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Mental Health

Where’s the CASH (Centralized Access to Supported Housing)?

Reflections on the evaluation of a single point of access to supported housing in Victoria, BC

Trudy Norman, PhD and Bernadette Pauly, RN, PhD

Visions Journal, 2017, 12 (3), p. 31

Like many regions in Canada, Greater Victoria faces ongoing concerns related to homelessness. More than 1,700 people use emergency shelters in the area throughout the year1; on any given night, almost 1,400 people experience homelessness.2 Social and supported housing is an important resource for people experiencing or at risk of homelessness. Accessing this resource isn’t easy: individuals and families must often navigate complex and fragmented service systems to obtain social and supported housing. This is very much the case for people experiencing poor mental health and/or using substances. Centralized or “single-point access” programs have been developed in the United States and the United Kingdom to help people find their way through these complex systems. CASH (Centralized Access to Supported Housing) is a program developed to help individuals access supported housing in the Greater Victoria area.*

CASH was launched in May 2012. The objectives of the CASH program are to ensure fairness and equity for everyone seeking supported housing. Applicants may submit a single application through a worker at any social agency with the goal of timely referrals and a clear referral and selection process. CASH also aims to use supported housing resources efficiently and encourages housing providers to share their experiences and best practices. After three years of operation, the CASH program was evaluated3 to determine if these objectives were being met and to learn about the successes, challenges and impacts of the CASH program, including whether or not it was consistent with Housing First principles.4

This evaluation (sponsored by the Greater Victoria Coalition to End Homelessness) highlighted that the CASH program received 2,171 referrals between June 1, 2012, and May 31, 2015. Referrals for males outnumbered referrals for females at a ratio of almost 2:1. Approximately 20% of the referrals were for people who self-identify as Aboriginal. Of those referred, 566 people were housed and 277 people were put on the CASH waiting list. The remaining referrals were closed for various reasons. Each month, the number of referrals exceeded the number of units available, with the waitlist for supported housing continually growing. For those fortunate enough to receive housing, the process took on average eight months from the date of referral to the day the individual was housed.

While the CASH program offered a single point of entry for application, which was viewed as a positive feature, and referrals could be made by any agency worker, the referral process was both ambiguous and slow. An unexpected and positive outcome of CASH was greater collaboration among housing providers than before the CASH program began.

A key concern among clients and referral agencies that took part in the evaluation was the lack of client involvement in the CASH process. Clients felt stressed and anxious about the CASH process and often had little information about the program. In the words of one client, “I had to actually ask what CASH stood for, and that was just a month ago. But when they said ‘CASH referral,’ I didn’t know that it was an acronym, so I’m thinking cash referral, I’m thinking, okay, cool!”5

Clients often had no idea where they were on the waiting list and if or when they might receive housing, often waiting months to hear the outcome of the review of their application. Even more concerning is that clients and others described the application process as traumatizing; clients were asked detailed questions about their personal lives and were not clear where their information was going or who was going to see it. This negatively impacted client health and well-being.

Specific attempts to ensure the design of the CASH process was comprehensive and objective (by removing clients and service providers from the selection process) had unintended consequences. The exclusion of clients from the process is contrary to recent developments in Housing First, drug user, HIV/AIDS and mental health consumer movements, which embrace the view that services such as housing and supports are more appropriately designed and delivered in partnership with service users.6

It became clear from the evaluation that it would be very difficult for the CASH program to meet its objectives due to three factors: a limited supply of housing, a lengthy referral and waitlist process, and a lack of understanding of the CASH program and process within the community. Victoria has a very low vacancy rate in market housing and long waitlists for social housing. Without a supply of housing, CASH cannot place people directly into permanent housing. CASH cannot therefore be considered a Housing First program, and without housing options it is difficult to incorporate Housing First principles. Essentially, CASH is a waitlist service for housing in a community with an inadequate supply of low-cost housing for those in need.

We made several recommendations for changes that may enhance the CASH program:

  1. Implement a community education plan around the CASH program.

  2. Provide more detailed information about CASH on the program website, http://victoriasupportedhousing.ca.

  3. Include clients at all stages of the CASH process. For example, clients should be able to easily access information about the status of their application and participate in redesigning CASH referral forms. 

  4. Revise CASH processes (e.g., referral forms) to limit the information collected to that which is relevant for determining waitlist standing so that there is a balance between protecting an individual’s privacy and collecting the information necessary to make good decisions.

  5. Establish a CASH partners lobby for increased investment in social and supported housing and greater access to rental supplements and rental market housing.

The Greater Victoria Coalition to End Homelessness has committed to reviewing the results of the evaluation and, where possible, implementing our recommendations. Changes that streamline the CASH process and embed client participation at all levels will undoubtedly enhance the program, particularly for clients. It will also be critical to identify what services must be available to clients in order to support transitions to housing and to ensure access to mental health and substance use services, including harm reduction services.

Key, however, is increasing the supply of safe, adequate, affordable housing options for people who seek social and supported housing. Without significant increases to affordable housing stock and enabling access to market housing with supports as needed, no program, no matter how well designed or intentioned, can meet the needs of those it seeks to serve. Indeed, in this case, the deck chairs on the Titanic can only be rearranged.

*Editor's note: The supportive housing stock in CASH’s registry is different than the stock in BC Housing’s supportive housing registry so someone in Greater Victoria could apply to both registries.

 
About the authors

Trudy is a Postdoctoral Fellow at the Centre for Addictions Research of BC at the University of Victoria. Her research focuses on social inclusion and the social determinants of health and social movements involving people who experience homelessness. She has worked with people who experience homelessness for 30 years

Bernie is an Associate Professor in the School of Nursing and a Scientist at the Centre for Addictions Research of BC at the University of Victoria. She is a Provost’s Community Engaged Scholar and the Island Health Scholar in Residence. Her research focuses on substance use, health equity and the social determinants of health

Footnotes:
  1. Albert, M. & Penna, T. (2015). Homelessness in Greater Victoria: 2014/15 Report on Housing and Supports. Victoria, BC: Greater Victoria Coalition to End Homelessness, 30.

  2. Albert, M., Penna, T., Pagan, F. & Pauly, B. (2016). More Than a Number: 2016 Greater Victoria Point in Time Count Summary Report. Victoria, BC: Victoria Community Social Planning Council.

  3. The results of this evaluation can be found at http://victoriahomelessness.ca/get-informed/coalition-reports/.

  4. Housing First Toolkit/ What is Housing First? (2015). Retrieved from www.housingfirsttoolkit.ca/key-questions1#1whatishousingfirst.

  5. Norman, T. & Pauly, B. (2015). Centralized Access to Supported Housing (CASH), Victoria, BC: Evaluation of a Single Point of Access to Supported Housing. Retrieved from www.victoriahomelessness.ca/get-informed/coalition-reports/, p. 1.

  6. Jurgens, R. (2005). “Nothing About Us Without Us”—Greater, Meaningful Involvement of People Who Use Illegal Drugs: A Public Health, Ethical and Human Rights Approach. Toronto, ON: Canadian HIV/AIDS Legal Network.

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