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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Housing First—The Triage Experience

Leslie Remund

Reprinted from the "Housing and Homelessness" issue of Visions Journal, 2007, 4 (1), pp. 30-31

In 2000, Triage Emergency Services & Care Society began to adopt a new housing model, called Housing First. This model was created in the US to respond to chronic homelessness.

From years of operating an emergency shelter in Vancouver's Downtown Eastside, we knew that local shelters were operating over capacity and that many of the same people were returning over and over again. Our statistics showed that over 54% of people were repeatedly returning to Triage Shelter. A significant group of people had either never secured housing between their shelter stays, or they had lost their housing shortly after moving in.

This trend of repeated shelter use was being reported across North America. Homelessness organizations were talking about the "shelterization" of the homeless population. Emergency shelters that were intended to be a short-term solution to a person's housing crisis were becoming, for some people, their only real housing option.

Housing First programs provide direct access to housing. Unlike housing programs that have specific conditions that need to be met in order to become a tenant, the goal is to re-house the person regardless of past or current behaviours. In Housing First projects, we don't, for example, require mental health treatment plans, addiction recovery, or other forms of compliancy prior to moving in.

Once a person is housed, staff support and work with the tenants to solve any issues that create problems in housing. This approach can greatly reduce the amount of time people spend homeless.

Princess Rooms

Triage's first project, Princess Rooms, opened in 2001 to house chronically homeless men and women. We knew the tenants would primarily be active substance users, that most had a mental illness and that they rarely accessed health treatment or medication. They had histories of evictions, had lived with no fixed address for lengthy periods of time or had adapted to a transient, street-based lifestyle. Our goal was to provide a high-tolerance environment that would create housing stability.

We learned a lot from the early days of Princess Rooms. We learned that there is often a transition period that our tenants undergo from being homeless to being housed. We learned that people who have spent significant periods of time homeless have difficulty trusting others. Most feel excluded from the systems that are supposed to help them. We learned to be patient as people adjust to indoor living at their own pace.

We learned that people who have been homeless develop survival skills; the streets are rough. Violence, aggression, problem guests, damage to rooms and buildings, hoarding, psychosis and non-payment of rent are all behaviours that we routinely encounter.

We created formal partnerships with health care providers and community organizations to increase our tenants' access to services. We brought services to the tenants. People's health issues, mainly untreated, include mental illness, addictions, HIV, hepatitis (A, B and C), wounds and abscesses, poor dental health and malnutrition. Connections to psychiatric treatment, doctors and other health care providers increased.

We researched current best practices and implemented the Strengths Perspective1 for our support work and case management. This model of working with people was designed by the University of Kansas School of Social Welfare. Instead of focusing on a person's weaknesses, deficits or "issues" and trying to 'fix' them, we focus on their strengths: resiliency, knowledge from past experiences, personal interests, hopes and skills. These strengths are often the same personal resources and talents that have helped the person survive and continue on through incredibly difficult situations. We also emphasize harm reduction† and health promotion, within the strengths-based approach.

We advocated with government funders for higher than usual - but appropriate - staffing levels. Typically, supported housing projects have one or two day staff and may or may not have overnight staff. Our Housing First projects have a minimum of two staff on at all times.

Despite the numerous challenges, we were encouraged by our success. Men and women who had previously been unable to maintain their housing for any significant period of time were actually staying.

The Vivian

Building upon the success of Princess Rooms, the Vivian Transitional Housing Program for Women opened in November 2004. The Vivian was a response to the unique needs of chronically homeless women.

We found that women were less likely to enter the shelter system, and if they did come to Triage Shelter, they stayed for a much shorter time than men stayed. And, disturbingly, the majority of women were checked out of the shelter to unknown circumstances. Women's survival mechanisms on the street often differ from men's. For example, many women will find an overnight or temporary solution, like staying on a floor or couch of an acquaintance, before choosing a shelter. Our statistics at Triage Shelter from 2003 showed that out of 345 women intakes, 43% of the women checked out to unknown circumstances, compared to 27% of male intakes.

The Vivian recognizes that there is a complex interrelationship between women's mental health, substance use, homelessness and experiences with violence. Existing services were designed to work with one aspect of women's experiences, but often excluded others. For example, many women who use substances can't access adequate mental health care, or women who live with daily exposure to violence because of sex trade work don't fit the mandate of women's transition houses. No women's housing project was specifically designed to work with chronically homeless women.

The Vivian houses the most marginalized women in our community. These women, based on their housing histories, are the least likely to succeed in supported housing, mental health, addiction or women's services.

Despite all the challenges associated with operating Housing First projects, Triage recognizes that housing stability leads to enhanced health and well-being. We believe that housing is a basic human right.

About the author
Leslie is Associate Director of Triage Emergency Services & Care Society. She's been a front-line worker in Downtown Eastside emergency shelters, and an HIV street outreach worker. Leslie has developed and coordinated homeless services, and has presented at conferences on women's issues, including homelessness, concurrent disorders and barriers to care.

 1. Saleebey, D. (2006). The strengths approach to practice. In D. Saleebey (Ed.), The Strengths Perspective in social work practice (4th ed.). Boston: Allyn & Bacon.


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