dwellings over the life of the program. States and Territories must demonstrate that at least 600 additional dwellings have been added to social housing stock by 30 June 2013.

22.

• Australian Government funding is provided for the capital component of the A Place To Call Home program. States and Territories are matching Australian Government funding to provide land, construction or refurbishment of dwellings, and support services.

• Some States are implementing innovative supported housing models, including Foyer models and Common Ground models to provide long term housing and support for people who have been chronically homeless.

• These more complex housing models require a longer planning and lead time for delivery than is acceptable under the National Building and Jobs NP, although all are expected to be operational by 30 June 2011.

23.

• An important final point:

• What gets measured gets done (NAEH)

• (Setting clear targets and making clear agreements was a great move!)