2.2. Choice and Control for Service Users

A key principle of Housing First is that people using the service should be listened to and their opinions should be respected. Someone using Housing First is able to exercise real choices about how they live their lives and the kinds of support that they receive.

This core principle of Housing First centres on enabling homeless people to decide what their needs are and how those needs can be met. In practice this means:

It should not be assumed that all homeless people with high support needs will share behaviours and other characteristics. Their needs cannot be effectively met with a standardised package of services which makes no allowance for individual needs, characteristics, behaviour or experiences.
The best way to understand a homeless person’s needs is to listen to the person and their views on the kinds of help they need.
To listen and respond to someone’s needs and opinions effectively, Housing First must respect that individual and their strengths, rather than focusing negatively on their limitations. A Housing First service cannot be patronising. Housing First cannot function on the assumption that Housing First staff understand someone’s needs better than they do themselves.
Compassion, warmth and understanding from Housing First staff are as important as respect, when enabling homeless people to choose the right combination of support for themselves.
Housing First actively encourages engagement with the treatment someone needs, including reducing the harm from drugs and alcohol and encouraging someone to seek help with mental or physical health problems. Help with community engagement and establishing and re-establishing social supports are also on offer. While control rests with the service user, Housing First workers actively work to inform someone using Housing First of the possibilities open to them to make positive changes in their lives (see 2.6).
Support must be flexible, imaginative and able to adapt to the specifics of what an individual person using Housing First requires. It is possible to maintain a set of clearly defined functions for support in Housing First (see Chapter 3) but Housing First must also be able to respond to the specific needs of each service user.
Housing First is tailored to individual needs, recognising individual strengths, and does not use a standardised or limited set of responses. Housing First service users are not offered help that they do not actually need. This requires recognising the strengths that each service user already has, or develops over time.

In Housing First, self-determination is seen as the starting point of recovery. Shared decision-making, between service users and service providers, is an essential part of recovery in the Housing First model((Greenwood, R. M., Schaefer-McDaniel, N. J., Winkel, G. and Tsemberis, S. J. (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology, 36(3- 4), 223-238.)). This is sometimes described as ‘consumer choice’ in North American Housing First services.

In Europe, there has been a growing emphasis on service user self-determination in social work and health services over the last 25 years. Self-determination is also used by some homelessness services. European practice, such as the ‘personalisation agenda’, can closely resemble self-determination in Housing First. Sitra defines personalisation in the following way((http://www.sitra.org/policy-good-practice/personalisation/)):

Personalisation means individuals having maximum choice and control over the public services they require – moving from the culture of ‘one size fits all’ to tailoring support to meet individuals’ aspirations and build on their strengths.

Housing First must balance the need for choice and control while working with each person to encourage and support engagement with treatment. Ultimately, Housing First aims to enhance the health, well-being and life chances of every individual who is supported, increasing their chances of a lasting exit from homelessness.

All Housing First services work by balancing priorities. Finding a balance centres on ensuring that service user choice and control is in place, while at the same time working actively to promote the well-being of each service user. Housing First ensures choice, respects opinions, supports individual strengths and is intended to be both understanding and compassionate, but it also actively encourages service users towards recovery((Löfstrand, C. and Juhila, K. (2012) The Discourse of Consumer Choice in the Pathways Housing First Model European Journal of Homelessness 6(2), 47-68)).