Experiences from an ACT programme in Copenhagen

This working paper presents intermediary results of a study of an ACT-program (Assertive Community Treatment) in Copenhagen, Denmark. The ACT-program 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 individuals who have 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 not only of social support workers but also of a psychiatrist, a nurse and 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. This study is based on quantitative outcome measurement in an intervention group of about 60 homeless individuals who through the program has 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 ten citizens receiving the support and eight staff members of the team. The study shows that a very high part – 95 pct. – of the individuals participating in the program remains housed throughout the study period. About half of the individuals have been housed in independent apartments in ordinary public housing. Amongst this group – all participants have remained housed. The other half has been housed in different forms of communal housing – two group homes, and one large communal housing unit with independent flats. Amongst the individuals in communal housing 90 pct. have remained housed. It has not been possible to control for selection of participants to the different forms of housing. The qualitative interviews show that the possibility to attend different dimensions of support needs - social support needs, health needs and administrative support needs is crucial to the success of the ACT-method. Especially 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 communal housing units there are mixed experiences – most are satisfied with their apartments but there are also signs that gathering many people with complex problems at the same place creates negative synergy effects especially by maintaining an environment marked by substance abuse. Such unintended negative effects of congregating individuals with social problems in the same housing units are well described in the research literature. All in all 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. Though no conclusive evidence can be given on the relative effectiveness on the different housing forms, due to possible selection effects to the different housing types, the experiences from the project point towards housing in independent, scattered housing as the preferable form of housing. The results also suggest that communal housing should be reserved for individuals who are not able to live in ordinary housing even with the intensive support of an ACT-team.