Housing for people with opioid use disorder

applied strategic

Housing for people recovering from opioid use disorder: success factors

Presented by Dr. Richard Littlewood

30 October 2016

WFTOD AATOD Presentation

applied strategic 1

Starting point

• Housing is an important factor in success for people addressing SUD1,2.

• For many there are significant problems in accessing housing, particularly on release from prison3,4.

• Restricted access to housing limits potential for recovery

• There is a need to deliver effective strategies to improve access to housing for people with SUD

• Understanding success factors for housing for people with SUD is important

applied strategic 2Source: 1Chartered Institute of Housing 2012: 2Milby JB, et al. Am J Public Health. 2010;100(5):913-918. 3Binswanger IA, et al. Addict Sci Clin Pract. 2012;7:3. 4Linton SL, et al.. MD. Drug Alcohol Depend. 2013;132(3):457-465.

Substance use disorder among homeless persons in the UK is common

applied strategic 3

39%• 36% had recently

taken drugs (within 30 days)1

• Cannabis (64%), prescription drugs (29%) and heroin (27%) reported 1

Source: 1. Homeless Link, ‘The Unhealthy State of the Homeless: Health Audit results 2014’. 2014

% of homeless persons in the UK take drugs/ recovering from a drug problem1

Many starting SUD treatment have no access to stable accommodation

• 9% of clients starting treatment for drug dependence had ‘no fixed abode’1,2

• An additional 15% had other housing problems: staying with friends or family, or living in short-term hostel1

applied strategic 4Source: 1Public Health England, ’Drugs and Alcohol: Recovery resources’; 2 Shelter, ‘Spotlight on Supporting Prison Leavers using substances’ 2015

9%

15%

Housing positively affects treatment outcomes in SUD patients

Housing (v. standard ’after care’) is effective at improving outcomes in people with history of SUD, positively affecting:

• Drug and alcohol use 1,2,3

• Employment 1,3

• Psychiatric symptoms 1

• Incarceration rates 1,2,3

applied strategic 5Source: 1Reif et al. Psych. Serv. 65:3 2016. 2Douglas et al. J. Psychoactive Drugs. 42:4 2010. 3Paquette et al. ‘Recovery Housing in the state of Ohio, June 2013

Aim

• Project completed to define critical success factors for housing services aimed at people addressing SUD

• Assessment of 16 housing services started in the period of research in NW England was conducted

• Results used to inform best practice

applied strategic 6

MethodStep 1 – success factors

• “Delphi” style consensus among representatives from 16 recovery housing services in the study

• Identified and prioritized important success factors for housing services

• Prioritized success factors can be used to assess/ compare the performance of housing services

applied strategic 7

MethodStep 2: assessment

• Online survey and phone interviews were conducted before and after 6 months working

• Participants assessed housing service performance against ranked success factors from Step 1

• Defined type of housing service (tenancy selection and SUD interventions)

• Recorded experiences in setting up the services

applied strategic 8

Results: consensus process , key success factors

Rank Success factors for housing projects

1• Interventions for SUD (for example, including

mutual aid) are offered

2 • Housing units of appropriate quality are available

3• Expert, specialist tenancy management services

are in place

4• Planning for special groups exists (on OST, using

illegal drugs, increased risk, such as history of arson)

5• Integrated social services are offered (including

activity programs/ training)

applied strategic 9

• 16 housing services offered 254 units (a unit is accommodation for 1 person) during the period of 6 months

Results: activity

applied strategic 10

Average occupancy across all housing services was 86%

Demand exceeded capacity in 31% of services.

Full capacity utilization was reached in 25% of services

86% of tenants came to housing on release from prison

44% of services housed only tenants released from prison

Results: consensus process Success factors for housing services


Offer treatment

Provide quality

Manage tenants

Special groups

Social services

81

94

6356

75Achieved

by (%)

Success factors in decreasing order of ranked importance

Tenant selection

ObservationsChoose what type of service you want to be…


SUD interventions

High intensity

Minimal/ No services

Abstinence (no OST)

3rd party services

Not selective

Selective (no illicit drugs)

Progressivehighly selective

for tenants, high intensity intervention.

Directive Abstinence, OST permitted,

tenants engage with third party services for SUD

SupportiveNo selection for drug use,

offering no/ low level of

interventions

Tenant Selection[% achieving outcome, N=16]

What happened?Tenant selection

Complete ab-stinence

Limited SUD medication

No specified limit

31

38

3131

25

44B

efor

e

Rea

l wor

ld


SUD intervention[% achieving outcome, N=16]

What happened?Interventions for SUD


56

44

0

19

50

31R

eal w

orld

Bef

ore

DiscussionDifferent types of housing services in networks is needed

• For housing services - there must be clear planning for tenant selection (substance use) and interventions for SUD

• Housing services will differ in their approach: “progressive, directive or supportive”

• Different types of housing in a network must be provided


Conclusions

• The work defined success factors for housing services supporting people aiming for SUD recovery

• These should be considered when measuring and comparing success in recovery housing services

• Intensity of SUD intervention and criteria for tenant selection must be considered by all new services

• Housing networks, ranging in selection criteria, are likely to improve treatment outcomes for SUD


Housing for people with opioid use disorder

Healthcare

Transcript of Housing for people with opioid use disorder