Presentation given by Pascale Estecahandy during the "Embedding Housing First at service delivery level: key barriers and opportunities" seminar at the FEANTSA 2014 Policy Conference, "Confronting homelessness in the EU: Seeking out the next generation of best practices", 24-25 October 2014, Bergamo (Italy)

1. P. Estecahandy
National coordinator operational side
DIHAL
First results of HF experimentation in France and next
steps

2. General Context
Homelessness: a key issue for public policy
Link between homelessness and health
Life expectancy 30 to 35 years shorter for homeless people
30% suffer from severe mental illness (SAMENTA Survey, 2010)
Difficult access to care, poor continuity of care, and discrimination.
2007 the « DALO » Law : the right to housing
2008 Report on Emergency Housing by French parliamentarian,
Etienne Pinte
2010 Creation of the DIHAL (Interministerial Delegation for Access to
Housing for the Homeless and Inadequately Housed)
2010 National report on ‘Healthcare for the Homeless’
2011: Creation of ‘Housing First’ program in France
A « housing led » policy and a stair case system

3. Testing HF in France using RCT
Provide and evaluate new solutions for access and retention in housing,
access to health care, human rights and citizenship of homeless people with
severe mental disorders and high needs
4 cities (Paris, Marseille, Toulouse, Lille)
Long-term homeless people with severe mental disorders and high
needs (addiction 79%)
In term of intervention : Pathways to Housing modèle (fidelity scale)
Operational side :
Rapid access to self-contained housing units with security of tenure
Priority given to user choice, respect and empathy
Recovery orientation and harm reduction approaches
Flexible, open ended offer of “floating” support (ACT team)
Client-centred approach and individual support plan
High degree of staff availability to users (1/10)
Budget intervention side
Ministry of health: 2,5 M€
Ministry of housing : 3,4 M€

4. Testing HF in France using RCT
In term of research : similar to the Canadian protocole
800 participants expected
Test and control groups randomly allocated
Quantitative evaluation every 6 months over 24 months
Principal outcome: number of hospitalized days
Secondary outcome: Quality of life, revovery, clinical aspects,
social cost, addiction
Ongoing qualitative evaluation
Analysis of implementation
Recovery individual process and trajectory
Professional practices
Final results expected in 2016
Comparisons cost / effectivness
Assessment between the two groups

5. First results : 3 years
14 structures involved in the governance
(hospital, social and housing associations)
60 professionals in 4 teams
A research team consortium
Local dynamics around steering
committee prefectural (ARS DDCS,
DRIHL, local authorities, social and
medical partners, the housing sector)
705 people included in the research
program
353 in the “un chez soi” arm
382 apartments - 11.5% in the public
sector
Average 4 weeks (48 hours to more than
one year)
Sustained support for 328 people by
multidisciplinary teams
Nearly 35,000 contacts : 4 sites / 3 years

7. First results at 12 months

8. First results at 12 months

9. First results at 12 months

10. First results at 12 months

12. First results at 12 months

13. First results at 12 months

14. First results at 12 months

15. First results at 12 months

16. First results at 12 months

17. First results at 12 months

18. First results at 12 months

19. First results at 12 months

20. Conclusion
Housing retention : 86%
No predictive criteria in the capacity to live in a independant
accomodation
Increase the « ontological security » of the participants
Needs :
time
High reactivity of the team
Multidisciplinar teams
Change in professional practices and in representations
The program manage to break down some barriers between
social, medical and housing fields
But a positive collaboration of stakeholders is needed

21. Conclusions
The main challenges
The need of affordable accommodation for every one (social or
private housing)
Issue of poverty
Solvability guarantee : lease should "slides" to the person who
becomes a "real" tenant
Access to ordinary employment
Segmentation of services : social, medical, housing
Resistance to change : « housing first strategy »
Professional training at all levers
Perspectives : 2 more years
modelisation

22. Thanks for your attention
For more informations :
Dr Pascale Estecahandy
DIHAL
pascale.estecahandy@developpement-durable.gouv.fr