The principles of Housing First recommend a caseload ratio of 1:7. No high caseloads, allowing availability, without question, to provide intensive support to those with multiple and enduring needs. Anyone who is familiar with the 7 principles, will know this is to allow support to remain flexible to the person’s needs.
The Legacy service has been providing support to some individuals for 10 years. We support a handful of people who still require Housing First, but have been settled in their homes for 5 plus years. Intensive support needs are still required; however, support needs have changed over the years and staff are available to provide check in’s rather than full time support.
Over time, staff have got to know individuals and established positive and trusting working relationships. Staff know that if someone is in crisis or in need of extra support, they are likely to ask for it. If they don’t ask, staff will often pick up on anything unusual that might be going on for them, and through an honest conversation, will be able to offer extra support.
People are comfortable in their own home and while they still require non time limited support from Housing Frist, they have their own routine and don’t want support provided in their home very often, as they are busy getting on with their life.
So, is there ever a good time to let fidelity slip? If you work as part of team, there should be room to accommodate movement. When supporting people for 5 years plus and providing the check in support, you should be in a position where you can take on another individual for support, without compromising the intensive support on offer to others. In order for this to be possible, you need to have the support of your team, so that if anyone requires more intensive support, you can call on a colleague to support you in managing your caseload.
Detailed below are two scenarios that evidence the effectiveness of the flexibility we work with.
Case Study 1
M has been supported by Housing First since 2010 and was part of the original Pilot. He has been in his house for 10 years. M has requested fortnightly support from Housing First and often this support will be for “check in”. M will call if he requires extra support and staff call him for a wellbeing check each week. M does not always answer his phone or indeed be in for his fortnightly support.
M currently uses IV Cocaine; the amount is dependent on his finances. He tends to manage on his own, getting on with his life. Housing First staff sometimes notice M is looking poorly or has lost weight and will encourage him to attend medical appointments.
Previously, staff noticed M limping and wincing in pain. When asked if he was ok, he replied he had an abscess in his groin. Staff were there to offer him support and encouragement to access medical help. M said himself, that if staff had not been there to encourage him to get medical attention, he would probably not have done anything until it was too late. He thinks he could have ended up losing his leg. Staff were able to increase M’s support during this time. Very soon, he went back to fortnightly support. Had M not still been supported by Housing First, the outcome could have been very different.
Case Study 2
G has been supported by HF since 2010, with a break of 2 years between 2014 -2016. At this time, G was back in touch with her family who were very supportive and she was getting regular access to her children. After a review with her care manager, G had decided she was no longer in need of Housing First support.
Two years later, Housing First received a call from G’s Housing Officer. She had met G, who looked very unkempt. When she had visited her, she noticed G had sold all of her white goods, stated she had fallen out with her family, no longer has access to her children and had started using substances again. Housing First staff went to see G and resumed her support.
A full package of intensive support resumed until 1 year ago. G stopped using substances, got back in touch with her family and built a really good relationship with her brother, who was very supportive, including her in family activities.
Support then moved from being intensive, to a weekly check in, which was often cancelled as G was out with her brother. Unfortunately, following another family argument, G very quickly started to use substances again. Her brother was still supportive, but she pushed him away as she felt he had not supported her during the family fall out. Housing First flexed up the support to G during this time as her needs had changed and engaged on a daily basis, either phone calls or visits.
Housing First supported G to reflect back on her time spent with her family and the positive changes she had made to her life. G’s substance use decreased when she got back in touch with her brother. G asked for Housing First to show her brother how to administer Naloxone should she have another lapse. Current support for G is medium due to the input from her family.