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Cohort Study Key Findings


Support Requirements and Accommodation Options for People in the ACT with High and Complex Service Needs

Cohort Study Overview [PDF 676KB]

Why do we need this study?

Homelessness can sometimes be seen as a transient issue; a short-term problem that can be resolved. For some people this is indeed the case and we have many success stories in the ACT. For others the reality is somewhat different and they can remain chronically homeless.

People who have enduring mental health issues, those battling drug and alcohol addictions, and those who have lost their community connections often need long-term managed support just to stay housed.

Without sufficient supports, many of these people are unable to live independently and can cycle in and out of our crisis system or remain for long periods of time. In 2017, the ACT Government conducted an extensive consultation process in the lead up to the first ACT Housing Summit. A clear message from the consultations, and at the Summit, was that there is a lack of exits from crisis accommodation, particularly for those who have complex and interrelated needs for support.

In February 2018, the ACT Government commissioned research (the ‘Cohort Study’) to better understand the specialist care, support and accommodation requirements of people with high and complex service needs (HCSNs) who are either homeless or at risk.

The aim was to develop a current picture of the homeless and at-risk population in the ACT, identify a range of models and options for responding to the needs of that population, and contribute to the development of methodologies and tools to underpin tailored responses to the needs of people with high and complex service needs.

Our research found that around 10% of people who accessed homelessness services were homeless or at risk of being homeless, and had high and complex service needs.This averaged around 380 people each year.

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The current state of homelessness in the ACT

Homelessness in the ACT

The Australian Bureau of Statistics estimated that 1,738 people in the ACT were homeless on Census night 2016.

Homelessness in the ACT declined by 8.2% at a time when the national figures rose by 11%. SPECIALIST HOMELESSNESS SERVICES

The ACT Government provides over $21m annually to the specialist homelessness services sector to provide supports to those who are homeless or at risk of becoming homeless.

People who sought assistance

Many individuals experienced one or more of these vulnerabilities.

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What we are seeking to understand

How many people in the ACT who are homeless or at risk of homelessness have high and complex service needs?

What is this group’s current and likely future demand for housing?

What are the characteristics of this group?

Are there any key demographics, such as age, gender, social history and cultural background?

What specific, tailored supports do they require and for how long?

What is the best physical environment for people who need permanent supportive accommodation?

How can we guide future accommodation planning and service provision?

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What we mean by high and complex service needs (HCSNS)

Some people have multiple and complex service needs. They often experience multiple disadvantage and social exclusion.

The term ‘high and complex service needs’ is a way of focusing on the kinds of tailored supports some people who are homeless or at risk need.

When a person is described as having high and complex service needs, this is more than having multiple vulnerabilities, such as mental health issues or drug and alcohol misuse.It is about the interplay between these issues.

In our study, a person was identified as having high and complex service needs if their main reason for seeking assistance was any of the following:

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Findings

Client data from the specialist homelessness services sector for the six years from 2011-12 to 2016-17 identified around 20,000 clients who had sought support.

Researchers interviewed government employees, providers of crisis services, community housing, specialist homelessness services, and those who have a lived experience of homelessness or of being at-risk of homelessness.

Of the total population who sought assistance from specialist homelessness services, an annual average of 10% (around 380 people each year) were people with high and complex service needs.

Of these, around 200 were people at risk of becoming homeless and about 180 were people who were homeless. Over the 6 years from 2011-12 to 2016-17, the number of people who were at risk rose, while the number of people who were homeless fell.

People with high and complex service needs were more likely to:

Consistent with the general trend of homelessness in the ACT, there has been a decline in those clients with high and complex service needs who are homeless when they first seek support.1

At the same time, there has been a rise in the number of clients at risk of homelessness with high and complex service needs.

High and complex needs service clients

  1. SHS annual datasets (Confidentialised Unit Record Files or CURFs) have a unique identifier for every client. These change annually. When annual data sets were combined, it was not possible to identify clients who appeared in multiple years. If a client sought assistance in more than one year, they appeared more than once.

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Aboriginal and Torres Strait Islander People

The research also found that the proportion of Aboriginal and Torres Strait Islander People who were homeless with high and complex service needs increased significantly over the 6 years from around 14% in 2011-12 to almost 21% in 2016-17, while the proportion of those at risk of homelessness rose from 11% to 22.5%.

Homeless and at risk people-Aboriginal and Torres Strait Islander People

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Women

The proportion of women with high and complex service needs who were homeless also increased significantly over the study period from almost 31% in 2011-12 to around 45% in 2017, while the proportion of those at risk of homelessness rose from around almost 43% to around 62%.

Homeless and at risk people-Women

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Youth

In contrast, there was a notable decrease in the proportion of younger people (15-24 years) with HCSNs who were homeless or at risk of homelessness. Over the 6 years from 2011-12, the proportion of homeless youth with HCSNs fell from 41% to almost 21%, while the proportion of those at risk of homelessness fell from around 24% to just under 18%.

Homeless and at risk people-Youth

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Meeting service needs

For those with high and complex service needs:

The best outcomes for those with high and complex service needs are when permanent supportive housing meets the following criteria:

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What do service providers and users identify as gaps in homelessness accommodation?

There is currently a range of short and medium-term accommodation options for homeless people, many of which entail (or indeed mandate) access to support services.

There is also a range of services that provide alcohol and substance abuse treatment services, case management and conduits, and referrals to specialist support services (medical, legal etc.) to people who are homeless or at risk of homelessness. But there are some who miss out on accommodation.

Service providers and service users identified gaps in accommodation options for:

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Backlogs and bottlenecks in crisis accommodation

A lack of affordable and accessible housing options means that people are often unable to access homelessness accommodation in times of crisis.

Those who do access accommodation often spend long periods of time in crisis or transitional accommodation due to lack of other permanent housing solutions.

Government income support is often not sufficient to cover rent in the private market, particularly for those on Newstart.

Demand for public housing can mean long waits, even for those with high and complex service needs.

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Opportunities and challenges

Rethinking the 'Staircase Model' of support

Like elsewhere in Australia and overseas, housing and support services in the ACT often adopt a conditional approach to the housing options offered. This is often referred to as the ‘staircase’ model of housing support.

People with high and complex service needs often have to demonstrate their ‘housing readiness’—their capacity to live independently and maintain a tenancy in order to progress to permanent (including public) housing.

Many said that this can create additional barriers to engaging with services and exiting homelessness.

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Staircase approach

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Supportive housing models for people with high and complex service needs

There is a large body of evidence which demonstrates that affordable and secure housing with some form of voluntary support services can successfully enable chronically homeless people with complex issues to sustain housing.

There is no single model of supportive housing for people with high and complex service needs but all link housing and ongoing support.

Supportive housing can be ‘congregate’−located on a single site with shared accommodation or independent units and onsite support.

Supportive housing can be scattered through buildings or neighbourhoods with off-site, mobile and person-centred support.

Common Ground in Gungahlin is an example of permanent supported housing with a mix of tenants, some who are formerly homeless and others on lower incomes who need affordable housing.

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Pathways out of homelessness

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The hidden costs of homelessness are far reaching. Homelessness is associated with poorer health, wellbeing and employment outcomes as well as limited familial, social and support networks.

The costs associated with these poorer outcomes are borne by the health, justice, child protection and welfare sectors.

Research on the outcomes of permanent supportive housing shows that the provision of affordable housing together with voluntary support can successfully enable people to exit homelessness and sustain housing.

People who are homeless often experience poor physical and mental health.Integrating health care with supportive housing can turn this around dramatically, as the program at Brisbane Common Ground has shown.

A study of costs and cost offsets at Brisbane Common Ground showed that tenants reduced their use of health, criminal justice and homelessness services after becoming tenants.

There is considerable evidence that permanent supportive housing can effectively end homelessness for people who are chronically homeless and have high and complex service needs.

Chronic homelessness and rough sleeping endures for this group, not because of their complex needs, but because policy and practice systems do not facilitate exits from homelessness and sustainable housing outcomes.

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Where to next?

The Cohort Study will assist us with the planning of services and anticipation of future needs.

It gives us a clearer sense of how people with HCSNs may move through different supports and services, compared with people who are homeless or at risk of homelessness but do not have HCSNs.

It identifies emerging cohorts including Indigenous people and women requiring support, and linkages and services across the human services system

And it has highlighted the role of supportive housing in addressing homelessness for a relatively small group of people in our community who have very complex issues and needs.

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The ACT Housing Strategy

The Study also supports implementation of commitments under the ACT Housing Strategy, such as:

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Supportive Housing

The principles of permanent supportive housing are critical to success:

The principles can be actioned through a diverse suite of supportive housing models.

Homelessness supports

By and large, stakeholders thought that a diversity of models is needed for people with high and complex service needs— single men or women, Indigenous people, families, and young people.

The community-based Reference Group which assisted the study team suggested trialling models, showcasing those that are successful, and taking a whole-of-government perspective on costs and services.

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The Reference Group also pointed to the imposition of conditional support and requirements for ‘housing readiness’ on homeless people with high and complex service needs as inappropriate.

The evidence from the Cohort Study can help guide responses that make sense for the people who may need permanent supportive housing.

There is an opportunity to look at policies and practices that underpin the way we deliver services and accommodation in the homelessness and social housing sectors.

And we can look at practical ways to back these responses up including knowing who is homeless, reaching out to them assertively, improving access to affordable and secure housing through housing allocation policies, and freeing up crisis housing for those who really need it.

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Housing models - responding to homelessness and housing need

Model

Key features

Strengths

Limitations

Suitable for

Example

Crisis accommodation

Low threshold of access

Access to case management

Referral gateway for support services (mental health, alcohol/ drug etc.

Short-term (usually around 3 months)

Shared facilities

Provides immediate shelter for people in crisis situations

Can enable people to exit violent relationships

Hub for service delivery

Short-term

Shared amenity subverts autonomy

Stigma

Successful outcomes contingent upon the existence of exit points

People experiencing housing crisis

People escaping domestic and family violence

Samaritan House (ACT)

Toora House (ACT)

Youth Emergency Accommodation Network (‘YEAN’, Salvation Army, ACT)

Congregate – permanent supportive housing

Secure, long-term tenure

Affordable rent

Independent, self-contained units in a single complex

On-site voluntary support services

Separated tenancy, management and service provision

Purpose designed communal spaces

Building visual amenity consistent with neighbourhood standards

On-site security e.g.concierge

Independent living

Reduced experiences of isolation

Close proximity to other service users increases sense of community

Social mix (if both tenants of social housing and affordable housing are included)

Highly responsive support services

Economies of scale

Sense of safety and security

On-site support and security can be experienced as intrusive

Close proximity to other service users increases risk of conflict

Greater chance of place-based stigma

People with HCSNs who experience:

chronic homelessness

mental illness

drug and alcohol issues

leaving institutions

medical conditions

social isolation

Common Ground

Lu’ma Aboriginal Children’s Village (BC, Canada)

Scattered site – permanent supportive housing

Secure, long-term tenure

Affordable rent

Independent, self-contained units

Cap on number of program units in any one area

Unit visual amenity consistent with neighbourhood standards

Mobile voluntary support services

Separated tenancy, management and service provision

Independent living

Normalised living conditions

Reduced place-based stigma

Easier integration with mainstream community

Greater user autonomy and choice

Less responsive support services

Risk of social isolation

More resource intensive

People with HCSNs who experience:

chronic homelessness

mental illness

drug and alcohol issues

leaving institutions

medical conditions

or who desire more privacy, independence and choice

Pathways to Housing (USA)

Housing & Accommodation Support Initiative (‘HASI’, NSW)

Supported Accommodation Innovation Fund (‘SAIF’, CatholicCare, Canberra and Goulburn)

Social housing

Secure, long-term tenure

Publicly managed stock

Affordable rent e.g. 25% of income

Housing security

Limited access to support

Homeless or at-risk non- HCSNs

People on income support

Housing ACT

Public housing authorities (Australia)

Affordable housing

Secure, long-term tenure

Privately or community managed

Affordable rent e.g. 75% of market rent

Housing security

Limited access to support

Homeless or at-risk non- HCSNs

Low income earners

Community Housing Canberra (‘CHC’, ACT)

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