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Collaboration and an individual approach by Housing First Exeter proves the key to success

Alex Lodge

Housing First Exeter is an innovative collaboration between Julian House and BCHA to provide intensive, flexible and empowering housing related support to some of the most marginalised individuals in Exeter City. Housing First Exeter is part of The Housing First England project, which has been working to support and grow a national movement of Housing First services since 2016, improving the lives of some of society's most vulnerable people.

Housing First Exeter began in November 2018 as an initial 18-month pilot and has been extended to 2021. The BCHA Housing First Team currently supports 15 people in Exeter with multiple, complex needs including experiences of long-term homelessness and rough sleeping. Additionally, a further six people (four single people and one couple) have been referred into the scheme and are waiting to be accepted pending a housing offer. 

Currently 12 of the 15 active cases are housed in permanent tenancies. Of these all are going well with a range of successes, although one tenancy could potentially be in jeopardy as the tenant is unwilling to engage to any extent with Exeter City Council (ECC) or BCHA staff.

The Housing First Team has continued to work throughout the Covid-19 pandemic and lockdown to provide an in-person service. Measures were taken to prepare for the second lockdown, a rise in cases and/or the potential of staff absences.

In particular, despite a brief spell of re-starting in-person team meetings, we took the decision to suspend these again. Being a dispersed team we are able to increase our home-working, coupled with the floating nature of appointments and avoid situations in which all the team will be physically together in one space and therefore more likely to all need to isolate should anyone develop symptoms.

What has worked well with Housing First?

Housing First has worked well where we have been able to utilise accommodation from ECC to house customers – for example 11 out of 15 individuals have been accommodated and are maintaining their own tenancies

The small caseloads and flexible and intensive support have meant that some very complex cases have seen successes in housing that they never had before – three have now been accommodated for one year or more following long-term homelessness.

It is important to consider that Housing First typically works with people who are suspicious or untrusting of professionals and support services. However, owing to the time allowed for relationship building, 11 out of 15 are engaged with additional support services including Together, GP, Social Care, Splitz, CMHT and Probation (NPS and CRC). This is despite there being no expectation that they engage with this support.

We now have multiple accounts of the life changing impacts of people having their first forever home, some whom many would never imagined would be housed.

Critical to the success of Housing First, has been the development of a really good relationship between the ECC Navigator Team, Housing Team and BCHA Housing First Case Workers. There is a lot of communication about cases and a general sense of working together for the best outcome for complex individuals. While there is more work to be done to ensure more understanding of the project, this has overall been successful and positive.

What are the challenges?

It has been challenging to obtain accommodation for all of the caseload and therefore we have seen a long waiting time for some people to have a home. This is in part due to limited amounts of housing – a local and national issue beyond this project – and has been compounded by the complexities that Covid-19 and lockdown.

There is still work to be done to create a culture change to recognise the Housing First approach as an alternative to the traditional model of housing. At times we have seen some cases in which a number of “stepping stones” are still expected before a tenancy will be offered. We need to promote Housing First further, particularly with operational staff, both in BCHA and ECC.

Across the wider delivery in Devon (predominantly in East Devon and Mid Devon) a particular challenge has been ensuring engagement from Social Care in cases in which people seemingly have eligible needs under the Care Act, but in fact also have multiple complex needs.

It has at times been difficult to engage social care in cases we are working with in which the individual has multiple complex needs. In recent Housing First forums with providers from across the country this has been a recurring issue. ‘Voices of Stoke’ have developed tools to support with ensuring Care Act assessments are undertaken in recognition that there is a common problem with assumptions being made by social workers without an assessment taking place. A notable exception to these difficulties relates to the Navigator Team and the relationship that Les Monk has fostered with the team. Les -  and the Navigator Team more widely – have been key allies in supporting the Housing First Team and caseload.

A further challenge is around managing risk, particularly in relation to County Lines and drug dealing. Our service is such that it could be exploited by individuals involved in County Lines because of the accommodation offered. We took that decision in-line with the rest of BCHA supported services in a revised version of the service offer to be clear in outlining that we will not work with individuals engaged in County Lines and may have to terminate support if we have good reason to think someone is involved in dealing.

Has the Housing First project been a success?

Overall, Housing First has been a success in Exeter. The results have been very positive – as discussed above – and the Housing First Team are very well regarded by local services. A number of some of the most complex and problematic cases in Exeter City have been accommodated and supported effectively. The wider impact of this on the local authority, housing services, medical and emergency services should not be underestimated. Not to mention the difference that has been made to the lives of the individuals on a day to day basis, having the security of their own instead of being caught in a cycle of homelessness.

Housing First works with some of the most challenging and complex cases, we cannot expect therefore for everything to go well all of the time. Because of the necessity in resolving the difficult or problematic cases in a multi-agency way, we spend far more time discussing problems and setbacks than we do discussing successes.

Summing up his experiences, Alex Lodge, Housing First Team Leader (Exeter), said:

“At BCHA we know that building a meaningful relationship with any person means taking the time to get to know them, sticking with them through the ups and downs and trusting that they are the expert of their own life. The Housing First model, driven by its core principles, comes with a body of evidence which champions this way of working; having small caseloads, keeping the same caseworker and utilising active, person centred engagement. As a result, we are seeing that some of the most complex people - who have struggled to work with any services in the past – are now thriving in their own homes and leading their own lives.”

BCHA Housing First Case Coordinator Julie Grainge, added:

“I see the real barrier for Housing First clients to be that they don’t have to be ‘tenancy ready’ or engaging in any other services. When they move in it is very alien and difficult with a lot of changes and responsibilities - they are generally very chaotic. They feel that everyone expects them to fail and they lack confidence in their ability, which hinders their recovery processes. Neighbours will not know that they are a Housing First client or any of their issues, and quite often have issues of their own. This causes instant problems and the clients feel they are judged and written off from the them start and are not given any patience or allowances. I’m not sure what the answer is, however, HS’s case study could be useful for us to discuss with Housing First clients as we prepare them when we have a move in date. HS’s story is an example of a high risk situation that demonstrates the need to discuss problems early to help clients build resilience and consider coping strategies. Housing Officer support and understanding is also integral to the success of the tenancy.”

Further information about Housing First and what it has achieved across England can be found in The picture of Housing First in England 2020 survey report.

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