Rehousing homeless citizens with assertive community treatment

This report presents the results of a study of an ACT-programme (Assertive Community Treatment) in Copenhagen, Denmark, which has been part of the Danish national homelessness strategy. The ACT-programme is aimed at rehousing homeless individuals and providing floating support in the citizens own home from a multidisciplinary support team. The target groups of ACT are homeless individuals with complex support needs due to for instance mental illness and/or substance abuse and for whom it is difficult to use mainstream support systems. The team consists of both social support workers and other professionals including a psychiatrist, a nurse, an addiction councilor, and social workers with administrative authority from the social office and the job center. In the international research literature ACT has been shown in randomized controlled trials to be a very effective method in bringing individuals out of homelessness and into a stable housing situation. The study is based on quantitative outcome measurement on about 80 citizens who have been assigned to the programme and who have received both a housing solution and support from the ACT-team. The study is not a randomized controlled trial as there is no control group. Furthermore qualitative interviews have been carried out with fifteen citizens receiving the support and eight staff members of the team. The study shows that a very high part – more than 90 pct. – of the citizens who have been assigned to housing and support remains housed throughout the observation period. About two fifths of the citizens have been housed in independent apartments in ordinary public housing and the rest have been housed in four different congregate housing units – places where all residents are formerly homeless or otherwise socially vulnerable individuals. In both housing types more than 90 pct. remain housed throughout the observation period. However, a considerable part of the citizens in congregate housing has been relocated to other forms of housing – mainly to independent public housing during the observation period. It has not been possible to control for initial selection of participants to the different forms of housing. The qualitative interviews show that the possibility to meet different dimensions of support needs - social support needs, health needs and administrative support needs is crucial to the success of the ACT-method. The incorporation of both specialist health professions and staff with administrative authority into the team gives a high degree of flexibility of giving tailor-made and coherent support to the citizens. The individuals who have been housed in independent, scattered housing are very satisfied with both their housing situation and the support from the team. Amongst the individuals in the congregate housing units there are mixed experiences – most are satisfied with their apartments but there are also indications that gathering many people with complex problems at the same place creates negative synergy effects especially by maintaining an environment characterized by substance abuse. The relocation of citizens from congregate housing units to independent housing during the programme period follows both the wishes of the citizens and the negative experiences of congregating many individuals with the similar problems in the same housing units. The study shows that ACT is a very effective method of supporting homeless individuals with complex needs to move into own housing and to remain housed. Especially, the study shows that with the support from an ACT-team it is possible to live in independent, scattered apartments in ordinary housing even for individuals with complex support needs. The experiences from the project point towards housing in independent, scattered housing as the preferable and optimal form of housing, though no conclusive evidence can be given on the relative effectiveness on the different housing forms, due to possible selection of citizens to the different housing types. The results also suggest that congregate housing should be reserved for individuals who are not able to live in ordinary housing even with the intensive support of an ACT-team and only after housing in independent housing has been tried, as it is not possible in advance to predict who will succeed.