One of the largest Housing First services St Mungo’s provides is in Camden, which we began running in 2014 with 20 clients. The service has since expanded four times, mostly through Rough Sleeping Initiative (RSI) funding, although its most recent expansion was through the Next Steps Accommodation Programme, increasing its capacity to 72 clients.
The power of choice
Housing First staff have small caseloads. They work intensively over long periods with clients, whose trust and belief in the model is key to its sustainability. Staff in Camden begin by asking a client “do you want to work with us?” It seems a simple question, but the most vulnerable clients may feel that past decisions have been made for or to them. Having choice put firmly in their hands from the outset provides a bedrock of empowerment at odds with past experience. Small caseloads have been consistent throughout expansion, with the service maintaining the necessary staffing to support this through partnership working with Camden Council.
The service works with a range of housing providers, affording choice to clients on where they want to live. This cements their power over their journey and provides a physical platform for recovery in the right environment. The service works with Camden Council and providers such as One Housing and Notting Hill Genesis with whom the service has negotiated service level agreements. These ensure that housing providers understand the Housing First client group, and streamlines processes to prevent clients being overwhelmed. Staff use personalisation budgets to purchase items clients choose which they feel will turn their tenancy into a home.
The right support
Housing First is based on clients’ strengths and aspirations, with no requirement for them to engage with support services. Recovery is not linear and, for many, the rigid structure of statutory services, with fixed treatment programmes and methods, can be difficult.
When clients are ready to engage, challenging the status quo of a treatment programme is important. Staff support clients to engage with these services but also support the services to engage with a client group that they may be unfamiliar with, attending multi-agency meetings to advocate on a client’s behalf.
As a result, 96% of clients in Camden Housing First are registered with a GP*, and 100% of clients with a mental, physical or substance misuse issue who need to engage with services are doing so*.
Camden Housing First provides an Occupational Therapist, Rosemary, supported by Homeless Link’s Housing First Fund, to work with clients who have the most difficulty engaging. Using her specialist healthcare knowledge Rosemary works alongside Housing First staff to ensure that clients can access services, especially where those rigid structures and methods have proved insurmountable in keeping clients within treatment and care programmes. Rosemary is able to assess, establish and evidence their clinical requirements and needs. This includes ensuring that capacity is assessed accurately, that adequate care is provided and stepping in when this is not the case.
Rosemary also works with clients to make sure they have everything they need to meet their support needs within their homes and to access the community through digital inclusion. This has been particularly beneficial during covid, affording access to virtual medical appointments and learning opportunities.
One client said, “Rose [the OT] is lovely. She gets things done, she don’t turn her back on nothing. She got a laptop for me. I get on fabulous with her and she does everything that’s required”.
Staff also link clients in with other organisations, such as Groundswell, who assist clients through the entire process of attending appointments. This can include getting ready and travelling to/from, ensuring access to vital medical care.
During the pandemic staff have been working with services to ensure that medication is dropped directly to clients’ doors where possible. Necessary face-to-face contact has been carried out safely, and food delivered when needed.
The service and partners in Camden Council identified a real need for a more trauma informed approach when working with female clients. They introduced a women’s worker to ensure a gender-informed approach: understanding and addressing barriers specific to women that they may face in accessing services. A dedicated women’s worker also allows for more time to be spent building up trust with those clients.
Support in Housing First services also includes practical things such as cleaning, shopping, and ensuring that the client is in receipt of the correct benefits. This helps people to develop skills which they can carry forward if/when they move on from the service. 100% of the clients at Camden Housing First have increased their ability to manage money as measured by an outcomes star*, and 100% are in receipt of the correct benefits with no sanctions*. The service also works with clients who are subject to court or Anti-Social Behaviour Orders, which staff support them to comply with, with a current compliance rate of 100%*.
Being a St Mungo’s client also means access to services such as the Recovery College, the Lifeworks psychotherapy service or the Putting Down Roots gardening programme. The St Mungo’s Palliative Care Team have supported staff with hospital and hospice liaison and coping with a client death.
Patience and persistence
It is these vital building blocks and wraparound support which help clients to maintain their tenancies – the ultimate goal of any Housing First service. In Camden, 50 out of 51 service users maintained their tenancies in the most recent quarter*.
The ethos of Housing First has often been summed up as never giving up on a client. What is perhaps even truer is that clients, who may have every reason to do so, never give up on us.
*Note: figures in this piece are from the reporting quarter 6th July – 4th October 2020