The role of community agencies when operating Housing First
This module is an overview of the role that community agencies can play in relation to the operation of Housing First programs. It is organized into three sections: (i) Key Messages, (ii) Key Questions and Challenges, and (iii) Appendices and Resources. The Key Messages section gives a summary of the various roles community agencies can play when coordinating operations with a Housing First program. The Key Questions section is organized into a series of general questions about common challenges that Housing First programs face when working or relying on other community agencies. Finally, the Appendices and Resources section contains additional information about working with community agencies when operating a Housing First program that includes external links to additional resources.
- The success of Housing First is dependent on collaborative relationship with other community agencies that can either impede the realization of consumer goals or create needless barriers to housing, services and recovery. Examples of coordinating agencies or community partners include:
- Street outreach providers, emergency shelters, and other programs that are part of the crisis response system. All serve as referral sources for Housing First programs.
- Provincial Housing Authorities or social housing providers often need to inspect and approve apartments before a Housing First tenant can move-in.
- Funding for housing or rent supplements and/or funding for services is often dependent on the approval of government agencies such as a community entity, public benefits and entitlements programs and others.
- Private landlords are essential housing partners for successful implementation and operation of Housing First and must be incorporated into the larger team and adopt a harm reduction or less risk aversive approach to property management.
- The existing mental health, health and addiction services are essential service partners and may be operating with a more traditional clinical or medical model approach and will need to adopt a consumer directed approach.
- If programs attempting to implement Housing First do not recognize the essential role of other community agencies, and successfully address the work needed to integrate these services into the program the effectiveness of the Housing First program can be compromised.
- Housing First programs provide both housing and support services to individuals with complex health and social needs. Even when these services are comprehensive, Housing First tenants must still navigate multiple types of community agencies (e.g. benefits office, mental health clinic or health clinic, emergency services, the police department, parks and recreation, etc.) to meet their needs. [see inset box below]
- Despite being juxtaposed to traditional service models that have been described as hierarchical, directive, paternalistic and based on provider (rather than consumer) expertise, Housing First programs operate within a larger network of community agencies and thus can impact overall community practice and attitudes.
Assertive Community Treatment (ACT) is a comprehensive service model that involves a multi-disciplinary team (e.g. psychiatrist, nurse, vocational specialist, peer specialist, etc.) to meet the needs of people living in the community who have serious mental illnesses. ACT is also used as a service delivery model within Housing First programs. Among other responsibilities, ACT team members are expected to help facilitate admission and discharge when hospitalization is needed, to accompany clients to appointments at benefits office, and to assist clients in identify community resources or opportunities for employment, social engagement, and recreation.
While we recognize that most Housing First programs are limited in the services funding and provide support using a case management or intensive case management model it is useful to bear in mind that the ideal service model is interdisciplinary, community based and consumer driven. Achieving this interdisciplinary team composition (it does not have to be a full ACT team) will require either additional funding or close collaboration with other community agencies.
This interdisciplinary approach is very useful especially in start-up years when working with clients with severe psychiatric, health, and addiction challenges. The Housing First team will do well to work with community agencies to provide direct services or opportunities for engagement in services through home visits.
Key Questions and Challenges
Challenge #1: Formalizing community agency partners
Housing First programs will predictably interact with local landlords, hospitals and public benefits offices. Proactively engaging these community partners and formalization relationships (e.g. Memoranda of Understanding) can improve ongoing communication and a collaborative working relationship as well as guarantee that these agreements are sustainability beyond personal commitments.
Challenge #2: Identifying other community partners
Often there can be existing community agencies that can meet the specific needs of Housing First clients but are unknown or difficult to find. Establishing and updating a list of community agencies and referrals can serve as a valuable resource. [See inset box below]
Community mapping is a method that aims to tap into and expand the breadth of knowledge and experience within communities to empower them to develop them capacity to deal with issues and problems. Researchers in Vancouver affiliated with the implementation of Housing First utilized community mapping as a tool to elicit information on how the housing-related support service system functions across 10 different communities. Participants identified both where various types of services were located as well as gaps in existing services. See https://academic.oup.com/innovateage/article/1/suppl_1/1077/3901095
Challenge #3: Engaging community agencies that do not share a similar culture/values/approach
Housing First providers may interact with community agencies that have different community obligations and responsibilities. Efforts to provide education through written materials or short presentations in the community about Housing First can often be beneficial in identifying possible points of collaboration. Formally recognizing the work that other agencies do can also open doors and facilitate attitudinal change.
- Example: Police were called to the home of a housing first participant who was experiencing a psychotic episode that was triggered by the sudden death of a family member. Unlike previous episodes, the officer effectively de-escalated the situation and the client went to the hospital voluntarily. The client’s social worker at the housing first program wrote a letter of commendation to the officer’s captain. At the request of his fellow officers after learning about the letter, the social worker was invited to present on housing first and better lines of communication between local police and the housing first program were established.
- It is useful to anticipate that there will be other community agencies (government, social, health, private) that do not ordinarily use client-directed, empowering, and harm reduction approaches. Advocacy for clients’ needs and advocating for systems change is an integral part of job for all who work in Housing First programs.
Challenge #4: Care coordination
Recognizing that care coordination between multiple types of community agencies is an inherent part of working with complex and disjointed community systems that cannot easily accommodate individuals with multiple needs, Housing First programs play a critical role. Still, care coordination is challenging
Appendices and Resources
In the United States, the adoption of Housing First has begun to result in community agencies interacting as part of a coordinated entry system (CES) into Housing First with mixed results:
- Policy brief on CES: https://www.hudexchange.info/resources/documents/Coordinated-Entry-Policy-Brief.pdf
- Report on the development of a coordinated entry system: http://homeforgoodla.org/wp-content/uploads/2015/07/CESProcessReport5-18-2015_Final.pdf
- Current issues with prioritization within CES: https://www.tandfonline.com/doi/abs/10.1080/10530789.2018.1482991?journalCode=ysdh20
Reports on Complex Care Coordination: