Key findings and recommendations from the report are provided here. These findings should be read in conjunction with their relevant sections of the report to understand the full context from which they have been drawn. Aspire...
moreKey findings and recommendations from the report are provided here. These findings should be read in conjunction with their relevant sections of the report to understand the full context from which they have been drawn. Aspire participants are a diverse group but Aspire is sufficiently flexible, adaptable and responsive to meet the needs of most participants and any potential future iteration of the program should retain its generalist focus. Key finding 2 Aspire participants have been experiencing homelessness for an average of approximately three years at program intake. Aboriginal people experiencing homelessness are not necessarily under-represented among Aspire participants because many Aboriginal people experiencing homelessness or sleeping rough in Adelaide are either away from home or not based in Adelaide long-term and are therefore ineligible for Aspire, or Aspire is not the appropriate support. Many people experiencing chronic or recurrent homelessness present with multiple and complex needs and benefit from holistic, wraparound supports both before and after being housed. The timing of intervention -offering a supportive approach where people can work with case navigators at the place they are at in their lives -is an important factor in the likelihood that a program such as Aspire will be able to meet participants' needs and support people to make changes to improve their lives. Referral processes from SHS providers to the Aspire program are smooth and generally work well. The eligibility criteria for the Aspire program are generally well targeted, appropriate and easy to apply, but may benefit from refinement in line with the discussion in this report. xiii Key finding 8 SHS referrers and Aspire staff exercise well-informed judgements about which clients are most likely to benefit from participation in the Aspire program. The long duration of Aspire program assistance helps to accommodate participants' non-linear recovery pathways and the ebb and flow of program engagement. Incorporating a referral process directly from hospitals and correctional facilities into the Aspire program is sensible and appropriate but has not been seamless in practice, and only a small number of referrals from institutional settings have translated into program enrolments. The Aspire program has a Housing First philosophy but not been able to put it into practice due to a lack of available and appropriate housing and this has compromised the benefits of the program for participants. Most Aspire participants remain highly engaged in the program while waiting for housing, with this engagement underpinned by strong relationships and open communication with case navigators, the provision of nonhousing supports and the development of community connections. Key finding 13 Participation in the Aspire program is associated with positive housing outcomes for participants in relation to securing and maintaining tenancies and exiting homelessness. Key finding 14 Participation in the Aspire program is associated with decreased use of emergency accommodation services. Key finding 15 Participation in the Aspire program is associated with decreased use of health services, including: a) fewer emergency department presentations; b) reduced use of emergency department services; c) reduced non-urgent emergency department presentations; d) fewer hospital admissions (according to medians), and shorter lengths of stay per visit; and f) hospital episodes defined by lower case complexity. Key finding 16 Participation in the Aspire program is associated with decreased interaction with justice services, including: a) fewer offences committed; b) fewer court appearances; c) fewer convictions recorded; d) fewer custodial sentences; and e) less time spent in custody. Participation in the Aspire program is associated with reductions in the use of health, justice and SHS services, generating significant and quantifiable cost savings for the SA Government. In relation to any potential future xiv iteration of Aspire, consideration could be given to further analysing how these cost savings are distributed and the implications for agency budgets and program resourcing. Participation in the Aspire program is associated with increases in personal wellbeing as indicated by: a) the Outcomes Rating Scale instrument; b) the Personal Wellbeing Index instrument; c) a reduction in use of hospital services for mental health care purposes; and d) a reduction in use of hospital services for drug and alcohol related reasons. Participation in the Aspire program is associated with modest improvements in engagement with education, training and employment, but this is a slow process and many participants face significant barriers to engagement in these areas. Participation in the Aspire program is associated with modest improvements in social inclusion, engagement with community and quality of personal relationships. The Aspire program is able to facilitate access to specialist mental health, disability and drug/alcohol rehabilitation services for most participants, notwithstanding systemic challenges in this area, but program delivery would benefit from additional staff training and enhanced accessibility of specialist supports in mental health in particular. Participants in the Aspire program benefit from a diverse range of supports tailored to their individual needs, including practical supports and simply being able to talk through problems with their case navigators without judgement. The Aspire program produces positive, often life-changing outcomes for most participants, including those for whom other interventions may not have been effective. The Aspire program plays an integral role in supporting participants to exit homelessness, avoid criminal activity, address problematic drug and alcohol use, and effectively manage their physical and mental health issues. Participants in the Aspire program, staff and key stakeholders agree that the Aspire model -sustained, intensive case management with wraparound supports -is an effective response to homelessness and there is a continuing need for a program of this kind in South Australia. The long duration of support as part of the Aspire program is a key driver of its success in achieving positive outcomes for individual participants and at a systemic level, although not all participants require three full years of supports. This flexibility is accommodated by the Aspire model. xv Key finding 27 The intensity of supports provided through the Aspire program is a key driver of its success in achieving positive outcomes for individual participants and at a systemic level and is dependent on keeping caseloads manageable. Key finding 28 Elements of the case navigator relationship that are highly valued by participants in the Aspire program, and recognised as important by other stakeholders, include: a) trust and mutual respect; b) support without judgement; c) open communication and honesty d) being encouraged, supported and empowered; e) flexibility and responsiveness; f) persistence and reliability; and g) continuity. The provision of support to secure and maintain housing is a key driver of the Aspire program's success in achieving positive outcomes for individual participants and at a systemic level, notwithstanding housing supply challenges that are largely out of the Aspire program's control. The Aspire program's case management approach aligns well with the evidence base on what works in responding to homelessness, including promoting tenancy sustainment to reduce the chances of people cycling back into homelessness. The experiences of Aspire program participants reinforces the importance of secure housing as protective and supportive, providing a foundation for people to address other issues in their lives. The key innovative features of the Aspire program are lower caseloads to permit greater intensity of supports for clients with complex needs, flexibility to tailor supports and sustaining supports across a longer time period to help people maintain tenancies after they are housed. It is unlikely that the key innovative features of the Aspire program would have been possible without the resourcing levels provided by the SIB framework. The Aspire SIB performance metrics are fit for purpose: clear, appropriate and measurable indicators that act as reasonable proxies for social impact. The key players in the Aspire SIB view the goal of the program as improving the lives of individual participants, notwithstanding that the SIB performance metrics relate to avoided service usage and resultant cost savings. xvi Key finding 36 Robust data collection and reporting practices were established early in the life of the Aspire program but in some areas (such as consistent use of the Penelope case management system) became more ad hoc over time, largely as a result of staff capacity and retention issues, and prioritising client focus over data collection. The Aspire program has had to accommodate a range of unexpected developments during its life so far and has demonstrated robustness and resilience in doing so. The Aspire program is responsive to the client voice but this voice has not been as systematically incorporated in monitoring, evaluation and continuous improvement processes for the program as it could be. Relationships between the key stakeholders in the Aspire program have been characterised by commitment, communication and trust, and this makes an important contribution to the success of the Aspire SIB and the program's underpinning case management approach. There are elements of the collaboration with other SHS and community housing providers through the Aspire program that could be strengthened. There is a strong collaborative relationship between Aspire program staff and a range of SA Government departments, particularly in relation to data sharing, but frontline staff in government agencies such as SA Health...