The many faces of Houing First

This blog is all about something that has been bothering me, and I hope that in writing this, I will have some kind of amazing sparkly epiphany and all will become clear (hopefully?). For the past week or so my tiny mind has been battling with the scope of Housing First in the US. In the UK we talk a lot about Housing First in terms of model fidelity, and I definitely came to LA with a very fixed idea on what Housing First was (scattered site tenancies, intensive support), and who it was for (long term homeless – substance misuse/poor mental and or physical health). In the US Housing First seems to be used as a much broader, conceptual idea, which at Downtown incorporates both scattered and onsite permanent supported housing for chronically homeless women, with intensive support, AND rapid re-housing schemes for survivors of domestic violence and chronically homeless women, where limited financial support is given to help clients find private rented tenancies, and the case management is light and short term.

I want to stress though, that the ‘core’ principles of the model remain the same here; the main points being that clients get their own tenancy, as quickly as possible, the separation of housing and support, no pre-requisites to housing, and all of this firmly underpinned by a philosophy of choice and self-determination. In my time here I have visited a woman who had been evicted from her previous tenancy due to domestic violence and re-housed through the domestic violence rapid re-housing programme; she had ended the relationship, is working, and did a lot of the work to find her new property herself. I also helped move a woman out of a tent on a corner, where she had lived for nearly three years, into her new private rented property. This woman has a mental health diagnosis and is deemed chronically homeless; she has been re-housed through Downtown’s Housing for Health programme and will receive long term, intensive support. My faith has been officially shaken! Now to make sense of it all…..

One phrase that does make sense, that I have heard repeated over and over again, by case managers, day centre staff, and clients themselves is, ‘We work with women and meet them wherever they are at’. That could start out as a shower, a meal and some colouring in sheets in the day centre, an appointment with the onsite therapist, or meeting a case manager to view a flat. The women I have met at Downtown are a diverse and wonderful bunch, who reflect the many faces of homelessness in the US, and whose experiences have been shaped by the intersections of gender, race, sexuality, immigration status and a rapidly changing political and socioeconomic landscape. No one-size fits all approach could ever begin to meet the varied needs and experience of these amazing women. Housing First has to do more in Skid Row, it has to mean housing, now, wherever a woman is at.

The importance of partnerships

Somehow (how?!?) its half way through week two of the transatlantic exchange, and I have abruptly realised that I've only got a few days left. How time flies!  That means two things, firstly that I must stock up on all the Reeses Pieces and Cheetos that I can realistically fit into a suitcase, and secondly, that I need to drag my attention back to my research questions and find out more about partnerships, as this is a key aspect of providing a Housing First service to vulnerable clients. It has made me think about which partnerships in particular are key when working with women; obviously mental health is one, as we know that chronically homeless women are more likely to have a diagnosed mental health condition than men. In that regard, the Downtown Women’s Centre have amazing mental and physical health services in their on site health centre, which includes a psychologist on staff, counselling and an impressive array of trauma groups and workshops. I’m going to come back to this in a later blog, as there is another key piece of innovative partnership working that Downtown are involved in at the moment, around homelessness and domestic violence.

Representatives from housing and homelessness, domestic violence services and the Los Angeles Homelessness Services Authority (LAHSA) have formed the Domestic Violence Services Coalition to tackle the huge systems gap that exists between the two sectors.  Sixty five percent of the women that come through the doors of the Downtown Women’s Centre have a domestic violence history or are experiencing on-going domestic violence. The coalition aims to change systems to better enable domestic violence survivors to avoid homelessness in the first place, therefore preventing chronic homelessness overall. The group is focusing on four different areas; mapping systems and looking at where the disconnects are, training, education and sharing knowledge and expertise, funding, and lived experience. The general focus is on the intersections between homelessness and domestic violence, and to tackle the silo approach where the woman can access support through the homelessness system OR the domestic violence system, but nothing in between.

Yesterday I was lucky enough to sit in on a coalition meeting, and was inspired by some of the points made by Anne Miskey, the CEO of Downtown Women’s Centre. Anne talked about how there was no one ‘model’ survivor and that as well as making sure service provision is trauma informed, we need to think about safety, and how that can mean very different things to different women. She talked about the need for a continuum of housing services that meet the needs of women, wherever she is at at that specific time, whether that is at immediate risk of being killed by her abusive partner, or a woman who fled DV several months back who just needs a house and a job, AND all the positions in between. She also made a crucial point, one that I want to focus on when looking at women and housing first, around those survivors that do not want to leave their perpetrators, or who go back to the situation, asking key questions around how we can provide safety in this setting.

Seeing partnerships like this, that are having these crucial conversations around risk and safety, around what is working and what is not, has been really inspiring. We are starting to have these conversations in the UK, but feel there is much to be learned from the coalition style approach taken by domestic violence and housing and homelessness organisations in LA.

Housing First.....it's all about context

So over the last few days I have ventured outside the streets of Downtown LA and done a bit of exploring. Probably due to everyone continually telling me, ‘Oh, you’ve got to have a car in LA’, I have been determinedly stomping around as much as I can, often surrounded by vast, concrete spaghetti junctions of freeways and accompanied by the soothing tones of car horns. These walks have helped me to somewhat understand the sheer scale of LA County (it is divided up into 85 separate cities), and the huge disparity between those that have and those that don’t. Walking back through the encampments, noise and rubbish on Skid Row, I reflected on my time at one of Downtown’s permanent supported housing units, and some of the discussions I had had with staff and clients there. 

Permanent supported housing (PSH), or Housing First, is a big thing in LA, as one practitioner mentioned in a meeting I attended a couple of days ago, “I wish we’d been doing this when I started 25 years ago”. Just as in the UK, those eligible for PSH must be ‘chronically’ homeless; in the US the definition of this is a person that has been homeless longer than one year and/or four or more times in a three-year period. Downtown’s 2016 needs assessment survey found that 58% of the women they surveyed had experienced chronic homelessness, this is over half of the female homeless population on Skid Row. Due to the chronic nature of their homelessness these women are much more likely to have poor and untreated physical and mental health and experienced violence or sexual assault. It comes as no surprise then that Downtown’s 119 on site, permanent supported housing units are in high demand!

I turned up at one of Downtown’s two onsite PSH, to meet case manager Zayda, who had kindly agreed to let me sit in on a case management session with one of the residents there. The building has 48 units, 40 of which are currently occupied, and residents share kitchens and bathrooms. The building has a lobby that is staffed 24 hours by a resident manager, but Zayda is the only case manager for the 40 women that live there (sometimes struggling to case manage my 6 clients, my jaw dropped when she told me this!). I sat in on a case management meeting with resident, Claire, aged 72, who happily announced that it was her 1 year anniversary of moving into her flat, and asked why no-one had thrown her a party! Claire told me that she suffers from depression, COPD and a number of other chronic physical ailments. She spent many years in temporary shelters and described how women and men were often put in the same dormitory, divided by a rope, which she tactfully described as ‘not good’. 

Zayda estimated that about 40% of the women that she supports are over the age of 65; this has made me aware of another stark difference between the US and UK context, where the local authority has a duty to house pensioners. Also, many of the women in the residence are domestic violence survivors, but due to the rules banning any boys over the age of 14 from the site, domestic violence is generally not an ongoing issue, as I have found it to be among our female clients in scattered site accommodation in the UK (although they have had some incidences of same sex domestic violence). A completely different way of ‘doing’ housing first then! Next week I will be visiting Housing First clients that live out in the community, in scattered site accommodation – cannot wait to compare and learn more!

Women, homelessness and Skid Row

I woke up early this morning, ate half a bag of Cheetos (seriously, they put Wotsits to shame, I plan on bringing as many packets of these back with me as possible), and attempted to process the mammoth amount of information that I took in from my second day at the Downtown Women’s Centre. I feel like before I go any further, or indeed stuff my face with yet more Cheetos, I need to re-wind and set the scene a little on women’s homelessness in the US and on Skid Row specifically, some of the issues women face, the services available to them, and how this differs from the UK.

In the US women can be homeless as a family, accompanied by their children, or be single, or to use the US term, ‘unaccompanied’ homeless. This is a key difference to the UK context as families with children are deemed as statutory homeless, and are therefore priority need for housing support. In the UK therefore, our homelessness provision only has to cover single or ‘unaccompanied’ women, in the US it has to cover EVERYONE; there is no statutory/non statutory division. It seems like resources for women then, have to be spread very thinly.

The Downtown Women’s Centre is based in the heart of Downtown LA, on the notorious skid row, and a survey they conducted in 2016 found that the majority of women there are as described above, unaccompanied by children (although they are still classed as homeless, women in families have broader access to shelter and housing than unaccompanied women). Before I came here, I knew that Skid row would be a pretty stark indicator of the sheer scale of  homelessness in LA, compared to in the UK, but on my first day walking up 5th street to get to the women’s centre, I was still astonished at the number of street, or to use the US term, ‘unsheltered’ women I saw. It is well known that in the UK homeless women are likely to stay hidden for longer, exhausting all options before they end up on the streets. Walking up 5th street that day, I wondered how many options these women had had available to them, and began to realise that it was very few.

A chat with Angel, the manager of the day centre at Downtown confirmed that homeless women on Skid Row experience many of the same issues as women in the UK. They are more likely than men to have experienced ongoing violence, trauma and abuse across their lives, experienced the loss of children, and to have worse mental health. What is different though, is how in the US these issues are compounded by lack of options, which for unaccompanied women boil down to either the streets, or a temporary bed in an emergency shelter (dormitory style and very short term - not comparable to hostels in the UK). Women on skid row are also more likely to be older, 48% of those surveyed were aged 51-61, so physical health then is likely to be much more of a concern (and no NHS?!?).  Most of the women are also African-American, which serves as a crucial reminder of the long term effects of institutionalised racism, and the way it  intersects with poverty and disadvantage.

So how does Downtown ‘do’ Housing First to address the complex and varied needs of the women that they serve? I’ll come back to that…....I’m definitely going to need more Cheetos.

Transatlantic Exchange Day 1: Thinking about identity (while jet lagged)...

A quick update on my first day at The Downtown Women’s Centre as part of the Transatlantic Practice Exchange #homelesslearning.

One of my key learning objectives was to find out more about ways of building self-esteem and resilience in women who are chronically homeless. When I stepped into the Downtown Women’s Centre this morning, I didn’t have to look very far because I could see examples of this in action wherever I looked. An open plan dining area, chefs and volunteers busy in the kitchen, women sitting talking, not talking, resting, getting what they needed, whatever that was, and whatever was important for them. A tour of the onsite housing, where the majority of the women are housed revealed a beautiful library, and a community room furnished with comfy looking sofas and flowers (photos to follow – I was too stunned to take any today!). I also popped my head into the Learning Centre, where women can learn IT basics/use the computers as they require.

Still trying to take all this in, and whilst trying to ignore the creeping jet lag, I met with Joe and Dena, who worked on the Downtown Women’s Centre social enterprise and workforce development planning. The Downtown Women’s Centre’s social enterprise scheme, “Made” has a coffee shop and two stores selling handmade products made by the women, they also provide one on one counselling, a job training programme and transitional employment opportunities as part of their workforce development arm.  What struck me most here was the way that Jo and Dena described how the social enterprise/work development scheme had helped to change stereotypes and stigma around homeless women in the community, that by involving community members perceptions had started to change, and how the women involved have grown in confidence and self esteem.

It made me think of something one of my female clients said to me, something that I’ve heard from many female clients before, “Oh, I can’t do that, that’s for normal people”.  Stigma and shame seem to be interwoven into the female homeless experience, into their very identities. Their perceived failure to live up to traditional expectations of femininity, as homemakers, keepers and mothers almost seems to become part of them. As practitioners, we seem to spend so much time trying to support women with their internal struggle, their mental health and the trauma they have experienced, maybe sometimes we don’t see how far external perceptions impact on their sense of self and how the internal and external are inextricably linked. Many of the things I saw and heard at Downtown seemed to demonstrate this awareness, from the flowers in the community room, to the lengths gone to to change perceptions of homeless women in the community. This effort does the invaluable work of telling women that they are worth it, and that ‘normal’ is whatever they feel. An inspiring day! Bring on tomorrow….

And so it begins.....

So I woke up this morning in Downtown Los Angeles, California, USA. The reason behind this is that I have been lucky enough to take part in the Transatlantic Practice Exchange. The Exchange is an exciting opportunity for myself, as a representative of St Mungo’s, and four other frontline staff from services across the UK to spend a fortnight in the United States, exploring different practice topics and sharing learning on our return. Similarly, services in the UK have volunteered to host five participants from the US. The exchange is a collaboration between Homeless Link in the UK and the National Alliance to End Homelessness in the US and is funded by the Oak foundation.

I have been a Housing First Worker at a St Mungo’s North London Housing First service for a year and a half now. Housing First works with people who have been homeless for long periods of time, and who have complex and varied needs. We provide them with a tenancy, intensive support to maintain that tenancy, and to make other positive changes in their lives.  When I started at St Mungo’s Housing First I was amazed at the different ethos and approach, and the great outcomes that had been achieved. With a background working in specialist services for women, and a keen interest in gender studies, I became interested in homeless women’s experiences of services, especially as their needs are so different to that of homeless men. The innovative research carried out by St Mungo’s in their ‘Rebuilding Shattered Lives’ report has highlighted how women are likely to have experienced sustained trauma, abuse and violence throughout their lives, have lost contact with their children, have complex and untreated mental and physical health issues, as well as myriad of other interrelated issues. This inspired me to start a project to find out more about the needs of women accessing our housing first service, what we were doing well and where the challenges lay. So when the opportunity to take part in the exchange came up, I knew exactly what topic I wanted to focus on.  

Later this morning, probably fairly dazed and half asleep,  I will make my way to my host organisation, Downtown Women’s Centre, on Skid Row in Downtown LA, to meet chief programme officer, Amy Turk, and begin what will be an intense but fascinating two weeks of learning. The Downtown Women’s Centre has a well-established housing first service for women, with 119 on site apartments as well as a community based housing programme. They also run an incredibly busy day centre, where 200 women a day take a shower, get meals, clothes and advice, and access to health and trauma recovery services. I have a busy schedule while I am here, and more questions to ask than I can count! I have done so much reading on Housing Fist and the context of homelessness in the US I feel finally ready to get out there and experience it first-hand.

@louamarie #homelesslearning