Research and analysis

Mobilising Housing First toolkit: from planning to early implementation

Updated 15 January 2024

Applies to England

1. Introduction and overview

This toolkit has been created with an aim of providing information for those looking to implement Housing First at a local or regional level. It has been produced by organisations involved in the evaluation of the Housing First pilot programme, funded by the Ministry for Housing, Communities and Local Government (MHCLG), and draws upon the specialist knowledge of Homeless Link and I-SPHERE (Heriot-Watt University). It includes:

• a brief overview of the pilot programme

• the process of commissioning Housing First support

• ideas for sourcing housing at scale

• good practice on mobilising and delivering services

The information provided in this toolkit is based on experience and practice observed through the evaluation, as well as from other sources. This toolkit will be updated as the pilots become embedded and further learning and good practice emerges. As the evaluation progresses and evidence of the effectiveness of the models becomes stronger it will enable clearer recommendations to be made.

All research and resources referenced can be found on the Housing First England website.

1.1. The guiding principles of Housing First

The name Housing First can be misleading and is often misunderstood. Whilst it can sometimes look like other housing led approaches and embodies good practice seen across a range of services, Housing First is a specific model evidenced to be highly effective at ending homelessness for people with multiple and complex needs. Housing First services are defined through their adherence to an internationally recognised set of principles and require change in the attitude, culture and approach of stakeholders to ensure they are delivered effectively and are sustainable. These principles are summarised as Figure 1.1.

Services with high fidelity to the principles achieve better outcomes^{[footnote 1]} for those they support which also ensures that resources are used effectively. The key principles were launched in England in 2016 and are now accompanied by more detailed guidance about what they mean in practice. Housing First should:

• be provided to those with complex needs and histories of homelessness, or preventatively with those who may experience or would be at significant risk of experiencing repeat homelessness in the future
• Provide independent and secure housing to people holding their own tenancy
• provide intensive and flexible support through small caseloads of 5 to 7 people

Figure 1.1: Summary of the Housing First principles

Principle 1: People have a right to a home

• Housing First prioritises access to housing as quickly as possible;
• Eligibility for housing is not contingent on any conditions but willingness to maintain a tenancy;
• The housing provided is based on suitability (stability, quality, choice, affordability, community integration) not housing type;
• The individual will not lose their housing if they disengage or no longer require support;
• The individual will be given their own tenancy agreement.

Principle 2: Flexible support is provided for as long as it is needed.

• Providers commit to long-term support with no fixed end date - recovery takes time and varies individually;
• The service is designed for flexibility of support with procedures in place for high/low intensity support provision and for cases that are ‘dormant’;
• Support is provided for individuals to transition away from Housing First if a positive choice;
• The support links with relevant services across sectors to meet the full range of user needs
• There are clear pathways into and out of Housing First services.

Principle 3: Housing and support are separated.

• Support is available to help maintain tenancies and address needs;
• Housing is not conditional on the individual engaging with support;
• The choices made about their support do not affect people’s housing;
• The offer of support stays with the person – if the tenancy fails, the individual is supported to acquire and maintain a new home.

Principle 4: Individuals have choice and control.

• Individuals can choose the type and location of their housing within reason;
• They have the choice, where possible, about where they live;
• They have the option not to engage with other services if there is regular contact with the Housing First team;
• Individuals choose what, where, when and how support is provided by Housing First;
• They are supported through person-centred planning and can shape the support received.

Principle 5: An active engagement approach is used.

• Staff are responsible for proactively engaging and making the service fit the individual;
• Small caseloads allow staff to be persistent and proactive, especially if engagement is low;
• Support is provided for as long as each participant requires it;
• The team continues to engage and support the individual if they lose or leave their home.

Principle 6: The service is based on people’s strengths, goals and aspirations.

• Services are underpinned by a philosophy that there is always a possibility for positive change and improved health and wellbeing, relationships and wider integration;
• Individuals are supported to identify their strengths and goals and develop the knowledge and skills they need to achieve them;
• Individuals are supported to develop increased self-esteem, self-worth and confidence, and to integrate into their local community.

Principle 7: A harm reduction approach is used.

• People are supported holistically;
• Staff support those using substances to reduce immediate and ongoing harm;
• Staff aim to support individuals who self-harm to undertake practices which minimise risk
• Staff aim to support individuals to undertake practices that reduce harm and promote recovery in other areas of physical and mental health and wellbeing.

1.2. The operational ingredients of Housing First

Whilst Housing First services are defined by the key principles, there can be many operational differences in design and delivery. These include whether the housing is sourced from the private, social or public markets and the structure of the support team (which is usually commissioned out). Housing First has two internationally recognised support team structures: Intensive Case Management (ICM) and Assertive Community Treatment (ACT).

• Intensive Case Management (ICM) is where a team of generalist support workers provide intensive support around tenancy sustainment, community integration and reaching goals and aspirations. They will support individuals to engage with wider health and social care services by ‘brokering’ or ‘navigating’ access. This is a familiar approach to support provision across the voluntary sector in England.

• Assertive Community Treatment (ACT) teams are comprised of professionals with a range of specialisms (e.g. psychiatrists, social workers, health professionals and housing workers) who function as a multi-disciplinary Housing First team to meet the needs of individuals supported. ACT teams are typically seen in countries where wider health and social care support is unavailable or difficult to access, or where individuals have significant and chronic mental health needs that cannot be met via ICM.

Almost all Housing First services in England are delivered through Intensive Case Management. However successful access to wider public services varies and depends in part on the relationships and partnerships in place^{[footnote 2]}. There are a few examples in which specialised roles are recruited or seconded into the Housing First service which can help to improve pathways into services.

1.3. The picture of Housing First in England

Housing First has been commissioned by local authorities in England since 2010, usually to meet an identified gap in homelessness service provision for those with very high and complex needs. These services are usually delivered across a single local authority area, are small scale in terms of the number of people served (although many scale up over time), and are delivered with local partners coming together, and working flexibly, to make them effective. An early evaluation of nine small scale pilots in England found that Housing First is effective in the context of English housing, health and benefit systems^{[footnote 3]}. In 2018, research was published about the implementation of Housing First in England and included in-depth case studies of five different services^{[footnote 4]}.

In the autumn of 2017, the Government announced a £28 million investment to test the delivery of Housing First at scale and the regional pilot programme was established. This has presented a rich opportunity to understand how Housing First can be delivered at a regional level, across multiple local authority areas, and to a significant number of people.

For more information about which local authorities have Housing First services visit: https://hfe.homeless.org.uk/services.

1.4. Overview of the pilot programme

Early planning for a pilot programme was based on a study considering the feasibility of implementing Housing First at a Combined Authority level across the Liverpool City Region^{[footnote 5]}. Following submission of initial implementation plans, funding was allocated in 2018 to three devolved regional authorities; Greater Manchester Combined Authority (GMCA), Liverpool City Region Combined Authority (LCRCA) and West Midlands Combined Authority (WMCA). Together these encompass 23 individual local authority areas. Over 1,000 individuals homeless and with multiple and complex needs are expected to be recruited onto the programme.

The programme is being evaluated by a consortium of research organisations and incorporates a number of strands. These include:

• measuring and capturing the outcomes for individuals supported
• the analysis of the financial costs and the benefits resulting, including estimating potential savings to the public purse
• an evaluation of the process of implementation and delivery to understand more about how the services operate, how they are experienced by individuals, and their adherence to the key Housing First principles

The pilot programme is overseen and monitored by MHCLG Programme and Evaluation teams and is supported by the Rough Sleeper Initiative team.

1.4.1. The regional pilots

Whilst all areas are committed to delivering high-fidelity Housing First, each has developed a different model:

Greater Manchester

• Commissioning: CA commissioned one consortium of 11 organisations branded as Greater Manchester Housing First. Lead provider (Great Places) has central programme management team.
  
• Management and control: Central team responsible for sub-contracting to partners, programme oversight and reporting to the CA.
  
• Delivery model: Region divided into four delivery zones each with a responsible delivery partner.
  
• Housing supply: Use of both social and privately rented properties (60/40 split anticipated).
  
• Lived experience involvement: Through a co-production group for development and ongoing input. This includes design, recruitment and policy and procedure development.
  
• Cross-region support delivery: Universal job descriptions, standardised pay rates and common team structures in each zone. Standardised training. Dual diagnosis practitioner in each zone recruited.
  
• Local authorities covered: The 10 authorities of:
  
  • Manchester
  • Bolton
  • Bury
  • Rochdale
  • Stockport
  • Oldham
  • Tameside
  • Salford
  • Trafford
  • Wigan

Liverpool City Region

• Commissioning: CA are delivering in-house following recruitment of service delivery teams.
  
• Management and control: CA have a central management team with a strong focus on system- wide change who oversee service delivery.
  
• Delivery model: In-house delivery teams working across the CA area and divided geographically.
  
• Housing supply: Primarily social housing initially (CA has above national average share of socially rented properties), but in the longer-term private landlords will also be a key source of properties.
  
• Lived experience involvement: Through lived-experience group for research, Pilot design and development, and recruitment.
  
• Cross-region support delivery: All working for CA at present, team structure based on feasibility study. Two pan-region psychologists recruited by CA as part of Pilot team.
  
• Local authorities covered: The 6 authorities of:
  
  • Liverpool
  • Sefton
  • St Helens
  • Wirral
  • Halton
  • Knowsley

West Midlands

• Commissioning: Funding divided between LAs with Birmingham City Council (BCC) being accountable body. Commissioning staggered across the CA although a common tendering process.
  
• Management and control: BCC overall accountability to MHCLG. Each LA monitors and reports on local progress.
  
• Delivery model: A service in each LA. Five commissioned externally and two in-house.
  
• Housing supply: Combination of social (housing association and local authority) and private rented sector housing.
  
• Lived experience involvement: An existing group has been consulted throughout.
  
• Cross-region support delivery: Birmingham Voluntary Service Council (BVSC) commissioned to support commonality - job descriptions, training and support. Three LAs commissioned the same provider.
  
• Local authorities covered: The 7 authorities of:
  
  • Birmingham
  • Coventry
  • Dudley
  • Sandwell
  • Solihull
  • Walsall
  • Wolverhampton

As delivery of the pilot programme continues, there will be continued opportunities for learning, and this toolkit will be updated as the evaluation progresses.

1.5. Toolkit structure

The remainder of this toolkit is structured as follows:

• Section 2: Planning Housing First – establishing a vision for Housing First in your area; determining who should be involved; assessing need and identifying funding; and developing your plan.

• Section 3: Commissioning Housing First support – the commissioning process; developing service specifications; and monitoring progress.

• Section 4: Mobilising Housing First – considering the time required; the staff required, their recruitment and support; subcontracting and external service providers; developing partnerships; and access to housing.

• Section 5: Housing First delivery – service entry and exit; eligibility criteria; delivering support; and working with housing providers.

2. Planning Housing First

2.1. A vision for Housing First

From the outset, it is important to determine a vision for the role and scale of Housing First locally. Although this will depend on the level and nature of demand and available resources available, which may change over time, setting a clear vision will help to engage stakeholders in the process of development and change. Consider things like how Housing First provision will sit alongside other services and whether it will be scaled up in the future.

Reviewing the effectiveness of existing support for different cohorts of people can inform considerations about the level of change required. For example, Housing First may be established to complement other services available, or the plan may be to implement wider systems change or service transformation where this includes transitioning existing temporary supported housing schemes to Housing First and other housing-led approaches. Whilst there is no evidence of a local area having done this in England, this is the approach adopted in Finland and promoted through the Rapid Rehousing Transition Plans in Scotland.

It is important to consider, at a systems level, how Housing First will align with other programmes and initiatives, and where it may be helpful to integrate resources or strategies. Consider how Housing First fits within local housing and homelessness strategies and any other relevant local strategic objectives (e.g. health, social care, criminal justice), and the nature, capacity, capability and service characteristics of local specialist provision.

Top tip: Partnership is key – you can’t do it on your own – at both strategic and operational levels.

Take time to engage senior staff in the right organisations early, ideally building on pre-existing positive working relationships or establishing new relationships where necessary. Although this may take time, it will allow you to harness their experience and ideas, reduce anxiety in the future and foster cross-agency commitment.

2.2. Assessing need

It is important to identify the scale of the local population to be targeted for Housing First services in your area, and their characteristics and circumstances, to establish the size and model of project required. Research indicates that the approach is most cost-effective for individuals experiencing multiple disadvantages. These are individuals with long or repeated histories of homelessness and other multiple, often interconnected, needs. Individuals are likely to have had repeat contact with services who have found it difficult to engage and support them effectively.

If the vision and anticipated scale allows, avoid focusing only on those who are already known to existing homelessness services as this may exclude other groups that may benefit from this approach, such as vulnerable women. Housing First can also be a preventative measure for those who have an expected trajectory into long-term homelessness or repeat but ineffective contact with services, such as vulnerable care leavers, people in prison and individuals in high cost care of hospital facilities.

Undertake a scoping exercise to assess the need for Housing First in the area. This may be through a formal research process or using intelligence held at a local level. Involve partners and localised intelligence systems to identify and predict the potential scale of provision and to view the complex needs cohort from multiple perspectives. Some areas use the New Directions Team assessment (also known as the chaos index) to quantifiably identify those that would be eligible for the service, while others have developed their own criteria.

The process of assessing the local need should not be limited to a fixed point in time. Ongoing reflection is needed to understand the characteristics of people who are experiencing homelessness and complex needs so that the service can adapt to different populations; ensuring accessibility and adequate support is provided.

Examples from the Pilots – Assessing the scale and nature of need

As part of their preparation stages, each Pilot undertook an assessment of need in their areas to provide an estimate of the potential demand for their services amongst the local population. Each area followed different approaches to preparing their estimates, which were used to inform their delivery plans.

Each Pilot drew upon existing local intelligence to estimate potential demand for their services:

• In one Pilot, a comprehensive assessment of local need was prepared as part of an initial feasibility study into delivering Housing First at scale, which itself drew upon the local homelessness data system which holds data on homeless assessments, interventions and characteristics for individuals presenting as homeless across the region.
• In a second each of the local authorities undertook separate scoping exercises to assess the likely demand for Housing First services. The approach to assessment varied between authorities, with some areas using the New Directions Team (NDT) assessment tool while others relied primarily on existing local intelligence.
• In the third, each local authority also produced assessments of demand, some using the NDT whilst others approximated numbers based on local intelligence (e.g. using Housing Options or other local data sources).

In practice, each of the Pilots found it difficult to estimate actual demand for their services solely on the basis of their needs assessments.

Finally, while as described above potential participants should not be restricted to those already known to local agencies, initial needs assessment exercises can also be helpful in identifying potential recruits, to allow recruitment to the service to begin early.

2.3. Who to involve

Coordinating a group of key stakeholders, from the start, can strengthen planning and mobilisation. Involving senior colleagues, such as Cabinet Members and Directors from across organisations, will assist in both the strategic planning of Housing First and in overcoming any operational issues that arise in the future. Although it is easier to engage senior stakeholders when homelessness is a political priority, the potential of Housing First often aligns with strategic priorities across sectors. Identify these when engaging stakeholders.

It can also be incredibly useful to involve people with lived experience at this stage. Their insights and experiences of existing service provision brings valuable information to the planning stage. This must be done meaningfully and in a way which enables people to contribute effectively.

Example from the Pilots – lived experience group input to the Pilots

Each of the Pilots involved individuals with lived experience in their development processes, with one featuring a group of 12 to 15 individuals with a dedicated facilitator. The group meets monthly having been formed as part of a previous National Lottery funded project and involved with the Pilot from the outset. Specific lived experience activities to support the Pilot included:

• Developing the Pilot – where the group were consulted throughout the process, including specific consultations on potential eligibility criteria, how best to introduce the service to potential participants, and how best to ensure sustained participation and that outcomes are achieved.
• Staff recruitment – the group were directly involved in the recruitment process for the Pilot’s support workers, including contributing to the design of job specifications (including specifying that formal educational qualifications were less important and ensuring that individuals with lived experience could be considered for posts) and in the selection process itself. The group designed and delivered a discrete element of the selection process, which comprised a ‘speed dating’ approach to test applicants’ values and attitudes.
• Service commissioning – the group were also involved in the commissioning of the Pilot’s psychology service, where they contributed to the appraisal of the bid documents and the accompanying interview process.

In addition, the lived experience group also contributed to a review of the housing allocation process in the region, building on previous work to review the local register of social and affordable homes.

Members of the lived experience group described how they had benefited from their involvement with the Pilot, seeing their role as an opportunity to ‘give something back’, help improve services for others, and develop new skills and experience. Importantly, they described feeling that their contributions were valued, acted upon, and that they were involved in a truly co-produced approach.

Do not assume that stakeholders involved fully understand Housing First and in particular the ways in which it differs from mainstream service responses. It is essential to define what Housing First is and what it is not, so as to help others to fully understand the approach and their role in making it successful. This will also help manage expectations around the time it can take to mobilise a service and ensure there are realistic perspectives about the impact that might be seen locally and reduce any initial concerns.

Top tip: Reducing concerns and barriers

Involving a broad group of stakeholders and interests from the outset can help address any concerns or perceived threats from Housing First to existing roles and practices. This can be achieved by illustrating how the service can complement existing provision, help identify shared objectives and address the common challenge of homelessness.

It can be beneficial to involve Housing First England, or commissioners and providers of existing services, at this stage. Consider developing brief training or information sessions to expand the knowledge of stakeholders as part of your mobilisation process. This can help raise awareness of the approach and key principles whilst offering an external perspective on delivery and learning.

2.4. Thinking about sustainability

The aim of Housing First is to offer open-ended support for as long as it is needed to individuals who require this stability.

Providing Housing First should not be thought of as a short-term intervention regardless of the scale.

Thinking about sustainability is important in all circumstances but especially when existing funding is not guaranteed in the future. Working early on long-term planning can reduce the likelihood of a cliff edge which could be extremely detrimental to individuals being supported.

Look to embed Housing First in local strategies so that it becomes a mainstream offer to individuals who would benefit now and in the future. Consider which commissioning partners need to be involved and how funding may be pooled across authorities or sectors, such as health and criminal justice. For sustaining the project in the future, determine what evidence should be collected in order to ‘make the case’ for future funding.

Without considering sustainability, landlord and stakeholder engagement may also be affected due to concerns about what may happen if funding ends and vulnerable tenants remain in their properties without an adequate level of support This may also affect staff turnover in provider organisations if contracts offered are short-term.

Those involved in designing and funding services should plan or commit to provide funding for longer durations than are custom in the homelessness sector to enable the service to become embedded. It was suggested to us that any contracts should allow for a minimum delivery period of at least 3 years, with 5 to 7 years being more practical. However, it must be acknowledged that some individuals supported by Housing First will require support for longer and planning for the service in the long-term should always keep this in mind.

We suggest an absolute minimum delivery period would be 3 years with 5-7 years being more practical and 7 years plus needed for some individuals.

2.5. Early adopter or test-and-learn projects

When developing a large-scale Housing First programme, initial small projects may be developed before the wider contract is commissioned or mobilised. These ‘pilots’ can provide learning to inform commissioning or roll out; including understanding any operational or systemic challenges. Starting small may help to bring people on board and identify any issues at a time when they can be more easily addressed. Any strategic work needed to take Housing First to scale can be identified, including developing new partnerships or processes.

Each of the Pilots had benefited to differing extents from a combination of previous exposure to Housing First services and the use of test-and-learn or early adopter approaches, as summarised in the example box below.

Examples from the Pilots – using test-and-learn or early adopter approaches

Prior involvement in Housing First provision had provided important learning in two of the Pilot areas and was considered by Pilot staff and stakeholders to have helped their Pilots move to service delivery more rapidly. This experience included a combination of early adopter and test-and-learn projects, operating within each CA under a range of funding arrangements, the learning from which helped shape the Pilot’s main stage services.

• In one Pilot an ‘early adopter’ service was commissioned in one authority area in January 2019. Delivered by an external provider, the early adopter built upon a previous service for individuals homeless and with complex needs, which included several features of the nascent Housing First service and worked with 25 individuals. Close working between the provider and Pilot staff enabled learning to inform the development of the full Housing First service, as well as establishing referral and assessment processes and working with DWP to enable flexibility in benefit payments. In addition, a second provider also delivered a small-scale Housing First project in one authority area, which provided learning to inform full service delivery.
• A second Pilot was designed with an initial test-and-learn exercise prior to the launch of the wider Housing First service. Delivered using an internally recruited team of support workers, the Pilot worked with a cohort of individuals for the first 12 months of operation, which provided a series of key lessons which informed plans for main stage delivery.

In two Pilot areas the Combined Authorities benefited from previous experience of delivering Housing First, albeit on a smaller scale, within each region. Stakeholders reported that levels of interest in Housing First were high, on the basis of the strength of the international evidence on its effectiveness and previous experience of delivery.

2.6. Developing your plan

Be realistic around timescales for mobilisation. If there are multiple commissioners involved then local governance arrangements, decision making and political allegiances may disrupt and delay progress. Contracting providers, especially if they then have to subcontract other partners, can also take time, as can effective staff recruitment. When delivering at scale, service planning and mobilisation can take anywhere from 6 to 12 months. Timescales will depend on the scale of the project, the strength of existing partnerships, and the local context.

Once the need has been mapped and potential scale of provision identified, develop an implementation plan setting out your proposed activities. This should include:

An outline of the scale of the programme/project and expected timeframes for implementation including whether there will be a test and learn phase;

• Expected number of beneficiaries (ensure this is profiled in line with recommended caseload sizes);
• Consideration of how the project will adhere to the principles of Housing First;
• Consideration of whether the scale of the project requires centralised coordination capacity;

Identification and engagement with housing providers and the development of a plan around how accommodation will be sourced;

• Identification of other roles involved in operational delivery (e.g. mental health or substance misuse specialists) and indication of whether these will be funded through the programme or enabled through strategic partnerships or secondments; and
• Information about any centrally provided training and support for delivery staff, including reflective practice, to ensure consistency.

During this stage it is useful to gain commitment and clarify the roles and input of authorities, housing providers and other stakeholders. Ask internal and external stakeholders, including people with lived experience, to scrutinise the plans and draw up relevant partnership agreements.

Information about how local areas have funded Housing First and research on cost-effectiveness can be found on the Housing First England website, along with guidance for commissioners.

2.7. Wider influence

Developing your Housing First service also provides an opportunity to review, and where necessary/possible amend, existing thinking and processes around addressing homelessness for people with multiple and complex needs; needing the wider housing, health and social care system to flex and work differently.

In this way, Housing First may also be a stimulus for ‘system change’, having an influence beyond its strict remit to influence improved practice for, and revised views and attitudes towards, the target group. The commissioning of Housing First services is one mechanism by which these ‘systems change’ benefits may be realised.

The evaluation of the Housing First Pilots will explore these wider effects over time and will included in future updates of this toolkit.

3. Commissioning Housing First support

The Housing First approach provides a model, proven to be effective internationally, often when other approaches have failed, with the intensity of support, the principle of individual choice and the commitment to provide ongoing support marking Housing First as different to other ‘housing-led’ approaches. New Housing First services must establish their place within the existing networks and local interventions, working closely with partners to ensure shared understandings and procedures.

3.1. Being a supportive commissioner

Housing First requires strong partnership working at all levels and can be a catalyst for changing cultures of service provision. Ensure this is reflected throughout the commissioning process by being transparent about objectives and expectations. Look to establish a dynamic underpinned by trust, a curiosity of learning and collaboration rather than one that is purely transactional. Good providers will operate in this way and expect this from commissioners

Do not expect that the necessary groundwork (strategic partnership agreements, changes to policies and procedures) will only start once the provider is in place as this will delay mobilisation. Take action to build relationships and influence partner agencies throughout the commissioning process to raise awareness and gain commitment to support the mobilisation stage.

3.2. The commissioning process

Most authorities decide to commission out Housing First support to partner agencies who have both the experience of supporting the target participant group and the infrastructure in place to deliver the service effectively. Depending on the scale of provision, one or multiple providers may be commissioned. Putting on a market engagement event can help to ensure that plans and expectations are clearly outlined. They also provide a chance for providers to meet and network.

The Housing First Pilots are providing valuable learning on service commissioning at the regional level, in contrast to experiences of commissioning services at a smaller scale and at the single authority level. While the research is ongoing, commissioning at a larger scale has brought a range of challenges in securing provision, including the availability of suitable providers and support workers. This is also influenced by the commissioning of other support, market maturity and external funding. If the market is insufficiently developed or flooded by short-term funding activity then it may struggle to respond in the short-term. At the same time, it has also provided the opportunity to influence change in existing support networks to better meet individuals’ needs. The Pilot’s approach to informing potential service providers is described below.

Examples from the Pilots – market events

Each of the Pilots have used a range of strategies to engage with their local stakeholders, including holding market engagement and other events, alongside individual and team briefings/presentations, as part of their commissioning processes. These were found to have a range of benefits and were helpful in raising awareness of the service and engendering commitment to it. As the examples below describe, these events could also provide benefits for wider partner awareness and partnership development.

A combination of group events, workshops, presentations and individual meetings were employed. Key stakeholders (commonly the local authorities, housing providers, health service representatives, probation services etc) have also been recruited to Pilot steering and/or working groups, where they can have a role in Pilot governance as well as contributing to service development. Despite the strong political and senior-level support in the majority of the areas, each Pilot has had to invest considerable effort in raising both awareness and commitment at the operational level. In some cases, this also involved countering concerns raised about the Pilots and the Housing First approach and overcoming political differences that had hindered commitment. One key lesson is that using a range of different communications approaches, and being persistent in delivering them, were key success factors.

Lessons from the Pilot experience suggest the following important considerations in delivering market events and other awareness raising sessions:

• promote events well and appropriately
• be inclusive in who is invited
• ensure the detail of the service requirement has been established in advance
• practice active listening, and encourage discussion and questioning
• be clear on the next steps – what is required to bid, timetables, etc

In areas where Housing First is perceived as presenting a significant change to the status quo, work carefully to engage providers and bring them on board. This may include taking time to raise their awareness and confidence pre-commissioning, but also making sure that the service specification is appealing to them. Some agencies may have early concerns over, or resistance to, new Housing First services, in some cases perceiving them as an implied criticism of their services and as a risk to their continued funding. In such cases, careful and detailed explanation of the Housing First approach can help allay such concerns, emphasising how it ‘fits’ with existing services, and demonstrating the early successes to prove themselves ‘in action’.

Consider any financial or other constraints that may affect smaller providers from being involved; they can have a lot to offer but may be excluded based on financial requirements if your programme is large. Consortium arrangements may also be considered to allow smaller providers to participate, but consideration should still be given to both provider capacity and their geographical coverage (the latter being less of an issue for single local authority services).

If there will be multiple tenders ensure that there is consistency in commissioning. Create shared service specifications and bring uniformity to the pricing of contracts and salaries where possible. This will ensure that commissioning is fair and consistent. It will also be beneficial to providers that may wish to bid for multiple contracts and to commissioners in setting a reasonable market rate.

Examples from the Pilots: service commissioning

Two of the three Pilots have commissioned their services externally, with the third recruiting a staffing team to delivering their services directly. In the first, commissioning took place centrally across the four defined areas within the CA, and in the second commissioning took place at the individual local authority level, with five local authorities commissioning externally and two delivering their service in-house.

Pilot 1

In the first Pilot area a service specification for a single consortium model was proposed. The specification was designed by the steering group with input from a working group and a co-production group including individuals with lived experience of homelessness. The specification emphasised the importance of establishing positive relationships with participants and the value of peer support. This was followed by a market event, involving presentations from the CA and Homeless Link, which provided detail of the Housing First approach and built expectations around the model. This was felt by several stakeholders to have helped the process of partnership development.

Following the issue of the service specification five bids were received, which were assessed by a panel. The assessment panel included individuals with lived experience who assessed the two sections of the bids (the value of relationships and peer support) which accounted for 20% of the overall score.

Pilot 2

In the second area the decision was taken for each local authority to commission their services individually, with a commitment to work collaboratively to establish a common approach and help ensure fidelity with the Housing First principles. A local VCSE organisation was commissioned to support the development of a common tendering process, including a service specification and a template job description for support workers. Following a series of briefings and training on the Housing First principles, it was agreed that a common support model would be followed, with small caseloads (five to seven per support worker) to offer support and brokering access to other services, formalised through a Partnership Agreement and reflected in the tender documents produced.

As each local authority was at a different stage of commissioning readiness, a staged approach was followed. Following an initial market engagement day in Autumn 2018, three authorities issued invitations to tender, which were assessed in January 2019. Subsequently all but two of the authorities undertook successful commissioning exercises, with the two opting for an ‘in-house’ model (given the comparatively small scale of the eligible population, concerns over the availability of suitable support workers, and the expectation that an internal model would improve the speed of access to local authority owned properties). The opportunity to ‘test out’ different delivery models was seen as a strength of the Pilot, as well as spreading the risk should a single provider fail.

The availability of a suitably experienced provider base with the capacity to deliver services at scale has been a concern for the Housing First Pilots from the outset, and in at least one case led to their decision to deliver ‘in-house’. There were also concerns over the availability of sufficient suitable support workers, with appropriate experience and values, within each area (as explored in Section 4.2). There was an expectation that additional services would be commissioned as delivery scales up, and so commissioning arrangements should be sufficiently flexible to allow for smaller contracts as well as those for larger Housing First services.

When offering longer term contracts to providers it is important to ensure good commissioning practice which protects both the commissioner and the provider whilst reducing the potential impact of contract changes on the continuity of the service and relationships that are established. Ensure the length of contract is appropriate to the design so that the likelihood of changing providers is reduced. However also build in reviews which will allow a change of provider if necessary.

3.3. Service specifications

Design a service specification and tender process that is fit for purpose and for your context. Traditional service specifications can include elements which contradict the ethos of Housing First and may affect the delivery of high- fidelity provision (see section 1.3.4). Be clear about the numbers of people expected to be supported by the service so that providers can profile their proposal in line with recommended caseload sizes.

Through the service specification and tendering process look to consider:

• how fidelity to the principles will be maximised and assessed throughout delivery to ensure quality and adherence
• how the commissioned provider will engage and work with landlords to source housing and identify solutions to supply challenges – including maintaining relationships once tenancies have been provided
• how support will be provided; including any expectations around multi-agency working or subcontracting
• how Housing First will align with existing services and/or any other system-wide approaches
• what the monitoring/reporting requirements will be (see below)

Look to involve others who can shape or sense check the service specification, including those who have been involved in the planning.

3.4. Monitoring and measuring progress

Housing First is a person-led intervention which does not place any requirements on individuals around the types of services they access or expectations around them addressing specific needs. Whilst information about support needs and service use is useful to collect for monitoring individual progression and measuring impact, the achievement of such outcomes should not be a commissioning requirement, as this could compromise adherence to the Housing First principles.

Whilst everyone involved will want to see individuals supported into homes, be realistic about timeframes for delivering accommodation outcomes. A number of factors can affect the length of time it takes to move an individual into stable accommodation once they’re accepted by the service. Expecting this to happen quickly may negatively affect engagement and tenancy sustainability in the long-term. In addition, while housing outcomes are key, the success of a Housing First intervention should consider recovery in a more holistic sense, and not focus solely on housing outcomes.

Similarly, it may take time to reach agreement on the data to be collected from individuals to monitor their progress through the service and the benefits and outcomes resulting for them. The metrics used, and the way in which the data is collected and analysed, will depend on the scale of the service and whether there is an accompanying evaluation. Irrespective of the detail, services should allow time to agree a set of metrics and responsibilities for collection and analysis from the outset.

Evidence on Housing First is generally collected around three themes:

• Fidelity to the principles: research demonstrates that services with higher fidelity are more effective. Assessing fidelity will help make the case for why the service is successful or shed light on any structural or operational challenges which may be affecting delivery.

Guidance and resources on achieving high fidelity, and how this can be assessed, are available at www.hfe.homeless. org.uk/principles-housing-first. These include a fidelity quality framework developed by the Greater Manchester Pilot to monitor and evaluate the fidelity of their services.

• Impact on individuals: evidence is collected across a range of domains on the experiences of individuals before and whilst accessing Housing First. Tools may be standardised measure or existing service recording systems depending on what is being evaluated. Qualitative reporting and case studies are helpful in showing idiosyncratic changes which can demonstrate valuable impact that might not be captured in other ways. For change to be measured over time, an initial baseline assessment is essential to capture the individual’s circumstances, history and current needs as close as possible to being recruited to the service. Subsequently data collected on the progress of the individual can be compared to their starting point to more accurately capture change over time. Data collection arrangements must be set within the context of the Housing First principle of choice, and while for evaluation purposes it is important to collect data on certain outcomes this should not set the expectation that each participant will be working towards the same goals.

• Cost-effectiveness: information about the contact that people have with services can be useful to demonstrate the value of Housing First to the public purse. Collecting information about an individual’s service use for a period of time before accessing Housing First and then monitoring this over time can be used to make a case locally for sustaining the service in the long-term.

Irrespective of whether data on individuals is collected primarily for monitoring and/or evaluation purposes, they key message is that any data collected must be useful, and be used, by providers to reflect on their provision, explore whether improvements can be made, and to enable them to make the case for increasing and sustaining funding. Here efforts taken to reach agreement on metrics, collection and analysis stages between partners will bear fruit through the establishment of a common data set, agreed monitoring protocols, and high quality and relevant monitoring data. Involving people with lived experience in determining what is measured and how, and in the process of doing so, can be extremely beneficial.

4. Mobilising Housing First

Having established a plan for your Housing First service, and commissioned providers as required, this section explores the key issues around mobilisation. It explores the time required to reach mobilisation, staffing and recruitment issues, partnership development and the key areas of service delivery.

4.1. Timescales

Mobilising Housing First can take considerable time, especially when this is being done at scale, and it is important to ensure that the expectations of senior and political stakeholders are managed from the outset. At scale, centralised functions are vital and these need to be in place before delivery teams are recruited; consider this as a necessary stage in service development and factor in time for subcontracting and staff recruitment. If necessary, consider mobilising ‘early adopter’ or ‘test and learn’ delivery teams whilst wider mobilisation takes place.

Formal and informal partnerships and protocols, across sectors such as with housing and health providers and the DWP, are useful for operational delivery. Whilst some of this can take place during the planning and commissioning stages, allow time for these to be established. Aim to bring relevant stakeholders on board earlier rather than later.

One way in which arrangements for mobilisation can be progressed to a common template is through the production of delivery manuals (setting out the various protocols required, and the commitment to fidelity to the Housing First principles) or, as in the example below, a Housing First Charter.

Examples from the Pilots – Housing First Commitment Charter

As part of preparations for mobilisation, one Pilot took a range of steps to secure commitment to its activities from housing associations and other partners in their area. The Pilot convened a working group which met monthly with representatives of the largest housing associations in the area, and held a series of workshops and individual meetings to introduce Housing First and establish common understandings. Alongside this a Housing First Commitment Charter and a delivery handbook for frontline staff were produced. Signees to the Charter included the 15 largest housing associations in the Pilot area.

Examples from the Pilots – Delivery guide

One of the Pilots produced a document for frontline staff in Housing Association and other partner organisations which provided information on the Housing First model, evidence of its effectiveness and how it will be delivered in the Pilot area, accompanied by operational guidance and examples of the documentation used.

The guide first set out the rationale and context for the intervention, including what makes the Housing First model different to more traditional approaches. The Pilot model is then described in detail, including the eligibility criteria used, staffing structure and contact points, and a series of frequently asked questions to address any common questions, illustrating how the Housing First principles will be actioned in practice.

Specific information is provided on the role of housing associations in the Pilot, including detail on the Housing First delivery process emphasising their role in allocating properties and subsequent tenancy management. Annexes set out the forms to be used to request or transfer properties, with a comprehensive contacts list for individual support workers.

4.2. Staffing

Staffing requirements will depend on the nature of the project developed – primarily in terms of whether services are delivered internally or commissioned externally. One particularly important thing to take into account is the need to support staff emotional and wider wellbeing, in recognition of the challenges and pressures associated with working with the service target group and the intensity of the support.

4.2.1. Centralised programme teams

At a regional level, it may be necessary to have infrastructure support in place. At a local level oversight and strategic input is usually provided through existing structures but when delivering a large programme it might be essential for there to be dedicated roles. These roles may be commissioned out, or held in house, but should be given the necessary authority to undertake their task effectively.

A range of roles may be beneficial to achieve:

• Programme and strategic coordination; to oversee one or multiple programmes
• Project management; to manage specific elements of the delivery particularly where multiple organisations are involved
• Quality assurance and data coordination; to monitor progress, identify issues and undertake reporting
• Partnerships and strategic influencing; to undertake work across authorities and sectors
• Practice development; to support culture change and good practice development
• Property acquisition or lettings leads; to explore pathways into housing and landlord liaisons
• Lived experience involvement; to ensure people with lived experience are involved in all relevant activity
• Internal and external communication; to create consistency across multiple providers and share good news stories
• Commissioning and finance management; where sub-contracting or working to influence commissioning

4.2.2. Frontline delivery teams

The ratio of management to delivery staff should be such that staff feel supported in their roles as this will allow them to deliver therapeutic support in line with the principles, as well as supporting their wellbeing and job satisfaction. Team managers or leaders should have capacity within their roles to be able to respond and proactively address challenges which arise on an individual or systemic level. Across the Pilots, support worker to team leader ratios ranged between five and seven support workers to each team leader.

At scale, team leaders and other managers benefit from meeting to share learning and foster consistency. This is especially relevant for individuals and organisations new to Housing First.

People with lived experience are extraordinarily valuable in the provision of Housing First, through either paid or voluntary roles, but there must be adequate resources and support in place. This may require a culture shift in some organisations

4.2.3. Recruiting staff

The values and skills required of Housing First support workers are quite different to other roles in the sector and recruitment can therefore take time to ensure that the calibre of staff is high (sometimes requiring multiple recruitment rounds). Recruiting the right people is essential so procedures should be adapted to include values-based exercises that assess the attitudes of applicants and how they relate to and work with others. Consider how the recruitment process can be made more accessible to people who have lived experience.

Salaries should be competitive in order to recruit and maintain high quality applicants. Regular turnover within teams can compromise the consistency of support, caseload size and fidelity to the principles. If multiple providers are commissioned through the programme, ensure that job descriptions and pay rates are consistent. This will reduce the risk of competition in recruitment, potential staff dissatisfaction and the likelihood that staff will move between providers.

Involving people with lived experience in developing the recruitment process can add real value. Their experience and insights can shape the person specifications and job descriptions and co-producing and delivering the interview process can help to determine which individuals are suited to delivering Housing First.

However, be flexible and consider individuals that show a potential to learn; most staff have ‘been on a journey’ with Housing First as it turns traditional support work on its head. Training and reflective practice can help staff to ‘unlearn’ practices from previous roles if necessary.

Recruiting the right people takes time and can be difficult. This is exacerbated when implementing a scaled-up service and where multiple providers are competing for applicants. Consideration should also be given to how the wider homelessness sector is impacted; be creative regarding where jobs are advertised.

Examples from the Pilots – recruiting support workers

One Pilot area following a model of internal delivery recruited a cadre of support workers (three teams each comprising four support workers and one senior support worker) in summer 2019.

The recruitment approach was designed to ensure that individuals are selected with the right attitudes and values for the role (e.g. an ‘assets’ rather than a ‘deficit’ approach), which was seen as equally or more important than their qualifications and experience within the homelessness sector.

The shortlisting process included the testing of individuals’ attitudes and values with members of the Pilot’s lived experience group, who designed and delivered a ‘speed dating’ approach for this purpose. Questions were designed to test whether applicants had an appropriate “asset” rather than “deficit-based” mindset to working with individuals. Approximately a quarter of the applicants were discounted at this point, with those remaining being interviewed by members of the Pilot team, with a similar assets-based focus, and job offers made to those who were successful.

On appointment, the support workers received an intensive two-week induction and training programme, designed by a member of the central Pilot team who received accreditation from the Housing First Europe Hub to provide Housing First training. The induction training is accompanied by an ongoing programme of training, featured seven modules (each of which focuses on different aspects of fidelity with the Housing First principles).

Successful applicants commented that the process had made them feel valued, well supported and motivated for their roles.

4.3. Recruiting specialised posts

At a greater scale it may be beneficial to sub-contract specialised posts to work with Housing First (e.g. mental health or substance misuse staff). These posts can help to circumnavigate systemic barriers, provide specialist expertise and the ability to lever and broker support from elsewhere within their sector.

Specialist posts can share their expertise with the wider workforce through reflective and consultative support. They may also hold a caseload of individuals who need more specialist input.

4.4. Multi-provider service delivery

At scale, and where multiple support providers are involved, it is beneficial for team managers and partner organisations to come together regularly. This can help to foster coherence and consistency but care should be taken to avoid stifling flexibility in local provision. Such forums can help to highlight specialist knowledge of different members which can be shared across the programme.

Where multiple providers are delivering Housing First across a number of authorities but within one programme, it can be beneficial to have a single brand and centralised communications about the project as a whole. This requires time to allow for effective co-production across stakeholders; enabling all to establish a shared vision and purpose which is invaluable for consistency and wider buy-in.

4.5. Training and supporting staff

The importance of providing staff with adequate training and support cannot be underestimated. Many may be new to Housing First and its principles, and it is important to ensure they are trained on the principles and philosophy of the approach. Design and mobilise the service with this in mind to ensure that new staff can receive an adequate induction before they are expected to carry a full caseload.

It can be challenging for staff to transition from traditional support approaches to Housing First. Training and on-going reflection about strengths-based and psychologically-informed working can help to shift mind-set and establish new practices. Involve people with lived experience in the training as their insights can help shift thinking and investing in reflective practice provides a space for staff to reflect on the emotional aspects of their work and on the challenges.

Where multiple providers are in place it may be appropriate for some training and support to be funded and coordinated centrally. This can help to foster relationships across providers and has the added benefit of ensuring that there is consistency in skills development. Opening up training to partner agencies can also raise awareness of new ways of working to encourage culture change to happen more widely.

Examples from the Pilots - Training support workers

Each of the Pilots described drawing upon a range of existing, and developing new, materials to be used in induction and on-going training programmes for their support staff.

Induction and staff training was coordinated centrally within each Pilot, and commonly included training on subjects such as: Housing First and the Housing First principles; reflective practice, Psychologically Informed Environments (PIE), asset/strengths-based approaches, conflict resolution, self-harm and suicide, and wellbeing and resilience. Training was being delivered by a mix of Combined Authority, Pilot provider and partner organisations, lived experience group representatives, and external stakeholders including but not limited to Homeless Link (on principles and fidelity). Examples from each Pilot are provided below.

• In one Pilot induction training comprised one day a week for the first month in post, to include: understanding the Housing First principles, use of local homelessness data systems, safety planning and lone working, the Pilot model and partners, asset-based working, psychologically informed environments (PIEs) and welfare benefits. A subsequent programme of further skills development training, some delivered by facilitated group sessions, included implementing PIE principles, asset-based working in practice, supervision skills (reflective practice), interpersonal skills, managing differently, self-harm and suicide, couples and relationships, conflict resolution, wellbeing and resilience, and implementing Housing First for different equality groups (including gender, age, disability, BAME, LGBTQ). While the majority of the training was delivered by the Pilot’s central team, other providers were drawn upon including Homeless link and the local mental health trust.
• In the second Pilot, staff were offered training in PIE, reflective practice and strengths-based approaches as part of their induction. Homeless Link also delivered training on the Housing First principles, and maintaining fidelity with them, on an on-going basis to ensure that all new staff are trained and messages reinforced. There was also an aspiration for practice to be trauma-informed, with a centrally commissioned training programme that all support workers were expected to attend. Training included understanding the Housing First principles, PIEs, reflective practice and asset-based approaches.
• In the third Pilot support workers were recruited from a variety of backgrounds, including the housing, criminal justice and substance misuse fields. Each received an intensive two-week induction and training programme, designed by the Pilot team, with additional modules being prepared for delivery during the Pilot’s test and learn stage. The support workers reported positively on the training received, which was felt to be comprehensive and well delivered, and provided them with the specific knowledge required to fulfil their roles.

Housing First support workers are recognised as facing a range of challenges in their roles and maintaining their emotional and wider wellbeing should be important considerations. More widely, factors such as ‘burn out’ and ‘compassion fatigue’ are widely seen as risks associated with working intensely with vulnerable participant groups, and measures are required to ensure staff are adequately supported in their role. A culture and system of reflective practice is also important to ensure staff have space to think and learn about their work, and its impact. Examples from the Pilots are provided below.

Examples from the Pilots – social and emotional support for staff

Each of the Housing First Pilots had included approaches to supporting the social and emotional wellbeing of their staff from the outset, recognising the pressures that accompany their roles. These approaches commonly included:

• a combination of one-to-one and group support
• facilitated reflective practice sessions and clinical supervision
• informal mutual support between colleagues

Consultations with support workers found that the approaches to support were valued, with particular reference being made to:

• frequent communications between support workers and team leaders – allowing challenges and issues to be discussed collectively in a spirit of openness and mutual support
• opportunities for individuals to ‘off load’ specific experiences one-to-one with colleagues – again within organisational cultures which both encourage disclosure and put systems for response in place
• open door policies – team leaders and senior staff making a clear commitment that staff can discuss issues in confidence with their managers at any time was valued
• the provision of specific, psychologically informed, support – for example in one Pilot where 2 psychologists commissioned to provide access to mental health services for participants also deliver wellbeing support and reflective practice sessions for staff

4.6. Developing Partnerships

Partnerships are essential for the effective delivery of Housing First. All stakeholders should consider which of their existing partners could be engaged further to strengthen and expand the service offer locally; maximising the knowledge and resources available to the Housing First service.

4.6.1. Awareness raising

It is important to ensure that relevant senior and operational staff from partner agencies understand the Housing First approach including how it fits with other services in housing, health and social care. Clarity around the intention for Housing First to be open-ended and sustainable is important, so share and discuss plans in order to consider together how it may be embedded in local provision.

There may be conflicting pressures and concerns amongst stakeholders, so take time to explore these and co-construct locally achievable solutions. Do not assume that other agencies will offer more flexibility with Housing First residents but do encourage them to be open to exploring new ways of working with Housing First and the individuals being supported.

4.6.2. Strategic and operational groups

Depending on the scale of the project, establish steering, strategic or working groups to provide governance, strategic support and operational oversight. Invite relevant agencies to be represented in groups including but not limited to:

• housing providers;
• probation and the police
• DWP
• health and social care agencies

Developing specific working groups can help to overcome particular challenges (for example issues with housing supply). All groups should be an open and honest space for challenges to be discussed and solutions to be found collaboratively.

4.6.3. Developing partnerships to overcome barriers

Specific barriers to delivery can be identified, or anticipated, through a systems mapping exercise. Work strategically to address them but do not assume that information agreed will filter naturally or quickly to operational staff in partner agencies. Flagging this as a potential issue from the outset may help. Development and sign off of relevant service level agreements and protocols can take time but will be beneficial in the long-term.

4.7. Housing

4.7.1. Sourcing housing

There can be numerous challenges when sourcing housing and these are especially significant when delivering Housing First at scale. At a local level, these include pressurised markets, inflexible allocations policies and competing demands with other priority groups or homelessness initiatives.

Source housing based on the local context and be creative and flexible where necessary; look to the social and private rented sectors for solutions and engage landlords through specific events. Inform them about Housing First and inspire them to be involved.

Consideration on the types and location of properties is needed. Due to the nature of the Housing First cohort, it is possible that individuals may have physical health needs impacting the types of properties required. For example, homes with ground floor access for people with mobility difficulties, properties with reduced communal spaces to support the individual manage interactions with neighbours and consideration of safeguarding in relation to property locations. This should be factored in at the planning stage when considering expectations around housing outcomes.

If a participant wishes to move out of area, take a pragmatic approach on a case by case basis. Where there is regional coordination it can reduce constraints around local connection.

Some landlords may be reluctant due to previous experiences of partnering with homelessness initiatives; provide information about the intensity of Housing First support compared to other tenancy support schemes and your plans around sustaining the support in the long-term. Celebrating early successes and sharing information about tenancy sustainment rates can help landlords feel engaged and encourage others to get involved.

4.7.2. Strategic commitment from housing providers

At scale, work with housing providers and authorities to determine allocations pathways and assess whether there is an appetite for schemes such as a social or ethical lettings agency. Recruiting specific posts to help acquire properties, or engage and support landlords, can help to broker relationships and improve delivery.

Gaining strategic commitment from housing providers can help to bring other landlords on board. Service level agreements will formalise commitments but may not instigate operational change around allocations and lettings. To address this, provide tailored information for operational staff in housing providers. Look for opportunities for frontline support staff and housing association staff to develop relationships and share knowledge and expertise.

Housing providers who also deliver support (and may be commissioned to do so in Housing First) are likely to be more flexible and forthcoming with properties. However, it is important that the support and housing functions are managed separately in line with the principles.

4.7.3. Sourcing homes from the private rented sector

Depending on the availability of social rented properties, and in order to maximise choice for individuals, sourcing homes from the private rented sector should be considered. The dynamics and processes of working with private landlords will vary depending on what type of property owner they are. However the standard of the property and ensuring the landlord complies with the law are essential when sourcing homes and considering ongoing management.

You may look to offer assurance to landlords through offering bonds or other financial commitments around potential damage to properties. Local and ethical lettings agencies can be a good way at gaining support and housing offers from private landlords, whilst providing a scheme that can manage placements effectively. Be mindful not to over- inflate the local private rental market by offering incentives above those that exist already.

5. Housing First delivery

As the Pilots progress there will be much more to learn about effective delivery of Housing First support, including where and how to involve multi-agency stakeholders. Early learning is documented here and will be updated in the future.

5.1. Housing First services

The range of support offered under Housing First varies between areas, influenced by existing service availability, the needs of individuals, and the scale of the project. As a minimum, services comprise teams of support workers who provide direct support and a ‘navigator’ function to help individuals access any additional support when required. This will necessarily include help in finding and securing a tenancy, preparing a new property for occupation, and negotiating access to social security (welfare benefit), physical and mental health, education and, for some, employment services. Where appropriate, support workers may also represent individuals’ interests in discussions with probation service workers and the police. Support workers also have a role in assisting the individual to integrate into their local community, and to help them to identify and work towards their goals and aspirations.

Given the multiple and complex needs affecting Housing First participants, close working with partner agencies is essential in ensuring that these needs can be met – as well as during the planning stage to identify potential service providers and gaps in provision. In some cases Housing First services extend beyond the ‘support and navigation’ functions to include more ‘specialist’ support as part of their core offer, as in the examples from the Pilots below.

Examples from the Pilots – services provided

All three Pilots include teams of support workers, based in contracted providers or delivered internally, whose roles include engaging new individuals, providing the support required to secure a tenancy, and providing continued support for social and community integration and a ‘navigator’ function to help to ‘navigate’ access to other services an individual needs (according to their choice).

The range of support worker activities is matched only by the diversity of need amongst the participant group, which can also include helping secure benefits, addressing long standing debts, accessing physical and mental health services (often for long-standing conditions that may have gone unaddressed), finding treatment opportunities for drug and alcohol use, representing individuals’ interests in involvement with the criminal justice system, and helping individuals settle into their new homes by providing help with furnishing, cooking and cleaning. In the longer term, support workers play an important role in working with individuals that leave or lose their housing, in addition to support focusing on the individual’s goals and aspirations. While Housing First services can help individuals address the challenge and issues facing them, the focus should be on the longer term and equipping the individual with the life skills and resilience necessary to integrate into society and build and maintain self-esteem.

While in most cases individuals are supported to access mainstream mental and physical health services, two of the Pilots recruited staff with specific health remits to support those on the caseload. In one Pilot two FTE Dual Diagnosis Practitioners were contracted from the local mental health trust, with a view to increasing to four later, to provide specialist mental health provision to individuals. They are also intended to help improve joint working with mental health and substance misuse services, and to help overcome the barriers individuals with complex needs face in accessing support for mental health and drug/alcohol use. In another Pilot, two psychologists have been contracted from a local hospital to work with both individuals and staff, the latter as part of the Pilot’s approach to supporting their emotional and wider wellbeing. In common with the Pilot mentioned above, it is anticipated that these dual diagnosis workers will similarly help negotiate access to specialist mental health services for those being supported.

5.2. Entering and exiting Housing First

5.2.1. Eligibility criteria

Previous evaluations of Housing First services show they are most cost-effective for individuals who face multiple needs and exclusions and for whom other housing pathways and support options may not be suitable.

People who are able to access and sustain contact with other types of housing services may require housing are highly unlikely to require the intensity and longevity of support afforded through Housing First. This being so, manage expectations of other agencies that may refer to the service.

If working across multiple authorities or service providers, establish shared eligibility criteria and ensure that these are understood by stakeholders.

Examples from the Pilots – eligibility criteria

Each of the Pilots developed their own eligibility criteria around the broad themes of homelessness and multiple and complex needs.

In one Pilot area eligible individuals must have multiple needs and not able to be accommodated through an existing pathway. A common methodology is applied to ensure consistency across local authorities, with a paper- based assessment tool being developed based on a slightly adapted version of the New Directions Team assessment. It was emphasised, however, that the resulting scores are not in themselves the sole means of determining an individual’s eligibility, and there is room for discretion in the application of the criteria. The assessment tool comprises 12 domains, covering:

• Housing
• Social effectiveness
• Engagement with frontline services
• Risk to others
• Risk from others
• Intentional self-harm
• Unintentional self-harm
• Alcohol and drug abuse
• Impulse control
• Stress and anxiety
• Meaningful use of time
• Personal self-care and hygiene

Each is rated on a five-point scale to capture an individual’s level of multiple need and exclusion - with a maximum score of 60, an indicative threshold score for eligibility was set at 38, although this is not applied rigidly and is subject to review. In addition to this score, other considerations include: the level of interest in taking up the Housing First offer, willingness to take up an independent tenancy, the level of perceived risk posed by their current lifestyle, and any forthcoming events likely to negative impact on their ability to start a tenancy.

In a second Pilot, a set of eligibility criteria for the test and learn pilot were established. Eligibility was not determined using a single tool but rather through a combination of methods, which included personal choice and histories of:

• Homelessness or unstable housing
• Repeated substance misuse
• Enduring mental and/or physical health issues
• Profound learning difficulties
• Long term and deteriorating physical health
• Repeat offending

In addition, the criteria also include judgements on whether other alternative service options would pose a significant risk to the individual. On referral, individual circumstances and histories were viewed in the round by a multi-agency panel set up for the Pilot to establish whether the threshold for participation had been reached.

To be eligible to join the third Pilot programme, individuals should in addition to being homeless have at least two of the following needs:

• Entrenched rough sleeping
• Affected by poor mental and/or physical health
• A history of offending
• A history of domestic abuse
• Individuals serially excluded from services
• Individuals with substance misuse issues

The criteria applied for joining the programme are therefore:

• Being homeless or at risk of becoming so, or entrenched rough sleeping, and have complex needs
• Individuals with complex needs and are identified by housing advice agencies or other partners likely to become homeless within 56 days
• Having at least two additional needs (above), with the chaos index/New Directions Team Assessment being used where needed to determine eligibility based on the highest need
• Being at risk of exclusion from mainstream or supported housing due to behaviour, previous behaviour or complexity of needs
• Having the mental capacity to enter into and understand that they are entering into a legally binding tenancy agreement

However, as in other areas, the professional judgement of staff is key in determining an individual’s appropriateness for the service.

5.2.2. Assessing eligibility

One tool that can be used to assess eligibility for Housing First is the New Directions Team assessment. This tool helps stakeholders be more objective in determining need, based on behaviours and vulnerability, and can help to prioritise individuals.

However, the assessment process should ensure that particular groups (e.g. women, care leavers) are not overlooked. They may score low on the tool due to their patterns of contact with services. Allow referring agencies and assessors to be flexible in their decision making to ensure vulnerable people are not excluded.

Part of the assessment process may include the individual’s willingness to have a tenancy or any particular events or circumstances which may impact this significantly. Opinions about an individual’s ability to sustain a tenancy, in light of previous housing history, should not be factored in and steps should be taken to prevent ‘cherry picking’ (where individuals are selected primarily on the basis of providers’ perceptions regarding their likelihood of achieving an outcome, rather than their level of need).

Finally, irrespective of the eligibility criteria followed or tools used, providers should consider how the Housing First recruitment process services is experienced by individuals. From the individual perspective the process should be as light touch as possible, to avoid triggering previous trauma. It is not uncommon for individuals to disclose previously unknown issues once they have established trust with their support workers, and so the recruitment process must balance the need to collect sufficient information to identify and address individual’s needs with appearing bureaucratic and intrusive.

5.2.3. Referral and decision making processes

Tailor the referral process based on local context and the scale of delivery. If delivering at scale, preparation work with referring agencies can take time but will be useful in ensuring that referrals made are appropriate. Where there are competing homelessness programmes ensure sensible decisions are made based on which individuals would benefit from Housing First in the long-term; this may mean moving people across programmes in some circumstances.

Decisions to accept someone onto Housing First should be made by a panel. This will reduce the likelihood of overly subjective decision making and increase control and oversight of the partners involved. Panel meetings should include the support provider and could be undertaken at existing multi-agency forums if appropriate.

During this process try to reduce layers of bureaucracy, guard against unrealistic timeframes and ensure the process mitigates raising expectations of individuals that may be wrongly referred. Meetings between the Housing First team, referring agency and individual can be very constructive but are difficult to arrange, resource intensive and can delay the process. Look to ensure these can be delivered with maximum flexibility.

Expect that some individuals may be difficult to locate or initiate contact with after the point of referral. Those accepted onto Housing First will not necessarily be ready to engage immediately in the process of finding housing, and engagement with support may be intermittent. Some eligible individuals may even decline the offer of Housing First, in which case they should be given an ‘open referral’ and the ability to access the service whenever they choose. See section 5.3.3 for more information on the initial engagement period.

As the experience of the Housing First Pilots suggests, support teams must balance maintaining an ‘open door’ policy for individuals meeting the eligibility criteria but choosing not to access the service, with the most effective use of their resources. Much time can be spent attempting to engage, or maintain contact with, those who are ‘harder to engage’, sometimes with limited results. However it is these very people where Housing First can have the greatest impact, so tolerance around engagement, and an understanding of the difficulties some people have accepting support, must be taken into consideration.

The scope of the service, and availability of other outreach provision in your area, will determine the time and flexibility given to the pre-tenancy engagement phase of the support work. Intensive outreach can be seen as an important part of the service as it allows a trusting relationship to be established where other services are unable to dedicate this capacity. Challenges to engagement may therefore be expected and factored in.

In other cases, decisions may be made about when the Housing First team should stop trying to make or sustain contact to ensure the resource is used effectively. It is recommended that this is done on a case by case basis and that an open referral is in place should that person wish to access the service. Contact from the Housing First team may continue sporadically or other providers, such as the outreach team, will continue to attempt engagement and offer the service.

Top tip – engaging potential participants

The experience of the Pilots suggests that a range of strategies can be employed to engage new participants. These include where individuals may be reluctant to engage for a variety of reasons, including feelings that they have been ‘let down’ by services or where their experience of trauma make it difficult for them to accept help, trust others and reengage with perceived authority.

Support workers report that providing potential participants with a clear understanding of the Housing First programme, and the degree of choice around where they are housed and the services they receive, can be helpful in differentiating their services from existing provision.

The Pilots provide copies of this guide for people offered Housing First.

5.2.4. Exit arrangements

Commissioning and delivery should not be profiled with an expectation that individuals will be moved through the service within a given timeframe or after a period of housing stability. In line with the key principles, cases should remain open and active. Exceptions to this might include where an individual moves to another area and continuing support would be difficult, or if an individual will be absent for a prolonged period, such as for a significant prison sentence.

Individuals that choose to exit the programme should be graduated or phased away from support in a process of ‘active disengagement’. It may be suitable for them to be referred to less intensive support provision such as other local floating support services. In one Housing First service in England a dedicated role is funded to provide a ‘step down’ support service. They work as part of the team adhering to the principles but have a higher caseload than colleagues; working with individuals who no longer require high-intensity support but who would still benefit from contact with the service.

Individuals who disengage for a prolonged period, where repeated attempts to re-engage have been unsuccessful, should remain as a dormant case on the caseload. Should they wish to re-access the service this should be facilitated. Equally, those who have graduated away may at times want to re-contact the service for support and should not have to go through a formal referral process to re-access it. In the case of the Housing First Pilots, the evaluation will explore processes and practice on the ground in terms of exiting or maintaining individuals on caseload.

5.3. Delivering support

The provision of intense, flexible support to individuals, with caseloads of between five and seven people per support worker, is a defining feature of the Housing First approach. Central to this is the relationship between the individual and their support worker, which should be built upon commitment and trust which in many cases takes time to establish, especially when previous experiences of support services have been negative.

In these cases, the ability to deliver positive benefits, such as supporting them to find and settle into their home, offering real choice around the support accessed, and working with people to identify their goals and interests can evidence this commitment and further engender trust. While support workers must be mindful of creating dependencies within what can be long-term relationships, this risk can be mitigated, for example by increasing contact with other support workers and services, building wider support networks in the community, and by ensuring the staff have access to adequate support to manage these relationships effectively.

5.3.1. Timescales

It is important in moving from development to delivery stages to ensure that the necessary policies and procedures, and arrangements to working with external stakeholders, are in place. For example, opening referral pathways when teams are not at full capacity can lead to higher than recommended caseloads which can compromise programme fidelity.

Senior stakeholders and funders should not pressurise providers thereby enabling support to be adequately tailored around the individual. This will allow for maximum flexibility and opportunity for positive engagement. Providers should be realistic with stakeholders about timescales from the outset.

5.3.2. Support hours

Although Housing First support should be tailored and flexed around the needs of individuals, it is likely that most of this can be provided within normal office hours. Support workers should have the autonomy to flex their working hours to meet the needs of those on their caseloads and should expect to be able to do so if necessary. Offering out of hours telephone support is useful for checking well-being and can also offer a point of contact for landlords, partner agencies and neighbours where appropriate.

The number of hours of support per individual each week will vary depending on their needs at any given time; they are more likely to need a lot of support when they first move into housing but this should taper over time. However even when individuals appear to be settled in their accommodation they may still experience crises, and intensive support worker intervention be required.

Introducing individuals to several team members will help to increase their rapport with the service, increases their support network and safeguards against disengagement should their support worker be absent.

5.3.3. Initial engagement period

Services and stakeholders should expect that some individuals may be difficult to locate or initiate contact with post referral. Each person’s journey into housing will be different. Initial assessments by Housing First staff should be light touch and undertaken verbally.

Some people may be reluctant, or fearful, of the support and housing on offer and the initial engagement may need to be taken more slowly to enable the necessary trust to be built. Peer mentors can have more success especially where individuals are reluctant to engage.

Individuals should not be expected or forced to accept assistance with housing. The principle of choice applies strongly here; the individual must want to take on a tenancy.

Don’t make promises, define timescales or pressure individuals to engage or make decisions. Take time to build a relationship and explore the individual’s interests and preferences around housing. Focus on achieving the softer outcomes which are important at this stage such as improved levels of engagement and positive conversations about accessing housing. Work at the pace of the individual; offering temporary or bridging accommodation in the interim can better enable this process.

5.3.4. Identifying harm and risk

Whilst it is important to understand the risk an individual may pose or be vulnerable to, identifying any such risk should be done in a way which reduces stigma and identifies resiliency factors. Housing First is underpinned by strengths-based and harm reduction approaches so focus on ‘safety’ rather than ‘risk’.

It is easier to have difficult conversations when a level of trust has been established. Be open and transparent about why information is required and be reflective regarding when and where such discussions are held. Make these interventions purposeful and meaningful for both the service and the individual. Balance the wishes and choices of individuals carefully with the duty to reduce harm and improve wellbeing.

Develop safety planning protocols and work with other agencies where appropriate to plan and adopt interventions. Always involve the individual concerned and co-create safety plans with them if they are amenable to this.

5.3.5. Exploring housing preferences

Support workers play a key role in helping individuals to identify their housing preferences. Discussions about what an individual would like and the reality of the local housing context and affordability can help to manage expectations whilst still facilitating choice. Discuss both the private and social rented sectors if this will increase the options available to them.

Individuals may find it difficult to understand their options or verbalise their preferences so take this into consideration. Taking individuals to different areas and, if possible different properties, can help them to further consider their options.

Top tips – visiting areas in advance

The Pilot evaluation identified cases where individuals were choosing the areas they would like to live in based on previous recollection, sometimes from many years ago. Several support workers described taking individuals to their selected areas in advance to have a look around, which in some cases led them to change their minds.

In other cases, visits provided insights into the availability of local facilities, activities and transport provision which helped inform the individual’s choice of accommodation.

5.3.6. Meeting individual housing needs and preferences

Whatever the situation, housing identified should be affordable to individuals and whilst there may be additional funding available to increase access, take care to ensure that an individual will be able to sustain their housing costs in the long-term.

There will need to be a degree of flexibility in the allocations policies and procedures of both local authorities and housing providers. Local authorities may agree to ring-fence a certain number of nominations for Housing First and housing providers may offer a number of properties. However matching individuals to properties should take place once their requirements and preferences have been identified. This can take longer but will reduce the likelihood of voids.

Individuals with specific needs, such as those with disabilities, those with pets or those requiring low-rise properties, may need to wait longer. However, housing departments can offer more flexibility to reduce waiting times for individuals.

Flexible practice may include facilitating direct lets so that individuals don’t have to bid and being understanding about how an individual engages in the process. Missed appointments or viewings should be understood in relation to the individual’s needs and not be interpreted as non-compliance or an indication that they do not want a home.

Where specific requirements or needs are realistic but likely to take time to coordinate individuals are often offered temporary accommodation whilst they wait. The use of temporary accommodation in such circumstances is still in line with the principles of Housing First; it may increase an individual’s choice and control, can reduce harm and will assist engagement.

5.3.7. Working with landlords to deliver housing

Housing providers may pledge their support to Housing First but the actual provision of homes can be slow, process driven and hampered by bureaucracy. Work with housing providers to reduce the timeframes and requirements throughout the allocation and tenancy sign-up period. This might include streamlining paperwork or arranging for the viewing and letting to occur simultaneously.

Relationship building with housing providers’ operational staff to increase awareness of Housing First and address any anxieties can help to overcome challenges in allocations and housing management. Staff may have concerns around voids, anti-social behaviour and perceived queue-jumping on social housing waiting lists. Addressing these through training and information can help to bring people on board.

5.3.8. Furniture and personalisation funds

Funds which enable an individual to settle into their home are important in Housing First and are often included in the commissioned support contract. Service providers should have appropriate and flexible protocols to allow the Housing First staff to administer and manage these funds in a personalised way.

Ensure protocols around furnishing homes maximise choice and control for individuals. Look to increase the sources of funding and other resources available to individuals as setting up home can be expensive. Work with housing associations to explore what they can provide; some offer carpets, curtains, white goods and basic furniture packages. Service providers may also offer Home Starter packs of basic necessities.

Attempts should be made to minimise the amount of time an individual’s home is empty after tenancy sign up. Information about the types of furniture and goods that may be required, in addition to good practice for social landlords, can be found on www.endfurniturepoverty.org/resources.

5.3.9. Managing challenges in housing

To manage any challenges that may arise with particular tenancies, ensure that relevant staff from housing providers are aware of, and in touch with, the Housing First support team. Encourage them and support staff to make contact with each other in order to flag any issues early and to determine together what approach to take so that there is a collective approach to problem solving and support. Some housing providers may use an indicator on their computer system so that automatic processes (e.g. warning letters) are not instigated without the support staff being made aware.

As Housing First participants are likely to be in receipt of Universal Credit, issues with rent arrears may arise for a number of reasons. Work with Jobcentre Plus, regional DWP partnership managers and the housing providers to reduce concern and mitigate problems; including through the set-up of alternative payment arrangements.

Where unresolvable issues do arise, work in partnership to arrange managed moves wherever possible either within the housing provider’s stock (which may be appropriate if the problem relates to location or neighbourhood bullying for example) or to another landlord. This will reduce costly evictions and negative outcomes for residents.

5.3.10. Ongoing support

Whilst moving someone into housing is a significant outcome, it is often just the start of the journey. Housing First support should be open-ended and focused as much on recovery and community integration as it is on tenancy sustainment.

New residents often require a great deal of support and reassurance early on. They may have fears that they will be unable to sustain the tenancy or that they will feel isolated. There may be times when some individuals continue to sleep on the street because this is more comfortable for them. If this continues over time it may be that the property they have is not suitable for them.

Working proactively to support tenants in their new neighbourhood can help to overcome social isolation. Take time to support them to establish connections with others and to explore and engage in new interests and hobbies, and in some cases reengage with old ones.

Once someone has moved into housing, tailor the support provided to meet their needs and be ready for this to change over time. Individuals may need support around independent living skills, identifying and working to reach aspirations, and support to manage relationships and reconnect with family. Through harm reduction and motivational interviewing, staff should encourage individuals to access other services when this is right for them.

Some individuals may have particular needs in which specialist knowledge and support is helpful, such as domestic violence or hoarding. Staff should seek specialist advice as needed to enable them to deliver support appropriately.

5.4. Further information

This toolkit providers information about how to plan, mobilise and deliver a Housing First service. Continued learning from the three regional pilots will be collected through the evaluation and shared in future toolkits.

For more information on developing and delivering Housing First in England visit the Housing First England website for resources, research and to learn about training and events.

The Housing First Europe hub website provides information and evidence to support the scaling up of Housing First in Europe, including the Housing First guide - Europe on the principles and delivery of Housing First:

The Canadian Housing First toolkit is an interactive resource providing comprehensive information for those developing and delivering Housing First:

1. See a review of international evidence. ↩

2. Homeless Link (2018). Understanding the implementation of Housing First in England. London: Homeless Link. ↩

3. Bretherton, J. and Pleace, N. (2015) Housing First in England: An Evaluation of Nine Services London: Homeless Link. ↩

4. Homeless Link (2018). Understanding the implementation of Housing First in England. London: Homeless Link. ↩

5. Blood, I., Copeman, I., Goldup, M., Pleace, N., Bretherton, J. & Dulson, S. (2017) Housing First Feasibility Study for the Liverpool City Region, London: Crisis. ↩