Prof Sarah Johnsen reflects on the wider utility of Housing First principles ‘beyond’ Housing First interventions in light of findings from the evaluation of an assertive outreach housing support service in Scotland’s Western Isles.
Echoing broader calls for a shift toward more trauma-informed approaches in health and social care for people experiencing homelessness, recent evaluations of Housing First have commented on a growing appetite within the homelessness sector for adoption of Housing First or (‘Housing-First-esque’) principles in other services given evidence of their positive effect on the engagement of and outcomes for homeless people with experience of multiple disadvantage.
Some service providers have been rather ahead of the curve on this, in that they have been delivering housing support services for vulnerable groups in ways that align with relevanti Housing First principles for a number of years. The Dochas service, which is delivered by Crossreach with funding from the Western Isles Alcohol and Drug Partnership (ADP) on Scotland’s Outer Hebridean Isle of Lewis, is one such example.
The Dochas service offers practical support and advice to adults (aged 16+) who are seeking recovery from substance use and at risk of homelessness. Staff work primarily on an outreach basis but have an office base in Stornoway, the main town on the island. The vast majority of service users are resident in either temporary accommodation or independent settled housing (i.e. housing association tenancies) within Stornoway.
Dochas aims to prevent homelessness by helping clients sustain their own tenancy or prepare them for taking up new tenancies, whilst also helping them address problematic relationships with substances and wider issues in liaison and via joint working with other relevant (statutory and voluntary sector) agencies. It has always provided both emotional and task-based support to enable clients to maintain recovery from substance use and sustain their tenancy. Its remit has evolved in recent years to incorporate a preventative focus as well as an assertive and non-time-limited approach to support delivery in the vein of the principles of Housing First.
An independent qualitative evaluation conducted by I-SPHERE concluded that that Dochas service was very positively received by service users and stakeholders. The nature of outcomes identified varied substantially at the individual level but included some combination of: a reduction in risk of repeat homelessness, greater engagement with (non-emergency) healthcare services, improved mental health, better management of finances, and reduction in social isolation. Impacts on substance use were variable, with some service users reporting little or no change, but others noting that the accountability provided by Dochas had contributed to the stabilisation or a reduction in alcohol and/or drug use.
Service user and external stakeholder interviewees deemed staff members’ commitment, non-judgementalism, and trustworthiness as key to the service’s effectiveness; so too their expertise in operationalising a trauma-informed and person-centred approach. The flexibility, stickability, and longevity of support were also widely deemed critical to Dochas’ success in achieving positive outcomes for the individuals supported, thus illuminating the beneficial influence of the service’s (Housing First based) principles.
It was also notable that Dochas’ rural context and the island’s unique religious history and culture shaped service delivery and user experiences in tangible ways. The time absorbed by travel to support clients living outside Stornoway, limited public transport options, and limited availability of specialist health and social care services presented significant challenges. The small population and reportedly ‘close-knit’ social networks on the island mitigates social isolation for some service users whilst simultaneously increasing risks of exclusion from other services because of either: a) reputations based on past misdemeanours; b) heightened concerns about confidentiality; and/or c) elevated perceptions of stigma. The prominence and nature of Christian faith(s) practiced in the Western Isles add an extra layer of complexity by enhancing levels of support for some service users (via membership of faith communities) whilst exacerbating concerns about stigma associated with substance use for others.
These findings not only highlight the broader utility of Housing First type principles when working with subpopulations and delivering services beyond the model’s traditional remit, but also makes a valuable contribution to what is currently a surprisingly limited evidence base regarding what works when supporting people recovering from substance use and/or at risk of homelessness in remote and rural contexts.
Download the evaluation report here.