Homelessness is a wicked problem that persistently presents a nearly impossible challenge to governments all over the world. In 2021, the World Economic Forum reported that 150 million people were homeless worldwide. Although hard to track, the number of homeless people increases each year, with an exception of few countries (www.weforum.org/agenda/2021/10/innovative-projects-tackling-homelessness-around-the-world/).
Homelessness is commonly connected to substance use, mental health problems, and debt. The predominant traditional approach to homelessness has been described as the “staircase model” (Tainio & Fredriksson, Reference Allen2009), more officially called the “linear residential treatment” (LRT) model (Tsemberis, Reference Tsemberis2010, p. 13). According to this traditional model, a homeless person may be offered a home only after he or she has at least ascended to the level of abandoning the use of alcohol and drugs. This creates a vicious circle. It is difficult to overcome one’s addictions and other problems if one lives on the street, without a permanent home.
Since its inception in the early 1990s, the concept of Housing First has had transformative influence on the efforts to reduce and eradicate homelessness in various countries. The idea is simple: Provide housing first, and then combine that housing with support and treatment services (Tsemberis, Reference Tsemberis2010, p. 4).
Since 2008, thanks to successive national programs and serious investment in building and providing affordable homes, Finland has had extraordinary success in reducing homelessness (Pleace et al., Reference Pleace, Culhane, Granfelt and Knutagård2015; Shinn & Khadduri, Reference Shinn and Khadduri2020). In 2018, the Finnish effort to eradicate homelessness was coming to a new turning point. The national program for the prevention of homelessness (2016–2019) was coming to an end, and the government in power did not show much interest in continuing such concerted national efforts. At the same time, there were indications that the continuous decrease in the numbers of the homeless accomplished since 2008 was being threatened, at least in some cities. The numbers of youth, women, and immigrants were growing among the homeless population.
In this context, the Research Engagement for Sustainable and Equitable Transformations (RESET) research group led by Annalisa Sannino at Tampere University started to approach actors in the field of homelessness work, offering its expertise to help redesign the strategy of homelessness work at three levels: that of local supported housing units, that of a major city, and that of the nation. In 2018 and 2019, Sannino’s research team conducted three interconnected Change Laboratory interventions, one at each level, to support the eradication of homelessness in Finland (Sannino, Reference Sannino2020, Reference Sannino2022). The first Change Laboratory was conducted with the staff and residents of a supported housing unit for formerly homeless young people, the second one with key actors working on homelessness in the city of Tampere, and the third one with public and third-sector organizations involved with homelessness work at the national level. These interventions led to the formulation of an action program titled Housing First 2.0 (https://asuntoensin.fi/asunto-ensin-2-0-tehdaan-yhdessa-jokaiselle-mahdollisuus/). This was the beginning of a long process of collective concept formation, a process that went on at the time of the writing of this chapter. The analysis presented here is to a large extent based on a recent report produced by Sannino’s research team (Sannino, Engeström, & Kärki, Reference Sannino, Engeström and Kärki2023).
In this chapter, I examine the historical background and critical characteristics of the emerging concept of Housing First 2.0. Whereas most of the cases analyzed in this book pertain to concept formation in relatively well-bounded constellations of activity systems, the case of Housing First 2.0 represents concept formation in a broad field of activities located at multiple levels, from national policy and government strategy down to counties, cities, and housing units working with individual clients. As such, the concept formation process is also lengthy and far from linear. One might now anticipate an account of the production of recommendations of an expert task force, then implemented top-down by service providers and frontline practitioners. From classic studies of implementation, we know that such linear processes hardly ever work in the way expected (Pressman & Wildavsky, Reference Pressman and Wildavsky1984). What happened and is happening in Finland differs quite dramatically from the linear top-down model.
In a recent paper on the evolution of the concept of energy efficiency, Dunlop (Reference Dunlop2022) characterizes it as a “motherhood concept.”
The definition and conceptualization of energy efficiency, while appearing to become more complex over time, has, in fact, narrowed. The concept is a useful political tool and, as a motherhood concept, it is a positively ambiguous euphemism for “good” and “virtuous,” and its seemingly uncontroversial nature makes it difficult to criticize. It is no surprise that European institutions have invested heavily in the concept both in monetary and in policy terms.
However, the historic and current conceptualization of energy efficiency omits important points, limiting its ability to solve contemporary complex problems such as reducing energy consumption and greenhouse gas emissions. … Historical analyses show that policies that imply a limit on energy services and consumption can easily be sidelined in favor of so-called “win-win” solutions, namely energy efficiency and technological innovation, which do not necessarily lower energy consumption.
The concept of Housing First may also be understood as a “motherhood concept” in the sense that it has become a widely accepted general principle, “a positively ambiguous euphemism for ‘good’ and ‘virtuous’, and its seemingly uncontroversial nature makes it difficult to criticize.” Just as a commitment to energy efficiency has not led to a reduction in total energy consumption, Housing First has in most cases not led to a reduction in the total number of the homeless.
However, the notion of “motherhood concept” is too vague. It does not reveal the critical relationship that forms the generative core of the concept. If we can trace and articulate this core, we may be in a better position to understand the potential and power of the concept, as well as the relative strengths and limitations of the different, sometimes conflicting variations of the concept. From a dialectical perspective, the core of the germ cell concept is a foundational relationship of two opposite yet interdependent forces within a system, a contradictory unity that gives rise to constant movement and development of the system.
But why is a concept of Housing First 2.0 needed to begin with? To answer this question, we need to look into the differences between the Pathways Housing First (PHF) model (Tsemberis, Reference Tsemberis2010) and the Finnish Housing First (FHF) model (Kaakinen, Reference Kaakinen2019).
8.1 Pathways Housing First Program
The The PHF model developed by Sam Tsemberis in New York is widely regarded as the original model of Housing First. The PHF model is based on the following principles (Tsemberis, Reference Tsemberis2010, p. 18):
-Housing as a basic human right
-Respect, warmth, and compassion for all clients
-A commitment to working with clients for as long as they need
-Scattered-site housing; independent apartments
-Separation of housing and services
-Consumer choice and self-determination
-A recovery orientation
-Harm reduction
PHF argues that scattered-site housing leads to social inclusion, whereas congregated housing in supported housing units leads to isolation of clients into communities that easily reinforce their mental health and addiction problems.
In fact, PHF is in itself a program quite isolated from the services of the general population. A client must be first accepted to become a member of a PHF program, and then basically all services are produced by the program, not by the general systems of health and social welfare services.
In the United States, the production and supply of housing is decisively market-driven, and there are comparatively very few publicly funded or subsidized affordable housing solutions offered on social grounds. Publicly funded social and health services that support housing are also few and fragmented, compared to most European countries such as Finland. Homelessness reduction programs based on the PHF model are local and serve a relatively small and selected group of “chronically” homeless with serious mental health disorders. In Tsemberis’ model, an Assertive Community Treatment (ACT) team is responsible for the care and services of such clients throughout the period that the client stays in the PHF program – usually many years. The ACT team includes a team leader, a psychiatrist, a nurse, an expert by experience, a mental health specialist (often a social worker), a welfare specialist, an employment specialist, and a substance abuse treatment specialist. So it is a very well-resourced and expensive model. As a rule, the ACT team itself produces the client’s services, relatively separate from the general services offered to the public, as far as these are offered at all.
Several researchers have found that the selection mechanisms of the PHF model leave outside services the great majority of the homeless (e.g., Namian, Reference Rissanen2020; Osborne, Reference Osborne2019).
A fundamental step in the housing first model is determining which individuals in the homeless population meet program eligibility requirements and who among this sub-population has the highest needs. … For example, the Vulnerability Index, a quantitative measure based on self-reported health information from street homeless people, is used to prioritise individuals for housing first interventions on the basis of their morbidity and mortality risk profile.
Despite the great positive publicity and high expectations associated with the PHF model, homelessness has increased in the United States in recent years. In 2015, there were 564,708 homeless people in the United States, while the number in 2020 was 580,466. From 2019 to 2020, the total number of homeless people in the United States increased by two percent. This was the fourth consecutive year in which the number of homeless people increased (National Alliance to End Homelessness; https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness/). For example, in New York, where Tsemberis’ model was originally created, the number of homeless people housed in temporary shelters was 35 percent higher in 2022 than ten years earlier. The number of homeless adults living alone was 111 percent higher than ten years earlier (Coalition for the Homeless; www.coalitionforthehomeless.org/basic-facts-about-homelessness-new-york-city/; see also Baker & Evans, Reference Baker and Evans2016, p. 31).
8.2 The Finnish Model of Housing First
The FHF model has been inspired by Tsemberis’ PHF model. But the Finnish model was from the beginning built independently, to fit the conditions of the Finnish welfare society.
In Tsemberis’ model, the only acceptable form of housing is a single rental apartment (“scattered site independent housing”), which is located in a building where no more than 20 percent of the apartments are rented to people with a history of homelessness. In Finland, it was known that a significant drop in the total number of homeless people would not be achieved with such a limitation. Sufficient numbers of affordable individual rental apartments could not be realistically provided within a meaningful time span.
That is why, in the Finnish model, temporary shelters and dormitories were rapidly eliminated and transformed into subsidized housing units with the help of public funding. In these housing units, the residents get their own rental apartments, with normal rental agreements, plus support services aimed at increasing the residents’ capacity for independent living. At the same time, the availability of affordable scattered rental apartments, with various forms and degrees of support, has steadily increased, offering a next step for many residents of congregated supported housing units. This combined solution started a significant reduction in the number of homeless people in Finland, which has continued consistently for about 15 years.
In Finland, it would be impossible to use a system of ACT teams based on Tsemberis’ model to handle support services for the formerly homeless. There would not be enough trained staff such as psychiatrists, and it would become unsustainably expensive. A new separate organization of social and health services would be created, which would only serve the formerly homeless, and which would blatantly violate the principle of equality. Since Finland has a strong and geographically comprehensive system of publicly funded social and health services available for the whole population, support services for the homeless or those who have moved away from homelessness into their own housing must also be organized with the help of the existing service system.
We may now use two complementary diagrams to summarize the main differences between the PHF model of Tsemberis and the FHF model (Figures 8.1 and 8.2).
Although Finland has a well-developed and comprehensive system of public social welfare and health services, the challenge in Finland is the fragmentation and often siloed character of the existing service system (Rissanen et al., Reference Rissanen2020). Homeless or formerly homeless clients who have moved to supported housing often do not know or cannot manage on their own to apply for the services that suit them. Thus, they are easily excluded from services or fall into gaps and cracks between different services. In other words, Finland has high-quality and professional services, but getting to them, staying in them, and moving between them are a growing problem.
8.3 Housing First as a Germ Cell Concept
Housing First is a functional concept, that is, a concept that guides the activity of homelessness work. New functional concepts are typically born as solutions to contradictions that have taken shape in the activity, cause disturbances, and may lead to crises in the activity. As shown in the preceding chapters, the most demanding and at the same time the most impactful functional concepts are germ cells that crystallize the core principle of the activity in a simple, practical form and at the same time give the development of the activity a vision that carries far into the future. Housing First is this type of functional concept.
Homelessness is very often intertwined with some degree of problematic substance use or substance dependency. In the traditional staircase or LRT model, a homeless person could only be given an apartment when the person proved that he or she could live without the use of substances.
in the LRT model, almost all permanent housing options, especially apartments, are available to clients only if they first demonstrate continued participation in psychiatric treatment and achieve a period of sobriety. These requirements create insurmountable hurdles for many people with co-occurring disorders – that is, those who have mental health and substance use disorders – causing them to remain chronically homeless.
In other words, living homeless, often among other substance users, makes it difficult to give up substances. This is how a contradiction arose that maintained both homelessness and addictions in a downward spiral. The contradiction may be depicted with the help of a diagram (Figure 8.3).
Figure 8.3 The contradiction between substances and home as driving force for the concept of Housing First.
The Housing First principle was created as a way out of the detrimental effects of the staircase model, that is, as a solution to the contradiction between substances and home. Tsemberis emphasizes the role of mental health problems along with substance use. However, not nearly all homeless people have severe mental health issues, and mental health problems certainly do not represent an “attraction” or drawing power comparable to alcohol and drugs.
As I pointed out above, the FHF model differs from the more generic model of Tsemberis in a significant way: namely, the Finnish model endorses rental apartments in supported housing units and is not restricted to the so-called scattered-site housing in individual apartments. The principle of the FHF model may be summed up in the signing of a legally binding rental agreement and the emblematic expression name on the door (www.hel.fi/static/sote/astu/nimi_ovessa.pdf). The solution was to offer the homeless their own permanent rental apartment – either in a supported housing unit or as a separate apartment in scattered housing – without the requirement to be free of substances. The solution model can be summarized with the help of Figure 8.4. The upward spiral describes a decrease in homelessness and, as a result, also a decrease in problematic use of substances.
Figure 8.4 The FHF concept as a solution to the contradiction.
This solution has worked remarkably well in Finland and in many other countries. The widespread adoption and diverse applications around the world testify to the generative power of this germ cell concept. However, the basic model of Housing First – or the concept of Housing First 1.0 – is not sufficient anymore.
8.4 Winding Road toward Housing First 2.0
The notion of Housing First 2.0 was first elaborated on in the Change Laboratory conducted in 2019 with Finland’s homelessness actors at the national level. The name “Housing First 2.0” was put forward to signify the need to update and redefine the Housing First policy in accordance with the changed circumstances and new challenges. At the beginning of 2020, the Change Laboratory produced an action plan in which the idea of Housing First 2.0 was formulated as “making together a possibility for everyone” (https://ysaatio.fi/aineisto/asunto-ensin-2-0-tehdaan-yhdessa-jokaiselle-mahdollisuus/).
The Finnish Housing First principle is in its present form an outcome of a large-scale societal learning cycle. This cycle has come to its end point and a new cycle has started. The strong initiative and commitment to a renewal of the Housing First principle among the key actors and housing units is evidence of the beginning of a new cycle. This is also reflected in the fact that the Housing First principle is explicitly stated in the program of the new government and the government has committed to the eradication of homelessness in eight years.
Two words in the title of the action program are particularly important: together and possibility.
Together refers to the urgent need to increase collaboration between the various public and third-sector actors working with homelessness. The Finnish systems of housing, social welfare, and health care services are quite comprehensive, but they suffer from fragmentation and silo mentality (Rissanen et al., Reference Rissanen2020; for a broader European view, see van Duijn et al., Reference van Duijn, Zonneveld, Montero, Minkman and Nies2018). For vulnerable clients who need multiple interconnected services, this can lead to falling in the cracks. The action program is aimed at elimination of such cracks by means of service integration and collaboration across organizational, sectoral, and professional boundaries. It also emphasizes the need to work more effectively together with the clients by means of low-threshold services and mobile support that come to and move with the clients (Muutoslaboratoriotyöryhmä, 2020, pp. 7–8).
Possibility refers to continuous and persistent work with every client, not stopping when an intermediate goal such as acquiring a home is achieved. For this, homelessness practitioners need what I have called possibility knowledge (Engeström, Reference Engeström2007a). In other words, clients’ housing pathways need to be seen as co-constructed in a field of possibilities rather than as following categorically fixed scripts (Engeström, Reference Engeström, Rogers, Russell, Carlino and Marine2023).
The action program paved the way for the concept of Housing First 2.0. It put forward a new name, but under it there were thirty-six recommended actions divided into six sections. In other words, the foundational principle, the new germ cell, was not yet formulated. A critical push toward the next step in this direction came about in an unexpected way.
A city-level Change Laboratory was conducted in Tampere in parallel with the national level one in 2019. Among the recommendations produced in that intervention, one struck us researchers as particularly innovative. Some participants of the Change Laboratory suggested a new type of multiprofessional mobile homelessness service which they named “Deerfoot” (“Nopsajalka” in Finnish, literally translated as “quick feet”). The name was taken from the name of the main character in the popular Deerfoot novels by Edward S. Ellis, translated into Finnish and widely read by Finnish youngsters some decades ago. Deerfoot, or Nopsajalka, was a young Native American renowned for his abilities as a runner.
Shortly after the Change Laboratory, Nopsajalka’s idea was included in the official City of Tampere 2020–2022 Action Program for Halving Homelessness:
In the Change Laboratory in Tampere, the team was named Nopsajalka, which offers help promptly and flexibly. The target group of the work are clients who are at risk of homelessness, who need special support, and homeless clients who move to their own apartment from emergency housing or other housing units. Clients are referred to Nopsajalka from, for example, psychiatric hospitals, in which case Nopsajalka supports their repatriation or resettlement. Landlords and housing advisors can also contact Nopsajalka about clients whose situation has become critical due, for instance, to mental illness. In this case, Nopsajalka’s task is to support the retention of the apartment. Nopsajalka’s work also includes support for housing clients from emergency housing. In the emergency housing unit there are long-term homeless clients, whose housing in scattered locations requires special support and multi-sectoral collaboration. Building trust in the client on the one hand and the landlord on the other hand is key.
What is special about Nopsajalka’s operations is the tailoring of services into a whole that meets people’s service needs, as well as their coordination. The work should be mobile and flexible in terms of time, i.e. offer more intensive support in a crisis situation and loosen its grip when the situation stabilizes. If necessary, the work must continue for a long time with the client. The Nopsajalka team has expertise in social work as well as substance abuse and mental health work. The team is organizationally positioned as part of adult social work services, but the practical work is done closely with the Konsti working group (support brought to the homes for substance use and mental health clients). Substance abuse and mental health problems are particularly emphasized in Nopsajalka’s clientele, so the team must have strong expertise in helping people with multiple problems, often intoxicated and sometimes psychotic or with other psychological symptoms. Knowledge of the service system and extensive consultation opportunities with basic and specialized medical care guarantee that crisis help is received quickly. If the situation requires it, Nopsajalka also organizes apartment cleaning or clearance cleaning.
Representatives of the homeless services of the city of Jyväskylä heard about Tampere’s Nopsajalka idea. They contacted their colleagues in Tampere and, after receiving permission, adopted the name Nopsajalka for their own initiative. In the autumn of 2020, the Finnish Ministry of Social Affairs and Health launched a national development project which allocated grants to support novel initiatives of social and health services in various cities to reduce homelessness. The funded subprojects in the cities of Jyväskylä and Tampere included the development and testing of multiprofessional mobile support based on the Nopsajalka idea.
In the meantime, Sannino’s research group started a project to support and analyze the development of collective professional agency among Finnish homelessness workers (Sannino, Engeström, & Jokinen, Reference Sannino, Engeström and Jokinen2021). On October 27, 2020, the research group conducted a nationwide online workshop on the topic “Organizing multi-professional mobile support for clients,” with invited speakers representing the Nopsajalka team in Tampere. The city of Jyväskylä had a strong participation in the workshop and its representatives asked several questions to the speakers.
Jyväskylä Nopsajalka project manager: “We have received really good information and experience here (in the workshop). And I would suggest that we could continue to compare and ‘borrow’ from each other a bit. And to look for solutions together, since there will probably be many issues before us in starting this… So thanks for the learning opportunity.”
Subsequently, Nopsajalka activity was developed in the two cities according to their own needs and conditions, while continuing to exchange experiences. In 2022, Sannino’s research group focused on following, documenting, and analyzing the development of this new service in Jyväskylä. This turned out to be decisive for the elucidation of the germ cell concept.
At the beginning of 2023, Sannino’s research group published its analysis of the evolution of the Nopsajalka service in Jyväskylä (Sannino, Engeström, & Kärki, Reference Sannino, Engeström and Kärki2023). A few months earlier, the Ministry of Environment and Housing appointed Juha Kaakinen, former CEO of Y-FoundationFootnote 1 and a leading proponent of Housing First policy in Finland, to investigate and assess the state of homelessness work and to produce recommendations for its further development. In January 2023, Kaakinen submitted his report to the ministry (https://valtioneuvosto.fi/documents/1410903/40549091/Selvitysraportti+asunnottomuuden+poistamiseksi+vuoteen+2023+mennessa.pdf/45d202aa-8b0f-fb92-fe27–911cbfb5b299/Selvitysraportti+asunnottomuuden+poistamiseksi+vuoteen+2023+mennessa.pdf?t=1677828135828). Citing Sannino’s research, he strongly recommended Jyväskylä’s Nopsajalka model as a critically important new component of the Finnish homelessness strategy.
In March 2023, Sannino’s research group and the national Housing First Development Network of the Y-Foundation launched a series of workshops with the purpose of collecting experiences and ideas of multiprofessional mobile support from the different counties of Finland, eventually aimed at producing one or more integrated models for organizing and conducting such support work.
As I was writing these lines in June 2023, the concept of Housing First 2.0 had been in the making for four years. Key steps in this process are listed in Figure 8.5. As the figure shows, the process has moved both with the name in the lead and with the action in the lead.
The winding road depicted in Figure 8.5 has generated a solid kernel for the concept of Housing First 2.0. This kernel can be grasped by elucidating the new contradiction emerging in homelessness work.
8.5 The New Contradiction
Those involved in homelessness work know that clients who are homeless or under the threat of homelessness today are more diverse than ever. The traditional image of a lonely, middle-aged alcoholic man living in the street or in the woods no longer covers the reality of homelessness. Actors in the field face new types of clients, new types of problems, and new types of service needs. This growing diversity of the client base is widely recognized as a challenge in homelessness work.
Much less attention has been paid to another major change, namely the increasing mobility of the clients. Clients of homelessness workers move from hospital or prison to the outside world, where they face the risk of homelessness. They move from their temporary housing locations to various support services, from one support service to another. They move from temporary housing solutions to permanent rental housing, for example in supported housing units. And they move from supported Housing First units to substance-free units or more independent forms of living – and unfortunately often also back.
Getting around is anything but problem-free for the clients of homeless services. The basic principle of the Housing First model is that permanent housing is arranged for these clients, which means security and the opportunity to settle down. However, even after receiving an apartment, the client must move to services and move between them.
In addition, in many cities, housing units may be subject to requirements to speed up the flow of residents, that is, the transition out of a supported housing unit into independent housing. This can be perceived as a threat to the permanence of the apartment, especially when it is known that, if independent living fails, the client may no longer return to the supported housing unit and may face a new period of homelessness. Anderson-Baron and Collins (Reference Anderson and Tulloch2018) analyzed in Alberta, Canada, this problematic pressure of “graduating” residents out of their Housing First apartments. They found that eight of the ten Housing First programs they studied had adopted “graduation expectations or requirements.”
Overall, most service providers who participated in the research were opposed to the idea of imposing graduation requirements, and associated expectations that case management involve “moving people through” (and eventually out of) the HF system. They expressed varied concerns about this practice and the negative influence it could have on clients’ wellbeing and trust in HF agencies. Several spoke of clients who sought to avoid graduation through disengagement or “self-sabotage” ….
The authors note, however, that “for many programs, it was necessary to graduate existing clients in order to admit those who were currently homeless (and often on waitlists for entry to HF)” (p. 602).
The contradiction between permanence and security, on the one hand, and mobility and independence, on the other hand, is real. For a homeless person, the contradiction appears as a difficulty in getting into services that would be necessary for his or her own livelihood and health. Staying outside of the services “on your own” or relying on a service that has become familiar but is insufficient, can be perceived as safer than setting out to search for new services in a fragmented service system. For those who have received an apartment in a supported Housing First unit, the contradiction appears as the difficulty and risk involved in moving to a substance-free unit or independent living.
During the last few years, those who purchase the services, i.e. the cities, have started to expect that more and more residents would move to independent living faster than before. … Several residents have expressed the fear that homelessness may reoccur as a key barrier to transitioning to independent living …. Service providers and buyers could together promise a resident who is thinking about moving independently to a new home, that s/he can return to the familiar and safe housing unit, if needed. If living independently does not succeed for some reason, the resident can much more confidently take the next step towards independent living.
Residents in Housing First units should be able to move as quickly as possible to substance-free units when they so wish. But, if a resident moves to a substance-free housing service, s/he must first give away the Housing First apartment. The resident has to consider whether s/he dares to take this risk. It is a big step just to ask for help for a substance abuse problem, let alone move to a unit where substance use is not allowed. Good places, but if you cannot stay sober, then you face a return to homelessness and, in the worst case, several years of queuing again for an apartment in a Housing First unit. This threshold is often too high. It would be great to be able to encourage sometimes residents to take these brave steps to a substance-free life, and to say “it’s worth giving it a chance and trying it.” Now this is difficult to do, because for few people giving up substance use succeeds on the first or even on the second try. Knowledge and threat of possible homelessness is real.
The emerging new contradiction of today’s homelessness work in Finland can be summed up with the help of Figure 8.6. As a result of the contradiction, a new downward spiral can easily arise in which many clients are left outside the services they need or fall into gaps and interruptions in the service system.
Figure 8.6 The contradiction between permanence and mobility in homelessness work.
This contradiction was vividly experienced by practitioners implementing the Nopsajalka multiprofessional mobile support service in the city of Jyväskylä. They started out by focusing on long-term support for clients who, in the terminology of the PHF model of Tsemberis (Reference Tsemberis2010), might be characterized as “chronically homeless.” This meant that a small group of clients tied up practically all the resources of the Nopsajalka team. This was not sustainable, so the model was changed.
And then we decided that now let us stop this flow of clients from the adult social work side for a while and go and do interventions in Ward 3 of the City Hospital. And RISE (the Criminal Sanction Agency) was another one. Let us take also other clients to see how the processes develop with them and what needs there are and how Nopsajalka can really be a multi-professional mobile team and move there in the network. And this was a good decision. Through this, the process has been developed in such a way that it is possible to make it Deerfoot, not a long-term process or service. They build the trust and map out the services and start the process. Then, when they see the other needs of the clients, they may do escorted transfers to take them to the other side. Short-term client relationships and, in a way, outreach work, strongly there in the networks, and also to some extent supporting work. In my opinion, those are perhaps the two themes that are now strongly visible in Nopsajalka. [interview with Jyväskylä Nopsajalka project manager, Spring 2022]
The transformation of Nopsajalka’s operating model is summarized in Figure 8.7.
Figure 8.7 Transformation of Nopsajalka’s operating model in Jyväskylä.
The change, represented by the arrow in Figure 8.7, has proceeded along both dimensions of the figure. On the one hand, it has been a shift from serving individual clients toward improving the functionality of the service network. On the other hand, it has been a shift from long-term support toward quick interventions in the client’s needs and services. This bi-directional change is fundamental in that work on an individual client becomes at the same time work to improve the service network. Of course, what is depicted in Figure 8.7 is not an either/or change. This is illustrated by the partial overlap of the spheres in the figure.
8.6 Germ Cell of Finnish Housing First 2.0
How can the contradiction depicted in Figure 8.6 be resolved? Experiences of the Nopsajalka service in Jyväskylä show that it is possible. In the data collected by Sannino’s research group, escorted transfer was the most frequently used expression to describe the new way of working of Jyväskylä Nopsajalka. It literally means escorting the client to housing and services, negotiating dialogue with the receiving services, and supportively following the client after the transfer. While this way of working prevents individual clients from being left outside of services or falling into gaps in the service system, it also mends cracks between services and opens blocks that make it difficult to access services. In other words, escorted transfer is service integration, but not by orders given from above. Escorted transfer starts from below, that is, from the needs of concrete clients and the joint recognition of these needs in dialogue and negotiations between involved parties (Figure 8.8).
As shown in Figure 8.8, escorted transfer is supported by collaboration agreements between providers of services related to homelessness. Working together was from the beginning a central idea of Housing First 2.0. Multiprofessional mobile support teams of the Nopsajalka type can become critical midwives for working together and integrating services. Escorted transfer gives rise to working together from below.
The expression escorted transfer (saattaen vaihdettava, in Finnish) comes from the railways. It reminds workers that, in order to avoid damage, the wagon in question must not be put into motion without a motorized escort. As if without noticing, escorted transfer has entered into the daily parlance of homelessness work, to describe a certain way of working. When asked, the participants in the study of Sannino’s research group clarified that, by using escorted transfer, Nopsajalka prevents the interruption of service paths of vulnerable clients in need of services. According to the Nopsajalka team, this practically means the following (Sannino, Engeström, & Kärki, Reference Sannino, Engeström and Kärki2023, pp. 30–31):
The client switches to another service from Nopsajalka’s service, so that the employee escorts the client during the transfer.
The client is not just directed to the service, in which case he or she may not even dare to go or get there.
The escort and the client’s receiver exchange information and ensure that everyone has a shared understanding of how to proceed with the client’s needs.
The employee of the new service receives the client, escorting and guiding him or her to the new service.
Duplication of work may arise during the switch, because the client may feel that he or she is a Nopsajalka client, even though he or she has technically switched to another service.
If the client wants an apartment, for example, Nopsajalka connection is not interrupted when the client gets the apartment.
The client is helped to open doors that may have been closed previously.
Escorted transfer requires quick, even improvisational intervention in the flow of events. At the same time, this way of working requires long-term planning and tenacity, because obstacles and interruptions inevitably emerge in the client’s process and problems recur. In previous research in other settings, this kind of work approach has been characterized as negotiated knotworking (Engeström, Reference Engeström2008a), that is, tying collaborative knots where there might be gaps.
Escorted transfer is a concrete mode of action that tackles and resolves on a daily basis the contradiction between permanence and mobility in homelessness work. A true germ cell concept can only emerge and evolve on such foundation of material action. As Leont’ev (Reference Leont’ev1978, p. 78) put it: “The realized activity is richer and truer than the consciousness that preceded it.”
The Nopsajalka model and the emerging concept of Housing First 2.0 are particularly powerful because they melt together work on specific clients and work on the entire service system.
My typical work day includes somehow client work and somehow collaboration in the client’s networks. These two I surely face every day in some form. [interview with a Nopsajalka team member, spring 2022]
At the same time, Nopsajalka offers a cost-effective model to combat homelessness also in sparsely populated areas where the numbers of homeless people do not warrant the construction of supported housing units.
8.7 Ascending from the Abstract to the Concrete over the Long Haul
It is said that a big ship turns slowly. Housing First 2.0 is indeed big in scope. The germ cell concepts discussed earlier in this book were embedded either in local activity systems (the concept of knotworking in the library and the concept of expansive degrowth in the food cooperative) or in a city (the concept of sustainable mobility in the home care of the city of Helsinki). Housing First 2.0 is embedded in the national homelessness policy, and put into practice in numerous counties, cities, NGOs, and local housing units across the nation.
The formation of the germ cell concept of Housing First 2.0 may be seen as ascending from the abstract to the concrete. As explained in Chapter 3, the first step of this process is experimentation with and transformation of the problematic domain which initially appears as diffuse sensory concreteness. This step was taken by the practitioners in Jyväskylä when they implemented the Nopsajalka service and found that it needed to be seriously reshaped.
Well, this is where we first started, with the idea that since these clients are in need of special support, those rehabilitation services are long-term processes. That is how it is, the need is great and thus empowerment happens slowly. And then we just concluded that as there were only two workers in the team in the spring and summer of 2021, nothing would come of this. If our client base consists of twenty clients and we serve them throughout the project, then we will not be able to cooperate with the service networks, as it was the idea.
As the researchers of Sannino’s team began to interview and observe Nopsajalka workers in Jyväskylä, they soon realized that the practitioners’ dominant notion about their work was escorted transfer.
They (Nopsajalka team employees) build the trust, map out the services and set the process in motion. But when they see other needs of the clients, they move the client by escorted transfer to the other side …. And also on that other side, the work is developed in such a way that there, too, they (employees in the other service) already are receiving the client by escorted transfer. They do not just catch the client, but the building of trust moves there side by side with Nopsajalka, so that the client dares to transfer and also trust also the receiving service …. This is the biggest change that has been made here.
We received a resident’s application through Nopsajalka. And the client had already received Nopsajalka’s support for a long time. Then an employee of Nopsajalka came with the client to visit and get familiarized with our housing unit. There was a familiar and safe employee with the client so it was a successful visit. And now the client, escorted by Nopsajalka, has become a resident in our housing unit. And this walking side by side still continues. With Nopsajalka, the client goes to his former apartment to finish cleaning together and other things. In my opinion, escorted transfer to services is really important because it is awfully difficult for these clients to create relationships of trust, or perhaps they cannot even present their own situation without having someone to support and help, to tell about the needs and the situation. They [Nopsajalka] have the opportunity to go with the client to different services and act as a service interpreter between the client, different units and services.
Similarly to the action of standing up from the chair in the case of sustainable mobility for elderly home care clients (Chapter 5), escorted transfer saturated the emerging new practice and discourse of the Nopsajalka service so forcefully that the researchers had to notice it and work out its meaning. This led to the second step in ascending from the abstract to the concrete, namely to the explication and modeling of the new germ cell relationship. The first versions of the model depicted in Figure 8.8 were presented by Sannino’s research group at a seminar in August 2022.
Although the germ cell concept depicted in Figure 8.8 is solidly rooted in the practice that took shape in Jyväskylä’s Nopsajalka service, it is still too early to say to what extent and in what timeframe it may stabilize, generalize, and actually transform homelessness work nationwide. In other words, ascending to the new expanded concrete has only begun. The ascending to the concrete needs to be followed and supported over the long haul. In this sense, the germ cell depicted in Figure 8.8 is a working hypothesis, understood in the spirit of George Herbert Mead’s prescient statement.
It is always the unexpected that happens, for we have to recognize, not only the immediate change that is to take place, but also the reaction back upon this of the whole world within which the change takes place, and no human foresight is equal to this. In the social world we must recognize the working hypothesis as the form into which all theories must be cast as completely as in the natural sciences. The highest criterion that we can present is that the hypothesis shall work in the complex of forces into which we introduce it. We can never set up a detailed statement of the conditions that are to be ultimately attained. What we have is a method and a control in application, not an ideal to work toward.
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