docs admin 1010171-v1-resource-guide_final1

Fred Victor Centre, Toronto Men’s Enhanced Support Program, Ottawa

The Oaks, Ottawa St. Andrew’s Place, Ottawa

Brigid’s Place, Ottawa Birchmount Residence, Toronto

PROGRAM REVIEW RESOURCE GUIDE Selected Longer Term Housing Stability Programs for

People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa

July 2011

Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa

Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing

Homelessness in Hamilton, Toronto and Ottawa

by

Social Planning, Policy, and Program Administration Regional Municipality of Waterloo

© Regional Municipality of Waterloo, 2011 Parts of this report may be reproduced on the condition that

proper reference is made to the Regional Municipality of Waterloo.

Recommended citation: Social Planning, Policy and Program Administration (2011). Program review resource

guide: Selected longer term housing stability programs for people experiencing homelessness in Hamilton, Toronto and Ottawa. Waterloo, ON:

Regional Municipality of Waterloo.

ISBN 978-0-9868622-2-9

Should you have any questions about this report please contact: Regional Municipality of Waterloo Social Services

99 Regina Street South, 5th Floor, Waterloo, ON N2J 4G6 Tel.: (519) 883-2117 Fax: (519) 883-2234

This report and the other six background reports are available on-line at:

www.regionofwaterloo.ca

Docs #952038

Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa Acknowledgements Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa was made possible through the committed staff and managers of the programs described within. Thank you for devoting significant time and effort to participating in face-to-face meetings, editing program drafts and remaining open and responsive to follow-up communication over the past two years. Report Contributors: Primary Nicole Francoeur Social Planning Associate, Social Planning, Policy and Program Administration Support: Marie Morrison Manager, Social Planning, Policy and Program Administration Lynn Randall Director, Social Planning, Policy and Program Administration Collette Whelan Program Assistant, Social Planning, Policy and

Program Administration

Funding for this report was provided by:

Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa Table of Contents BACKGROUND .............................................................................................................. 1 STRUCTURE .................................................................................................................. 2 LEVEL 5 PROGRAMS (MANAGED ALCOHOL) ........................................................... 5

The Annex Harm Reduction Program (the Annex) ...................................................... 5 Managed Alcohol Program/Men’s Enhanced Support Program (MESP) ..................... 9 The Oaks ................................................................................................................... 15 Claremont House Special Care Unit (Claremont House ............................................ 16

LEVEL 4 PROGRAMS (SUPPORT) ............................................................................. 23

Brigid’s Place ............................................................................................................. 23 Fred Victor Housing ................................................................................................... 29

LEVEL 3 PROGRAMS (ACKNOWLEDGEMENT) ....................................................... 32

515 MacLaren – Supportive Housing for Women ...................................................... 32 Overview of Hope Living, St. Patrick’s Residence and St. Andrew’s Residence ....... 36

Hope Living (Stage 1) ............................................................................................ 36 St. Patrick’s Residence (Stage 2) ........................................................................... 37 St. Andrew’s Residence (Stage 3) ......................................................................... 38

Options Bytown .......................................................................................................... 39 LEVEL 2 PROGRAMS (DAMP) .................................................................................... 41

Birchmount Residence ............................................................................................... 41 SUMMARY .................................................................................................................... 44 REFERENCES .............................................................................................................. 45 LIST OF APPENDICES Appendix A: Brigid’s Place Agreement to Reside ........................................................ 46 Appendix B: Birchmount Residence Community Contract ........................................... 47 Appendic C: Annex Care Compared to Usual Shelter Care ........................................ 51 Appendix D: Promising Practices: Specific Design Features ....................................... 52 Appendix E: Site Visit Data from Other Communities .................................................. 57 Appendix F: Local Site Visit Reference Information ..................................................... 58 Appendix G: Summary Table of Level 3-5 Programs in Other Communities ............... 59 Appendix H: Site Visit Reference Information In Other Communities .......................... 60 LIST OF FIGURES Figure 1. Background Reports Informing STEP Home Year 3 Evaluation ...................... 2 Figure 2. Substance Use Services Continuum in the Context of Housing ...................... 3 Figure 3. Medical Services Continuum in the Context of Housing .................................. 3 Figure 4. Timeline: Opening of Managed Alcohol Programs .......................................... 5 Figure 5. Claremont House Special Care Unit – Resident Composition ....................... 21 Figure 6. Shepherds of Good Hope Housing Continuum ............................................. 36


1

BACKGROUND In September 2007, the Regional Municipality of Waterloo (the Region) released a report of the Ad-Hoc Working Group on Persistent Homelessness1 (the Persistent Report). The Persistent Report was one of ten background reports commissioned as part of a larger project – the development of All Roads Lead to Home: A Homelessness to Housing Stability Strategy for Waterloo Region (the Strategy). The Strategy was released in 2007 and was designed to promote housing stability in Waterloo Region.

One of the actions of the Strategy was to “Develop a strategy for flexible, affordable, low demand housing with support for people experiencing persistent homelessness”. The Program Review Resource Guide: Selected Longer Term Housing Stability Programs for People Experiencing Persistent Homelessness in Hamilton, Toronto and Ottawa (Program Review Resource Guide) has been developed in response to this action. The Program Review Resource Guide summarizes features of innovative programs designed to serve people experiencing persistent homelessness. Data has been collected through site visits conducted throughout the spring and summer of 2009 at various supportive housing programs in Hamilton, Toronto and Ottawa. Each site visit involved a tour of the program by front-line staff, an open-ended interview with a supervisor and/or front-line staff and an informal conversation with residents/tenants2, as available and appropriate. Several appendices further inform the Program Review Resource Guide.

This document has been produced to support local planning and program development and informs the companion document We’ll Leave the Lights on For You: Housing Options for People Experiencing Persistent Homelessness Who Use Substances (Alcohol and/or Drugs) (Lights On). The Lights On report explores approaches to services and introduces a substance use and medical services continuum in the context of housing.

1 A variety of scenarios indicate that a person may be approaching or experiencing persistent homelessness: • When homelessness has become the new “normal” and skills are oriented to surviving on the streets rather than living in housing. • When there is a longer term pattern of cycling between experiencing homelessness and being at-risk of housing loss. • When a person may not be strongly connected to the idea of more “conventional housing” (e.g., family home, housing covered under the Residential Tenancies Act, 2006 or Long Term Care). • When it would be challenging to find another suitable alternative if the current housing was lost. • When a longer period of time may be needed to build a trusting relationship with another person. • When a person has either extensive use of emergency services and/or a large number of disconnections with community-based programs. 2 Note that “tenants” is used to describe housing participants who are covered under the Residential Tenancies Act, 2006 (RTA) and “residents” is used to describe those who are not covered under the RTA.


2

It provides an overview of select supportive housing and community support services for people experiencing persistent homelessness both locally and across Ontario. Promising practices and recommendations for moving forward are included. The Lights On report is available on the Region of Waterloo’s website at www.regionofwaterloo.ca. Resources to support this report were provided through The Aging at Home Strategy (2008-2011). The Aging at Home Strategy is a provincial initiative that was launched by the Ministry of Health and Long-Term Care (MOHLTC) and administered by the Local Health Integration Networks (LHINs). This Program Review Resource Guide serves as one of seven background reports informing the STEP Home3 Year 3 Evaluation Report. All STEP Home background documents are illustrated in Figure 1.

Figure 1. Background Documents Informing STEP Home Year 3 Evaluation

STRUCTURE The programs described in this document are presented according to where they are situated on the Substance Use Services Continuum in the Context of Housing (see Figure 2). In total, 12 programs are reviewed and presented from Level 5 to Level 2.

3 STEP Home refers to a set of seven person-centered programs designed to end and prevent persistent homelessness in Waterloo Region offered through eight agencies at 13 sites. For further information, visit the Region of Waterloo’s website at www.regionofwaterloo.ca.


3

Note that there are no Level 1 or Level 6 programs represented, as it was determined early on that Dry programs (Level 1) would not be the focus of this research and there are no Managed Drug Use programs (Level 6) in Ontario. For further detail with respect to promising practices around specific design features for longer term housing stability programs that serve people experiencing persistent homelessness, refer to Appendix D. Figure 2. Substance Use Services Continuum in the Context of Housing

This document also makes reference to comprehensive, partial and non-medical services as described in the diagram to follow.

Figure 3. Medical Services Continuum in the Context of Housing

NON-MEDICAL

No on-site or visiting medical services available to the program May or may not support adherence to prescribed medication

PARTIAL MEDICAL

Some on-site and/or visiting medical services available to the program Support adherence to prescribed medication

COMPREHENSIVE MEDICAL

Some level of 24/7 medical services (e.g. physicians, psychiatrists, nurses) on-site and/or visiting

Regular visits from other healthcare professionals May or may not provide palliative care

LEVEL 3: ACKNOWLEDGMENT Acknowledge (formally or informally) use on site

LEVEL 1: DRY No substance use on site (i.e., “dry”) Typically not allowed access if under the influence

LEVEL 2: DAMP No substance use on site Allowed access if under the influence

LEVEL 4: SUPPORT Various forms of support to reduce harm

LEVEL 6: MANAGED DRUG USE Offering supervised injection and/or direct support for non-

injection substance use (e.g., inhalants)

LEVEL 5: ALCOHOL ADMINISTRATION Providing and administering safe beverage alcohol on site

WE

T: U

se o

n si

te


4

For further detail with respect to the Substance Use Services or Medical Services Continuum in the Context of Housing, please refer to the Lights On report. Where possible, each program is presented according to six main topic areas:

• Background – program development, capacity, program funding source, RTA, non-RTA

• Population Served – demographics of population served • Transition from Homelessness to Housing – referral and intake process • Housing Model – model and features. Refer to Appendix D for additional details

related to specific design features. • Support and Services Model – staffing model, how services are organized,

harm reduction approach • Program Outcomes - results of program evaluation

To review summary tables of program information, see Appendix G and H. For further information with respect to data sources for used to inform the Program Review Resource Guide, please refer to Appendix E and F.


5

Seaton House Men’s Shelter (the Annex), Ottawa.

LEVEL 5 PROGRAMS (MANAGED ALCOHOL)

Figure 4. Timeline: Opening of Managed Alcohol Programs

The Annex Harm Reduction Program (the Annex) Background

In the winter of 1996, there was a coroner’s inquest into the freezing deaths of three men on three separate nights on the streets of Toronto. The coroner’s jury recommended that 24-hour in-shelter harm reduction programming be implemented in the shelter system to address the serious gap in service for these men through mainstream services such as police, prisons, emergency departments, hospitals and other societal services (Svoboda, 2006). In response to this recommendation, the Annex Harm Reduction Program was established as a satellite program of Seaton House Men’s Shelter in November 1996. It was originally described as a City-run emergency shelter with 20 beds. The purpose of the program was to provide housing for men experiencing persistent homelessness who avoided shelters or who were repeatedly restricted from using shelters due to challenging behaviours related to alcohol use, mental health issues or other factors (Svoboda, 2006). For a comparison of the Annex to usual shelter care, please see Appendix C. Within a couple of days of formally opening, the Annex was at its maximum capacity. During these early days, men slept on mats and there was no food served because it was considered to be an overnight program only.

1996 20062001

Annex opens MAP opens Claremont House opens

- MAP transforms into MESP (includes Recovery and Overflow beds)

- The Oaks opens

2010


6

The vision was one of an alcohol storing rather than an administration program, where alcohol would be handed in upon entry to shelter staff and returned to the resident in the morning. Despite these guidelines, alcohol was informally being administered to residents to limit panhandling and avoid the onset of seizures due to alcohol withdrawal. The program also included an alcohol exchange component where non-beverage alcohol (e.g., cooking wine, rubbing alcohol, Lysol) could be traded in for less harmful alcohol beverages (e.g., wine, beer, whiskey, sherry). Throughout the years, the Annex had been located in several buildings, but is currently housed on the third floor of The Seaton House Men’s Shelter located at 339 George Street in downtown Toronto. Seaton House is one of Canada’s largest emergency shelters, with space to accommodate over 400 men. The Annex is Canada’s first and largest managed alcohol program. Two managed alcohol programs in Canada have since been inspired by the Annex, including the MAP (Managed Alcohol Program) in Ottawa and Claremont House in Hamilton. Since its establishment in 1996, the Annex has been supported through Emergency Shelter funding (per diem) administered through City of Toronto. It is considered to be a “hostel” and is therefore not subject to the conditions of the Residential Tenancies Act, 2006 (RTA). With respect to the managed alcohol component of the program, residents pay $0.50 per glass of wine (each glass is 180ml). Each resident’s consumption is noted throughout the day and they are billed at the end of each month for the wine they consume. Annex residents in receipt of Personal Needs Allowance (PNA) are required to turn over their PNA as a show of good faith. In turn, residents can participate fully in the program and people who smoke are provided with four cigarettes per day. Residents who have an income (usually Ontario Disability Support Program (ODSP), some Canada Pension Plan (CPP), Old Age Security (OAS)) pay a 30% maintenance fee and pay for the wine they consume. These residents can also purchase their own beverage alcohol and cigarettes for storage and distribution by Client Support Workers (CSWs). Population Served The Annex serves “vulnerable”4 men experiencing persistent homelessness who avoid shelters or who face service restrictions from shelters due to difficult behaviours related to alcohol use, severe mental health issues and other factors. The Annex is well equipped to address behavioural issues and will not permanently restrict service to any resident who requires service. Essentially, the program serves those for whom there is no other option.

The age range of residents is 28-73 with the average age being in the mid-forties and the average length of homelessness being 14 years. Although the program has a maximum capacity of 128 at any given time, the reality is that a reduction in funding has resulted in inadequate staffing levels to support this number. As such, it is generally understood that there is no more than 100 people in the program at one time.

4 The word “vulnerable” is commonly used by the Annex to encapsulate the diversity in the population served.


7

Transition from Homelessness to Housing

Men are generally referred to the Annex from the Seaton House Men’s Shelter (including the Infirmary5), other shelters across Toronto, and medical institutions (There is a strong referral relationship with St. Michael’s Hospital). Occasionally, men are also referred from other communities. Out-of-town referrals are limited however, as it is people are supported to develop connections in the area from which they are being referred. Housing Model

The Annex offers a congregate living environment on a single floor of the shelter. The Annex residents can access any of the services available at Seaton House Men’s Shelter. There are approximately 25 shared bedrooms with four to six beds per room and four shared washrooms, along with one attendant care washroom located in one of the bedrooms. The floor design resembles that of a hospital or long-term care home with one main hallway with bedrooms and sitting areas that branch off. In total, there are four common areas including, a bar room, TV room, library (often used for family visits) and a dining area. The kitchen area and laundry facilities are located on the main level of the shelter, and are not commonly accessed by residents. There is no outdoor space, with the exception of a small paved courtyard at the front of the building that is shared by all shelter residents. Additionally, there is no designated staff meeting or break space. Support and Services Model

The Annex offers a managed alcohol program (Level 5) and partial medical services. The Annex is staffed by CSWs, who provide a wide range of support to residents. There are a minimum of four CSWs on-site 24/7 at the Annex. CSWs work three 12-hour days in a row and are then off for three days. They are recruited based on experience and compassion working with the population served and are skilled in de-escalating conflict. It is the expectation of the program that CSWs continue to provide support to residents despite challenging behaviours. The program also offers support management and counselling services. In the ideal scenario, the Annex would have five support managers on staff; however, the program was operating at a reduced capacity with two case managers in 2009 due to cutbacks in funding. In addition to the on-site staff, other support is provided to Annex residents through Community Care Access Centre (CCAC) and a Family Health Team. The Family Health Team includes a variety of professionals such as an Addictions and Mental Health Worker and a Recreation Therapist, which will vary depending on the needs of residents. Although the Annex offers partial medical services, it is the expectation that CSWs advocate with the mainstream health care system should health issues arise. Medical supports available on-site include an Infirmary and nursing care.

5 The Infirmary includes dedicated space to care for people with physical health issues. It serves as an in-house medical clinic shared by residents of Seaton House and The Annex.


8

The nursing staff is on site 16 hours per day, seven days per week from 6:15am to 10:00pm. There is also a doctor training program run through the Inner City Health Program where resident doctors have the opportunity to gain experience serving residents of Seaton House. There are no medical clinics available on week-ends and there are no dental services offered. The Annex has provided palliative care on occasion where deaths were expected, although it does not formally offer this service. Medical services offered do not include intravenous administration. Managed Alcohol Services (Level 5) It should be recognized that although the alcohol administration component receives the bulk of media attention from the general public, it is only one piece of the overall harm reduction approach that can lead to a significantly improved quality of life for residents at the Annex. The stability and self-control that this general approach offers can be the catalyst for other changes such as self-care, respect and dignity (Johnstone, 2008). For some men at the Annex, managed alcohol services are introduced gradually after being in the program for a period of time, whereas others are able to start soon after entering the program. Residents receiving managed alcohol services (Level 5) must agree to drink only in the program and not to consume alcohol out of doors or alcohol not provided by the program. In the event that a resident goes off the property, the first drink once returning is skipped (90 minutes). There is flexibility exercised for residents who leave the property for medical appointments. Residents can remain in the program 24 hours a day (Svoboda, 2006). Residents receive seven ounces of white wine (or another beverage alcohol that is submitted to CSWs for distribution) every 90 minutes in the bar room. Intake is closely monitored by CSWs as many men have liver damage when they enter the program and have a reduced tolerance to alcohol. Residents can have up to ten drinks per day, where the amount of alcohol administered is determined based on a person-centred support plan. For example, some residents have only four cups of wine per day, others have a glass of water before each cup of wine and some only have a half cup of wine. A U-Brew service used to accommodate the large quantities of wine is needed but the City requires that the wine now be purchased through a City bidding process. This has caused the price of alcohol to rise substantially since the program opened. In 1996, the price was two dollars per litre, and by 2009, the price had doubled to four to five dollars per litre. This increase in price has been absorbed by the City of Toronto Hostel Funding. The annual cost of wine is approximately $100,000. Program Outcomes Research has found that the Annex is more effective than the abstinence-based usual shelter care approach. One study found that there was an 87% drop in emergency room visits and a 43% decrease in detoxification unit visits that could be directly attributed to the program (Svoboda, 2006). Further, many people receiving managed alcohol services (Level 5) reduce their alcohol intake and approximately five per cent stop drinking altogether and go on to treatment, long term care or stay with family.


9

Shepherds of Good Hope Emergency Men’s Shelter (MAP), Ottawa

Managed Alcohol Program/Men’s Enhanced Support Program (MESP) Background In 1999, the City of Ottawa undertook a collaborative planning process, which resulted in the first action plan to end homelessness. The plan outlined the need to improve health services for people experiencing persistent homelessness including for those requiring palliative and long-term care. In response, an ad hoc cross-sectoral group formed to explore ways to implement the health-related recommendations in the action plan, and Ottawa Inner City Health Inc. (OICH) was formed. The ‘founding partners’ of the OICH included several emergency shelters and service centres for people experiencing homelessness, primary health care facilities, public health, Canadian Mental Health Association (CMHA), the City of Ottawa and the University of Ottawa. Although the project did not have the support of the police during the early years, it now shares that support. At that time, through an informal count, it was recognized that approximately 70 people within the population of people experiencing persistent homelessness were accessing shelters and not being well cared for despite their complex health needs and frequently used emergency services. The inability to address the needs of this population stemmed from a combination of complex issues including serious physical health, mental health and substance use issues as well as challenging behaviours. In response, OICH developed a harm reduction approach to deliver health services to people experiencing persistent homelessness with substance use issues within the shelter system. Shepherds of Good Hope shared an interest in developing a harm reduction approach that included managed alcohol serves (Level 5) to meet the needs of shelter residents. A relationship was established with the Annex Harm Reduction Program in Toronto, which provided support, advice and staff training during the program development stage. There was little resistance to the idea of developing the Managed Alcohol Program (MAP), most likely because of its status as a pilot project and its location in the Lowertown area of Ottawa where there is a high concentration of poverty and community housing.

In 2001, $60,000 in funding was secured to support the pilot project through the federal Supporting Community Partnerships Initiative (SCPI) to be delivered in partnership with OICH and Shepherds of Good Hope. The pilot served ten people in one room and had one staff. There was no medical component at that time.


10

Despite an extremely positive program evaluation and demonstrated cost savings of $3,000,000-5,000,000, the pilot project funding ended in March 2003 without a commitment of ongoing funding from the MOHLTC. Between March 2003-2005, the program continued to operate on a combination of donations from partner organizations and one-time funding from the MOHLTC. In 2006, MAP received permanent funding from the MOHLTC. Each resident contributes $100.00 per month towards alcohol and cigarettes from their PNA and keep $28.00. Residents are assisted with managing finances, as required. Population Served Men and women can be accepted for admission to MAP if it is clear that an abstinence-based environment would not be a viable option. Additionally, a person must meet the following criteria:

• Long history of “street drinking” which has been unresponsive to addictions treatment and which poses a serious health risk to the individual.

• Complex health problems, which are not being addressed due to alcohol use. • Frequent user of emergency services (police, ambulance and emergency). • Cause concern in the community due to alcohol-related behaviors.

There is space for 28 tenants in MAP, and a waiting list is being kept. At the time of the site visit, there were 26 men and two females in the program who ranged in age from 35 to late 50’s. Transition from Homelessness to Housing Referrals for MAP are accepted from across the City of Ottawa and, in some situations, from across the Province. Most commonly, potential tenants are referred by shelter staff, police or community workers familiar with the person’s history of persistent homelessness. A person can also self-refer to OICH or Shepherds of Good Hope. At the time of referral, a person is assessed to determine if they meet the criteria listed above and, at that point, it is determined whether or not they will be accepted into the program or placed on the waiting list. The waiting list is quite flexible and people’s names can be re-ordered depending on the severity of the need. Admission is arranged upon agreement by the resident, program staff, program manager and a registered nurse. When accepted for admission, the program is explained in detail and an opportunity to enter the program on a trial basis (usually for a few days) before deciding whether to be admitted is presented. People who are admitted must consent to participate in OICH. This means that they must consent to:

• Agree to the “house rules” which are set in partnership by staff and the other tenants in the program

• Participate in health care provided by a team of health care professionals • Contribute $100 of $128 monthly personal needs allowance (PNA) toward

program expenses (i.e., tobacco and wine covering approximately 60% of the total program costs).


11

• Not drink outside of the program, panhandle, or engage in other behaviours that may cause a disturbance to the public

At the point of formal admission, the resident remains in the program for six weeks before a decision on continued participation is made. This decision is made based on a team meeting (including the participation of the resident). The program is very lenient with new tenants and it is not expected that they follow any strict guidelines for the first six months. During this time, a ‘two steps forward, one step back’ philosophy is anticipated as long as tenants agree to take any medications recommended by a mental health professional. There is no time limit with respect to length of stay provided that the person continues to benefit from participation. Housing Model MAP is housed on the second floor of the Shepherds of Good Hope Men’s Emergency Shelter. The Shepherds of Good Hope Men’s Emergency Shelter has a total capacity to serve 100 men (including the 28 spaces in MAP). There is very little outdoor space around the main doors of the shelter as it is located at a busy downtown intersection. There are cameras in each hallway and in the common rooms that are connected to a digital video recorder (DVR) in the staff office (providing live feed). The housing model at MAP offers a congregate living environment, where there are approximately ten shared rooms (three to five people per room). There is one room designated for females (males and females do not share rooms). Each room is furnished with a single bed and one full-sized locker per person. MAP also has one shared kitchen and dining area where meals are served, two common areas, a laundry room, two bathrooms, two shower stalls, and access to a tub room during the day in the shelter on the main floor. There are two staff offices in the program: one for Shepherds of Good Hope staff and one for staff of the OICH Team. A particularly unique feature of this program is the “smoking balcony,” which provides a safer way for tenants to smoke outside. The alternative is interacting with all other shelter residents outside of the main doors, where entrenchment back into street life is a constant threat. As of 2006, funding to support MAP has been provided by the MOHLTC through the Local Health Integrated Networks (LHIN’s) and the program is governed under the Residential Tenancies Act (RTA). Support and Services Model MAP offers a managed alcohol program (Level 5) and partial medical services. Support for MAP tenants is provided by both support workers and Client Care Workers (CCWs). Support worker services are offered through Shepherds of Good Hope who provide non-medical day-to-day support such as preparing meals, organizing recreational activities, filling out applications for OW and ODSP. CCW services offered through OICH provide support for more specialized medical needs such as nutrition, hygiene, health needs and medications. CCWs also dispense regular medications and manage alcohol intake for tenants.


12

The program is staffed 24/7. Days are staffed by one support worker and one CCW. Nights are staffed by one CCW. Due to the connection with OICH, MAP is able to incorporate a medical component into the program. Nurses and doctors visit MAP periodically to assess and treat tenants. MAP staff work to advocate with the mainstream health care system and tenants are encouraged to seek health care from family doctors, specialists and the hospitals. Although palliative care is not formally offered, many tenants will experience end-of-life while in the program. MAP also operates a Day Program where men from other supportive living programs in the city of Ottawa can participate. The funding for the Day Program is the same as for the residential program in that each participant makes a contribution towards program expenses (i.e., wine and tobacco). The Day Program provides a flexible and creative way to serve additional people, despite capacity limitations of the residential program. It has been very useful for former tenants who have transitioned from MAP, but continue to require managed alcohol services (Level 5). At the time of the site visit, there were four participants enrolled in the Day Program (three males and one female). The structure of the Day Program is similar to the residential program with the exception that the tenant’s last drink is one hour before that of the residential tenant. Due to the limited amount of space in the common areas of MAP, the expansion to offer a Day Program has also caused some challenges with respect to triggering incidents for tenants. Such incidents can occur when there are too many people with complex issues in a small space. Managed Alcohol Services (Level 5) The managed alcohol component of the program is person-centred and based on an intake and assessment process. It can vary in a number of ways from person to person in terms of the amount and frequency of alcohol administered, and each person is assessed before every drink. At a maximum, MAP provides five ounces of wine (red or white at 12% alcohol) between the hours of 7:30am to 9:30pm to tenants in the program (up to 14 drinks per day). Tenants receive seven ounces of wine for their first drink of the day. Tenants can also purchase their own alcohol off-site for administration, based on preference. Yearly cost of wine is $20,000 for all managed alcohol tenants/participants. The wine is made on the first floor of the shelter. Each tenant is also given the equivalent of one pack of cigarettes per day. The amount is broken up over the morning and early afternoon. Program Outcomes

Over time, the benefits of MAP have been shown through reduced need for emergency services as well as the reduced number of people on the street. Further, many MAP tenants have reduced their alcohol intake as a result of the managed alcohol services (Level 5) and a small number of tenants have become abstinent. Such tenants have chosen to remain in the program because the hourly ritual of receiving an hourly drink with peers (e.g., grape juice) continues to provide a sense of security and consistency.


13

Men’s Enhanced Support Program (MESP)

MAP was transformed in April 2010 and is now called the Men’s Enhanced Support Program (MESP). Although the funding structure remains the same, the program is a more clearly defined, and less “quasi supportive living”. The new program inhabits the same physical space as MAP (located on the second floor of the Shepherds of Good Hope Emergency Shelter), and now has the capacity to serve 50 men. It is also possible for MESP to lay eight mats down at night in case of absolute emergencies, which would bring the program’s total capacity to 58 (not included in the description below). Since opening the program had 58 tenants on two occasions and it averaged 45 tenants for the month of May, 2010. The MESP program was able to increase capacity (i.e., from 28 to 58 spaces) due to its expansion to include a Recovery and Overflow program, of which there is a substantial degree of overlap between these two programs. For example, when Recovery runs out of beds, Overflow beds are used. As such, the Recovery and Overflow beds are often presented as a combined program. For the purposes of clarity however, the two programs are described separately below. The three program components of MESP are as follows: 12 MAP beds Essentially, this program has started over again as many previous tenants have moved to the Oaks (refer to section that follows for a description of the Oaks). Tenants in MAP require intensive support and are active in their substance use. MAP only serves men, however there is a Day Program able to accommodate four women. The MAP area of the program currently consists of three dorms (with four tenants per dorm), the kitchen/dining area, and the former Ottawa Inner City Health office (now shared space for both MAP and OICH staff). There is a door between Dorm 3 and Dorm 4 to separate MAP from the Recovery and Overflow programs. MAP differs from the Recovery and Overflow programs because it is longer term and there are managed alcohol services offered (Level 5). It is the intention that the MAP tenants progress and are eventually able to move to the Oaks as space becomes available. 30 Recovery beds

There are a total of 30 Recovery beds. These beds are shorter term and provide a safe area, where people under the influence of alcohol and or mood alternating substances can become sober from 8:00pm to 6:30am. It offers Level 2 services on the Substance Use in the Context of Housing Continuum (see Figure 2). This program serves people with high-level needs who have faced service restrictions from all other agencies. If tenants request help, they will be referred to a Royal Ottawa Hospital Addiction Counsellor who also visits the program twice a week. However, it is a non-judgemental program that puts “zero pressure’” on people. There is an understanding that treatment will not work unless the resident is ready, and on their own terms.


14

This program also existed prior to April 2010, as a 21-bed program on the first floor of the Shepherds of Good Hope Emergency Shelter. Upon establishment of the MESP, the floors were divided by gender so recovery for men was relocated to the second floor. In addition to these 30 beds, there is a Recovery Program for women operating out of the first floor of the Shelter. 8 Overflow Beds There are a total of eight Overflow beds (usually mats on the floor), which are used when the Recovery Program is at capacity. This program operates similarly to the Recovery Program. The MESP has retained the same staff from the former MAP. Note that there is also a nurse coordinator assigned to the MESP five days per week. Below is the adjusted staff schedule for MESP: 7:00am to 3:00pm

• MAP: 1 Support Worker, 1 CCW • Recovery/Overflow: 1 Support Worker

3:00pm to 11:00pm

• MAP: One CCW • Recovery/Overflow: One Support Worker

5:00pm to 1:00am

• One Support Worker operating between all three programs

11:00pm to 7:00am

• Two Support Workers operating between all three programs. (MAP is closed from 10:00pm to 6:30am as tenants are sleeping or relaxing in lounge)


15

The Oaks, Ottawa

The Oaks

The reduction in the number of MAP beds from 28 to 12 coincided with the opening of The Oaks, which began operating in January 2010 in two former hotels located in the west end of Ottawa. The supportive housing program is a partnership between the Shepherds of Good Hope, OICH and the Canadian Mental Health Association, coordinating the housing and health services, respectively. The capital purchase was funded using six million dollars from the federal and provincial governments. The provincial Domiciliary Hostel Program provides operating funding for 45 units. The Canadian Mental Health Association provides support (paid through the LHIN’s) to 10 self-contained units for which tenants pay affordable rent. The Oaks consists of a total of 55 rooms (19 and 36 units per building, respectively), in semi private self-contained units (including kitchenette). The smaller building and the top three floors of the larger building consist of apartments and rooms that house the tenants. The ground floor of the larger building houses the administration functions, staff offices, and common areas for both buildings, such as the kitchen, dining room, TV rooms, exercise room and wine-making room (Homelessness Forum and Managed Alcohol Program, 2009). Two tenants share each room and have access to cooking and cleaning services (Mauro, 2010). The Oaks provides supportive housing to men and women who have experienced persistent homelessness with concurrent mental, physical and substance use issues. Thirty units are reserved specifically for tenants in MAP who are ready to move onto a more independent supportive living environment. The Oaks offers a managed alcohol program (Level 5) and comprehensive medical services. Tenants receive the same managed alcohol services (up to five ounces of wine each hour) as tenants who participate in MAP located at the Shepherds of Good Hope Emergency Shelter. In January 2010, 40 tenants moved into their units at the Oaks and the remainder of the units were occupied in May 2010. Intensive case management support is provided on a 24/7 basis by at least two staff from Shepherds of Good Hope and Ottawa Inner City Health (OICH). Staff provide assistance with activities such as cooking, laundry, bathing and transportation to appointments. There is also a full-time nurse, a registered practical nurse (RPN) and a psychiatric nurse available to tenants. A doctor visits twice a week (CBC News).


16

Claremont House resident, Hamilton

Claremont House Special Care Unit (Claremont House Background For many years, people experiencing persistent homelessness with substance use issues had very limited housing options in Hamilton, due to the abstinence policies in place at emergency shelters. The exception was Wesley Urban Ministries6 that took a harm reduction approach, serving people active in their substance issues. It was open 24 hours a day and offered a needle exchange program. In response, Hamilton health and social service providers, along with police, shelter staff, and addiction workers took the initiative to address the issue by forming a Steering Committee in 2003. A summary of actions taken by the Steering Committee in the development of Claremont House included:

• Site visits to Seaton House (the Annex) in Toronto and Shepherds of Good Hope (MAP) in Ottawa.

• Information gathering regarding the potential demand for this service in Hamilton. Discussions regarding potential participants occurred with outreach workers, shelter staff and police officers.

• From those discussions, there was agreement to propose the creation of a 20 bed managed alcohol program (Level 5) that would reach out to both men and women.

• Discussions were held with municipal and provincial funders to brainstorm possible longer term funding strategies should such a project come to fruition in Hamilton. Although no commitments were made, the inclusion of funders at an early stage laid the groundwork for future discussions.

• Discussions were held to determine the structure for operating this project in Hamilton. The steering committee agreed that Wesley Urban Ministries was best positioned to lead this project from an operations perspective.

• A partnership with McMaster University School of Nursing to support the development of primary health supports for the project was established.

• To leverage the strength of collaborating partners, a comprehensive model was proposed to the community that could coordinate both health and social services to deliver clinical evidence-based care through an inter-professional team.

6 In August 2010, in response to a significant drop in the number of overnight emergency shelter residents, Wesley Urban Ministries closed its emergency shelter (Wesley Centre) and transitioned to a day-time drop-in program. This allowed the other existing emergency shelters to remain open. Now, people are allowed to enter all other shelters, which have extended their hours to have 24/7 access. The needle exchange program is not being administered by any other shelter.


17

The development of a managed alcohol program (Level 5) was included as a special priority item in the Hamilton Community Plan Update for 2003-2006 and the project was successful in acquiring funds from the federal Supportive Communities Partnerships Initiative (SCPI) in 2004-2007. Subsequently, the program was funded by the Ministry of Health and Long-Term Care (MOHLTC) 2007-2008; and the Local Health Integrated Network (LHIN’s) from 2008 to present. Support for the project was strengthened as a result of the timely release of a local research study that involved tracking the use of medical services for 21 people experiencing persistent homelessness in the downtown. The study found that it was a much more appropriate use of resources to house people experiencing persistent homelessness than it was to keep them in a homeless situation. In March 2006, Claremont House opened its doors to residents. From concept to completion, the program took four years to develop, and the building itself took seven months to renovate. Claremont House is located on a multi-acre property that is home to St. Joseph’s Healthcare Hamilton (SJHH), about a ten minute drive away from the downtown. Claremont House residents do not make direct use of mental health outpatient clinics offered through SJHH, but do use services available through SJHH Rehabilitation Services (e.g., recreation, smoking cessation, computer skills). SJHH provides specialized tertiary mental health services and community services to thousands of outpatients.

Claremont House is managed by Wesley Urban Ministries and governed by the Wesley Board of Directors. In addition, there is a community advisory board. The advisory board is comprised of members of the neighbourhood, shelter representatives, public health, SJHH, police, addictions, etc.

The purpose of the advisory board is to: • Provide a forum for sharing information amongst the staff and interested

community stakeholders about Claremont House, its accomplishments and challenges

• Build capacity to support the program When Claremont House initially began operation, the community advisory board met monthly. Over time, meeting intervals have been reduced to quarterly; however the ability to call further meetings as necessary remains an option. Upon opening, a staggered intake approach was used in order to allow staff to become comfortable with protocols and the model of service delivery. As such, it took close to six months for the program to reach full capacity. Population Served Claremont House serves men and women experiencing persistent homelessness who have substance use issues combined with serious health issues that have led to a cycle of repeated visits to emergency rooms, hospitals, detoxification centres and correctional facilities.


18

Claremont House has a total capacity of 16 spaces. Residents range in age from 40-75 years (mean age is 52 years). The program has one room that locks and is suitable for two female residents. A waiting list is kept and, at the time of the site visit, there were three to five people on that list. Transition from Homelessness to Housing Referrals are made as a last report in situations where other treatment options have not been successful. Referrals are accepted from any source such as hospitals or shelters, as well as self-referrals. It has also become more common for judges to court order residents to Claremont House. Several residents have chosen to remain in the program after the court order has expired. In the 18 months preceding the site visit, a total of 90 referrals were made to the program. An intake interview is completed for all referrals made to the program. Approximately 40% of referrals are accepted (others are seen as inappropriate and counselling on alternative programs is provided). All referrals are discussed with program staff and a joint decision with respect to acceptance is made. If accepted to the program, residents must complete End of Life Planning including a Living Will. All residents are strongly encouraged to have a trustee. Housing Model As indicated above, Claremont House is located on an expansive property that is home to SJHH. There is one main entrance into the building, where clear sight lines for staff eliminate the need for an external security system. Claremont House provides a congregate living environment and is conceptualized as a health facility. The program is housed in a single-floor building that formerly served as office space for SJHH staff. The building is historic, but was renovated with an open concept design that allows for a great deal of light. Upon entry, the kitchen, small common area, and front reception desk are all within full view. During the renovation process, six bedrooms on the main floor along with a combined palliative/clinic room, overflow and staff office space were constructed. There are two washrooms on the main floor (one for residents and one for staff). There is a recreation room along with a laundry room and pantry in the basement. One of the most prominent features of Claremont House is the expansive back yard/patio space. This space is used for eating, socializing, smoking, recreational activities as well as resident appointments with counsellors and psychiatrists. The outdoor area can be easily accessed by residents.


19

Support and Services Model Claremont House offers a managed alcohol program (Level 5) and comprehensive medical services. The program provides short stay assessment, longer-term continuing care and palliative care. In addition to managed alcohol services (Level 5), the following services are offered at Claremont House:

• 24/7 Nursing Care • 24/7 Social Services • Physician care (Through the Shelter Health Network) • Psychiatric care (Through the Shelter Health Network) • Personal Counselling • Housing Counselling • Health Assessment and monitoring • Stage-based motivational strategies

Claremont House delivers comprehensive medical services and formally offers palliative care. The care model resembles service delivery in a long-term care home with 24 hour supervision and 24 hour access to a social worker (BSW), registered nurse (RN) or registered practical nurse (RPN), and physician. In situations where an RPN is on staff, there is an RN on-call. Additionally, there are psychiatrists on staff that visit Claremont House monthly. Further, the program makes use of a variety of additional services to include Transitions to Homes Program (formally called Hostels to Homes and operated by Wesley Urban Ministries); Mission Services for Trusteeship; PX Dermody Funeral Home for Counselling; and Mental Health Public Health Outreach Team (for residents who formerly had case workers from the team). Claremont House does not often make use of services such as Community Case Access Centre (CCAC), and the Assertive Community Treatment Team (ACTT). Staff also share the responsibility of planning daily recreational activities which may include going to the SJHH gym, walks, bowling, a boat cruise, Society for the Prevention of Cruelty to Animals (SPCA) pet therapy, Wii, pool tournaments, etc. On-site staff work 12 hour shifts (9am-9pm and 9pm-9am) coinciding with Wesley Urban Ministries staff scheduling model. Claremont House also offers short-term assessments of up to two weeks, where a resident’s substance use behaviour is monitored and a harm reduction plan is developed (e.g., context, pattern, quantity, etc.). The plan can then be applied to a community setting where the resident resides and staff continue to be available to offer guidance and support throughout its implementation. The need to expand capacity for short-term assessments was identified. At the time of the site visit, there was one person enrolled in the Day Program. This person was abstinent and spent his days in the program enjoying the company of other residents and participating in recreational activities. At its peak, there were four people in the Day Program.


20

There is a high level of student involvement from social services, nursing, medicine and rehabilitation sciences. Such placements are an integral part of the program. Not only are McMaster University students given the opportunity to complete course work but are in addition, they are provided the opportunity to be immersed in a setting serving a population facing a number of barriers in mainstream society. In addition, McMaster University students from a variety of disciplines across campus are given opportunities for Service Learning at Claremont through the undergraduate Health Sciences Poverty and Homeless Course. Several volunteers offer services to Claremont House residents. Volunteer activities include: cooking, attending AA meetings with residents and recreation activities such as attending football and hockey games. Managed Alcohol Services (Level 5) The managed alcohol services (Level 5) offered at Claremont House consist of the administration of four to seven ounces of white wine or a serving of beer per hour from 7am until 10 pm (based on a person-centred plan). Other alcohol (e.g., scotch and sherry) can be purchased by residents and served as well; where one and a half ounces is the equivalent of 5 ounces of wine or a serving of beer. Claremont House has an agreement with the same winery used by Seaton House for the purchase of wine (DeSousa Wine Cellars). The beer is made at a U-Brew location, where residents participate in its preparation every two weeks. Program Outcomes The program was described as a “journey” by one Claremont House resident because it helps a person to transition from a certain way of life on the streets that is focused more heavily on survival, getting alcohol, and finding shelter to being able to address traumatic experiences and persistent mental and physical health concerns. Of the total composition of Claremont House residents, 30% are re-integrated into the community, 25% have multiple admissions, 25% experience end-of-life care and 20% are in the program on a short-term assessment basis (less than two weeks).


21

Figure 5. Claremont House Special Care Unit – Resident Composition

Claremont House Special Care Unit - Resident Composition

30%

25%

25%

20%

Multiple Admissions Some residents have multiple admissions to Claremont House. These residents typically have difficulty adhering to the managed alcohol program and choose to continue a pattern of binge drinking. In fact, it was estimated that one in five residents will not be able/desire be part of a managed alcohol program. As such, the decision to transition from the program is mutually determined after a series of attempts. Residents may also experience difficulties with the realities of communal living. When a person leaves Claremont House under these circumstances and has behavioural challenges, there are few alternatives available beyond the streets, incarceration or finding housing through the newly funded Transitions to Homes program. Accordingly, it was identified that there still remains a small group of people experiencing persistent homelessness who remain difficult to serve in Hamilton. Community Re-integration While it was originally anticipated that most residents would remain in the program until end-of-life, Claremont House has discovered that 30% of residents are being re-integrated back into the community. In response, there is an increasing need for housing support co-ordination services as part of the host of services offered through the program. The Transitions to Homes program has become an important link to Claremont House for such individuals. Development of Multiple Addictions

It has been observed over time at Claremont House that some residents experience challenges with multiple addictions (e.g., crack and alcohol). In addition to the legal issues, this situation presents complexities because the program is not equipped to serve people with drug use issues (although methadone can be prescribed).

Short-term Assessment

Multiple Admissions

Experience end-of-life

Community Re-integration


22

In the scenario where multiple addictions become evident, residents work with the physicians and staff to determine a suitable plan. Reduced Alcohol Consumption/Abstinence Initial research has demonstrated that the managed alcohol services have led to a substantial decrease in alcohol consumption and, in some situations, abstinence for residents (6 out of 16 residents were abstinent at the time of the site visit). These unanticipated outcomes are currently being further studied by a team of researchers from McMaster and Athabasca Universities. Research questions generated by the team include:

• What are the staff variables that might contribute to abstinence? What is the influence of non alcoholic beer? What is the effect of seeing other residents abstain?

• What is the effect of seeing other residents experience end-of-life?

Need for Additional Supportive Housing On-site At the time of the site visit in 2009, St. Joseph Healthcare Hamilton (SJHH) was planning for the re-development of its site. This would displace Claremont House. Currently, Claremont House is exploring opportunities to relocate to another larger building at the SJHH site.


23

Brigid’s Place, Ottawa

LEVEL 4 PROGRAMS (SUPPORT) Brigid’s Place Background

The City of Ottawa was aware of the need and lack of resources with respect to housing options for women experiencing persistent homelessness with substance use issues and challenging behaviours. The Hope Outreach Emergency Shelter of Shepherds of Good Hope is one of two shelters in Ottawa that accepts women 18 years of age and older. The women being served at the Shepherds of Good Hope are often turned away from other shelters due primarily to lifestyle choices and behaviour. In response, a coalition formed which became known as the “Women’s Roundtable.” The Women’s Roundtable consisted of a group of women representing some of the key agencies in Ottawa working with women experiencing persistent homelessness, including: Shepherds of Good Hope, Elizabeth Fry Society, women’s shelters, housing providers, etc. The group originally consisted of 30 women, which slowly became a group of six core members. The Women’s Roundtable agreed that, in accordance with the City of Ottawa’s Strategic Plan, more permanent housing rather than shelters would be the main focus of attention. The group conducted site visits at other low barrier housing programs serving women with complex issues across Canada. Brigid’s Place was inspired by “The Vivian” in Vancouver that provides housing for women experiencing persistent homelessness living with concurrent mental health issues, addiction and other challenges using a harm reduction approach. The local program was named Brigid’s Place in recognition of the Agency’s roots which started in the basement of St. Brigid’s Church. It also seemed fitting that the name Brigid represents the Gaelic goddess of survival. Brigid’s Place is a program of Shepherds of Good Hope located in the Lowertown area of Ottawa. It offers permanent housing with the intention to be transitional7 for women who experience multiple barriers to securing and maintaining housing, including but not limited to substance use, mental health issues, poverty and involvement in the criminal justice system. A harm reduction approach is adopted where it is not expected that tenants abstain from using alcohol or drugs, or street-related activities on-site as long as they do not engage in these activities in common areas of the house and are respectful of other tenants and staff.

7 Brigid’s Place is funded under the provincial Domiciliary Hostel Program and is therefore considered to be permanent housing protected under the RTA. However, the intention is that the program will assist tenants to transition towards greater independence and find permanent housing.


24

Funded through the City of Ottawa, Brigid’s Place opened in 2008 as a six month pilot project. After the pilot project funding ended in 2008, Brigid’s Place secured two years of funding through the Provincial Domiciliary Hostel Program (2009-2011) as well as through the federal Homelessness Partnership Strategy (HPS) to offset the costs of staffing. Population Served Brigid’s Place serves women who:

• Have a concurrent disorder • Are active in their substance use (most commonly crack cocaine, morphine or

methadone) and are motivated to explore harm reduction alternatives • Are street entrenched • Could be involved in sex work • Could be involved with the criminal justice system • Have a shelter stay of over 90 days • Have difficulty accessing housing due to lifestyle • Need the most assistance

The women residing at Brigid’s Place range in age from 26 to late 50’s. With respect to housing history, most women have had housing for a few months to a few years, but have not been able to maintain that housing due to behavioural challenges or unability to pay rent. Many women have experienced persistent homelessness and may have experienced service restrictions at emergency shelters. Brigid’s Place is not intended to serve:

• Men of any age • Women under the age of 18 • Women not active in their addiction • Women with very low levels of independence (e.g., unable to shower or eat on

one’s own). However, it is the expectation that the women may sometimes need to be reminded to do these things

• Women with physical disabilities because there is no elevator • Women with complex and chronic medical issues because medical staff is not

on-site 24/7 Transition from Homelessness to Housing Most referrals for Brigid’s Place are received through the Ottawa Inner City Health (OICH) Team, which operates a special care project at the Hope Outreach Emergency Shelter. When accepted to Brigid’s Place, the intake process is very straightforward with minimal signing of forms required. Although tenants are protected under the rights of the RTA, in lieu of signing a lease or tenancy agreement, tenants sign an Agreement to Reside (Refer to Appendix A). This Agreement to Reside includes an understanding of the following:


25

• All forms of violence are discouraged. Anyone involved in violent interactions has the right and responsibility to deal with it accordingly (i.e., call police if necessary) to resolve or improve the situation.

• Tenants will not bring weapons in the house or onto property in order to maintain the safety of the environment.

• Tenants will respect the common areas of the house and refrain from bringing drugs/alcohol/paraphernalia into these spaces.

• Tenants will be accountable for any and all visitors that are invited into the house. If a tenant is suspected of dealing from on property, she will not be allowed visitors.

In addition to the Agreement to Reside, the following general guidelines apply to tenants in the program:

• Treat all other tenants, staff and the house with respect. This includes respecting personal boundaries, opinions and lifestyle choices.

• Bring forward any feedback in a constructive and non-threatening manner using the feedback procedure and monthly tenant meetings. Work collaboratively with staff to ensure the issue is improved upon or resolved.

• Help keep the home safe and clean. This includes maintaining a clean and hazard-free bedroom, cleaning up after oneself in common areas including the kitchen and bathroom and taking necessary precautions to prevent hazards from occurring and when they do alerting staff immediately.

• Provide input on meals, and be present during meal times. Maintain the repair of all furniture and linens provided by Brigid’s Place and maintain personal hygiene.

Other guidelines at Brigid’s Place are flexible and can be altered in response to the changing needs of the house with staff and tenant input. It is the expectation that tenants are involved in all relevant decision-making processes. Housing Model Brigid’s Place is housed in a duplex owned by Shepherds of Good Hope located in the Lowertown area of Ottawa at 78 Nelson Street. The building itself has little identifiable signage, with the exception of a small plaque on the front door. There are security cameras located outside of the building, although they are inconspicuously placed.

The housing model at Brigid’s Place offers a congregate living environment with 11 private bedrooms and two washrooms located on two floors. All bedrooms are furnished in a similar way and include a bed, bed dressing, night stand, TV, small fridge and window coverings. There is one common area located on the main floor of the house next to the kitchen. Further, the basement was recently renovated and provides quiet space for the tenants, computer use and weekly support group meeting space. There is also a small backyard with a deck and a barbeque. There is a staff office space with a large window located next to the front door, which allows staff to easily monitor activity of tenants and guests. Brigid’s Place tenants are not expected to contribute their personal needs benefit (PNB) in the Domiciliary Hostel Program. OW or ODSP cheques are mailed to Brigid’s Place and made out to the Shepherds of Good Hope (pay direct). Cheques are signed by the


26

tenant and cashed by the Shepherds of Good Hope Finance Department. In turn, tenants receive a monthly PNB (in addition to a special diet allowance or transportation allowance, if appropriate) paid in cash on the day the cheque arrives. Support and Services Model Brigid’s Place offers a Level 4 approach to substance use and non-medical services. The program has on-site staff 24 hours a day, seven days a week and includes three shifts. The program is largely single staffed with day and evening shifts benefitting from more staffing presence. At the time of the site visit, the program had ten staff in total, including managers, full-time front-line staff and casual staff. Casual staff can work up to four days per week. Most staff have a background in criminology, social services and/or counseling. The bulk of staff duties include assisting tenants to:

• Build and enhance life skills, which could include financial management, cooking/shopping, accessing services in the community.

• Enhance individual well-being. This could involve safety to self and others, health services, mental health services, and substance use options. Work on the options for the future (e.g., housing search, education, income and employment).

• Work through issues by employing support management strategies and using motivational interviewing techniques.

Staff is responsible for providing tenants with two meals a day (lunch and dinner) based on the posted menu. Tenants are encouraged to join the others for meals, although the reality is that often meals will go missed by some or all tenants. With the support of tenants, staff also help organize events and activities such as crafts, gardening, movie nights and other events that take place both within the residence and in the community. A great deal of effort has been made by staff to connect the tenants at Brigid’s Place with resources available though OICH, Public Health and the health care sector. The program has connections with mobile outreach workers, sex outreach workers and CMHA who also visit Brigid’s Place on a weekly basis. Further, there is a concurrent disorder group offered through CMHA and Oasis on a weekly basis. One of the many roles of staff is to educate regarding risks and safety as several tenants have Hepatitis C or HIV/AIDS. With respect to medical support, a doctor and a nurse visit the residence for two hours on a weekly basis, and tenants can request an on-site appointment outside of those designated times. Additionally at the time of the site visit, there was one volunteer providing cleaning services twice per week and another who prepared dinner for the tenants on a weekly basis. From time to time, there are also students who volunteer at Brigid’s Place. Tenants are encouraged to take advantage of the Social Initiatives Program, where various tasks or chores are completed around the residence in exchange for a gift certificate (e.g., Giant Tiger, The Bay, etc.).


27

Brigid’s Place originally had a Visitor’s Policy where tenants were able to have up to two visitors at a time (maximum allowed per room according to the fire code). Visitors were to be accompanied by the tenant at all times in all spaces of the house (i.e., bedrooms and common areas). As of 2010, this policy was altered so tenants are now able to receive a maximum of two visits per day and there are no overnight stays. There are visitor-free days on Wednesdays and Sundays. As well, from Monday to Sunday, no visitors are permitted from 5-7pm or after 11pm. Staff on duty keep an up-to-date “Visitor Log” in the office as a way of staying informed with respect to the number of people in the house at any given time. Harm Reduction Approach to Substance Use Brigid’s Place adheres to a harm reduction philosophy, where risks and consequences of a particular behaviour rather than the behaviour itself are the focus. In the context of substance use, this means focusing on strategies to reduce harm. Tenants are not expected to abstain from using alcohol or other drugs (e.g., crack, heroine, marijuana, morphine) or from carrying on with street activities while living on-site. Drug use and other activities are not condemned or condoned, but are addressed as a health concern. In order to promote safe use by tenants, SITE Needle Exchange Program provides supplies (e.g., needles, alcohol swabs, tourniquets, Vitamin C packages, condoms). These supplies are located in a drawer in the common area and are available at no cost to tenants. Staff keep 40 syringes in the drawer at all times. Biohazard containers are also provided so that tenants can safely dispose of their supplies. The only supplies not provided are crack pipe kits, although tenants are able to obtain these materials from City outreach workers. Tenants can access supplies without asking staff first and there is no limit as to how many needles can be given out. Tenants do not need to hand in needles in exchange for clean ones. Program Outcomes Since opening in late 2008, success for tenants has been realized in a number of ways including:

• A reduction and/or stability in substance use • Links to community resourcesSetting goals • Reconnecting with family/children • Increased quality of life

Further, tenants themselves have noted the following positive impacts as a result of the program:

• Feeling accepted • Strong sense of community • Feeling like my voice is heard • Feel more “normal” • A reduction in cravings, substance use and sex trade work • Having my own space


28

Brigid’s Place

A place for women called Brigid’s Place, all the women here being from coast to coast.

Every attitude you will find, a lot of addictions on the mind. All the girls with a horrid past, society wondering if we will last.

Most of us never knowing a home before, so we hang a welcome sign on our door.

Having house meetings where all are involved, hoping some of our problems can be resolved.

Waking up from nightmares from our past, bringing them out to talk about it at last.

Finally people that will listen to us, All our problems we need to discuss.

As communication is a must, digging our memories out that we just covered in dust.

Staff, thanks for opening this house with love and care, A roof over our head for all to share.

Going out in public without fear, big thanks for letting us know there are people who truly care.

Written by: Dakota, Brigid’s Place Resident


29

Fred Victor Housing, Toronto

Fred Victor Housing Background

For over 116 years, Fred Victor (FV) in Toronto has acted as a multi-service organization with a goal to provide basic needs to people experiencing homelessness. Over the years, the organization has expanded tremendously. In addition to providing permanent housing, FV offers shelter services, women’s programs, food services, employment and skills training as well as community programs. In 1980’s, FV worked with other anti-poverty organizations to develop a plan for the development of permanent supportive housing for people experiencing persistent homelessness in Toronto. In response, FV closed its short term men’s hostel and senior men’s home in 1988 and replaced it with 194 units of supportive housing on the corner of Queen and Jarvis Streets. Since opening, there has been a degree of “not in my backyard” (NIMBY) due to the high concentration of services in the area (there are 1,200 shelter beds in the immediate vicinity of the building). The NIMBY has been particularly pronounced in more recent years with the combination of an influx in tenant drug use and the neighbourbood becoming gentrified as condominium buildings are being erected. FV continues to prioritize its focus on community awareness and strengthening these relationships. FV Housing is funded through the Social Housing Unit at the City of Toronto, and the units are rent-geared-to-income (RGI). As such, the program must comply with the Social Housing Reform Act. FV Housing is covered for vacancy loss as there is no financial penalty for non-payment of rent or abandonment of units.

The program collects approximately $300,000 per year total in RGI, which covers about 15% of the total operating expenses (approximately $2 million). It is estimated that 90% of tenants at FV Housing are in receipt of OW or ODSP. The income from the remaining tenants comes from a combination of Canada Pension Plan (CPP), Old Age Security (OAS) as well as paid employment. Other expenses are covered by a combination of funding sources that include the City of Toronto, federal government, United Church, individuals, foundations and corporations. FV Housing operates under the Residential Tenancies Act (RTA), and is therefore permanent housing. Population Served FV Housing offers low-barrier housing and serves people with medium to high level support needs (low level healthcare needs) who have experienced long periods of living on the streets, in shelters or in health or correctional facilities. Often tenants are active in their substance use.


30

At first, I wasn’t impressed at six people living in one unit. However,

everything has worked out okay. It is just we have to find different times to

use the common area where the stove and fridge are. We all get

along pretty well.

Quote from: Toward Effective Strategies in Harm Reduction

Housing, 2009.

Candidates who display extremely violent behaviours and/or cannot reside with others would not be a good fit for this program as it offers shared accommodation. Tenants range in age from 20 to 73 years, with the average age being 45 years. There is space for up to 194 women and men at FV Housing and a waiting list is kept. Average wait period is six to nine months for men and less than a month for women. Transition from Homelessness to Housing Although FV Housing is governed under the Social Housing Reform Act, the program is exempt from selecting tenants from the centralized co-ordinated access list due to the special needs of the population and specialized services provided (there are over 70,000 people on this list). As such, a reverse referral process is used where referrals are received from other shelters across Toronto as well as through walk-ins and self-referrals. FV Housing also has a referral agreement for 10 units with Streets to Homes to provide immediate housing to people in that program. As a result of the shared accommodation model, the intake process is very important. Potential tenants are asked about their substance use behaviours as well as their ability and preferences as they relate to living with others. Honesty by tenants and a non-judgmental approach by intake workers are critical to this process in order to ensure that tenants are placed in a unit that is a good fit with his or her lifestyle. Housing Model

FV Housing consists of two four-story apartment buildings side-by-side in downtown Toronto close to amenities and other shelter services. The building on Jarvis has been owned by the FV for many years and the building on Queen was purpose-built. FV Housing has a single point of access, as all other entrances are secured with magnetic locks. There is a security guard at the front entrance and cameras located in the elevators. Each building has two elevators. On-site staff offices are located at the back of the building. The housing model offers shared accommodations with three to six bedroom units. Each tenant has a single furnished bedroom (10x12), with a small fridge and lockable kitchen cupboards. A washroom is shared with one other tenant, and the kitchen and living space is shared with all other tenants in the unit. Redevelopment of FV Housing began in May 2010 to be completed in May 2011 At the time of the site visit, FV Housing was in the process of completing floor plans for renovations that would reduce the density of the population and offer higher levels of support. The intention was that the first floor would provide additional program and office space, and the second floor would operate using a shelter per diem model (non RTA) with 20 smaller units. Second floor units would be smaller than a bachelor unit and would not have a kitchenette. The programming element and design would be targeted toward people with high-level needs.


31

The upper floors will provide a shared living arrangement, similar to what currently exists. The new design provides tenants with larger bedrooms with private washrooms. All rooms will have air conditioning, and important fire safety features, including overhead sprinkler units. As such, this new model would provide for a range of housing options for people with varying levels of support needs. Support and Services Model FV Housing offers a Level 4 approach to substance use and non-medical services. Support to FV Housing tenants is provided by housing workers who are on site 24 hours a day, seven days per week. There are a minimum of two housing workers on site at any given time. Housing workers assist tenants in making a successful transition to permanent housing in a variety of ways, which could include:

• Support and encouragement in decision-making (unit and general building meetings take place once per month and are facilitated by a housing support worker)

• Support to overcome isolation through participation in social and recreational activities, employment opportunities focusing on building safety and maintenance

• Support in conflict resolution and eviction prevention strategies • Support co-ordination

Meals are not provided in the program, as this is self-contained housing, although many tenants eat on-site at Friends Restaurant that is operated by FV. The restaurant serves low-cost nutritious meals and offers a credit system for those unable to pay. Generally tenants do their own laundry; however housing workers and other community services are able to assist, as needed. Health services are provided by a Family Health Team that consists of a nurse, case manager, psychiatrist and physician that are available during business hours, and also have drop-in hours. FV Housing also has a partnership with CCAC (available during business hours). It was identified that a higher level of primary health care support is needed in order to meet the specialized needs of FV tenants. FV Housing staff operate using a harm reduction approach. As such, they work realistically and in a non-judgmental way when it comes to substance use, accepting that this behaviour is a reality in the lives of tenants. Staff provide referral services, peer facilitated support, education about substance use and ways in which to minimize the potential danger when using. They provide safer use kits, condoms and biohazard containers, as well as instruction on safe disposal of used products. Program Outcomes FV Housing has a vacancy rate of 6% and approximately six to eight units become available each month due to voluntary departure, abandonment and eviction. There is a higher turnover rate for women than for men. In 2008-2009, 80% of tenants maintained their housing. People who move on from FV Housing often go on to live in independent housing, long-term care facilities, rehabilitation programs, or other shelters in the City.


32

LEVEL 3 PROGRAMS (ACKNOWLEDGEMENT) 515 MacLaren – Supportive Housing for Women Background Through the 1980’s in Ottawa, there was a growing recognition that permanent housing for women experiencing persistent homelessness was in demand. In response, All Saints Anglican Church established a program called Martha’s, which offered a small number of cots for women experiencing homelessness. In 1986, Martha’s moved into a new facility and was able to house 15 women experiencing homelessness. This program became known as the Women in Crisis Project. In 1989, the Women in Crisis Project opened a 20-unit supportive housing building at 515 MacLaren St. 515 MacLaren was a program of the Anglican Diocese and in 1999, the organization changed its name to Cornerstone/Le Pilier. In 2000, Cornerstone/Le Pilier opened a six bed cooperative living residence for women recovering from difficult experiences, trauma, newcomer issues as referred from Cornerstone’s Emergency Shelter and The Catholic Immigration Centre. In 2011 Cornerstone/le Pilier will open a supportive housing facility for senior women experiencing homelessness in partnership with OICH. 515 MacLaren is owned and maintained by Centretown Citizens of Ottawa-Carleton Corporation (CCOC) and the units are rent geared-to-income. The manager of the 515 MacLaren program acts as a landlord on behalf of CCOC by collecting rents. The support component is currently funded through the provincial Consolidated Homelessness Prevention Program (CHPP), which is administered by the City of Ottawa. Tenants receive income from a variety of sources including OW, ODSP, pensions and paid employment. 515 MacLaren is considered to be permanent housing and is governed under the RTA. Population Served 515 MacLaren offers low barrier housing for women with medium to high level support needs (low level healthcare needs). All support is person-centred, and meets the person “where they are at”. General guidelines (rather than rules) with respect to behaviour exist. Originally, 515 MacLaren housed women with mental health issues only; however their mandate has expanded in response to the need over years. Presently, they support women over the age of 18 experiencing or approaching persistent homelessness with complex issues that create barriers to independence. Such issues/barriers could involve a combination of mental health issues, substance use issues related to alcohol, developmental challenges, language barriers, and/or physical health challenges. Women in the program currently range in age from 35 to 67 with the average age being 47 years.


33

515 MacLaren does not house men and is unable to accommodate those who are not ambulatory as there is no elevator in the building. The program does not typically accept women with substance use issues related to street drugs because this may pose a safety issue for other women in the building. However, if a tenant living at 515 MacLaren develops an addiction; she would be able to remain in the program and be encouraged to access the services of an addictions worker and other community services. Eviction would only be considered as a last resort and would be based on behaviour, rather than substance use. Transition from Homelessness to Housing Candidates for 515 MacLaren are identified by Cornerstone’s Emergency Shelter case managers (75%), outreach workers, and other community agencies such as Citizen Advocacy, Royal Ottawa Hospital (ROH), ACTT, Canadian Mental Health Association (CMHA), Ottawa Salus Corporation, etc. Beginning in the Fall of 2010, all candidate applications will come through the central Supportive Housing Network.

When a room becomes available, the manager of Supportive Housing meets with the potential tenant and completes a need and eligibility assessment and application form. Guidelines for behaviour mainly relate to the common areas and include:

• Physical violence or abusive behaviour is not tolerated • Alcohol and drugs are not allowed in the common areas • Smoking is not permitted in the home • Quiet time is respected in the common areas from 11pm-7am on weekdays and

midnight to 7am on week-ends • Tenants share in all responsibilities of cleaning their own room and common

space (e.g., bathrooms, carpets, after dinner clean-up) The final candidate selection is determined based on urgency of need for care and support, and fit with the other 19 tenants. Before or on the move-in day, the tenant signs a lease and a food plan contract. The support workers and or manager inform the person’s source of income support (e.g., OW, ODSP) of the change of address and rent requirements. Although there is a waiting list of 100 people for 515 MacLaren at any given time, at times challenges remain filling the units because some women are unwilling to sign a lease due to mental health issues or because their stay at the temporary Emergency Shelter has been months (because no openings at 515 MacLaren) and has become home to them. As such, women are reluctant to leave their new “home” at the shelter. 515 MacLaren is a home and as such visitors (including male visitors) are permitted in the residence (including overnights) if the guest first meets with the manager for a meet and greet (assessment). The visitor’s policy and guidelines were created by the tenants.


34

Housing Model 515 MacLaren is a four-story supportive housing apartment building located in Ottawa. This building was selected because of it is location within close proximity to amenities and because it was within a residential neighbourhood. The housing model offers 20 private rooms on the second, third and fourth floors, while the lower level contains the shared amenity areas. Rooms are comparable to a small bachelor apartment and include a small kitchenette with a sink and small fridge. Each floor has two shared bathrooms with showers and/or bathtubs, and laundry facilities are available at a minimal cost. Due to the varying interests of tenants, the common area on the lower level is divided (using furniture as partitions) into a TV and reading/radio/telephone area. Tenants can also choose to purchase telephone and cable services for their private rooms, if preferred. There is a small library and a piano located in this area as well. One large common kitchen exists in the common room for tenants and staff to work together making meals as a life skills program done with a person-centred approach based on the coaching/teaching need of that particular tenant. The staff offices are located on the first floor at the entrance to the home in order to ensure the support and safety of the tenants. One of the unique features of this building is the rooftop patio that serves as a place of relaxation for the tenants as well as extra space for the program when needed. The building is not equipped with an elevator. Support and Services Model 515 MacLaren offers a Level 3 approach to substance use and non-medical services. Support to 515 MacLaren tenants is provided by a minimum of two support workers on a 24/7 basis. In total, there is a team of 18 female support workers (3 full-time, 3 part-time and 12 relief). A link staff model is used where each tenant is linked to a support worker who assists with goal planning, early intervention plans, monthly reports, advocacy, etc. Relief workers assume exactly the same duties as the staff that is being replaced, and is therefore linked to the same tenant. This link system was put in place in order to ensure that tenants did not “fall through the cracks” due to being quieter or more isolated than others. Each staff is linked to approximately three tenants. Further, there is an advocacy support worker who works from 7am-2:30pm (Monday to Friday), and the Manager is accessible from 8am-4pm Tuesday to Friday. Most staff work eight hour shifts with the exception of support workers who work 12-hour shifts. Further, Centretown Community Health Centre, OICH, CMHA and other outreach visit 515 MacLaren regularly. Although this program can provide a high level of support to tenants, staff do not have medical training and therefore there is no medical support component. Medication is stored in the office and staff ensure tenants take their medication (packaged in dosettes) as well as oversee several Community Treatment Orders. With respect to off-site services, specialized supports are available for individual tenants with physical health needs including home and nursing care.


35

There is also a volunteer coordinator on-site who manages a roster of 20 male and female volunteers. There are approximately two volunteers per day who assist in leading activities such as crafts, gardening, movie nights, cooking, cleaning, painting, and social visiting. Bi-annually, a Volunteer Day of Caring occurs with an average of six to ten volunteers coming in to assist with large issues such as spring cleaning, etc. A dedicated person in this position allows for support workers to focus their energy on planning and responding to crisis. Unlike other permanent housing, all tenants participate in the program’s food plan, and pay for it along with their monthly rental payment. They are provided with their own food to cook breakfast and lunch. Food for dinner is purchased weekly and cooked together with a support worker as a life skills program individualized to tenant needs. Program Outcomes In addition to the 20 units at 515 MacLaren, Cornerstone Supportive Housing also has six bachelor units in the attached building available to women who choose to move on to a higher level of independence. The demand for these units is much greater than the availability as a unit only comes up once every six months. Ninety-eight per cent of women in these units are successful because they are still able to receive the support available through 515 MacLaren (the two buildings have a shared hallway). The women at 515 MacLaren stay on average anywhere from 3-20 years. This can create challenges when some tenants want to stay to end of life, but the program is not equipped for palliative care. Cornerstone/Le Pilier will be opening a new building in March 2011 in partnership with the OICH also located in the downtown and accessible to many existing community services.


36

Hope Living, Ottawa

Overview of Hope Living, St. Patrick’s Residence and St. Andrew’s Residence Hope Living, St. Patrick’s Residence and St. Andrew’s Residence operated by Shepherds of Good Hope in Ottawa provide a continuum of housing across the three locations. These housing programs are designed to allow people the flexibility to move from one level of support to another depending on individual needs. The programs offer a mix of housing types from private bedrooms and shared living spaces to self-contained one bedroom units (CIC, 2010). Figure 6. Shepherds of Good Hope Housing Continuum

Hope Living (Stage 1)

Hope Living is a 35-unit housing program in Ottawa for men and women with a concurrent disorder or serious mental health issue who have had a history of homelessness. It was established in 1999 and comprises Stage One on the continuum where a higher level of support is required. The program is located on the third floor of the Shepherds of Good Hope’s main building (256 King Edward Ave). The majority of potential tenants are referred from the Women’s and Men’s Shelters. The program is funded by the MOHLTC through the LHIN’s as a housing program and is governed under the Residential Tenancies Act (RTA). Each tenant has his or her own room equipped with a bed, fridge and a dresser. All remaining areas are shared including the washrooms, kitchen and resource room. Tenants cook their own meals. There is also a food bank located across the street that tenants can make use of once per week. Hope Living offers a Level 3 approach to substance use services and non-medical services. Support to tenants is available on-site on a 24/7 basis. The program also partners with a number of outside agencies who provide additional support both on and off-site. Some of these partnering agencies include CMHA, John Howard Society, ACTT, the local Community Health and Resource Centre, among others.

levels of independencelower higher

STAGE 1 Hope Living

STAGE 2 St. Patrick’s Residence

STAGE 3 St. Andrew’s Residence


37

Weekly activities are organized for Hope Living tenants that promote community inclusion through life skills development such as community kitchens, leisure activities, workshops and social enterprise. In February 2010, tenants opened a Tuck Shop. It is operated by two tenants and is open three hours per day, seven days a week. All proceeds from sales go back to tenants in the form of added programming (e.g., self-funded camping outing) and improvements to existing resources (e.g., three new computers for the Resource Room were recently purchased). Tenants have input into how proceeds from the Tuck Shop are spent. Tenants operating the Shop are remunerated for hours worked. St. Patrick’s Residence (Stage 2) St. Patrick’s Residence was opened in 1999 and is considered to be Stage Two on the housing continuum. It is funded by the MOHLTC through the LHIN’s. Tenants are covered under the RTA. Support to tenants is available on-site on a 24/7 basis. The program can serve up to 13 men in private bedrooms. Each tenant has their own washroom, however other spaces are shared. This residence is intended for people who have acquired a level of independence and require a lower level of support. St. Patrick’s Residence offers a Level 3 approach to substance use services and non-medical services.


38

St. Andrew’s Residence, Ottawa

St. Andrew’s Residence (Stage 3) St. Andrew’s Residence was established in 2005 as a 35-unit supportive housing program. It is considered to be Stage Three on the housing continuum and is primarily intended for men and women who are ready to move on from Hope Living and St. Andrew’s Residence to a more independent lifestyle. As with the other two programs, the target population is people with a concurrent disorder or mental health issue who have a history of homelessness. It is funded by the MOHLTC through the LHIN’s. Tenants are covered under the RTA. St. Andrew’s Residence is located in the Lowertown area of Ottawa, within close proximity to other Shepherds of Good Hope services. Each unit is self-contained and there are both one-bedroom and two-bedroom units available. Tenants share a resource room and laundry facilities.

St. Andrew’s Residence offers a Level 3 approach to substance use services and non-medical services. There is support available to tenants of St. Andrew’s Residence 24 hours a day, seven days per week on an as-needed basis. Support staff assist with programming that promotes greater independence. Tenants in the building are very actively involved in a variety of activities, including the Tenant Association, development of monthly newsletters and organizing social gatherings on the garden roof-top deck. Although there was a degree of “not in my backyard” (NIMBY) when the purchase of this building by Shepherds of Good Hope was first announced, it has had more of a positive transformational effect on the neighbourhood and community than any other of the Shepherds of Good Hope programs. The superior upkeep of the building combined with the friendly rapport with neighbours has resulted in not only wide acceptance but a positive influence in the community. It has also helped to dispel myths and stigma associated with people experiencing homelessness with mental health issues.


39

Options Bytown, Ottawa

Options Bytown Background The first Options Bytown apartment building was built in 1989 in response to the International Year of Shelter for the Homeless. The building is located in the Byward Market area of Ottawa. Options Bytown serves up to 60 tenants on five floors. In 1992 a second building was opened in Centretown that houses another 60 tenants on 7 floors. The buildings are staffed by Housing Support Workers 7 days a week, in the daytime only. The Byward Market building has night time security on an occasional basis. In addition, there are several surveillance cameras located in the public areas of the buildings. However, they are not monitored. In recent years, access buzzers were moved to the outside of the Byward Market building, in order to reduce the amount of unwanted activity occurring in the entranceway. Options Bytown is owned and maintained by Ottawa Community Housing Corporation (OCHC) and the units are rent geared-to-income (RGI). Staff collect rent on behalf of OCHC and tenants are governed under the RTA. The support component of the program is funded through a combination of Consolidated Homelessness Prevention Program (CHPP) and the Homelessness Partnering Strategy (HPS); however tenants are not required to sign a support agreement as a condition of tenancy. Most tenants are recipients of OW or ODSP and some tenants are employed. Population served Tenants include men and women over the age of 18 who have experienced persistent homelessness and are able to live independently. Tenants range in age from early 20’s to early 60’s with most tenants between 35 and 55. The program is intentional about maintaining a 60:40 split of men to women, which was agreed upon when the program first opened. Over the years, the intake process has become more intensive in order to ensure applicants are able to live independently and will benefit from the supports that are offered. Those needing assistance with daily living are not well suited to this program. There are approximately 14 units that turnover each year. Housing model

The building consists of a combination of one or two bedroom and bachelor units (the last four bedroom unit was converted into four bachelor apartments). There is common space located on the main floor with a pool table, TV and internet access. Additionally, there are laundry facilities available and a landline for people who need to make local calls on the main floor.


40

Support and Services Model Options Bytown offers a Level 3 approach to substance use and non-medical services. Support workers address housing-related issues (e.g., income, quarterly unit inspections) as well as support needs. Some tasks have been delineated to include working on the waiting list and managing tenancy issues. If agreeable, when a tenant moves in, he or she is assisted in drawing up an individual short and long term goal plan. These goals could span a number of areas such as financial, health and nutrition, socialization and recreation, community development and community resources awareness, well-being and self-realization, safety and security and housing. Housing Support Workers also assist in mediation with other tenants and community. There is no medical support offered on-site, however support workers provide assistance to tenants in getting connected when medical assistance is required. Such connections include CCAC), ROH, Salus, ACTT, OW, ODSP, Community Health Centres, shelters, etc. In addition, for the last two years, there is an on-site addictions worker funded through the federal Homelessness Partnering Strategy (HPS). There are volunteers who assist with special events on site such as computer training, sewing classes, cooking lessons and holiday dinners. Further, tenants and support workers work together to organize such activities as coffee house, workshops, movie nights and craft evenings. The roster of recreational opportunities offered help to increase socialization skills and self-esteem, and encourage tenants to display talents and to learn new ones.

Program Outcomes Over 80% of tenants remain housed for more than two years and half of those have remained housed for more than 10 years. Under a new Service Manager local priority directive, tenants of supportive housing will be given a priority status to receive a social housing unit without supports, if they have been recommended by their supportive housing provider. Since this new directive was introduced on May 1st, 2010, Options Bytown has recommended 20 tenants out of 121 tenants to be capable of moving to more independent living.


41

Birchmount Residence, Toronto

LEVEL 2 PROGRAMS (DAMP) Birchmount Residence Background In the mid-1990’s, Toronto began a restructuring process that involved establishing smaller programs in order to better serve those with specific life situations. Specifically, it was recognized that there was a group of older adults (aged 50+) experiencing persistent homelessness who were no longer able to be appropriately served by the Seaton House Men’s Shelter due to the intensive level of support required. Further, this group was being preyed upon by younger shelter residents. In response, the City of Toronto established a program for these men which became known as Birchmount Residence. The program is located in Scarborough (approximately 30 minutes from downtown Toronto) in a gentrified neighbourhood referred to as Birchcliff Village. It is situated next door to a community housing co-operative and group homes owned by the same landlord that owns Birchmount Residence. Initially, there was a great deal of community and neighbourhood opposition to news of the establishment of Birchmount Residence. Those in opposition were mostly concerned that the program would lower property value. In response, a Community Contract was developed that clearly outlined the expectations of residents, staff and the community (refer to Appendix B). Further, the Birchmount Residence Community Reference Board was assembled in order to address possible concerns arising from the community. Over the past ten years, only three concerns have arisen, and the neighbourhood now has a sense of confidence in the program as it has become a fixture in the community.

The program took approximately six months to set-up, and there were some initial challenges filling the beds in the early months due to the location. Some potential tenants were reluctant to move to a suburban setting away from their favourite coffee shops and services. Funding Birchmount Residence is a satellite program of Seaton House Men’s Shelter, and as such receives Emergency Shelter funding (per diem) administered through the City of Toronto. The per diem amount covers approximately 35% of the total expenses required to live at Birchmount Residence. The remaining 65% of the funding is provided by the City of Toronto directly (through property taxes) and also covers lease of the facility. Although the program identifies itself as a senior’s transitional supportive housing, it is funded as a hostel (emergency shelter) and is not subject to the conditions under the RTA.


42

Population Served

Birchmount Residence serves up to 60 men experiencing persistent homelessness over the age of 50 (although the program will also accept men in their late 40’s). The average age for residents is 63, and the oldest person in the program was 93 at the time of the site visit. There are approximately seven people on the waiting list at any given time. Specifically, Birchmount Residence serves people experiencing persistent homelessness who have stayed at Seaton House Men’s Shelter for an extended period of time. Birchmount acts as longer-term housing for approximately 30% of residents. For others, they may be waiting to move onto a more independent living situation, or long-term care. Of the total residents, 30% per cent have substance use issues related to alcohol, 30% have a mental health issue, and 40% are experiencing a concurrent disorder (mental health and substance use issue). Several men also are refugees and have experienced family loss. Due to the stipulations outlined in the Community Contract, Birchmount Residence cannot accommodate those in the following life situations:

• Men who require high levels of medical support • Men who display extremely challenging behaviours (e.g., physical aggression,

unsupported mental health conditions) • Men who are active in their drug use (i.e., crack or cocaine) • Men on probation and parole

Further, when possible, Birchmount Residence accepts people with the following life situations:

• Men without Canadian status • Men with a communicable disease that is not contagious • Men who are not ambulatory and require a wheelchair

Transition from Homelessness to Housing Although referrals to Birchmount Residence are most commonly received from Seaton House Men’s Shelter, as of 2005, with the Birchmount Residence Community Reference Board support, admissions from all shelters are now accepted. On occasion, the program also assists men from other communities and even across the country. Once a person is referred to the program, they are interviewed by the on-site counselor and given a tour of the Residence.

Over the years, the population of Birchmount Residence has shifted as admission is no longer based on a long-standing relationship with staff at Seaton House Men’s Shelter as was the situation in the early years. A potential resident’s ability to adhere to guidelines outlined in the Community Contract is the foundational criteria for admission.

There is recognition and acceptance that residents in the program are drinking alcohol outside of the house, however residents are not encouraged to drink within the Residence nor are they administered alcohol as part of the program (e.g., managed alcohol – Level 5 services).


43

Housing Model Birchmount Residence is located in a three floor, 20,000 square foot building that formerly served as a retirement residence. Although the building is situated on a busy Scarborough street, it boasts a spacious front and back yard that serves as a smoking area and gathering place for barbeques and other social events. All residents and staff enter the Residence through the main entrance, and there are no security cameras on the premises. The housing model offers a congregate living environment with 23 bedrooms (two to four beds per room), with the average room size being approximately 120 square feet. Bedrooms do not have locks on the doors. There are a total of 15 washrooms, five of which are common, three tub rooms and two shower rooms. The remaining washrooms are located in the bedrooms. The building is not equipped with an elevator. The building has a large dining area in the basement with a remarkable “Memorial Wall” that pays tribute to former residents. Laundry facilities are available for resident and staff use. There is no staff meeting space. Support and Services Model Birchmount Residence offers a Level 2 approach to substance use and partial medical services. Birchmount Residence is staffed by Client Service Workers (CSWs) 24 hours a day, seven days a week. There are at least two CSWs and one supervisor on staff at all times. There are ten staff on the day shift, four staff on the afternoon shift and three staff on night shift. Additionally, there are three to four staff on all day on week-ends. CSWs provide support to daily living for residents, including the preparation of meals and snacks on-site. Each Birchmount resident has access to a fridge if their preference is to purchase their own food. Of the total program residents, 10% opt to eat their own food solely (usually due to cultural preference) and 50% eat some of their own food. In addition to CSWs who often provide support to daily living, accompaniment to appointments and advocacy, there are a host of supports and services available to residents at Birchmount Residence. These services include a Housing First team (based at the City of Toronto Head Office), support coordination, psycho-geriatric counseling, CCAC, and mental health services. With respect to medical support, there is 12 hours per day of nursing on-site for residents Monday - Friday from 8am to 8pm and 10 hours per day on Saturday and Sunday. Further, a physician visits Birchmount Residence every week and a psychiatrist holds a monthly clinic. Additionally, a Property Services Worker is on staff daily to address cleaning and maintenance issues. Birchmount Residence no longer has an Activities Coordinator on staff, as that funding was directed to increasing nursing staff. However, CSWs organize such events as bingos, bowling nights, music nights, out-of-town excursions, etc. Ten residents at Birchmount Residence volunteer in some way (e.g., helping out at the Food Bank, delivering papers, etc.) Residents can also assist with chores around the Residence and receive a stipend of three dollars per hour. There is one computer at Birchmount Residence for residents to use. The program also has a cat that all residents communally provide for.


44

Program Outcomes Since 1999, there have been approximately 200 people who have exited the program, with the average length of stay being one year and three months. Former Birchmount Residence residents have been assisted to find housing in a variety of alternative accommodations that include long-term care facilities, supportive housing, independent subsidized units, independent market rent units and with family or friends. When men move on from Birchmount Residence, CSWs are closely involved to offer encouragement, assist with filling out application forms and assessments, as well as accompaniment to view housing units. Further, staff help to develop relationships with landlords, provide assistance with the move and with finding furnishings and connect the person to community services. Follow-up support is offered by CSWs for as long as required. Less then ten per cent of men who exit the program return. SUMMARY Although each housing program described operates uniquely, the commonality lies in the shared commitment to understanding the challenges faced by residents/tenants on their own terms. As such, programs are designed to respond to needs as they emerge and transform. It is intended that the information contained in this Program Review Resource Guide will offer the opportunity to continue the dialogue around gaps in housing options for people experiencing homelessness in Waterloo Region. Findings may also support program development and funding proposals to address gaps in local housing options.


45

REFERENCES

Carson-DeWitt, Rosalyn; Macmillan-Thompson, Gale (2001). Alcohol and drug-Free Housing. Encyclopedia of Drugs, Alcohol, and Addictive Behavior. 2nd Ed. Retrieved July 2009 from http://www.enotes.com/drugs-alcohol-encyclopedia/ alcohol-drug-free-housing.

Community Information Centre of Ottawa (CIC). Retrieved June 2010 from

http://ottawa.cioc.ca/record/OCR0617?UseCICVw=39 Gnaedinger, Nancy (2007). Supportive Housing for Homeless and Hard-to-House

Seniors: An In-depth Case Study of Fairway Woods. Canadian Mortgage and Housing Corporation. Retrieved February 2009 from http://ftp.cmhc-schl.gc.ca/chic-ccdh/Research_Reports Rapports_de_recherche/eng_unilingual/Housing_Homeless_HH_Seniors(w).pdf

Homelessness Forum and Managed Alcohol Program (2009). Accessed January

2010 from http://www.knitnut.net/2009/11/homelessness-and-alcoholism. In the Mind’s Eye (ITME) (2009). Housing and Harm Reduction Survey Results.

Kraus, Deborah; Serge, Luba; Goldberg, Michael (2006). Research Highlight:

Homelessness, Housing and Harm Reduction: Stable Housing for Homeless People with Substance Use Issues. Canada Mortgage and Housing Corporation. Socio-economic series 05-027.

Lenk, Anna; Serge, Luba; Gnaedinger (2004). Housing Options for Elderly

Chronically Ill Shelter Users. Canada Mortgage and Housing Corporation. Retrieved December 2009 from https://www03.cmhc-schl.gc.ca/catalog/productDetail.cfm?csid=1&cat=32&itm=35&lang=en&fr=1281713062069.

Mauro, Ellen. A Chance to Lead a Better Life. The Ottawa Citizen. June 25th, 2010.

Retrieved July 2010 from http://www.ottawacitizen.com/news/chance+lead+better+life/3193324/story.html?cid=megadrop_story.

Tinker, Anne; Clelland, John (2010). Six Month Report on Streets to Housing

Stability: One Step Forward. Streets to Housing Stability, Cambridge Shelter Corporation.

Zamprelli, Jim (2009). Research Highlight: Housing Person With An Intellectual

Disability in Intentional Communities: Identifying Relevant Physical and Governance Structures. Canada Mortgage and Housing Corporation. Socio-economic series 09-012.


46

APPENDIX A: Brigid’s Place Agreement to Reside


47

APPENDIX B: Birchmount Residence Community Contract


48


49


50


51

APPENDIX C: Annex Care Compared to Usual Shelter Care (Svoboda, 2006) Usual Shelter Care Annex Program Care in Addition to Usual

Shelter Care Overnight emergency shelter Support to Alcohol use ± Difficult Behaviour: First come first served / reserved

beds Storage of personal alcohol

Overnight bed Non beverage / wine exchange Meals – 2-3 meals/day Staff: selected based on compassion toward

and commitment to this more difficult population, higher staff to client ratio, more adept in de escalation techniques

Laundry / showers / min personal storage

Intoxicated clients encouraged to stay/return

Social work – obtaining financial support / getting ID, etc.

Activities of daily living (ADL) support (e.g., assistance with taking medication, hygiene, and eating meals)

Staff supervision In shelter primary medical care integrated with program

Hosp/agency visits arranged / escorted Financial Support Banking Social support directed to shelter

program except for personal needs allowance ($27/week)

Sliding fraction of social support directed to shelter program with a larger portion remaining for client

Drinking Program: 1-2 drinks / 1-1.5 hours (8am – 11pm) can remain indoors x 24 hours Encouraged to drink in program rather than

outdoors


52

APPENDIX D: Promising Practices: Specific Design Features

The information to follow has been informed through the literature as well as local and provincial site visits, community discussions and informal conversations. For further detail around the sources of the site visit information below, please refer to Appendices E and F. The literature citations are included in the References section within the main body of the report. Building Design/ Floor Plan

• In the building design stage, it is crucial to involve people who may become future residents (Brigid’s, 2009).

• The ability to divide a floor into separate wings should be a consideration in the event of a pandemic (CHSCU, 2009).

• Pay attention to vertical sound transfer of the building and ensure that there are enough resources to invest in a reliable elevator (Gnaedinger, 2007).

• Ensure that the building is not easily recognizable with signage and other identifiers. This is especially important for buildings located in the downtown area. It is best if the building has a “home-like” feel and fits in naturally with other buildings in the neighbourhood (Brigid’s , 2009; Gnaedinger, 2007; ITME, 2009).

• Buildings should be constructed using an “evolving design” so that structures can be added or altered. Further, the application of universal accessible design features are critical as residents age and/or experience physical challenges (bars in washroom, wider doorways to accommodate mobility aids, lower than standard window sills etc.) (Gnaedinger, 2007; FV Housing, 2009).

• The building should encourage social interaction and community participation (Carson-Dewitt et al., 2001).

• Consideration of residents’ needs to be loud at odd hours of the day and night should be factored into the design of the home (Tinker and Clelland, 2010).

• People experiencing persistent homelessness have spent many years outdoors. As such, buildings should have high ceilings, plenty of windows, and a great deal of natural light which gives the illusion of space and reduces feelings of claustrophobia. Paint in earth tones can also enhance the comfort level for residents (CHSCU; FV Housing, 2009).

• Co-location of managed alcohol programs in emergency shelters is not always ideal (Annex, 2009).

• Separate buildings may be best suited to house managed alcohol programs (Annex, 2009).

• Advantages and disadvantages to a congregate living setting should be carefully considered in the design phase. The advantage to congregate settings is that they build a sense of team and community within the program. The adjustment may be easier for some people because they have been ‘institutionalized’ for years. However, it could also lead to overcrowding and lack of personal space for belongings, triggering incidents, etc. On the other hand, some people could find being ‘alone’ in private bedrooms or units to be overwhelming (Tinker and Clelland, 2010; Annex, 2009; MAP, 2009).


53

• Self-contained units can be overwhelming with respect to responsibility (both on a physical and financial level) for people who have experienced homelessness for a long period of time (Tinker and Clelland, 2010).

• Substantial separation between residents (e.g., separate sitting areas, outdoors buildings and outdoor space) is especially important in congregate settings. People should also have a place to burn things outdoors (Tinker and Clelland, 2010).

• Energy efficiency should be a major consideration in the design stage. For example, windows should be double-paned (FV Housing, 2009).

• Fire safety features should be a major consideration. For example, installing a device that is timed to open all bedroom or unit door when the fire alarm sounds should be a consideration in the design phase (Gnaedinger, 2007; FV Housing, 2009).

• A PA system with direct communication to residents’ units is especially important to programs with limited staff (FV Housing, 2009).

• Building should have air conditioning (515 MacLaren, 2009). • Sheet flooring, laminate or polished concrete is ideal as it is most hygienic and

durable (Gnaedinger, 2007; FV Housing, 2009). • The building’s floor plan should be very straightforward and easy to remember

and negotiate (Gnaedinger, 2007; Annex, 2009; CHSCU, 2009). • By establishing a program on one floor with a single point of entry, clear sight

lines are created. Building design can therefore facilitate surveillance, which reduces the need for a security system (Gnaedinger 2007; Brigid’s, 2009; FV Housing, 2009). Monitoring is especially important in wet programs where residents are active in their substance use (Kraus et al., 2006). Building security guards and security cameras can have a negative impact when trying to foster a sense of community and inclusion (Annex, 2009). A security system may be necessary when programs are co-located in a shelter, however. In this situation, a camera with recorded security footage is less intrusive than a live PVR feed (Annex, Lincoln). Staff can also wear panic necklaces in the event of an emergency (Lincoln, 2009; Brigid’s, 2009)

• “Open” circulation systems or “sociopetal spaces” in a building bring people in contact with one another to socialize, greet each other and notice people during the day (e.g., areas that have nooks and side areas where people can stop and chat, centrally located corridors with wide openings to bedrooms They create lively and engaging spaces. (Carson-DeWitt et al., 2001).

Gender • Men and women do not need to be segregated in separate buildings, but where

possible, people should be grouped according to their needs (e.g., concurrent disorders, dual diagnosis, mental health issues) (Lenk et al., 2004).

• Where possible, couples should be able to share a bedroom (MAP, 2009; CHSCU, 2009).


54

Program Size • Smaller scale programs are most suitable for people with complex needs as they

help to build and maintain a sense of community and facilitate better efficiencies in service delivery. In most situations, programs should have a maximum of 20-50 people, depending on the level of support required (Annex, 2009; Gnaedinger, 2007).

Housing Design Features

Bedrooms • Choice and flexible options are key to a resident’s success. Forced sharing does

not usually work, however some people prefer dorm style (3 or more beds per room) or semi-private rooms (2 beds per room). A private bedroom with shared living space offers a balance of both private and shared space (FV Housing, 2009; Brigid’s, 2009).

• Women seem to experience the most success in private bedrooms (Brigid’s, 2009).

• Providing furnished rooms is a necessity as many residents enter such programs with little to no possessions. Furnishings may include a bed, dresser, nightstand, bedding and window coverings (Annex, 2009; MAP, 2009; Brigid’s, 2009).

• In dorm style bedrooms, a locker is an important feature for residents to store personal belongings (Annex, 2009). Although dorm style rooms generally do not have locks on the doors, it would be the expectation that staff always knock and wait to be invited in before entering the room (Annex, 2009).

• Providing a small fridge in private bedrooms is a good option for residents who need or prefer to store personal food items (Birchmount, 2009).

Kitchen • A functional kitchen is more important than a large kitchen (especially relevant in

self-contained units). If possible, extensive pre-planning in the design phase is extremely important (FV Housing, 2009).

• In a congregate living environment, it is a good idea to have both a resident kitchenette and a servery kitchen - ideally physically linked to one another (CHSCU, 2009; 515 MacLaren, 2009). A servery can act as space to provide cooking classes, as people often have limited cooking skills that they bring from the street into housing (Tinker and Clelland, 2009; ITME, 2009). The servery may contain appliances to cook simple meals such as a toaster oven and hot plate. With two kitchens, resident independence can be fostered while still ensuring space for staff to prepare full communal meals.

• All appliances need to be safe-guarded. For example, stoves should have safety elements installed so they turn off at a programmed temperature (FV Housing, 2009).

• Convection ovens are a safer choice than microwave ovens (FV Housing, 2009). • The dining area should be large enough to accommodate all residents, which can

help to foster a sense of community. Also, it is also more hygienic for residents


55

who would otherwise take food to other areas of the building, which can lead to infestations (Annex, 2009; ITME, 2009).

• Square rather than oblong tables tend to best suited to promoting socialization (Gnaedinger, 2007).

Bathroom

• A maximum of two people sharing a washroom is considered ideal. Over sharing can trigger behaviours, reduce cohesion and increase maintenance costs over the long-term (FV Housing, 2009).

• Depending on capacity, congregate programs should have at least one attendant care washroom for people with mobility challenges (FV Housing, 2009).

• Providing a cleaning service for the kitchen and bathroom areas when residents live in self-contained units will contribute to the upkeep of the unit (FV Housing, 2009).

Shared Space • A spacious recreation room/common area is important and most suitably located

on the main floor (FV Housing, 2009; Options Bytown, 2009; Brigid’s, 2009; CHSCU, 2009; Gnaedinger, 2007; ITME, 2009). Creative space stocked with supplies would be desirable (Tinker and Clelland, 2010).

• Basement spaces are not used as often by people who have formerly experienced persistent homelessness (CHSCU, 2009; Gnaedinger, 2007).

• Establishing more than one common area to accommodate different tastes/preferences is important. It is a good idea to separate recreation/common areas into sections that can be used for multiple activities and serve to assist in the re-socialization process for residents (e.g., TV, reading, listening to music, talking on the telephone, playing board games, etc.). (MAP, 2009; 515 MacLaren, 2009)

• In buildings with self-contained units, locating mailboxes in the main lobby within view of staff office space provides an opportunity for staff to make contact with residents on a frequent basis (Gnaedinger, 2007; FV Housing, 2009).

• Creating ample outdoor/green space should be a consideration. Outdoor space can be used for socializing, smoking, eating, and gardening (CHSCU, 2009; MAP, 2009; Annex, 2009).

• A balcony addition offers a viable option for creating outdoor space when a building has limited green space capacity (MAP, 2009).

• In programs that offer medical support, there should be private palliative space and clinic space (Annex, 2009; CHSCU, 2009; ITME, 2009).

• Private staff meeting and break space is deemed critical as the duties front-line workers in such programs are often demanding which necessitate uninterrupted breaks. This space should be located close to the entry/exit for monitoring purposes (Annex, 2009; MAP, 2009; CHSCU, 2009; Gnaedinger, 2007).


56

Storage • Wine/beer storage room is important for managed alcohol programs. For

example, MAP uses nine 200 gallon barrels of wine every two months. This requires a substantial amount of storage space (MAP, 2009).

• Some limited storage space within the building should be available to residents so hoarding does not become an issue in private bedrooms (Zamprelli, 2009).

• A strategy and facilities for the separation of food storage should be developed (Tinker and Clelland, 2010).

Utilities

• Utilities should be included in rent with smart meters in order to monitor utility use (Tinker and Clelland, 2010).

• Training around utility use may be important for new Canadians that have arrived from hot climates (Lincoln, 2009).

• A shared telephone should be available in the lobby so all residents have the ability to make emergency phone calls (Lincoln, 2009; Options Bytown, 2009; 515 MacLaren, 2009).

• When possible, internet connection and cable should be included in the cost of utilities because they can serve to pass the time for people experiencing homelessness who may be used to being witness to a higher level of activity (ISH, 2009).


57

APPENDIX E: Site Visit Data from Other Communities


58

APPENDIX F: Local Site Visit Reference Information

Program Citation Site Visit Date Interview Contact Other sources of data (excluding literature) Website

Cambridge Shelter Corporation:

Supportive/Transitional Housing

Supportive/ transitional housing, 2009

March 23, 2009 Anne Tinker, Executive Director

Inventory of Housing Stability Programs in Waterloo Region, 2009 Available on-line at: http://www.region.waterloo.on.ca/web/social.nsf/DocID/612846FFA89DAC288525700C004983FD?OpenDocument

http://www.cambridgesheltercorp.ca/

House of Friendship: Cramer

House

Cramer, 2009 March 9, 2009

Ron Flaming, Manager; Wendy Kirk, Support Worker

Inventory of Housing Stability Programs in Waterloo Region, 2009 http://www.houseoffriendship.org/

Regional Social Services:

Domilcilary Hostels

Dom Hostels, 2009 August 18, 2010

Lisa Dawn Wismer, Social Planning Associate

Inventory of Housing Stability Programs in Waterloo Region, 2009

http://www.region.waterloo.on.ca/web/social.nsf/DocID/612846FFA89DAC288525700C004983FD?OpenDocument

House of Friendship: Charles

Village

Charles, 2009 March 9, 2009

Ron Flaming, Manager; Taylor Martin, Support Worker


http://www.houseoffriendship.org/

House of Friendship: Eby

Village

Eby, 2009 March 9, 2009

Ron Flaming, Manager; Christine Stevanus, Support Worker


http://www.houseoffriendship.org/

YWCA Kitchener – Waterloo Lincoln Road Apartments

Lincoln, 2009 February 5, 2009

Cathy Middleton, Manager


http://www.ywcakw.on.ca/

SHOW SHOW, 2010 August 25, 2010

Cathy Middleton, Manager

STEP Home Reference Group Minutes, May 28, 2010

http://supportivehousingofwaterloo.org/

The Working Centre: Integrated

Supportive Housing ISH, 2009

February 13, 2009 Chad McCordic, Support Worker


http://www.theworkingcentre.org/

The Working Centre: Hospitality

House

Hospitality House, 2009 September 24, 2009

Jennifer Mains, Manager; Kara Peters Unrau

Hospitality House/At Home Outreach Program Description

http://www.theworkingcentre.org/


59

APPENDIX G: Summary Table of Level 3-5 Programs in Other Communities

Feature

Brigid’s Place

Birchmount Residence 515 Maclaren

Fred Victor Centre

Housing Hope Living Options

Bytown St.

Andrew’s Residence

St. Patrick’s Residence

Year Established 2008 1999 1989 1988 1999 1989 2005 1999

Location Ottawa Toronto Ottawa Toronto Ottawa Ottawa Ottawa Ottawa

Population Served

Up to 11 women, 26 to late 50’s

Up to 60 men aged 50+, 63 to 93 years *

Up to 20 women over the age of 18, 35 to 67 years *

Up to 194 single adults over the age of 18, 20 to 73 years *

Up to 35 men and women over the age of 18

Up to 120 single adults over the age of 18, 35 to 55 years*

Up to 35 men and women over the age of 18

Up to 13 men with severe mental health issues.

Housing model

Congregate living, private bedrooms, in self-contained building in downtown

Congregate living in a former retirement residence away from the downtown

Self contained building - private units with shared bathroom away from the downtown

Self-contained building - shared units with private bedroom in downtown

Private bedroom with shared living space co-located in shelter downtown

Self-contained bachelor and one-bedroom units in downtown

Private self-contained one and two bedroom units in downtown

Self-contained building - private bedroom and washroom with shared living space

Governed under RTA? Yes No – considered

a hostel

Yes – Social Housing Reform Act

Yes – Social Housing Reform Act

Yes Yes – Social Housing Reform Act

Yes Yes

Staffing model

24/7 support workers






24/7 support worker 24/7 support workers

Housing and Support Funding

Housing: Provincial Domiciliary Hostel Program Support: HPS

Housing and Support: MCSS; Emergency Shelter

Housing: CCOC Support: CHPP

Housing: RGI, City of Toronto, HPS, United Church, foundations, corporations, individuals Support: MOHLTC

Housing and support: MOHLTC

Housing: OCHC Support: City of Ottawa

Housing and support: MOHLTC LHIN

Housing and support: MOHLTC


60

APPENDIX H: Site Visit Reference Information In Other Communities

docs admin 1010171-v1-resource-guide_final1

Documents

program administrationsupport

program administrationfunding

program drafts

annex harm reduction

programs describedwithin

ottawa bysocial planning

programs managed alcohol

report contributors