Supportive Housing Frequently Asked Questions
What is Supportive Housing?
Supportive housing is affordable housing that provides opportunities for individuals to stabilize their personal situations and re-establish connections with the community. The housing is linked to support services that are voluntary and flexible to meet the resident’s needs and preferences.
Supportive housing can be provided in a variety of ways and takes various forms, including social housing buildings where all the units are supportive (dedicated), social housing buildings where some of the units are supportive (mixed), or in scattered market apartments with rent supplements.
The level of support varies from building to building and within buildings, as the services are flexible to meet the needs of residents. Some support services are provided by on-site staff, while in other instances support may be delivered on an outreach basis. Part of the work of the staff is to link tenants to services that are available at other locations throughout the community, in places like community health centres, schools, recreation and community centres.
Supportive housing is one type of housing available in the city. The housing continuum contains: independent housing, which can be provided in market housing or social housing; supportive housing, which is also available as both market and social housing; residential care facilities; and shelters.
Where will the 10-15 new buildings go? What are the criteria?
Supportive housing already exists in a number of neighbourhoods. Mental illness and addictions are health conditions that can affect people of all socio-economic backgrounds living in all city neighbourhoods and City Council policy is to locate supportive housing throughout the city. If it is located city-wide, it provides opportunities for people to access this kind of housing where family and friends are nearby and where they are familiar with the services and the neighbourhood.
The location requirements of supportive housing are not different from other higher density residential buildings. Supportive housing will be located within zones that permit apartments. Accessibility to transit and to commercial and community services are features in these zones.
The Strategy recommends that wherever reasonably possible, new supportive housing should be located to support geographic balance across the city. There are 14 City-owned sites that will have supportive housing:
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Is there any funding available now for new supportive housing projects?
The Province is providing $333.4 million and the Streetohome Foundation is providing $20 million towards construction as part of an agreement that will see the foundation raise money from the private sector. The City has contributed 14 parcels of land valued at about $64 million.
http://vancouver.ca/ctyclerk/cclerk/20070313/documents/rr1.pdf
http://vancouver.ca/ctyclerk/cclerk/20070313/documents/rr1appendix.pdf
What kind of treatment will people receive in supportive housing?
The supportive housing identified in the Strategy is not treatment facilities, and people do not generally receive any treatment services on site. There are different types of supportive housing – mental health, addictions, and low barrier housing, which provides services to the homeless and at-risk populations. The need for treatment is determined between the individual and the housing provider. The treatment services are provided in the community, for example at mental health teams, community health clinics, doctors’ offices, counsellors’ offices, and so on.
The housing support workers who work at the supportive housing sites are there to provide basic life skills support/coaching, to help tenants to link with community resources, and to help people maintain stable tenancy. In some settings, they provide services such as medication support or meal provision. While the housing support workers do not provide treatment, they do help clients to maintain participation in treatment. The housing support workers contact the client’s treatment team when the client is not doing well or is in need of attention, and may accompany the person to treatment if necessary. The aim of supportive housing is to assist tenants to stabilize their lives, enhance independent living skills, and re-connect with the community.
What is the staffing level at these supportive housing sites?
There are several different models of supported housing, and the staffing levels vary according to the model. In some cases, staff support is provided on an outreach basis, with housing support workers visiting tenants’ homes on a regular basis. In other models, staff may be located on site, with hours ranging from daytime only, to 24 hours a day, 7 days a week. A thorough assessment is completed with each supportive housing candidate, to determine what model of supportive housing would be the best fit for that person. People with greater needs for staff support and services would be referred to supportive housing sites that provide up to 24/7 staffing and services such as meals or medication support, while people with less need for staff support may be referred to sites that have daytime staffing only.
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How long will people stay in supportive housing?
The length of time that people stay in supportive housing varies, depending on the needs of the individuals, and on the model of supportive housing.
In the alcohol & drug-free addictions supported housing, the expected length of tenancy is around 18 months. This provides enough time for people to achieve their personal recovery goals, which may include entering school or the work force, re-connecting with friends, family and social supports, learning healthy coping strategies, and, of course, achieving a significant period of abstinence. After leaving the transitional supported housing setting, many people will be employed and able to move to market housing. Others will move to subsidized housing.
Supported housing for people with mental illnesses tends to be longer term, with no fixed limits on length of tenancy. There are a few transitional mental health supported housing sites, such as the Fraser Street site (where people may have also be in recovery from addictions), but in most mental health supported housing, the tenants become residents of the neighbourhood for many years. There is always a focus on recovery and enhancing independence in mental health supported housing, and many tenants are able to gain skills that enable them to move from more intensive to less intensive supported housing sites over time, but many people with severe mental illness require some level of support on an ongoing basis.
Is supported housing a treatment program?
Supported housing is not a treatment program. However, everyone who comes into supported housing must be engaged in regular professional treatment for their mental illness or addiction and must keep up that involvement in treatment to retain their housing. Professional treatment occurs away from the housing setting at mental health teams and community health centers, and through physicians and counselors.
Supported housing provides two very critical components: it ensures that the rent is affordable; and it provides regular supports to the tenants around learning basic life skills related to running a household, help with managing medications, support to link with community resources (including education and employment options), encouragement to identify strengths and talents, and support to maintain involvement in treatment and manage stress. There is a strong collaboration between the supported housing staff, the tenant and the professional clinician in working to help the individual maintain and move forward with their recovery.
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Will this supported housing be attracting people who do not presently reside in Vancouver?
No. Eligibility requirements are such that a prospective client must have resided in Vancouver for a year or more, or must have close ties to Vancouver (such as family, school, treatment) in order to be considered.
Is supported housing experimental?
Supported housing is not at all experimental. As mentioned above there is a 25-year history of successfully delivering supported housing for individuals with a mental illness in Vancouver. There are presently 16 apartment sites outside the Downtown Core providing supported housing for 354 people with a mental illness.
An excellent example of local experience with alcohol and drug free housing for people in recovery from addiction is the 44-unit alcohol and drug free McCready Residence, in operation since 1987. The stability of the individuals living at this site has been exceptional with the majority of tenants staying for five years or more. Evidence from other places in Canada, the United States, Britain and Australia tells us that alcohol and drug free supported housing is a well-accepted intervention. In particular, the Central City Concern organization in Portland, Oregon has created a total of 936 units of alcohol and drug free housing in that City. They have found that this housing has resulted in improvements in the number of people finishing their treatment programs, and numbers who had better paying jobs. Many people moved on to permanent social housing.
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How does supported housing improve the outcomes related to housing stability, employment, health and abstinence?
With respect to alcohol and drug free supported housing, a number of studies have compared outcomes for people who receive treatment while in alcohol and drug free supported housing and those who do not. On measures of abstinence, studies have found that individuals receiving treatment and living in alcohol and drug free settings could have between 2 to 2 1/2 times higher rates of abstinence as those in treatment but not living in abstinent housing. Similarly, studies have found higher incomes among the group living in an alcohol and drug free environment, increased social relationships, greater housing stability and fewer housing problems. Research has also shown that individuals in supported housing are three times more likely to complete a treatment program than those who are not in alcohol and drug free housing.
We know from our own local research that being in supported housing can reduce the need for emergency room visits and cut the use of hospital in half in the year after moving into supported housing. Being able to pay attention to basics such as sleep, nutrition and hygiene and having regular physician contact improves overall health.
Once people have that safe, supported environment in place they are able to focus on treatment and their recovery goals, such as furthering their education or getting a job.
How often do you expect that people living in addiction supported housing will have a lapse in their abstinence?
As is the case for any chronic health condition, lapses are to be expected in the recovery process. We do know that the high-risk period for lapses is in the first 60-90 days of recovery when individuals are in support recovery or treatment setting. While it is not possible to predict how often or how many people will have lapses once they move into supported housing, we do expect that the likelihood of lapses will be significantly reduced as we will have screened out those who did not make it through the initial stages of recovery. Any person who has lapses they cannot address immediately will be required to leave the alcohol and drug free housing and will be assisted to find accommodation elsewhere.
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What do you plan to do if they lapse?
A person in an alcohol and drug free housing setting who has a lapse in abstinence will be supported to re-commit to abstinence. This will involve active intervention by housing support staff and professional clinicians, such as the tenant’s alcohol and drug counselor and/or physician. A person who cannot re-commit to abstinence within a 48 hour time frame will be required to leave the housing setting and will be assisted to find alternative housing elsewhere.
How will you know if they have had a lapse?
There are many ways that a lapse may come to the attention of either housing support staff or the clinician. In many cases, the person themselves will report a lapse to housing support staff or to off-site clinical staff. The individuals who will be living in the supported housing are a select group who are very committed to recovery and are often involved with programs such as Alcoholics Anonymous or Narcotics Anonymous, which encourage openness and honesty regarding substance use. In other cases lapses will be reported by fellow tenants who are well acquainted with the signs of substance use, are committed to their own recovery, and want to ensure the building remains alcohol and drug free. Housing support staff and addictions clinical staff are very familiar with the signs of lapse and relapse, and will be sensitive to behavior changes or other signs that may indicate a person is using drugs or alcohol. When they observe such signs, they will intervene, including communicating directly with the tenant, as well as with other members of the support and clinical team. The final check on lapses will be the clinician who is seeing the individual in regular treatment.
Will urine testing be used?
Urine testing is not part of supported housing. It is a clinical procedure that may be used as part of a treatment program for some people in supported housing, but it is not part of the housing itself. The need to undertake urine testing to confirm drug use is a decision that is made by the clinician providing treatment based on their assessment of clinical need. For example, urine testing is routine in the treatment of individuals receiving methadone. It might also be clinically indicated if there were changes in an individual’s behaviour assessed to be substance use related. The housing support staff would be working in close collaboration with the clinician providing ongoing addiction treatment and would provide feedback about day to day functioning of the individual in the housing environment. Urine testing is a tool that may be used in combination with client self-reporting, clinician assessment and housing support staff observation for some individuals.
One study suggested that clinicians were only accurate about 50% of the time in identifying lapses as opposed to urine tests. This is likely due to the fact that they only saw the client for short periods in an office setting. In a supported housing environment these clinical observations are bolstered by the daily observations of housing support staff.
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What are the long term substance use recovery rates following discharge from a treatment program?
Substance use is a chronic health condition and like all chronic conditions cannot be “cured” but can be managed. While there are many studies with different percentages about how many people stay abstinent post treatment, generally it appears that we can expect that at one-year post treatment completion that about 40-60% will have returned to substance use. The converse of this is that 40-60% will still be abstinent. Studies do indicate that even those who return to substance use have a lower level of use.
These findings of the rate of return to substance use post treatment discharge have resulted in new ideas about the need for ongoing recovery monitoring as we do with other chronic diseases such as diabetes and hypertension.
What safeguards are in place to ensure that there will not be any negative impacts on the community as a result of the supported housing?
Before entering supported housing, prospective tenants are assessed to ensure they are eligible, understand and agree to the expectations for participation and behavior in the housing, and have the necessary skills to live as independently as the particular housing site requires. Each housing site is overseen directly by contracted service providers, and linked to clinical staff who are available to respond to community concerns or issues. The contracted service providers are overseen by management staff from Vancouver Coastal Health. Housing support staff know each tenant well, and work with tenants to address any behaviour that may negatively impact the local neighbourhood. If a tenant is not able to refrain from negative behaviours, s/he is required to leave the housing setting, and is assisted to find a more appropriate setting wherever possible.
An operational management plan may be implemented to assist a new housing site to integrate successfully into a neighbourhood. Such a plan would include regular meetings with community members to address and remedy any neighbourhood concerns about the operation of the site.
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Is there evidence of increased crime rates in communities with supported housing?
In 25 years of experience with supported housing in Vancouver, there is no evidence that there has been an increase in crime in areas around these buildings. There are 16 apartment buildings outside the Downtown Core ranging in size from 9 to 34 units that are located in apartment zoned residential neighbourhoods. A review of the complaints filed with the City’s Licenses and Inspection Department and Vancouver Police Department show few calls have been made by neighbours of supportive housing projects. In fact, the calls that have been received are often calls about activities near the address but unrelated to the tenants in the supported housing. This may be due to the presence of housing support staff, who call to report suspicious activity near the supported housing sites.
There are numbers of studies that have looked at the impacts of housing on neighbourhoods in other jurisdictions. This topic was addressed in the literature review done by CARMHA (Centre for Applied Research in Mental Health and Addiction) at SFU. It concluded that conventional fears about crime rates are not justified. The studies found that even when looking at homes for people in recovery from addiction, there was no statistically significant increase in criminal activity. However, these studies have tended to focus either on small group homes or much larger developments. One study looked at 14 supportive housing facilities in Denver to see if there was a relationship with crime rates. The overall conclusion was there was no statistically significant evidence that supportive housing led to increased crime rates. The study looked at a subset of facilities that serve mental health, addictions and corrections populations. Again they found there was no increase in crime rates. The study did identify that for buildings larger than 53 units there was an increase in criminal mischief reports, close to these seven large facilities that ranged in size from 53 units to 164 units. These facilities were for physically compromised, often elderly residents and the authors are cautious in saying they cannot definitively determine what caused the crime rate increases. It is important to note that plans for supported housing in Vancouver outside the Downtown are looking at much smaller sites of about 30 units and that sites of this size have already been successfully integrated into communities.
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What does the City plan to do to ensure crime rates in our neighbourhood do not go up? How does the city plan to keep the people in our neighbourhood safe?
As noted previously supportive housing apartment buildings are now successfully integrated into many neighbourhoods. The existing buildings located outside the Downtown core have not resulted in high police calls from neighbours. We believe this will continue with the additional proposed buildings. Ensuring Vancouver neighbourhoods remain safe is important to all Vancouver residents, workers and business owners. Everyone has a role to play. In the last few years the Police have worked in partnership with public and the media on innovative crime prevention programs and there has been a reduction in property crimes. Reducing property crimes is a priority with the Vancouver Police Department.
Prevention is an important part of keeping neighbourhoods safe, and we are confident that the staffing associated with supportive housing buildings will result in adequate surveillance to ensure safety of the tenants, and to discourage unwanted activity coming into the buildings. In addition the Police are committed to responding quickly to any reported criminal activity.
Will Vancouver Police respond in a timely way to calls related to this facility?
The police have indicated they will provide the same response to supported housing that they provide to other establishments in the community. Some facilities report that crime declines in the vicinity of the building because of the increased surveillance provided by the staff. People living in addictions housing will be stable people who do not need to engage in crime to support a drug habit.
Will property values be affected?
A literature review by CARMHA (Centre for Applied Research in Mental Health and Addiction) at SFU indicates that property values have not declined with supportive housing. The report looked at 18 different studies and found there was no significant effect on either the sales price of homes in the neighbourhood or on the number of sales. A 1996 study by the Housing Ministry in BC looked at the impacts of seven social housing projects on neighbouring property values. The study demonstrated that social housing projects have not had a negative impact on the sale prices of nearby homes based on a comparison with a control area.
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What is being done with respect to planning for other high needs groups such as seniors, people with physical disabilities and for families with children?
It is important to note that the housing for individuals with a mental illness or an addiction does not exclude seniors, single mothers or physically disabled individuals as these populations are all served. However, Vancouver Coastal Health is also working on specific developments for high health risk groups. Over the past three years 270 units of subsidized assisted living for seniors have been developed. Another 304 units are in construction at four sites in Vancouver, which will be fully operational by the spring of 2008. The development of these sites has been a partnership between non-profit organizations, BC Housing and Vancouver Coastal Health. Funding for the housing is from BC Housing and funding for the support services from Vancouver Coastal Health. The projects were all selected through a competitive Request for Proposal process that was held in 2003.
Vancouver Coastal Health is also adding supported housing options for individuals with physical disabilities and acquired brain injury, in order to support individuals to be able to live as independently as possible in the community.
There has also been a recent introduction through BC Housing of a rent supplement program for low-income families that provides them with some rental assistance in the private market. This program is open to any family who is eligible based on income. The Province’s recently announced budget included:
- Funds to convert social housing units to supportive housing to make them more accessible for seniors and others with special housing needs
- Extending eligibility for the Home Owner Grant to lower-income seniors, regardless of their home’s assessed value
- Allowing people to start deferring their property taxes at age 55 rather than age 60.
The City’s social housing priorities include a range of people - low and modest income families with children, seniors on fixed incomes or in need of support, SRO residents, and the mentally ill, physically disabled, and others at risk of homelessness. The City is working with the Provincial government and its programs to provide housing for these groups – for example providing density bonusing and parking relaxations for buildings housing low-income seniors and others
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