Focus on Ghent (BE): open Dialogue as a guidance method for residents in Robust Housing

Situation
The URBACT ROOF project (2020-2022) connects 9 European cities in the quest for eradicating homelessness. All the cities deliver an integrated local action plan: a co-created long term policy plan to end homelessness on a local level. During the ROOF project, all cities exchanged knowledge on how to eradicate homelessness through data collection, prevention and housing-oriented solutions. The connection between the cities, mainly digital due to Covid, fostered a greater local knowledge, political leverage and a joint visibility on the international scene of homelessness policy work. Together, we genuinely believe and promote that ending homelessness is possible, realistic and necessary. Our message is backed by scientific validated practices and examples all over the (western) world.

Ghent delivers an integrated action plan that focuses on ending homelessness for legal residents by 2040. We do this by mainly focussing on three aspects: more prevention, more and diverse housing offer and specific supporting methods to complement with the different housing solutions. Through our model and actions, we deliver a systemic approach that targets to house all different profiles of homeless people: young, old, disabled, working, acute homeless, long term homeless, etcetera. We generalize where possible (maximizing regular social and private housing with support) and diversify where needed (sufficient alternative housing solutions for those who do not succeed in regular housing).

The European URBACT program gave all partners the possibility to do small tests of parts of the local policy plans that were created: Small Scale Actions. In Ghent, we chose to test the support method of Open Dialogue like it’s practiced in Aarhus in Denmark. This method specifically operates as connector in the existing fragmented field of care and support in Ghent, although that is what we are testing. The method has the potential use to support those people with complex problems that repeatedly fall out of the existing system of care and support.

Robust Housing
One of the alternative housing solutions in Ghent are the Robust Houses. Based on the concept of the Danish Skaeve Huse, we are now building 11 houses that will be rented out by a regular social renting contract, but are different than regular social housing in the following aspects:

• the houses are on a site without direct contact with neighbours;
• the houses are built with a lot of attention to different gradients of privacy;
• the houses are built robust to prevent potential damage;
• the site is surrounded with green and has focus on stress relieve;
• the houses come with specific intensive and multidisciplinary support;
• there is an on-site working unit for the site manager (only daytime).

The target audience criteria are:

• chronic homelessness;
• complex multi-problems that make it difficult to function in (existing) regular housing solutions for the homeless;
• a history of unsuccessful housing experiences (nuisance, eviction,…) because of his/her complex problems;
• difficult connection within the existing service-driven support system. An alternative demand-driven approach makes sense;
• can function at least independently, possibly in combination with ambulatory care, and does not pose a direct danger to himself or the surrounding residents.

In the search for the right form of guidance for future residents, the professional network that is already involved with this target group came up with the unanimous vision: start from a network that already has a mandate with the target group, rather than introduce new guidance.

With this target group, everything stands or falls by focusing on the needs and questions of the target group, working on the basis of equality and trust and working at the client's pace.

Starting from these basic principles, the methodology of Open Dialogue was presented to us. This method has already shown its effectiveness in projects in Aarhus Denmark, among others, in organizing network and care for people with complex problems and is also applied there in the context of alternative forms of living/housing first.

Open Dialogue
Open Dialogue is a goal-oriented approach to psychiatric care and treatment, which seeks connection and dialogue with all those involved as quickly as possible, by listening openly to different experiences and perspectives in broad conversations. This goal-oriented Open Dialogue approach is based on 30 years of international practical research and is characterized by 7 core principles, continuously attuned to the people and situation involved:

• immediate help: response within 24 hours of the first contact;
• social network perspective: the patient's social network is mapped and all relevant persons are involved in the dialogue;
• flexibility and mobility: care providers adapt to the changing needs of the patient and his environment and ideally an Open Dialogue meeting takes place in the home context;
• responsibility: the first professional contacted organizes the first meeting with the patient, the family and other involved parties;
• psychological continuity: an integrated network consisting of all necessary disciplines and specializations continues to work with the patient and the family for as long as necessary;
• tolerance of uncertainty: open listening and searching together are central, without the agenda and the outcome of a conversation being fixed in advance;
• dialogism and polyphony: creating a dialogic environment in which all experiences and perspectives are listened very respectfully in the quest to better understand the situation.

Small Scale Action
With the support of URBACT, Ghent selected 3 pilot cases where Open Dialogue was tested as method. The network of housing coaches and outreachers searched for 3 formerly homeless people that recently received social housing and who meet the robust housing target group criteria. With the client's consent, an Open Dialogue process was started with the client's network involved, each time supervised by 2 process counselors from the Flemisch Centre for Mental Health vzw Psyche.

In addition to the individual client networks, a steering group was started, a learning network that meets every three months to discuss success factors and bottlenecks in the process.

In the course of the trajectories we want to see what added value the use of the Open Dialogue method has in the context of good care and guidance for the client, and in the context of sustainable living quality for the client and his environment.

Successes
The test period was only a few months so far, but we already can see some successes: For example the openness and willingness of the target group to participate in the process is there. What seems evident, is quite an achievement within the context. Secondly, there is a very high level of support and enthusiasm among the professional network partners. Here we touch upon an important aspect. The engagement indicates that this way of talking with instead of about clients and their network is greatly appreciated by the support workers themselves. It ensures that people feel heard and consequently that real connection is made. It is through this type of connection that certain matters are discussed and treated that would otherwise remain untouched. Thirdly, the test is bringing partners from different sectors together on a horizontal base. Through Open Dialogue, the participating support workers are suggested to let loose their expert position, to be able to enter a discussion with the client, about his/her needs and concerns at the time. The shift from service to demand driven forces the support workers to jump from their expert-oriented gaze into the open ended daily reality of the client. This shift could be a first step in the restructuring of the field of care and support, especially for those whose needs are not answered through the fragmented offer of today’s care and support system.

Bottlenecks
Besides the successes, we also see some problems arising. Firstly, the housing situation where the test was ran is not ideal. At this moment, the target group is living in regular social housing, which is not in the most suitable form of housing. Conflict and housing pressure are greater than they would be in robust housing. We experience more pressure from the environment to intervene.

Secondly, we deal with a target group with who it is very difficult to reach agreements. We struggle to coordinate the Open Dialogue with structured agendas of partner organizations. The heavy caseload of most of the support workers makes this type of approach difficult.

Thirdly, we feel that continuity of care is practically only possible when the support is not bound in time. Several participating support workers are still working with a limited mandate for temporary support (for example only as long as the housing contract is running, not after eviction). We need more flexibility in organizational roles to be able to live up to the needs of an Open Dialogue.

Finally, we felt that not all parties involved in the network agree (yet) with the vision of Open Dialogue. For example the social housing company understandably wants problems to be tackled and resolved as quickly as possible. It takes more time to work towards a joint vision that combines the needs of clients, housing companies and support workers, to be able to fully organize an Open Dialogue.

Conclusion and actions for the future
With the test of organizing an Open Dialogue, Ghent took the risk of learning by doing. It is understandable that the method is not fully installed yet and that we do not have solely positive successes. It is through practice that we are learning what aspects are fundamentally needed in order to book progress. For sure all participants are in favour of working towards more integrated and demand driven care. It is through such small scale actions that we are searching for practical knowledge, best practices and collaborative leverage to get new support systems in place that are able to deal with people’s real needs.

For the near future, we will continue to work with the methodology and process guidance for the clients that were selected. We are also organizing our first information sessions about Open Dialogue with the aim of getting more care providers to participate in this way of working. We finally will use the gathered knowledge in setting up a new and specific support system for those who will be housed in the Robust Houses. The houses are planned to be housing ready by the beginning of 2024.