Homelessness is increasing across Europe, with the exception of Finland. In Amsterdam there are 186,000 social housing units - the average wait for these is 11-15 years. 90,000 people are actively searching for affordable housing and an estimated 70,000 more homes are needed in the Amsterdam region.

In the Netherlands, the ‘staircase model’ is the dominant approach to homelessness. This means ‘treatment first’ for homeless people, and/or moving them through a series of stages before they are ‘housing ready’. Housing First is radically different - it moves homeless people into permanent housing as quickly as possible with ongoing, flexible and individual support for as long as it is needed, but on a voluntary basis. The Housing First approach to ending street homelessness in Amsterdam started in 2006 as a joint initiative between Jellinek Mentrum, Alliantie Amsterdam, and HVO Querido. Jellinek Mentrum provides treatment and counselling for people with mental, psychiatric and addiction problems. Alliantie Amsterdam is a housing association and HVO Querido offers guidance and care to vulnerable people - for example, people who find it difficult to live independently, homeless people, or people who have other social, psychosocial or psychiatric problems. Discus is a department of HVO Querido, which has expanded its Housing First initiative rapidly over the last decade. In 2006 there were just three support officers and one project leader supporting 15 Housing First service users; in 2019 there are now 85 case workers providing support to 350 clients, including three team managers, six co-ordinators and four admin workers.

Objectives

Discus’ goal is to end street homelessness, empower people, respect their choices, help them modify harmful drug and alcohol use, and support them to participate in society again, in a way they choose to. They do this by focusing on prevention; sufficient and suitable housing; healthy and caring neighbourhoods; and learning and monitoring.

They start by providing the basic needs, safety, a home and basic care; and then support clients to make decisions about how they wish to improve their lives.

At the start of the project Discus housed people from the streets directly into individual housing. Over the years the target group has expanded and they now house people from night shelters, 24-hour shelters and half-way housing.

Clients are referred to Discus by De Veldtafel, a group of professionals from separate care organisations under supervision of the municipal health service of Amsterdam. Each client has different challenges and experiences and, as such, Discus takes an individual approach to find an effective and successful way to help each client reach their goals. The social work programme of service delivery is entirely client-focused and takes a strength-based approach, which celebrates, boosts and fosters positive working - rather than traditional services that are risk-assessment heavy and based on a deficit view of clients.

The Discus strength-based approach has six basic principles:

1. Believe in the resilience of people.
2. Think and work from positivity; make use of existing competencies; use positive problem-solving and always look for opportunities.
3. Support the client to take more control.
4. Be aware of and invest in good working relationships.
5. Work as much as possible in the natural environment of the client.
6. Make maximum use of all resources.

Everything that Discus achieves depends upon the ‘client/caseworker match’. Each individual client is assessed in order to identify the right worker to support them. This process requires significant time and in-depth understanding - of both client and caseworker - as well as monitoring and evaluation through self-reflection and consistent and timely managerial/collegial feedback.

Due to the unpredictable nature of caseworkers’ roles, Discus uses atypical recruitment strategies, most notably a focus on personality and behavioural characteristics rather than technical or academic skillsets. Potential employees are interviewed based on their ability to encompass the three most important parts of Discus methodology: core ‘DNA’, ‘Fuzziness’, and ‘Approach’.

Fuzziness is a key methodology - developed by Discus - used to agree and action key development goals for clients. It encourages ‘out-of-the-box’ thinking and provides ongoing inspiration and impetus for the client. It involves a number of key elements:

• Festive - looking for and highlighting key moments in a client’s development. These are celebrated together in a festive and creative way, to create a milestone from which future development can take place - for example, using personalised ‘boarding passes’ for clients entering the project, to indicate the ‘take-off’ of a new life.

• Challenging - Discus believe, ‘If you do what you did before, you will get what you have’. When discussing goals, clients are challenged to consider past actions and avoid repeating negative behaviours by taking a different perspective.

• Transparent - clients are encouraged to make their own choices, and as long as they do not directly conflict with case workers, Discus or the wider environment, then those choices are paramount.

• Yes - case workers are aware of the power of positivity and proactively look for opportunities to say, ‘Yes, we go for it’ with clients.

The annual budget is €10 million ($11.2 million USD).

Since 1 January 2015, municipalities in the Netherlands have been responsible by law for supporting the self-reliance and participation of people with disabilities, chronic psychological or psychosocial problems. This law - the Social Support Act (WMO) - helps citizens to continue to live independently at home for as long as possible and participate in society as much as they can. On average, Discus receives €22,000 ($24,810 USD) per client, per year, from the municipality of Amsterdam. This covers all support costs, and any surplus is returned to the municipality.

Every client who is registered in Amsterdam and receives support from Discus also has an income provided by the municipality. This monthly income is around €1,000 ($1,122 USD) plus extra support for the rent (€300 / $337 USD).

The rental cost of each Housing First unit is €500-700 ($560-785 USD) – clients receive an additional housing allowance subsidy of around €200 ($224 USD) so will pay around €300-400 ($336-449 USD) per month.

In contrast, social housing rents are around €700-800 ($785-897 USD) without extra financial support and private rents in Amsterdam are around €1,000 ($1,122 USD) per month.

Discus also receive expenses to provide training and support for professionals and organisations implementing Housing First across Europe. They charge around €700 ($785 USD) per trainer per day – in 2019 they earned €15,000 ($16,827 USD).

They have received Erasmus Funding (€180,000 / $202,000 USD) from the European Union for a project to tackle loneliness amongst their clients. Working with organisations in other European countries (Macedonia, Spain, Hungary, Czech Republic and France) they are developing a training module and a toolkit.

Evaluation

Individual client goals are set by the clients themselves and progress is discussed with them and within the wider team. The resident committees provide feedback about services, while the Care Counsel monitors the quality of assistance. The client board helps Discus management examine the organisation’s functioning and every two years an independent agency conducts a satisfaction survey with the clients, the latest one showing a score of 8.3 (out of 10) from Discus clients.

The quality and care of clients after five years was assessed, and they rated their quality of life much higher after Discus began working with them. Many felt proud again, a part of society, they had stopped taking drugs, started occupational therapy, and improved their mental health and reconnected with family again. People rated their quality of life on a scale from 1 to 10. On average clients scored their quality of life 7.5 compared to 4 before they got their own house. In 2013, research by Radboud University showed a 93% housing retention rate from 100 Discus clients.

Innovation

Discus Housing First was the first Housing First programme in the Netherlands. It takes an ‘individual’ approach to each client as they believe it to be the most effective and successful way to help them reach their goals. Clients define the characteristics and style of support that will work best and are then matched to the most appropriate caseworker. Clients know that they are taken seriously and get tailormade support which fits their needs. After many years of experiencing the same issues, many clients are often able to finally overcome old negative patterns of behaviour. And clients are always able to change their support programme if they feel it is not working effectively. Their work aims to ‘break paths of negativity’ through positivity and have created a methodology called ‘It-can-also-be-different’, which breaks through the traditional circle of social work by using creative and out-of-the-box tools to achieve small successes. For example, a client was not managing living in a house and so Discus worked with the municipality to get a permit for him to live on a small boat - Discus also supported the financing for this.

Environmental impact

Discus workers are encouraged to use their bikes as much as possible (95% of employees do this) or use public transport, and all workers can use electric bikes for free. People try to copy or print as little as possible and they separate waste. They use biodegradable cleaning products and make people aware of food wastage. They do not have an office, but instead work everywhere around the city. This increases flexibility and integration in the community with their clients.

Last year they introduced a project for clients called ’Stop wasting, start sharing’. They requested donations of second-hand items on the internet and from friends and family. These were collected and divided amongst the clients. HVO Querido signed a Green Deal agreement with 150 other organisations to make daily processes more sustainable. In 2018, they obtained a bronze environmental certificate, making them the first healthcare institution in the country (other than hospitals) which meets additional environmental requirements for all 24-hour facilities. For example, they have seven electric cars and an electric scooter for caretakers. They also set sustainability requirements for suppliers, including office supplies, washing linen, energy supply and transport. Discus has also introduced specific energy-saving measures, such as LED lighting, thermostatic valves, water-saving features and automatic light switches.

Social Impact

Overall, Discus has housed 600 formally homeless people.

In 2013, Discus were included in a European project to evaluate the effectiveness of Housing First. Clients face complex and multiple issues when they are first housed. However, researchers found that almost all Discus clients experience improvements in their living situation (91%), general quality of life (89%), daytime activities (79%), and resilience (79%). A majority also experience an improvement in their physical condition (73%), mental condition (70%), reduction of substance abuse (71%), finances (70%), housekeeping and self-care (68%), and relationship with their own children (67%).

All clients are included in decisions relating to their housing and support. This includes location of housing, activities, volunteering work, length, time and frequency of support sessions. Discus contacts clients’ neighbours and families - if the client agrees - as they can play a vital role in encouraging them to be a part of society as much as possible.

Clients worked with Discus to change housing policy in Amsterdam. Joint presentations were made to the local municipality, which included powerful stories of their positive journeys. The Housing First model became local policy in 2017.

Recognition

Discus are well known internationally for their pioneering approach to delivering a successful Housing First model. They share knowledge, best practices, connect through work projects like Erasmus, speak at international conferences and deliver training on the Housing First model. Discus hosted the cities of World Habitat’s European End Street Homelessness Campaign during their Annual Gathering in November 2018.

The biggest challenge was getting the municipality on board with the project. When it first started, the dominant approach to addressing homelessness was the ‘staircase approach’. Housing First is now more widely accepted as Discus has demonstrated its positive impact and involved the municipality in every development. This has led to the continuing expansion of the model in the city and the change in Amsterdam’s homelessness policy.

Focusing on the Housing First principles and its methodology continues to be challenging. Finding the right employees, who are committed, flexible and creative, is not always easy. It was also difficult to get treatment and support separated in their approach – they want to see clients as people rather than patients. Complaints from resident communities of Housing First tenants remains a challenge, which is common in other cities. Discus staff work closely with local communities to educate and explain the nature of its clients, to attempt to alleviate potential complaints

Lessons Learned

Discus have worked closely with clients and evaluate the impact of their approach, which has helped them to adapt their model. Their workshops across Europe, and the international conferences they speak at, have a particular focus on sharing the lessons they have learned to help other cities to develop Housing First.

They have learnt that one cannot have rules at every level - it is important to have a tailor-made approach to each client, which means investing in the relationship to identify their individual needs. Discus has innovated new tools usually by prioritising the most urgent topic they are dealing with. For example, loneliness has been an ongoing issue for a significant number of clients. After working on a range of approaches they developed a pan-European project to bring together good practice, share ideas and develop a toolkit.

In 2019 an expertise centre will be created that will focus on professionalisation - this will involve training modules which will be offered to all care organisations, focused on the Housing First methodology and based on best practices and creativity.

Transfer

Discus was inspired by Pathways-to-Housing, a Housing First project innovated by Sam Tsemberis. Discus took this principle and developed a more creative and tailormade Housing First approach to support their clients within their own homes.

Discus have played a vital role in the growth of Housing First across Amsterdam, the Netherlands and Europe. After a few years of successfully implementing Housing First, more than 20 cities have adopted the model and Discus was asked to train all local workers.

They are an active member of Housing First Holland and share best practice with a wide range of organisations in the Czech Republic, Spain, Macedonia, England, Scotland and Belgium.

After the European End Street Homelessness Campaign Annual Gathering visit to Amsterdam, Discus provided training to Torbay in the UK to enable them to launch their first Housing First programme.

World Habitat Awards: https://www.world-habitat.org/world-habitat-awards/winners-and-finalists/discus-housing-first/