Responses to Homelessness – A Mini-Series About the Evolution of Alberta’s Response – Part Five
We’re nearing the end of our mini-series! This article provides a bit more context to Housing First through a look at the three primary schools of thought associated with it.
The Three Schools of Thought
Housing First has broad connotations. To help breakdown some of the nuances, this philosophy has largely been grouped under three different schools of thought, each represented by their own champions: Dr. Sam Tsemberis, Iain DeJong, and Stephen Gaetz.
Dr. Sam Tsemberis founded Pathways in Housing in New York in 1992. Developed on the assumption that housing is a human right, this model of Housing First provides immediate access to permanent supportive housing (PSH) and targets the unhoused population who have concurrent mental health and addiction problems. Pathways focuses on psychiatric rehabilitation and an individual’s right to choose; it was “designed to address the needs of consumers from the consumer’s perspective” (Tsemberis et al., 2004, pg. 651). Consistent with the next two schools of thought, Pathways does not place any prerequisites on individuals participating and has a focus on wrap-around supports. In this model, these wrap-around services are offered through Assertive Community Treatment (ACT) teams that are traditionally comprised of “social workers, nurses, psychiatrists, and vocational and substance abuse counselors who are available to assist consumers 7 days a week 24 hours a day” (Tsemberis et al, 2004, pg. 652). They have since added a nurse practitioner and a housing specialist to the team.
Iain DeJong’s school of thought focuses on the ground level, program fidelity to the Housing First philosophy, and wrap-around supports. DeJong argues that those working in the homeless serving sector should be able to tell anyone what the method and approach is that that they are using to do so. As such, DeJong focuses on the training of front-line staff, a coordinated access point, as well as the use of the SPDAT. The SPDAT and the vSPDAT was created by DeJong following his involvement with the At Home/Chez Soi study to prioritize service provision in a “defensible, reliable, consistent and valid way” (De Jong 2011, pg. 1). The vSPDAT and the SPDAT are meant to be utilized to determine who should be served and what type of housing intervention should be used. The vSPDAT is meant to be used as a screening tool to determine if the individual needs Housing First or rapid re-housing intervention and, from there, who needs to complete the full SPDAT. The SPDAT provides case managers with case management focus. With the continued demonstrated success of the SPDAT, communities across North America have been utilizing the SPDAT for many years, and the use of the SPDAT continues to spread.
The final of the three schools of thought is championed by Stephen Gaetz. This school of thought is largely focused on systemic change and targeting policy changes at the federal level. At a high-level, Gaetz views Housing First as a tiered system of sorts, where philosophy acts as the guiding principle for the work being done. Following this is the integrated systems approach which highlights the need for a systems approach to ensure the philosophy of Housing First is being adhered to. This means building a system of care where “all services and program elements…are guided by the principles of the model:” (Gaetz, 2014, pg. 15). Meaning, while not all interventions are Housing First programs, each service within the system of care should support the Housing First goals (Gaetz, 2014). Furthermore, a systems approach must also consider elements of service that may contribute to homelessness, such as the justice, education, and health systems (Gaetz, 2014). Program model follows and refers to the operationalized services offered by a community/agency. Touted as one of the many advantages of Housing First, Gaetz is quick to acknowledge that there is not just one standard program model to abide by (Gaetz, 2014). The final tier, case management, looks at the options available to best provide the wrap-around supports for participants. This often is broken down into two categories: assertive community treatment (ACT; where “a multidisciplinary team in the community where the individual lives, rather than in an office-based practice or an institution, provides case management” (Gaetz, 2014, pg. 16).) and intensive case management (ICM; a team based approached for participants who are less complex but still need intensive support for a shorter period (Gaetz, 2014).
Next Time
Our next article in the series will look at some of the stats that support the use of Housing First and different complicating factors. In the meantime, should you have any comments or questions, please share them through email at a.burke@albertacounsel.com.