To illustrate key sustainability issues and lessons learned, two cases are presented below. In the first case, we present a sustainability example from Toronto. The Toronto site was involved in the At Home/Chez Soi project and received funding through the demonstration project. As with each of the sites, the Toronto site was faced with the challenge of sustaining funding for the housing and clinical services to participants once the demonstration project ended. In the second case, we present an example of Housing First in Calgary. In Calgary, the Housing First approach was derived in the context of a 10-Year Plan to End Homelessness. Following a comprehensive planning and implementation process, there was a need to continue efforts and to develop long-term and sustainable funding mechanisms.
The Development of a Local Advisory Committee and Sustainability Planning Group
Toronto was one of the sites chosen to participate in the At Home/Chez Soi project. At the start of the national project, a research team was formed and in collaboration with the City of Toronto, a research proposal was made to the Mental Health Commission of Canada (MHCC) and subsequently approved for Toronto to be one of the five sites in the project. In addition to St. Michaelâ€™s Hospitalâ€™s Centre for Research on Inner City Health and the City of Toronto, three local service providers were selected to establish teams, which would conduct the research and deliver the program. A Local Advisory Committee of external stakeholders was established and chaired by the MHCC Site Coordinator to offer advice throughout the project. The Committee had representation from the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Community and Social Services, Veteranâ€™s Affairs Canada, the City of Toronto, as well as mental health and housing service providers, family members, and people with lived experience. In the interest of developing the program with long-term sustainability, Faye More, MHCC Coordinator of the Toronto site, arranged presentations by other ministries such as the Ministry of Municipal Affairs and Housing. As Ms. More explained, â€śRight from the outset, we had engagement with and regular participation in discussions of people who could potentially help down the road with sustainability for participants.â€ť
â€śIt was a huge weight on everyoneâ€™s mind â€” what was going to happen with the people who were housed when the project ended.â€ť
According to Ms. More, The Sustainability Planning Group included representatives from relevant Ministries, Veteransâ€™ Affairs, as well as city officials and project leaders. With long-term sustainability as the goal, the group requested a number of meetings with relevant stakeholders, many of which took months to schedule.The group prepared informative materials and presentations about the program to bring to these briefings, which were circulated to the other sites as helpful examples.
From sustainability discussions and early reaction from potential funders, it was apparent that having some research results from the At Home project would be critical to making the case for continued funding; however, at the time in which key meetings needed to occur, the final research results were not ready. To address this problem, interim research results were prepared by the national and local teams, which proved critical to sustainability discussions with politicians and staff at the federal and provincial government levels and across parties. In Ontario, from the outset, the most appropriate and most likely source for ongoing funding was the provincial Ministry of Health and Long-Term Care, as it was supportive of and actively engaged with the project, and already funded similar mental health housing and Assertive Community Treatment (ACT) and Intensive Case Management (ICM) services across Ontario. The City of Toronto had competing demands for its federal and provincial housing dollars from other high needs groups in the community. The City also did not have the resources or mandate to fund the necessary mental health supports that the project provided and needed sustained along with the housing supports.
The Sustainability Solution
At the time of this writing, the Toronto At Home program continues to thrive, having transitioned in 2013/14 from a project mode with five partners to a program with three partners working as one Housing First program, funded by the Central Local Health Integration Network and the Ministry of Health and Long-Term Care. A current challenge is establishing flow-through for the program by graduating participants from the program who no longer need or want such intensive mental health supports, but who do need their rent supplement continued. Discussions are ongoing with funders and service providers to establish a process that will enable the program to focus resources on individuals most in need. The program continues to focus on graduation planning, particularly to maintain a focus on recovery, which is a goal for program participants.
The Toronto site provides several key lessons for stakeholders interested in sustaining a Housing First program:
It is critical to have government representation â€” both provincial and municipal â€” at an early stage of discussions to plan and deliver the program. Include government officials of all levels and who represent a range of programs (e.g., health, social services, corrections, police, courts, etc.) and populations (e.g., seniors, children, persons with physical and developmental disabilities, various cultures and languages, veterans, etc.) in the discussions. Incorporate their views and ideas throughout the process and keep them updated on progress and outcomes.
Involve the â€śrightâ€ť partners
By involving relevant stakeholders and community partners, programs will be able to move participants across programs, based on their needs.
Relationships are key
Establish key relationships at an early stage, and focus on educating stakeholders about the program. Keep them informed and engaged at all stages, and encourage participation by developing a broad-based external advisory group. Funders, in particular, should be engaged and involved in the planning and implementation process.
Research and evaluation matter
Consider the types of benchmarks that can best inform of results and will help to convince funders of the importance and effectiveness of the program. Plan the timing of some results to be shared alongside funding requests to provide an evidence base. For instance, housing stability, reduction in jail use, and reduced court involvement are important, as these are cost factors. Hospital and mental health outpatient services, shelter use, and emergency service use are also important to track. Explain the context of costs to funders. For instance, alcohol and drug rehabilitation is a positive cost, in that it is indicative of client progress to deal with substance use issues.
Make the case with personal stories
The personal experiences of program participants have a strong impact on potential funders. When funders learn about the personal impact a program is having on lives, and the risks of discontinued funding, the case for continued funding becomes compelling.
In Calgary, community-based emergency supports were provided to individuals who were homeless without an integrated â€śsystemâ€ť in place. Thus, there was a need to develop a comprehensive and integrated plan to end the homelessness crisis. To provide the critical shift from a loosely coordinated patchwork response to a well-coordinated system response, the Calgary Committee to End Homelessness (CCEH) was formed in 2007, with the goal of developing a 10-Year Plan to End Homelessness. The CCEH included representation from service agencies, the private sector, the faith community, foundations, the Calgary Health Region, colleges and universities, the Aboriginal community, the City of Calgary, the Province of Alberta, and the Government of Canada (Gaetz et al., 2013, p.3).
The CCEH developed a plan, with Housing First as the guiding vision, based on research conducted by the City of Calgary on affordable housing and homelessness. The Calgary Homeless Foundation (CHF) was selected to implement the plan (Gaetz et al., 2013). The CHF â€śbecame the central force in creating a shift toward the adoption of Housing First strategies in the cityâ€ť (Gaetz, Scott & Gulliver, 2013, p. 17). The response to homelessness is organized by an independent, not-for-profit foundation, with funding from government and the private sector. The Province of Alberta provides funding for emergency services, including shelters and drop-in centres.
The Sustainability Solution
A key component of the sustainability plan in Calgary was providing evidence of continued effectiveness. In Calgary, significant efforts were directed toward evaluation at an early stage, and it was important to sustain evaluation efforts over time. The CHF publishes updates about the plan to end homelessness, â€śincluding progress to date and milestones achieved, including: number of people housed, housing retention rates and changes in use of other social servicesâ€ť (Gaetz et al., 2013, p.16). Also key to sustainability efforts was linking the plan to a comprehensive affordable housing strategy, including direct investment, zoning, and creative financing and incentives for the private sector (Gaetz et al., 2013, p. 17). â€śIt is important to demonstrate to funders and policy makers that the status quo â€” emergency shelter systems and ultimately health, social and correctional services â€” is not sustainableâ€ť (Gaetz et al., 2013, p. 17).
(summarized from a personal communication with Tim Richter and Katrina Milaney, & Gaetz et al., 2013, p. 18-20)
Sustainability is about performance
Ultimately, high performing programs and communities that achieve results receive continued support. To achieve sustainability from an early stage, programs must reflect on strategies for ensuring performance of the Housing First program.
A broad and diverse stakeholder coalition is key
The CHF recommends recruiting a broad and diverse stakeholder coalition, including recruiting accomplished people from outside the homeless system to become Board members. Having a broad and diverse Board builds credibility in the community and with government, and is also helpful to fundraising efforts.
â€śBecome the voice of the issueâ€ť:
It is important to â€śown the issueâ€ť of homelessness in your community and to also communicate the success of your Housing First program. The CHF initiated the majority of news stories on homelessness in Calgary, and set a goal of having at least one communication per week with stakeholders along with a â€śconstant and active presence on social media.â€ť Effective communication, including â€śleadership, presence, and brandâ€ť is critical to fundraising and obtaining public funding. Additionally, the CHF recommends keeping in close contact with government officials through media and lobbying efforts. It is essential to build a supportive network of stakeholders. To do so, consider bringing in experts to speak to the community, mobilizing the news media, and communicating with the community to dispel myths.
Shift emergency services funding to funding for long-term solutions:
Since much funding is dedicated to emergency services, such as shelters, there is a need to advocate for funding to be reallocated to long-term solutions, such as Housing First. Public funding is key, and private investment can complement this. Thus, it is important to seek multiple sources of funding (federal, provincial, and private). The CHF also developed social finance opportunities with the â€śSocial Enterprise Incubator.â€ť
An integrated system is needed:
Housing First can be most effective when delivered in the context of a 10-Year Plan to End Homelessness, which includes â€śprevention, housing development and changes to systems and policies that contribute to homelessnessâ€ť (Gaetz et al., 2013, p. 18).
Housing First must be linked with an affordable housing strategy
Affordable housing is critical to the long-term sustainability of a Housing First program. Affordable housing â€ścan be expanded through a combination of direct investment (building new stock), zoning (inclusionary zoning, legalizing and regulating secondary suites), creative financing and incentives for the private sectorâ€ť (Gaetz et al., 2013, p. 19).
Evaluation contributes to Adaptability
The CHF is committed to research and evaluation. This provides â€śa constant visibility of performance.â€ť
Become a â€śKnowledge Leaderâ€ť:
Leaders of the CHF recommend becoming â€śknowledge leadersâ€ť by researching best practices on Housing First and related services. By solidifying your expertise on housing and homelessness, programs become â€śindispensible and trustedâ€ť by government. This also builds a programâ€™s influence in terms of advocacy for policy change.