"...Then things started to change. I started working real close with them, being honest with them."
We want to take a moment to acknowledge the great story that The Indianapolis Star wrote about Penn Place, a first-of-its-kind Housing First program in Indianapolis, IN. This article is an excellent example of how we can be public advocates for our programs and the people that we serve. Penn Place also used this opportunity to ask for donations from the community and received resources to support their participants. Educating our communities about the Housing First Model and its benefits can improve the public support of programs like Penn Place. But, it’s not enough. We have to remember to continue educating the participants in our programs about the Housing First Model as well.
Think about the mindset of a person entering a Housing First program from homelessness. Their days are dictated by survival—wondering where their next meal is coming from, where they can sleep, what dangers might await them if they manage to close their eyes for a few hours. Without a sense of safety, they are under constant stress and it is difficult to focus, think logically, and connect with other people. An opportunity to escape the constant struggle of homelessness is presented and they jump at it! When you’re offered housing, there’s no space to consider the benefits of reduced service requirements and a client-centered approach. That means what we tell someone at intake or orientation about the Housing First Model might not be absorbed. So, we should seek other opportunities to reinforce our approach and why we use it.
There are aspects of the Housing First philosophy that are expressed in our daily work with clients. Any time we collaboratively help someone explore potential solutions to their problems, we highlight the Housing First emphasis on flexibility in services and valuing their perspective. In addition, we should explicitly describe aspects of the Housing First Model or they may go unnoticed. As one Housing First program participant explained, “It was shortly after that in one of our one-on-one sessions where [my case manager] said…’You realize your housing is not contingent on you being abstinent?’ And I hadn’t realized that at that point…Then things started to change. I started working real close with them, being honest with them.” All the flexibility and support in the world doesn’t make a difference if people don’t know it’s there. Even if we explain upfront that abstinence from substance use is not required, our clients are conditioned to assume that service providers have certain expectations. That’s why it’s so important that we revisit the Housing First Model with our participants and discuss the meaning of harm reduction and our commitment to deliver services that they want. Continually educating participants about Housing First can help us develop trusting relationships.
As helpers, our lives can get hectic. It’s easy to get caught up in managing our caseload and the day-to-day needs of our clients. But, it’s important to find opportunities to reinforce the approach to housing used in our programs. The Penn Place article itself is another opportunity to revisit the Housing First Model with our participants. It could be shared with them in a home visit or a community meeting. Finding ways to help participants understand our programs ensures that they get the most out of them. We should engage our participants about Housing First—what it is, what makes it different, and how it can benefit them.
We saw this story the other day about a shooting at a homeless encampment in Seattle. The initial report is that these people were not targeted because they were homeless. But, it serves as a reminder of the extreme risks people are exposed to when experiencing homelessness. As service providers, we know that survival—in the face of violent episodes like this one or complex health problems—is a constant struggle for many of our participants. The average life expectancy for a person who is homeless is 15 years lower than the average American. Housing is a critical determinant of health. For people experiencing homelessness there is a straightforward solution to alleviate their condition and improve their quality of life, provide housing first. An essential element of that approach is a Low Threshold Admission Policy (LTAP).
In my years of doing street outreach I’ve learned firsthand about the realities that people face when they live on the streets or in shelters. People I tried to help have died while waiting for the housing they so desperately needed. One woman died from her chronic health problems just days before she was approved to move into a housing program. I will always remember the pain of knowing how close she was to having a place of her own. Physical health conditions pose the greatest risk of mortality to people who are homeless, as opposed to substance use disorder or mental illness. However, all of these health conditions are exacerbated by the circumstances of homelessness—the lack of sleep, poor nutrition, difficulty maintaining medications, and exposure to the elements.
Random acts of violence and hate crimes targeting people who are homeless are another reality our participants face. One night, a person I worked with came into the shelter bloodied. He explained that he was attacked on his way there by a group of high-school aged kids. Others have told me stories of being woken up in the night by somebody robbing or assaulting them. The shelters can only provide limited protection since they are frequently overcrowded and underfunded.
But, my experience is not unique. We work with an exceptionally vulnerable population—people who are homeless, oftentimes with co-occurring disorders and limited resources. A tragic fact is that we will lose people we care about in doing this work. It’s not a question of if but when. For those of us that work in homeless services, we know that this is the world that our participants are living in and we hope to be a part of changing it.
The life-threatening risks of homelessness create an urgent need for the Housing First Model and its LTAP for supportive housing programs. LTAP means simplifying our intake processes and removing as many barriers to entry as possible in order to expedite the process of getting people off the streets and into housing. It should not be acceptable to deny a person entry to our programs because of ongoing substance use, untreated mental illness, or criminal background. We must open our doors to people and embrace the idea that housing is a human right.