Challenges & Strategies

What are some key challenges to anticipate during the planning process?

Our consultations with stakeholders experienced in planning a Housing First program revealed several challenges. We organize these challenges into four sections: 1- Confusion, resistance, and concerns about Housing First; 2 - Developing an effective decision making process; 3 - Planning a Housing First program adapted to the specific needs of the community; and 4 - Securing funding for a Housing First program. Each section describes several experience-based strategies from stakeholders with Housing First planning experience, as well as planning knowledge gained from the At Home/Chez Soi project.

Challenge: Confusion, resistance, and concerns about Housing First

It is often difficult to communicate what Housing First is, as well as how it works. After the community learns about scattered-site housing and some of the challenges faced by Housing First participants, resistance and concern is not uncommon. Misconceptions about the Housing First model can contribute to resistance from communities. For instance, a common misconception of individuals unfamiliar with Housing First is the belief that the program will “dump” vulnerable individuals into housing without providing support. Additionally, stakeholders currently involved in ongoing community-based housing programs are often concerned about what will happen to existing services. Stakeholders may perceive competition between Housing First and current supportive housing models.

What are some strategies for overcoming confusion, resistance, and concerns about Housing First?

1. Address misconceptions about Housing First right away.

Address common misconceptions of Housing First by engaging the public in a discussion of the model and its key components. Members of the housing and clinical teams of the At Home/Chez Soi program and other key stakeholders noted that to combat the misconception that individuals are housed and forgotten, it is important to explain that Housing First participants are connected with a dedicated and responsive service team. It is particularly important to communicate this message to potential landlords, community members, and the public.

2. Frame your Housing First program as a way to add innovative services.

Service providers from other programs may express understandable resistance to Housing First if they perceive it as a threat to their organization and services. Within the At Home/Chez Soi project sites, stakeholders described initial tensions between individuals and organizations, due to previous experiences, competition around roles, differing priorities, and lack of familiarity with one another’s work1. These tensions were often rooted in concerns related to organizational survival. Housing First should be understood as a new and innovative approach to providing services, and a way for existing service-providers to expand service-delivery options, as opposed to a replacement for current services and staff. Help organizations to think of the possibilities of the Housing First model in the context of shifting resources and ways of working with participants. For instance, shelters can be encouraged to shift back towards providing emergency short-term housing, and become part of a common, system-wide referral pathway towards permanent Housing First. When suggesting a reorientation of services, some individuals will be more open and enthusiastic than others. It is important to engage enthusiastic individuals at an early stage of the planning process to facilitate “buy-in” from the larger organization. It is also important to engage stakeholders who express resistance at an early stage, and to directly address and discuss their concerns.

To successfully reorient service- providers toward Housing First, stakeholders indicated the importance of developing a common vision- for instance, stakeholders can articulate a common vision of developing recovery-oriented services, within an overall system of care with a common referral pathway guided by Housing First principles. Service providers, people with lived experience, and other key stakeholders should share this common vision. Within the At Home/Chez Soi project, many sites came to a shared vision around the notion that housing is a right rather than something to be earned. Sites also found that the Housing First program model itself, when communicated consistently and clearly, provided an effective basis for a common vision. Having a clear, common vision of Housing First, including both what it is, and what it is not, can help address another common barrier, which is the sentiment that “we do this already”. To counter this, it is helpful to review the items in a Housing First fidelity self-assessment tool, which can be a helpful way of convening an initial dialogue about what is or isn’t Housing First.

Additionally, think about how the Housing First program will work in conjunction with existing services, and make use of existing resources within your community, including programs that are already doing similar work. You may find that existing resources and networks can help with the planning process. For example, stakeholders in Winnipeg described how capacity-building was an important focus as they collaborated with other stakeholders to deliver ICM  Intensive Case Management (ICM) is an approach designed for participants with moderate needs. Efforts are integrated across multiple staff members and agencies. Staff members accompany clients to appointments and coordinate services. Services and supports are provided seven days/week, 12 hours per day. The team typically convenes monthly case conferences.  and to develop ACT teams.  Assertive Community Treatment (ACT) is an approach designed for participants with high needs, including psychotic disorders. A multidisciplinary team, including a psychiatrist and a nurse, provides services and supports. At least one peer specialist is on staff. The client/staff ratio is 10:1 or less. Services and supports are provided seven days/week with 24-hour crisis coverage, and the team typically meets daily.  It is particularly important to bring together partners from the housing sector, who will provide housing services, and the mental health/services sector, who will provide ACT, ICM and other services. Additionally, it is important to go beyond these to sectors to form partnerships with local business people, landlords, housing agencies, universities, and government representatives at municipal and provincial levels.

3. Establish the “right team” at an early stage.

Many stakeholders described the “right team” as a group of individuals who share values and a vision for the Housing First program and its transformative potential. As one stakeholder explained, “When you start planning leadership and the team, give yourself the chance to pick the right people - it might not necessarily be the ones with the most seniority.” At an early stage, the team should include individuals with grassroots perspectives, particularly service providers in the field and people with lived experience. Individuals providing leadership over the program should fully understand and believe in Housing First values and principles.

When hiring staff, carefully consider fit. To assess fit, it is helpful to identify the specific skill set that is necessary for each position. For example, stakeholders suggest hiring empathetic and forward-thinking staff with regard to mental health and the other challenges experienced by a community’s target population. It is also helpful to think proactively about potential gaps, particularly for smaller programs. If it is not possible to employ staff to meet all needs of the program, consider partnering with community organizations that can provide support, and solicit the help of volunteers in the community. You may also consider coordinating and consulting with other local, provincial, or national Housing First sites to share experiences, resources, and ideas.

For more resources on this topic, see:

PLANNING TASK 6: HIRING STAFF

JOB DESCRIPTIONS

4. Engage local, provincial, and national champions of Housing First.

To gain community support for Housing First, several stakeholders described the importance of engaging Housing First “champions”- individuals knowledgeable about Housing First who can support the initiative with passion and knowledge. The help of Housing First champions at the local, provincial or national levels has been an effective strategy for mobilizing new Housing First programs.

For more resources on this topic, see:

PLANNING TASK 1

5. Gain community support for Housing First by emphasizing the role of responsive housing and clinical teams.

Several stakeholders described significant community resistance to the idea of housing participants in the community, which made it difficult to recruit landlords. For instance, stakeholders from the Moncton site described a common community perception that Housing First provides free housing to people who use drugs, and emphasized that is important to “counter that myth right at the beginning”. Additionally, stakeholders expressed that it is important to “sell” the program to the community by emphasizing that participants will be supported by a highly responsive team. The stakeholders described how community resistance was eased when they explained how the team will meet with the participant weekly and respond to any issues that might arise.

It is important to foster a sense of security through responsiveness and good communication with landlords and community members. To maintain community support, stakeholders emphasized the need for staff to be available to promptly respond to crisis situations, particularly if police are called. In addition, bring leaders from the community into the program from the beginning, as they can engage the rest of the community. Community leaders can also provide insight about the specific needs of the target population, in order to provide effective services.

Jim is one of the "At Home" project's 15 housing agents. It's his job to convince landlords to take a chance on the project participants. (NFB)

6. Be prepared to make a case for the potential economic benefits of Housing First.

According to several stakeholders, a strategy for garnering support for Housing First is to describe the potential economic benefits. To do so, it is important to develop strategies for collecting data on the cost of services currently in place in the community. Additionally, programs can build a cost analysis into their overall plans for evaluation.

7. Communicate what Housing First is and what it means to staff through training.

Stakeholders explained the need to plan trainings for staff in order to introduce them to Housing First or to foster a reorientation toward the Housing First approach. As staff become oriented to the Housing First approach, training may address recovery, harm reduction, early adjustment issues, motivational interviewing and strengths-based approaches, the impact of trauma/trauma-informed care, and other topics pertinent to the target population.

During the planning stage, it is important to acknowledge the limitations of Housing First and to manage staff expectations. For instance, eviction/rehousing is to be expected. Also, some participants will experience early adjustment difficulties, as well as fear and resistance. Many participants have had negative experiences within a system that has failed them. Implementing Housing First means engaging people with lived experience in peer support roles, and this should be an important component of training.

8. Challenging negative staff perceptions of the participant population.

Service-providers may have developed a belief that this population (particularly individuals with mental illness and histories of chronic homelessness) are incapable of recovery - it can be challenging to change this perception. Stakeholders suggested sharing research and evaluation findings that report success with similar populations. Also, consider connecting the staff with successful Housing First teams that can describe experience-based successes with participants. Identifying ways for staff to hear directly from people for whom HF has been effective is a powerful way to challenge negative perceptions.

Challenge: Developing an effective decision-making process

When planning services for less complex problems, it is common for planning to be driven by single agencies. When dealing with homelessness, however, it is necessary to adopt a multi-sectorial or “whole of society” approach to planning and decision-making. Also, as groups begin the planning process, tensions can arise in the decision-making process, particularly between “top down” approaches, where decision-making is driven by leaders of an organization, and collaborative approaches, through which there is more inclusive participation from diverse stakeholders involved in program planning . There is also a tension between using a collaborative approach and the inevitable deadlines and realities of the planning and service delivery environment.

What are some strategies for developing an effective decision-making process regarding planning?

1. Use a cross-sectorial approach.

A cross-sectorial approach is crucial to success at the planning stage. Collaborating across sectors is a way to ease doubt and uncertainty and to facilitate community “buy-in.” In order to build strong relationships across sectors, stakeholders emphasized the importance of consensus-building, open dialogues, and mutual respect. When planning a Housing First program, think broadly about engaging potential stakeholders- include the perspectives of stakeholders beyond the housing and mental health/service sectors, including individuals from the justice sector, individuals experienced with income assistance, landlords and people with lived experience of homelessness, mental health issues, and other issues experienced by the target population.

By using a cross-sectorial approach, communities can benefit from the experiences and perspectives of a broad cross section of stakeholders to better understand the needs of the target population. For instance, the coalition can collaboratively explore community-specific issues, such as the specific needs and challenges of the target population, the extent to which current services are meeting these needs, gaps in services, and vacancy rates/the current housing market.

When using a cross-sectorial approach, it is important to build bridges between sectors, and also “between the worldviews of different communities”. In the Winnipeg site, for example, stakeholders were proactive by providing a forum for sharing and discussion during the planning process. “Two days were set aside for teaching and sharing, [making] sure there was time and opportunity for people to come together and find out about each others’ work” . Within the At Home/Chez Soi program, the Site Coordinator position was often instrumental in helping the various partners voice areas of disagreement, and develop a common vision for proceeding. This site coordinator was often someone experienced and trusted with the multiple sectors of the project: someone who had worn “multiple hats” and was skilled in navigating a complex terrain of interests and perspectives. The value of finding “neutral space” also became apparent, as a way of helping the various players to begin the dialogue that was necessary for moving forward.

2. Establish a culture of problem-solving and learning.

Findings from At Home/Chez Soi and consultations with stakeholders suggest that it is important to establish a collaborative approach. Establish a culture of “learning as we go” that is not punitive to staff or participants for making mistakes. The process of working through problems collaboratively is an important team building experience that is facilitated by a culture of problem solving and learning. Additionally, to establish a learning culture around Housing First, stakeholders suggested developing a “Community of Practice”, which is a diverse group of individuals with shared interest and diverse experiences regarding Housing First. Within the Community of Practice, stakeholders can share effective strategies and lessons learned regarding program planning.

3. Provide clarity regarding staff roles and responsibilities during the planning process.

It is critical to establish roles and responsibilities early, particularly between housing and clinical teams. Stakeholders suggest developing clear protocols about decision-making and accountability for both housing and clinical teams from the onset. Additionally, it is important to distinguish (for Housing First stakeholders and professionals from other programs) between which services are provided through the mainstream system versus those provided through Housing First teams.

4. Engage the voices of people with lived experience in the planning process.

Involving people with lived experience at an early stage is crucial to effective engagement and the development of meaningful and inclusive roles. It is important for people with lived experience to be present at planning meetings, and to ensure that people with lived experience are given opportunities to voice their perspectives with regard to planning tasks. It is essential to think through potential roles for people with lived experience to ensure that they are able to provide meaningful feedback, communicate concerns regarding implementation, and appropriately engage with program participants. In order to integrate peers meaningfully onto teams, it is important to plan training opportunities for clinical staff who may have limited experience engaging with co-workers with lived experience. In acknowledging the importance of roles for people with lived experience, it is important to provide honoraria for participation, and to create full-time, paid positions for these individuals. Two important roles are:

Peer support workers - It is important to create peer-support roles within the framework of clinical service teams. Peer support workers are included as part of an ACT team. For more information about peer support roles, click here to access documents about engaging people with lived experience.

A peer ombudsmen – A peer ombudsmen is a person with lived experience who can consult with program participants and take complaints regarding their experiences with the Housing First program. The ombudsmen should have knowledge of homelessness and services and the community and be housed in an agency not associated with the program (e.g. consumer or peer support centre).

By including people with lived experience during the planning stage, stakeholders can learn about the specific needs and perspectives of the target population, as it relates to adopting the Housing First model. For instance, if the target population includes survivors of domestic violence, these individuals can provide input about housing options that will best meet their needs and cultivate a sense of safety. Similarly, if the target population includes Aboriginal participants, it is important to understand cultural perspectives on the type of housing options that are most preferred.

Challenge: Planning a Housing First program adapted to the specific needs of the community

Another challenge to anticipate during the planning process is ensuring that the program will meet the needs of the target population and community context. Specifically, it can be challenging to adapt the program to address community needs while maintaining fidelity to the Housing First model.

What are some experience-based strategies for developing a Housing First program that meets the needs of your community context?

1. Anticipate challenges unique to your program context and plan potential local adaptations, while maintaining fidelity to Housing First principles.

It is important to consider what is unique about your context and population, and to plan for meaningful adaptations to enhance the success of your program. As one stakeholder explained, “you need to be able to mold the program to meet the needs of your community.” Housing First has been implemented in rural and urban areas, with First Nations and ethno-racial populations, and with groups with a high prevalence of addictions. Thus, it is critical to understand the population characteristics well. One important way to understand the needs of your population is to engage the participation of people with lived experience of homelessness and mental health challenges and/or other challenges experienced by the target population. These individuals can articulate the specific challenges faced by their communities.

Delivering culturally competent services is an important aspect of meeting community needs. At the Toronto site, for instance, a crucial component of the program was planning culturally appropriate services for ethno-racial communities. In the process of developing culturally competent services, stakeholders in Toronto were able to benefit from particular areas of expertise provided by different local agencies . Likewise, in Winnipeg, stakeholders developed the Aboriginal Cultural Lens Committee during the planning process. This committee was formed to ensure that Aboriginal perspectives were meaningfully included in the development of services. The Committee provided feedback on how consistent services were to Aboriginal values through the seven sacred teachings.

2. Create relationships with landlords well before the program begins.

At an early stage, it is helpful to brainstorm about ways to connect with potential landlords. Engaging existing housing organizations may be one approach, as these groups can draw on their connections with landlords in the community. To develop an approach for engaging landlords, it is important to understand the overall housing environment. Also, think about strategies for eviction prevention and understand the common stumbling blocks and adjustment difficulties specific to your participant demographic.

To address the concerns of potential landlords regarding renting an apartment to participants with complex issues, stakeholders from the At Home/Chez Soi sites noted that it is important to emphasize that participants are connected with a responsive support team. Additionally, they advised program staff to explain that risky tenancies are typically rare, and to note that many participants go on to have successful tenancies, even with complex issues.

Jim Kennedy meets with two different landlords
who have two different reasons for taking
a chance on housing At Home tenants. (NFB)

Some stakeholders suggested “going high up the ladder” to building owners or executives to secure apartments in urban areas, as these individuals are likely to find the regular payments associated with the rent subsidy motivating. When recruiting landlords, it is also helpful to have recruiting information that clearly describes the program.

3. Develop a process to evaluate the program and to measure success at an early stage.

During the planning stage, it is important to develop outcomes measures and an evaluation plan. Also, develop a process to measure and report the successes of your program and a reporting strategy. Some stakeholders suggested the need for software or a digitized system/template early in the planning process to keep track of tenancies, including rent payments, housing history, participant characteristics, and challenges. This information is helpful for tracking participants and for information sharing and reporting. Additionally, evaluation is a useful tool for managing Housing First programs and a tool for quality assurance. Evaluation can be a valuable tool in ensuring that staff members are providing services consistent with the model and identifying areas for growth and improvement.

Challenge: Securing funding for a Housing First program

It can be challenging to secure funding for a Housing First program. The potential streams of funding vary widely by context, and it can be difficult to navigate various funding streams relevant to housing and services.

What are some experience-based strategies for securing funding for a Housing First Program?

1. Consider multiple funding streams and sources relevant to your context.

While funding mechanisms vary widely by context and province, stakeholders engaged in the program planning process can consider a number of potential funders, including municipal, regional, and provincial governments, community entities for the Homelessness Partnering Strategy (HPS), and private foundations.

2. Consider reaching out to funded Housing First programs in other areas to learn about how funding was secured.

While funding mechanisms vary widely by context and province, stakeholders engaged in the program planning process can consider a number of potential funders, including municipal, regional, and provincial governments, community entities for the Homelessness Partnering Strategy (HPS), and private foundations.