Presentation given by Judith Woolf/Dorieka Wewerinke, UMC St Radboud at the FEANTSA/French Permanent Representation to the EU seminar, 'Housing First: A Key Element of European Homelessness Strategies', 23rd March 2012.

1. Discus Amsterdam: Housing First
Evaluation
Dorieke Wewerinke
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
© UMC St Radboud
Maart 2012
Judith Wolf, Marjolein Maas, Sara Al Shamma

2. Onderzoekscentrum maatschappelijke zorg
Contents
• Discus Amsterdam: Housing First
• Research objectives & study components
• Discus clients: selection criteria
• Profile of clients
• Main outcomes:
Onderzoekscentrum maatschappelijke zorg
Health, social contacts, Quality of life, residential stability, rates of nuisance,
“gedreven door kennis, bewogen door mensen”
perceived benefits (satisfaction with Discus and QoL improvements), fulfilment
of expectations
• Policy implications
• Future implementation

3. Onderzoekscentrum maatschappelijke zorg
Discus Amsterdam: Housing First (Pathways to Housing, Tsemberis, 1992)
• Target group: roofless people
• Independent accommodation (dependent rent contracts)
• Housing accommodation dispersed throughout city
• Rehabilitation approach: focus on individual strengths
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”

4. Onderzoekscentrum maatschappelijke zorg
Selection criteria for Discus Amsterdam: Housing First
1. Be motivated
2. Cause no nuisance
3. Pay the rent
4. Accept at least one home visit per week by the housing support worker
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
5. Agree to income management
6. Comply with the Discus behavioural rules

5. Onderzoekscentrum maatschappelijke zorg
Evaluation: objectives and study components
(Commissioned bij HVO Querido, City of Adam, Agis Health Insurance Company)
Gain insight into: Study period: 010 2010 – 010 2011
 Profile of participants
 Health  One semi-structured, face-to-face
interview with clients (use of
 Social contacts standardized instruments)
 Quality of life and QoL improvements
 Completion of interview
 Residential stability questionnaires by support workers
Onderzoekscentrum maatschappelijke zorg
 Rates of nuisance
“gedreven door kennis, bewogen door mensen”
 Perceived benefits from Discus:  Group interview with support
workers
- QoL improvements
- Satisfaction with Discus  Analysis of nuisance data recorded
by housing associations and Discus
No conclusions can be drawn as to whether Discus is better than other types of housing provision.

6. Onderzoekscentrum maatschappelijke zorg
Profile of Discus customers
84 customers registered with Discus between Dec 2010 - Feb 2011;
64 participants in study, response rate 80%
 78% male, average age 45 (range: 24 to 62)
 55% of ethnic minority background, 74% non-Western
 41% primary or no education
 80% unmarried
 88% single
 Onderzoekscentrum maatschappelijke zorg
48% had children, 65% had 1 or 2 children
“gedreven door kennis, bewogen door mensen”
 94% lived partly or wholly from social benefit, 72% from social assistance
 41% were in paid employment or voluntary work
 Average monthly disposable income: €208
 70% in debt → €13,000 on average (range: €100 to €120,000)

7. Onderzoekscentrum maatschappelijke zorg
Health
 Self-appraisal of physical and mental health: reasonable to excellent: 67% (physical),
80% (mental)
 52% had physical health problems, 45% had long-term health problems, 45% were
currently in treatment
 Higher rates of mental health problems (anxiety, depression, psychosomatic symptoms,
hostility) in comparison to Dutch general population
 ≥ 50% reported past-month use of ≥ 5 daily units of alcohol, cannabis, crack or powder
Onderzoekscentrum maatschappelijke zorg
cocaine, or methadone / LAAM / buprenorphine door kennis, bewogen door mensen”
“gedreven
Indication of vulnerability: lifetime use of mental health services
 52% outpatient addiction treatment
 52% inpatient addiction treatment
 64% outpatient psychiatric treatment
 42% inpatient psychiatric treatment

8. Onderzoekscentrum maatschappelijke zorg
Social contacts
Visits within personal network:
 Family: 40% at least once a week, 29% never
 Friends and acquaintances: 52% at least once a week, 24% never
Loneliness Discus- Dutch
customers population
Not lonely 25% 68%
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
Average loneliness 47% 28%
Rather lonely 23% 3%
Extremely lonely 5% 1%

9. Onderzoekscentrum maatschappelijke zorg
Quality of Life (scale 1-7: ‘terrible’ to ‘delighted’)
General quality of life reported high: average score 5.0
Highest satisfaction rates:
Household maintenance and self-care: 5.7
Sense of safety: 5.7
Accommodation: 5.4
Emotional health: 5.4
Social functioning: 5.4 Onderzoekscentrum maatschappelijke zorg
Resilience: 5.4 “gedreven door kennis, bewogen door mensen”
Relatively lower satisfaction:
Finances: 4.4
Relations with family: 4.6
Relations with offspring: 4.0

10. Onderzoekscentrum maatschappelijke zorg
Residential stability
Customers registered with Discus between inception in 2006 and 6 April 2011: n = 123
Still housed with Discus Support:
77% (n = 95)
No longer participating:
23% (n = 28)
Onderzoekscentrum maatschappelijke zorg
- 7 had independent rent contracts
“gedreven door kennis, bewogen door mensen”
- 10 transferred to different type of housing provision
- 3 departed due to severe nuisance
- 8 departed for other reasons:
3 died, 1 withdrew voluntarily, 1 returned to family abroad, 3 entered prison

11. Onderzoekscentrum maatschappelijke zorg
Rates of nuisance (2006-2011)
Complaints to housing associations:
 26 nuisance complaints for 100 flats
Most complaints were by neighbourhood residents, most were about noise.
Complaints to Discus:
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
 41 complaints, 75% involving mild to moderate nuisance
Discus takes up the complaints, but precise outcomes are not always clear.
Needs improvement.

12. Onderzoekscentrum maatschappelijke zorg
Perceived benefits from Discus: QoL improvements
General quality of life (N=63)
Housing situation (N=63)
Finances (N=63)
Structured daily activities (N=63)
Household maintenance and self-care (N=63)
Relations with family (N=61)
Social contacts (N=63)
Sense of safety (N=63)
Physical health (N=63) Onderzoekscentrum maatschappelijke zorg
Mental health (N=63) “gedreven door kennis, bewogen door mensen”
Substance use (N=62)
Relations with offspring (N=21)
Personal resilience (N=63)
0% 20% 40% 60% 80% 100%
Better Unchanged Worse

13. Onderzoekscentrum maatschappelijke zorg
Perceived benefits from Discus: Satisfaction
Satisfaction: Average score: 8.2 (1-to-10 scale)
69%: expectations fulfilled, satisfaction with outcome
– ‘Things are going great.... I’m satisfied with my flat. Discus recognises my
problems and accepts me like I am.’
– ‘I’ve improved 99 per cent. I hadn’t expected that.’
19%: expectations partly fulfilled
Onderzoekscentrum maatschappelijke zorg
– ‘I’m much more independent. It’s succeeded halfway. I’m still in debt,
“gedreven door kennis, bewogen door mensen”
unemployed and not financially stable.’
12%: expectations not fulfilled, outcome below expectations
– ‘I’m disappointed. I’ve got no job. I believed that if I got a flat, I’d soon get a job,
but things were different in practice. My social life is also not as good as I had
hoped.’

14. Onderzoekscentrum maatschappelijke zorg
Conclusions
 Discus reaches a severely deprived group: people with weak socioeconomic
status, multiple problems and high use of social and health services (past and
present).
 High satisfaction rate with Discus: a score of 8.2
 High quality of life and high rates of perceived improvements in many life
domains Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
 Relatively low rates of nuisance complaints
 After 5 1/2 years of Discus, the majority of clients (77%) were still housed with
Discus support and the real dropout rate was low (2.4%).
 Discus Amsterdam is successful!

15. Onderzoekscentrum maatschappelijke zorg
Policy implications
 Parties concerned (HVO Querido, municipality of Amsterdam, and a health
insurance company) want to continue policy of extramuralisation
 Invest in Housing First: health insurance company already agreed on
budget for 240 extra care packages for Housing First (commitment is 300
or more)
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
 In collaboration with housing associations 240 houses have to be made
available for Housing First (and possibly more).

16. Onderzoekscentrum maatschappelijke zorg
Future implementation
 Further development of strength based aproach, own direction and
rehabilitation
 Continued investment in (new) workers;
-recruiting and selecting workers with qualities needed to strengthen the team
-keeping up with new knowledge and training
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
 Focus on consensus within and between teams to assure internal quality
 Practice based learning: reflecting on practice, developing procedures and
annually assessing necessary adjustments

17. Onderzoekscentrum maatschappelijke zorg
Thanks are due to
Customers of Discus
Discus housing support workers
Members of the advisory committee:
Wessel de Vries, Noor Bertens, Paul van Dijk and Nienke Boesveldt
Onderzoekscentrum maatschappelijke zorg
Research team:
“gedreven door kennis, bewogen door mensen”
Sara Al Shamma, Marjolein Maas, Nicoline Jansen, Astrid Altena and Judith Wolf
Interviewers

18. Onderzoekscentrum maatschappelijke zorg
Thank you for your attention.
Any questions?
Onderzoekscentrum maatschappelijke zorg
“gedreven door kennis, bewogen door mensen”
Discus: Wessel de Vries: discus@hvoquerido.nl
UMC St Radboud: Judith Wolf: J.wolf@elg.umcn.nl