Homelessness as unfairness 9

Chapter I

The HOME_EU Project on Housing First as

a Path to End Homelessness in Europe
José Ornelas
HOME_EU Principal Investigador (www.home-eu.org)
APPsyCI – Applied Psychology Research Center Capabilities and Inclusion (appsyci@ispa.pt)
ISPA – Instituto Universitário, Portugal (www.ispa.pt; jornelas@ispa.pt)

Abstract:
Homelessness is a persistent, prevailing and life threatening and deprivation situation that is the
expression of major structural, institutional and circumstantial maladjustments. In this contribution
we provide some background information about the contributions upon which the HOME_EU Project is

impacts for the present and future strategies to reverse homelessness in Europe.

Key Words
Homelessness – Housing First - Social Impact

Acknowledgements
The author thanks all the partner teams for their investment, persistence and capacity to entail the
predicted and unpredicted practice and theory-driven contributions for the completion of all the aims
of the HOME_EU Project.

The HOME_EU Project Background

The HOME_EU Project emerged from a long standing experience of research and intervention with University-
Community partnerships in areas associated with community mental health, deinstitutionalization and
social integration of people with severe mental illness. Since 2009, we coordinated a National Research
Project “Capabilities Approach and Integration of People with Mental Illness” [PTDC PSI-PCL/113301/2009
Fundação para a Ciência e Tecnologia], that resulted in contributions for an in-depth understanding of
the potential of crucial roles for practice of constructs such as Empowerment, Recovery (Jorge-Monteiro;
Ornelas, 2016 a and b), and the applicability of the Capabilities framework within Community Mental
Health (Sacchetto… Ornelas, 2016; Sachetto, Ornelas, Calheiros and Shinn, 2018).
During the same year of 2009, the Housing First model for long-term homelessness, severe mental illness
and substance use, was introduced in Portugal through a state-community-university partnership, with a
Protocol signed amongst the stakeholders and international consultants Sam Tsemberis and Marybeth
Shinn.
10 Homelessness as unfairness

Protocol signature at ISPA – Instituto Universitário with Teresa Duarte (President of the Board of the AEIPS, the implementing
NGO), Edmundo Martinho (Director of the Social Welfare Institute), Marybeth Shinn (Vanderbilt University), Sam Tsemberis
(Pathways to Housing) and José Ornelas (ISPA – University Institute Lisboa, Portugal).

European year against Poverty and Social Exclusion1.

Link for Video “Getting out of Poverty - Manuel – Portugal, available at:
https://ec.europa.eu/employment_social/2010againstpoverty/mediagallery/video_en.htm

The program was progressively integrated in intervention programmatic initiatives, including the
national homelessness strategies (2009-20132), and later the (2017-20233). The development of Housing
First programs4 was crucial for the understanding and documentation of the challenges associated
with the implementation of an individual, scattered, and permanent Housing First Program for people
with long-term homelessness experiences, and severe health, mental health and/or addiction related
situations (Ornelas, Martins, Zilhão, Duarte, 2014; Ornelas, Jorge-Monteiro, Duarte, 2014; Ornelas, Esposito,
Sacchetto, 2014; Martins, Ornelas, Silva, 2016).
During the previous years of entailing the HOME_EU Project there were intensive network building

1
Link for Video “Getting out of Poverty - Manuel – Portugal, available at:https://ec.europa.eu/employment_
social/2010againstpoverty/mediagallery/video_en.htm
2
National Strategy for the Integration of Homeless People: Prevention, Intervention and Follow-up http://www.seg-

3
National Strategy for the Integration of the Person in an Homelessness Situation http://www.enipssa.pt/enipssa
4
In 2009 with the Associação para o Estudo e Integração Psicossocial (www.aeips.pt); In 2011 with the Municipality
of Cascais and the NGO “Gaivotas da Torre” https://www.redesocialcascais.net/respostassociais/clube-gaivotas-da-
torre-apoio-alimentar/; in 2013 with the Associação CRESCER – Associação de Integração Comunitária (www.crescer.
org/)
 Homelessness as unfairness 11

efforts in different locations including the European Countries United States and Canada, with whom

Community Research and Action; European Community Association; European Federation of Psychology
Associations, and other extended world-wide networks), and also extended network of Housing First

(2018) and the next is planned for Toronto (2021), that are crucial for efforts for sustainability, mutual

providing housing and supports for people with long term experiences of homelessness.

HOME_EU Reversing Homelessness in Europe: The

Challenge
The project was integrated in a call on reversing inequalities with the reference H2020-SC6- REV-INEQUAL
– 2016, that challenged proponents to advance an empirically informed European Theory of Justice and
fairness.
The consortium was composed of 7 Universities (ISPA - University Institute, Portugal; UNIVERSITY OF
LIMERICK, Ireland; UNIVERSITA DEGLI STUDI DI PADOVA, Italy; UNIWERSYTET OPOLSKI, Poland; STICHTING
KATHOLIEKE UNIVERSITEIT, The Netherlands; UNIVERSITE D’AIX MARSEILLE, France KAROLINSKA INSTITUTET,
Sweden; one Municipality CAMARA MUNICIPAL DE LISBOA, one Federation EUROPEENNE D’ASSOCIATIONS
NATIONALES TRAVAILLANT AVEC LES SANS-ABRI, Belgium, and 3 NGO’s ASSOCIACAO PARA O ESTUDO E
INTEGRACAO PSICOSOCIAL, Portugal; CRESCER, Portugal, and RAI S, Spain.

Final Congress, Madrid June 2019

12 Homelessness as unfairness

This consortium was characterised by different forms of diversity namely different organizational

Housing First and Stair Case Model Services and outreach teams; the consortium also integrates policy

sciences, and health economy, epidemiology, social work, and political science. Each of the partners
played a different roles focused on responding to the challenge here organized in three main vectors:
a) the systematization of personal accounts of inequality; b) Housing as a Human Rights approach to
Homelessness, and c) Facilitate the social dialogue about integration.

a) Systematization of personal accounts of inequality

Within the HOME_EU consortium we acknowledge the power and relevance of experiential knowledge
(e.g. Borkman, 1976; Baillergeau & Duyvendak, 2016), therefore our studies proposed were delineated to

person accounts) about how Homelessness is an expression of extreme inequality.

we were aware of prior accounts of people who were in homelessness situations for periods from 10 to
20 years. So, the voice of those with personal experience is essential for the in-depth understanding on
how to reverse it.
The quantitative data were gathered in two-time points through an extensive protocol (Greenwood,
et al., 2020) designed to expand our understanding the ways in which the Housing First and the Stair
Case model services may be differentiated both on the rationale and the outcomes. The protocol was
organized in three main axes: 1. Setting & Support Services (Work Alliance; Service Satisfaction; Choice;
Housing Quality); 2. Rehabilitation related Recovery (Housing Status; Psychiatric Symptoms; Alcohol and
Drug Use, and Physical Health), and 3. Personal Growth related Recovery (Mastery; Capabilities, Recovery;
Community Integration, and Distal social supports) (See also Chapter II of this publication).
In Greenwood…Ornelas (2019), we focused on the relevance of recovery with an approach aimed at
the access to resources, but also a capability and personal growth approach for those who experience
homelessness. From this rational we also needed to expand our understanding of the meaning of recovery
including notions of sense of community and citizenship, also present in other studies (e.g. Pelletier et al,

Programs reported fewer psychiatric symptoms, and experienced more community integration, justifying
the need to advocate for an independent, scattered and permanent model as emphasized by Tsemberis,

The Housing First group spent more time in independent accommodation (their Own homes), reported
fewer psychiatric symptoms, and greater community integration.
The qualitative section of the Service User’s Study was delineated to expand the potential of the
Capabilities approach associated with the lived experiences of Housing First and other Service Programs.
 Homelessness as unfairness 13

Considering that the participants of the Housing First Programs experienced long-term Homelessness,
may support the comparison their experiences both on their present situation in Housing First and
their previous experiences in Stair Case Model Services. The description of other Homelessness services
are also documented by participants who are still living on the streets, are using shelters or other
transitory accommodation. In this section of the service user’s study, it is emphasized the meaning
of having a home as a means towards enhance personal capacities, improving the social relations,
increasing personal affordances and reducing constraints associated with the homelessness situation.
For personal experience we also probed to document with people who are currently homeless how their
situation threatens their longevity, health, mental health and global well-being (see also Chapter II of
this Publication).

b) Housing as Human Rights Promotion

We understand the human rights approach, and the Millennium Development Goals provide a guiding
framework to advance housing as a basic human right (for more information see “Affordable housing
and social protection systems for all to address homelessness”6, and assumed by the EU as stated in the
Articles 18 (Long-term care) and 19 (Housing and assistance for the homeless) of the EU Pillar of Social
Rights (2017)7.
Systematic country-based and cross-country information on how the current public policies impact real
people in concrete homelessness situations. Perceive the role of services in reversing their Homelessness
circumstances. Demonstrate how Homelessness is a barrier to basic human rights attainment in the
perspective, Service Providers and Key-Stakeholders. For this purpose, we probed to document the
preferences of the EU Citizens and how are they were distributed in a continuum of tolerance vs. contest
Homelessness in the Human Rights Perspective.
Petit…Auquier (2019), reported that 76% of the Citizens living in the eight partner countries consider that
the governments should invest more to end homelessness, and 49% (with wide country variations) are

Based on the contribution by Gaboardi…Shinn (2019), documenting the service providers perspective, we
were able to understand that both Housing First and Traditional Stair Case Model service providers share
the same goals and principles, but discussed and experienced differently within each of the Teams. The
Housing First model providers enhance the collaborative capacity with other services and community
resources to respond to concrete service user’s situations, and tend to discuss more and challenge the
existent resources, and require more specialize training to support their intervention (See also Chapter
IV of this publication).

For more information see https://www.un.org/millenniumgoals/

6

7
European Pillar of Social Rights https://ec.europa.eu/commission/priorities/deeper-and-fairer-
economic-and-monetary-union/european-pillar-social-rights/european-pillar-social-rights-20-
principles_en
14 Homelessness as unfairness

From the social policy studies (See Vargas-Moniz, et al. in this publication) we also were able to
understand that Housing First is already transversally incorporated in the national and strategic policy
documents in the eight counties. A substantive percentage of socio-political stakeholders (62.6%)
consider homelessness a moderate or a major social problem in their Municipalities, and acknowledge
(42.4%) that there is no policy aimed at reversing homelessness in their region or country. When we focus

already implemented in their municipality, it is important to mention that although data were collected in
31 European cities including a set of major capitals, the implementation is still expanding. Through these
exploratory data we are now better prepared to implement data-driven strategies for the differentiation
of concrete policy analysis, the perception and concrete implementation of homelessness policies. We
may develop guidelines for mainstreaming solutions and result oriented proposals for transformative
social policies.

c) Facilitate a Dialogue about Social Integration

The generation of a fruitful dialogue amongst different ecological levels of analysis incorporated sectors
who play a crucial role, both on understanding the problem, but also the focus on collaborative solutions
approaches (Wolf, 2010). So, for the HOME_EU studies we have included individuals with personal
homelessness experience, professionals working in Housing First support teams and Stair Case model
services including temporary shelters, day-care centres or outreach teams, socio-political stakeholders

backgrounds (e.g. psychology, philosophy, public health, health, social work or political science). Through
this myriad of stakeholders we were able to have an in-depth understanding of the social dynamics
around a complex phenomenon such as homelessness, including the public perceptions.
Adopting insights from community science such as advancing systematic understanding of the links
between individuals and communities, the ability to respond to pressing community problems, integrating
science and socially relevant interventions, as well as changing public policies (e.g. Wandersman, 2003;
Tebes, 2017).

innovation and the development of services and practice aimed at reversing inequalities related to
Homelessness.
This selection of Ecological levels of analysis EU Citizens, User’s, Providers, Policy Actors, and Policy
related documents, provide us a broad and updated perspective on the stakeholders with a relevant role
on this particular phenomenon, and inform an evidence-based perspective aimed to reduce unfairness
and concrete inequalities.
One of the basic concepts anchoring this project is the capabilities approach as a guiding theory to pursue
social justice operationalizing the theory into an empirical strategy. The consortium acknowledges the
Housing First as a mean to reverse unfairness, and that is an intervention inspired by the ecological
perspective requiring the direct connection with contextual intervention to understand how stakeholder’s
 Homelessness as unfairness 15

Long-Term Homelessness.
This framework is relevant for understanding and measuring economic welfare and human development;

not include consideration of crucial dimensions when assessing of human well-being and quality of
life. Sen´s new proposal was to shift the focus from incomes and commodities to opportunities and
agency; from resources or means to capabilities or ends. Sen’s idea of justice is a social choice theory
(Sen, 2010), based on the analysis of liberties and rights also inspired by Rawls (1971). This approach has
underpinned measurement of welfare and social outcomes of efforts towards global poverty reduction
at the transnational level. For instance, Sen´s approach was used in the UN’s Human Development Report
(UNDP, 2010).

The HOME_EU Project current and prospective Impacts

Considering that the EU Governments are being pressured mostly by civic society organizations to
support housing options to respond to homelessness, the role of evidence practices and the emergency
of an informed theory of justice, requires effective forms of communication that reversing homelessness
does not include options such as new forms of institutionalization such as reopening the doors
of major psychiatric institutions, prisons, or asylums for the people in extreme poverty. Reversing
homelessness is not about expanding new forms of congregating people in segregated urban areas, or
develop congregated housing options like apartment buildings or group-homes in the community that
concentrate problematic situations generating new forms of inequality and unfairness.
The HOME_EU compromise was to empirically inform a European based theory of justice generating a
debate and a renovated focus on concrete action focused on individualized, scattered and permanent
housing solutions for the people who experience long-term homelessness, for which the housing is the
departing point for a recovery and integration path. The Housing First model represents a paradigm
shift for the integrated nature of social intervention, a strategy to renew the social fabric of cities,
and a renovated opportunity to rethink the community life, contributing for the reversion of severe
inequalities.
From 2016 to 2020 and in alignment with the aims of the HOME_EU Project some advancements have
been achieved.
The Housing First model in the partner countries and others largely emerged with the impulse of civic
society organizations or movements has up-scaled from pilot or experience projects to integrate the
national strategies on Homelessness, being explicitly adopted as a privileged social policy in France,
Ireland, and Spain. It is mentioned in national documents and operating and with Local Government and
Municipal support in The Netherlands, Portugal (2009 National, currently Municipal) and Sweden, and
Italy, and Poland started in 2019 a pilot project in 3 major cities. Other locations in EU countries are also
adopting and/or upscaling Housing First Programs (e.g. Romania, Check Republic, Norway, etc.).
Nevertheless, the HOME_EU project advances a crucial model feature that potentiates capabilities, recovery
16 Homelessness as unfairness

and community integration that is an individualized, scattered and permanent housing as opposed to
group or congregate formats of housing for people who experience long-term homelessness.
Therefore the debate and the results dissemination are still relevant in order to ensure effectiveness
and results in preventing recurrent paths of homelessness and advance the relevance of community
science to support the reversion of severe and persistence of social phenomena.
There are many recent and relevant documents and reports tackling the current status of Homelessness
in Europe; the FEANTSA’s fourth report on the Index of Housing Exclusion (2019), focused on the role
of housing in the life of the EU populations and with some close-up examples with a country focused
perspective; the OECD (2020) policy brief on data and policies to respond to homelessness are relevant,
particularly for the descriptive nature and explanatory potential on what might be the potential or the
perceived causes of homelessness. This report advances a threefold series of causes including structural,
institutional and individual to explain homelessness; each of the mentioned elements are relevant but
the interdependency of the three realms is in fact far more challenging from the point of view of the

“contingency of social circumstances”.

One of the contributions of the HOME_EU was the study conducted with the participant of European
Citizens in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden, with a sample size

countries (see Taylor…Auquier, 2019 and Chapther III of this Publication).

expected from point- in- time and homeless service use statistics. There was substantial variation
in estimated prevalence across the eight nations. Coupled with the well- established health impacts
of homelessness, medical professionals need to be aware of the increased health risks of those with

people exposed to homelessness.

HOME_EU Project When asked to list the three leading causes of homelessness, respondents in every
country mentioned job loss (60.3% of overall sample); addiction was also mentioned in all countries,
except in France where indebtedness was mentioned more frequently, closely followed by divorce or the

thought that homeless people had shorter lifespans than members of the general population, were the
victims of violence, and were discriminated against when seeking employment. A sizeable proportion of
respondents (48.3%) agreed with the statement that homeless people remain homeless by choice.
Respondents from our study reported not seeing people who are homeless in an average week, recognized

proportion reported that many people in their area are homeless (14% vs. 3%). This combination may
 Homelessness as unfairness 17

moving them on from public spaces, banning panhandling, or the hostile design of urban spaces to

ameliorating public concern with or awareness of homelessness. This argument therefore corroborates
that the complexities of such numbers require a careful reading of prevalence rates (Idem, 2019).
There are several reported impacts for the HOME_EU Partners, including presentations in major National
Governmental or Institutional instances (e.g. the Irish Parliament; the Portuguese President or the
Spanish Prime Minister).
Presentations in major international sessions with different scales and scopes, from which we emphasize
a few Fifty-eighth session of the Commission for Social Development: 10 – 19 February 2020 in an NGO
session organized by SPSSI (Society for the Psychological Study of Social Issues), represented by Ronni
Greenwood, and the Portuguese national accreditation of Maria Vargas-Moniz; the presentation by
the PI and Teresa Duarte in the International Seminar “Moradia para População em Situação de Rua“8
for Governmental instances in Brasilia; the presentation of the PI on the National Norwegian national
9
.

symposia, besides the events integrated in the HOME_EU Project, presenting and disseminating results

including France (Nice), Ireland (Dublin), United States (Chicago and S. Francisco), Canada (Ottawa), Chile
(Santiago), Portugal (Lisboa, Oporto), Hungary (Budapest), or Russia (Moscow).
In terms of national devolution of the The HOME_EU results, the Italian Partner team lead by Massimo
Santinello from the University of Padova organized an Event in the University of Roma “La Sapienza”,
with the presentation of the HOME_EU results, and promoted several Photovoice exhibitions across
Italian Cities; the Portuguese team organized an event in Lisboa at ISPA – Instituto Universitário for
national stakeholders
The Spanish partner consolidated their visibility with formal presentations with the Prime Minister, the
National Coordinator of the Spanish Research Agendas 2030, and the Final HOME_EU Project Congress,
was held in Madrid with an expressive support to Housing First of the Minister of Health. In Portugal
there was a Protocol signed with the HOME_EU and the National Portuguese strategy and the direct
reporting to the Portuguese President, as well as the participation in the National Research Agenda 2030
for Citizenship and Inclusion, and national consultants for the Horizon Europe, and the organization

8
Housing for the Population in a Street Situation.
9
Housing for Welfare 2014-2020 Norway https://www.regjeringen.no/globalassets/upload/kmd/boby/housing_for_
welfare_national_strategy_for_housing_and_support_services_2014_2020.pdf
18 Homelessness as unfairness

of a Public presentation of results in the presence of several key national representants, and there is
a forthcoming debate and public hearing in the Portuguese parliament; The HOME_EU Project is being
used as an example in training sessions for new stakeholder in the Portuguese National Agency for
Innovation.
The Polish partner represents for the Consortium one of the most rewarding achievements. The team
leader Anna Bokszcsanin from the University of Opole integrates the training and evaluation team impact
of the new pilot project in 3 major Polish cities;
There is an overall dynamics of upscaling Housing First in the partner European Countries (e.g. France,
Spain, Portugal, Ireland), and others like Belgium or Norway, and emerging initiatives in Check Republic
and Romania. Housing First has recently been a selected topic for discussion in national Parliaments,
and the European Parliament .
The core issue of the current social policies is the fact that although mentioning housing as a path

and systematized and consistent bodies of evidence that were generated in different continents and
countries with different cultural backgrounds with coherent results.
Individualized, scattered and permanent housing options with the availability of support teams is a
path that demonstrates the solvable nature of a phenomenon such as homelessness; therefore there
is the need to convey the notion that long-term homelessness is a social emergency situation, a life
threatening condition, and an inclusive society is no more than a mere abstraction if homelessness is
not effectively tackled.

violence survivors, and a strategy to support the deinstitutionalization of youth in sheltered or foster
care, women and families survivors of domestic violence, psychiatric institutions, or imprisonment

growth, development empowerment and recovery of other social groups who are at risk for homelessness
situations.
 Homelessness as unfairness 19

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