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#housing first

Housing First is a relatively recent innovation in human service programs and social policy regarding treatment of people who are homeless and is an alternative to a system of emergency shelter/transitional housing progressions. Rather than moving homeless individuals through different “levels” of housing, whereby each level moves them closer to “independent housing” (for example: from the streets to a public shelter, and from a public shelter to a transitional housing program, and from there to their own apartment in the community), Housing First moves the homeless individual or household immediately from the streets or homeless shelters into their own accommodation.

Housing First approaches are based on the concept that a homeless individual or household’s first and primary need is to obtain stable housing, and that other issues that may affect the household can and should be addressed once housing is obtained. In contrast, many other programs operate from a model of “housing readiness” — that is, that an individual or household must address other issues that may have led to the episode of homelessness prior to entering housing.

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Place someone with PTSD from their schizophrenic hallucinations and someone with severe PTSD from trauma who attacks people during nightmares in the same room due to no other options. leave for the day hoping no one chokes each other accidentally

(this is why i have qualms about housing first approaches applied in transitional housing settings)

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            Canadian statistics show that women are the fastest growing sub-population who experience homelessness (Fotheringham S., Walsh C., Burrowes A., McDonald A., 2011). Often, these women end up homeless to protect themselves from their abusers or due to financial instability. However, there has been an initiative called “Housing First” that has been recently implemented to combat women’s homelessness. This initiative focuses on transitioning women from the streets into housing. While this may have been a good idea at the time, the demand for housing is growing out of control. There aren’t enough beds and space for these women to comfortably live and not enough service providers of health care.

           The Housing First model started using Photovoice which is a research methodology that allows women to freely express themselves. Researchers wanted to understand why women’s shelters are increasing out of proportion and what they can do to control and minimize the number of clients. Photovoice allowed women to reflect on their experiences coping with homelessness and the usefulness of services provided to them.

         I believe this is an extremely useful method to analyze homelessness amongst women. First, this provides researchers with qualitative data which will help in re-evaluating how women’s shelters can improve and expand to provide more beneficial services. Second, it gives these women a sense of autonomy. When they have fled from possibly the worst experience of their lives, they are vulnerable and afraid. I believe that we need to help these women bounce back from their abuse and one way to do that are to give them a voice. It is important to provide these women with a way to vent and express themselves because it helps give them a peace of mind.

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Gabor Maté’s In the Realm of Hungry Ghosts page 25
When my addict patients look at me, they are seeking the real me. Like children, they are unimpressed with titles, achievement, worldly credentials. Their concerns are too immediate, too urgent. Succumb to like me or to appreciate my work with them, they will spontaneously express pride in having a doctor who is occasionally interviewed on television and as an author. But only then. What they care about is my presence or absence of a human being. They gauge with unerring eyes whether I am grounded enough on any given day to codexes with them, to listen to them as persons with feelings, hopes, and aspirations that are as valid as mine. I can tell instantly whether I’m genuinely committed to their well-being or just trying to get them out of my way. Chronically unable to offer such caring to themselves, they are all the more sensitive to its presence or absence in those charged with caring for them.
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An issue that faces anyone in poverty, especially people living with addiction or mental illness is homelessness. I am a huge believer in the housing first model and have seen it work first hand for years. The first job I had that was an example of this model was a long term shelter for chronically homeless  addicts living with mental illnesses at a program called Safe Haven. The agency ran group homes and long term housing programs and a well known fact at this agency was that no one wanted to work at Safe Haven. When I began working there I soon found out why. Our entire way of thinking about social problems in this society is based on the idea of determining who is worthy of assistance. From treatment programs to drug testing for SNAP benefits we are always assessing “worthiness”. If you work you are worthy, if you dont you are not worthy. If you can stop using drugs you are worthy, if you can not you are not worthy. These are the messages we receive in the media, from our families,  and from politicians. The ability to achieve the American Dream is based on our ability to conform to the status quo, pull ourselves up by our boot straps, and learn to be completely self sufficient regardless of how isolated, empty or unhappy that might leave us.

Housing First models are based on the idea that all people have a right to get their basic needs met regardless of what they do and who they are. These basic needs include being housed. In Western culture this idea is counterintuitive. But I believe in it firmly. The reason that House First Programs are so successful is that they do not put conditions on peoples right to have a safe living environment. You don’t have to be clean, you don’t have to take medication, you don’t have to work, you don’t have to go to therapy,  you don’t have to be deemed worthy by social standards. In other words you are not forced to change in order to have this right. It has been proven over and over that internal motivation makes someone more likely to sustain change than some external motivator that is often absent after a time.

Returning to my experience at Safe Haven, I like the rest of the employees I met, struggled immensely to make an internal shift in my thoughts about our program, our clients, and our purpose. There were times where I was horrified that a client had drank all night, defecated in there pants, called me worse names that I had ever heard and there were no consequences! I thought, to myself “this man should be punished!” Or a client would refuse to take there medication, refuse all therapeutic services, smoke crack cocaine all weekend, spent there social security on prostitutes and then yell about how we were not doing enough for them. What I saw over time is my own immense need for people to get healthier, my own victim-blaming beliefs about addiction, and ultimately how powerless we really are over other human beings. Another thing I began to notice was that if a client got clean in that shelter they stayed clean. Unlike a programs where everyone is forced to abstain from drugs and 99% use the day they leave. Many of our clients went on to permanent supportive housing and have not been on the street since. So whether they chose to engage in any further types of treatment is secondary to the fact that they were successful.  They were finally in a stable house, with a stove and a shower, many of them for the first time in over 20 years.

These programs save tax payer money, reduce crime, and restore dignity in peoples lives. I believe that all humans have a right to a place to sleep, food and clean water, and also to a community that does not shame and condemn them. Communities that have heavily endorsed housing first programs have almost no homelessness. I don’t know how anyone could perceive that as anything other than great success.

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This day serves to raise awareness of those who don’t have a place to call home and to remember those who have died as a result of being homeless. I am sad that this day even exists - not because these people aren’t worthy of our honor and respect - they absolutely are! But because we know how to end homelessness! I got informed and got involved. You can, too. 

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© Zack DeClerck 2014.

Bradley Loce, Hubert Wilkerson, and Kevin Robinson became residents at the Dorothy Day House, an apartment building for the chronically homeless, in 2012 and 2013. By May 2014, all three men had left the program; one on good terms, two on less favorable terms. A look into their struggles with mental health and substance abuse reveals that, even in the most flexible housing programs, integration back into mainstream society involves an uphill battle with self.

In December of 2012, St. Joseph’s House of Hospitality and the House of Mercy, both homeless shelters, joined forces with St. Mary’s, a downtown church, to purchase a 12-unit residential building at 407 South Avenue in Rochester, NY. The building underwent several repairs and was named the Dorothy Day House, in honor of the late social reformer. Rochester’s Dorothy Day House is unlike other transitional housing because it adopts the “housing first” philosophy and among a general lack of rules, it is a wet house. The general flow for acquiring housing in Rochester, NY among other American cities is to acquire means to pay for housing first. The people that enter into the Dorothy Day House generally have no income. That includes income from social services. In this instance, residents are given an apartment first, then helped to acquire income. Residents, such as Loce and Wilkerson, have also burned many bridges with landlords and housing programs elsewhere in Rochester.

Kevin Robinson was brought into the Dorothy Day House as a residential supervisor. Kevin is not a paid professional at the Dorothy Day House, but has an extensive background in social work. That background is based on his life-long experience of working to help others in poverty, but he has no official education or credentials. Kevin was also homeless in Rochester and Atlanta on many occasions dating back to his teens. “I’m a man of faith, which is difficult because I’m a gay man. It is hard to be myself within the religious community without getting preached at. Homosexuality is not really welcome in the black community. It’s big in the homeless community, though.” Kevin initially ran away from home, fleeing judgment.

Trying to escape a life-long cycle of addiction and self-sabotage means accepting the amount of help and change that is needed. That can be daunting and humbling. Hubert Wilkerson, 60, reflects on his situation prior to residence at the Dorothy Day House, “I was evicted and I needed a place to stay. I need a place to stay.” Hubert knows how to charm. He’s been involved with advocacy and activism for the homeless for several years. Despite the impression that he is better off than the men and women he helps, he has been unable to maintain stability for extended periods. “I’ve got this problem. When I live deep hood, I start to assimilate the environment and everything that goes with it. Well I’m here, let’s do this.” Included in that assimilation is Hubert’s battle with crack cocaine use.

His drug use, which resurfaced in April of 2014, created tension with the program supporters and undesirable risks associated with drug activity in the house. After missing rent for multiple months, Hubert agreed to leave the Dorothy Day House and recalls his conversation with the program supporters, “I don’t need you guys, I’m practically sixty years old guys. I don’t need you guys.” He is now living in a rooming house on Rochester’s troubled northeast side in exchange for night security at The House of Mercy Homeless shelter. “I’m back in the warzone. I’d rather be back on South Avenue. I mean, you can play golf over there.” Hubert was initially meant to play a supervising role, assisting Kevin, but the organizing body of the Dorothy Day House found him unfit because of his drug use and level of dishonesty. Hubert is in denial that he plays a role in his life situation and has condemned many people who have tried to help him.

Bradley Loce will not blame his position on others. Bradley is vocal in his acceptance that alcohol has brought him to a lonely place. However, he does not see himself going down a different path. Many in Rochester’s late night bar scene along Monroe Avenue know him for his drunken George C. Scott monologues. Bradley will be quick to tell you that he has always dreamt of being an actor, that Scott is his favorite actor, and that Scott died an alcoholic. Bradley’s wife also died an alcoholic. He is convinced; he too, will die an alcoholic. Behind closed doors, when the booze wears off, his loneliness becomes very real. Bradley has been diagnosed with Schizophrenia, yet refuses to take medication and disagrees with the diagnosis. He has been estranged from his son for the better part of thirty years, yet will talk about him for hours at night. “He’s ashamed of me because I’m a drunk. You can’t blame him. I’m not a bad person though.”

While at the Dorothy Day House, Bradley attended a 28-day inpatient drug rehab. He maintained only a day of sobriety after release. Shortly after, Bradley left the Dorothy Day House after missing two months’ rent. “I’m not one for conflict.,” he says. “An old friend is allowing me to sleep in her cellar. It’s very humbling.”

Nationally, homelessness is on the rise. According to the National Center on Family Homelessness, one in thirty children under the age of 18 experienced homelessness at some point in 2013 in the United States. That number is up 64.8% from just three years prior. Most people, however, only experience homelessness in temporary or relatively short periods of time. Some have been homeless for such extended periods of time; they have fallen off the radar of any kind of social service and are much harder to keep stats on. There are also individuals that may not experience long uninterrupted homelessness, but instead have reoccurring episodes of homelessness over and over. People in these two scenarios are considered chronically homeless.

Most shelters have rules and regulations that are incompatible with an individual who is mentally unstable, chemically dependent or both. Public policy in the realm of mental health took a nosedive at the end of the 20th century. The 1981 Omnibus Budget Reconciliation Act under the Reagan administration ended federal involvement with mental illness care. The states did not pick up the slack. One of the many looming vacant buildings in Rochester, NY, is the Terrence Building on Elmwood Avenue. The 16-story state hospital-turned-Rochester Psychiatric Center closed its doors in 1995. A few blocks away, a new facility was built with a small fraction of the beds that were previously available. The decline of government spending for psychiatric hospitals in the 1980s was compensated for with the increase of prison spending spanning from the 1990s until today. A study conducted by Human Rights Watch in 2006 revealed there were 1.25 million mentally ill individuals in U.S. jails and prisons. That number is up over 400% from 1998. Prisons are not hospitals and offer little to no help integrating already unstable individuals back into mainstream society.

In May 2014, Kevin Robinson independently moved into his own one bedroom apartment in a high rise one mile from the Dorothy Day House. “I believe it’s a good program. It just needs a lot of work. You need to pay staff.” Kevin was often unable to sleep as a supervisor at the house. “I had tenants knocking at my door all hours of the night.” “I’m learning to say no. It’s hard.” Kevin briefly relapsed back into his cocaine addiction while at the Dorothy Day House. “It was just too much. I still stop by the house and work with the tenants, but I can’t live there.” Kevin, unlike Hubert or Bradley, has accepted both that his drug use was responsible for many of his problems and also that he can be free from it with the help of others. “I’ve had a problem with drugs all my life. That’s something that will always be a part of you. I accept that, I claim that. At least I haven’t lost my mind. I least I still have the ability to seek help.” Kevin admits with sorrow that some never end up being able to reenter society and die with nothing.

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Housing First: The Five Key Principles

The five key principles of the Housing First model of providing effective housing and support services to people experiencing chronic homelessness.

Awesome concept, awesome video!  Check out additional videos in this series here.  Please share widely!

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