Abstract
Housing is a human right. Despite this, Aotearoa NZ (NZ) has high rates of homelessness and preventable health inequities. Housing First (HF) is based on core principles that prioritise housing and support for people experiencing homelessness. The intervention has been tested internationally but there are no in-depth academic studies comparing HF’s transferability within NZ. This has led to concerns and opposing claims about HF’s effectiveness, particularly for Māori, the indigenous people of NZ. This study aimed to identify the main factors influencing HF’s transferability; describe HF’s initial implementation in NZ; identify the factors critical to HF’s transferability in this novel context; and develop a framework to guide HF’s implementation in NZ.
Building on the literature review findings, this thesis draws on Critical Realism and a system framework and compares four case studies of HF’s implementation, one in Hamilton, one in Auckland, and two in Wellington. Data consists of 19 key informant interviews predominantly with government policy officials, sector experts, and providers leading HF’s implementation between February 2018 and May 2019. Publicly available documents and internal programme documents shared by government and provider organisations were a second source of data. Findings from each case explain why and how providers implemented HF and adapted service design and delivery to meet the needs of people experiencing homelessness. Each case was at a different stage of implementing HF within the context of rapid policy change and new political leadership.
This thesis consolidates literature about the challenges and success factors related to HF’s transferability. The literature shows HF is flexible and has been adapted and implemented in varied international social, political and cultural contexts, at a programme and system level. Important factors were leadership, political buy-in, adequate funding and resources, and an alignment and coordination of policy and service delivery. There were considerable variations in funding models, rent subsidies, relationships with public and private landlords, and the primary need to have a variety of skilled and experienced support staff working as a team, including peer support.
In NZ, this study compared four case studies and identified the challenges and success of implementing HF, at macro-, meso-, and micro- levels. At a macro-conceptual level, there were different framings of the problem. In one frame, homelessness was due to poverty and inadequate housing. In another, homelessness was caused by colonisation and on-going breaches of Te Tiriti o Waitangi. At macro and meso-systemic-levels challenges included inadequate government leadership and fragmentation of policy and service delivery; inadequate public and affordable housing, and inequitable funding of Māori-led organisations to address homelessness. Within the meso-community level, some residents opposed supported housing being built in their local community. Local council enforcement of alcohol by-laws were another point of tension. There were tensions between homelessness service providers, partly due to the competitive funding environment, and political and cultural issues. Within organisations, the complexity of HF’s implementation, inadequate training and technical support and resources compared with the increasing demand on services. At a micro-level, difficulties related to the intensity of support required, a clash of staff values, beliefs, and attitudes with HF and Māori cultural principles, and gaps in staff knowledge, skills, and experience.
Conversely, success factors relating to HF’s transferability were a conceptual alignment of the international bill of rights, Māori cultural principles, Te Tiriti o Waitangi, Whānau Ora, and HF principles; a new political climate, buy-in; policy and funding to address homelessness at scale. At a meso-level, success factors were leadership, inclusive governance, political buy-into a homelessness strategy or plan, and an alignment of values and beliefs with HF and Māori cultural principles. A useful strategy was drawing on pre-existing community and organisation strengths and relationships, and international and local knowledge, skills and resources. Most providers reconfigured their service and sought relationships with a variety of landlords. At a micro-level, successes related to staff adapting HF and establishing practice within HF and Māori cultural principles, and focusing on relationships by prioritising people’s needs, choices, and preferences, supporting moving into housing and remaining housed, and peer-support.
To an extent, HF was effective, but Māori-led organisations were initially excluded from policy decisions. Greater systemic change is required to fully implement HF and Māori cultural principles. Six recommendations from this thesis are: focus on systemic change; utilise the strength of partnerships; create local strategies or plans; increase the variety of housing supply; commission support; and build system capacity. Conceptually this assumes a Te Tiriti framework based on HF and Māori cultural principles.