As a nurse, health professional, and health educator, I spend a lot of time talking about housing.  Working with people experiencing homelessness, there is no shortage of traditional health concerns to be worried about: mental illness, addictions, wounds, communicable diseases, infection, etc.  However, looking at both the cause of and solutions to health issues on the context of homelessness, I come back time and time again to housing.  It can be intimidating trying to gain mastery over another area when healthcare is consuming enough, but making the links across sectors is crucial in creating solutions.

Much of the preliminary work on health and housing was on linking housing as a determinant of health and therefore demonstrating a relationship between these.  This has led to a plethora of studies stating, for example, that homelessness is bad for one’s health.  Newer working (refreshingly, for those who are tired of reading of the same correlations) is digging into intervention studies, and in particular housing as a health intervention.  The report “Housing and Health: Examining the Links” from the Wellesley Institute does exactly this, breaking down the various housing interventions that offer some promise in terms of improved health.

Most interesting to me in the report is the ongoing refinement of the differentiation between a Continuum Model of housing versus a Housing First Model.  In a Continuum Model, the individual is expected to advance along a progression of demonstrated capacity to demonstrate ability to move towards independent, market-rent housing.  In Housing First, housing is provided up-front, and supports to the appropriate degree are attached to the housing.  I personally see the most promise in the Housing First model, as this recognizes that for many, advancement along a continuum is not in the perceivable future.  This is not to give up on people, but to recognize for many, recovery simply looks like survival.

In reviewing the Homes for the Hard to House report by St Leonard’s Society of Canada, what struck me was the role that staff play in terms of housing those who have experienced homelessness.  The transition in homelessness services through 2000-2010 was on using the language of housing first.  Now the common message is housing first with supports.  What supports equates to is people, whether on-site of off-site, those who can provide real assistance when individuals experience challenges that put their housing tenure at risk.  This report offers some practical tips for those creating housing with supports for individuals who have had difficulty with their housing.

The primary recommendation in the report with regards to staff is to ensure that they are well trained.  This of course means individuals with an educational background in human services, such as social work or social service worker training, as well as supplemental certification, and of course work experience.  There are so many individuals that I have had the privilege of working with in social services in London who would fit all of these requirements.  However, organizations face two very real challenges: 1) staff cost, and 2) finding the right people.

Cost is of course a challenge as social services face limited access to funds at all sources of government.  In the context of housing, it may be possible to find funds for capital, but then operations costs of the ‘with supports’ component may be harder to fund. Of course, agencies would be happy to fill their staff compliment with those with a Master’s of Social Work (MSW) degree and 15 years experience, but this comes at a price.  There is often a temptation/pressure to decrease your expectations to meet the realities of your budget.

The other challenge is finding the right people; having an MSW degree does not mean you are good at each and every social service position.  And, there are many great individuals coming out of various social service programs who would be great in an organization but don’t have the years of work experience on their resume.  This is where the suggestion from the report on integrating student placements comes into play to solve both of the concerns I have brought up here.  Students can provide service with no cost as part of placement hours.  Also, having students in can be a great way to get to know people who might be good for you organization.

However, the primary warning is that students require adequate and appropriate supervision.  They are not able to fill in a gap in terms of staffing, but rather can compliment existing staff.  So, rather than thinking of student placements as a core solution to staffing, they should be considered a nice supplement, allowing you to provide the full range of services you might otherwise not be able to fund.  In this way, no proposal for housing with supports should be dependent on placements to be viable.

I’ve finally gotten around to putting together an accessible summary for our health and homelessness project from late 2011: