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Substance Abuse and Mental Health Services Administration
Personalized Budgets: A Person-Centered Approach to Ending Homelessness in London
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Broadway, a London, UK-based non-profit, has piloted “personalized budgets,” an innovative person-centered method of reaching out to people experiencing chronic homelessness. Broadway targeted long-term “rough sleepers” who had been living on the streets for between four and 45 years and asked each: “What do you need to help you off the streets?” Each person was offered a personalized budget of 3,000 British pounds (about US$4,750) to meet these needs and to spend as he or she pleased. The budget was combined with flexible, personalized support from the project coordinator.

At first glance, it seems like a radical solution: make funds available to people living on the streets, and allow them to define what they need to get off the streets and begin the process of achieving stable housing. Yet, that’s what Broadway, a London charity, has done for twenty-two individuals who “sleep rough” nightly on the streets of the City, London’s financial district. Of those twenty-two, seventeen are now in housing, and fourteen have spent more than six months under the same roof. All of the housing solutions are individually tailored for each person.

The project has municipal funding, provided as part of a broad plan to end homelessness. Twenty-two rough sleepers were presented with the possibility of structuring a personalized program with a long-term support worker. Each person was offered a personalized budget of 3,000 British pounds (about US$4,750) and could spend it as he or she pleased. Each individual and his or her support worker carefully worked out the budget. The strategy targeted long-term rough sleepers, people who had refused standard offers of support for years, and had poor relations with outreach teams. Participants had been sleeping in the streets for between four and forty-five years. While the program has some aspects of a conditional cash transfer, there is an essential difference, according to Howard Sinclair, chief executive at Broadway.

“The old approach was to approach people and say, ‘This is what we’ve got, do you want to opt into it?’, particularly with people who’ve been on the streets a long time and clearly don’t want to opt in. What the personalized budget program does is to go to these people and ask, ‘Okay, what would it take to get you off the streets into somewhere safer and better?’”

“It’s coming at it from a different angle. It gives service providers a bit of humility. We recognize that we don’t have the answers. The answers are best sought from the individual. Asking people what they needed allowed them to save some face as well, and to re-engage. It got them out of their trenches and their ways of thinking for a bit. The money was just a hook, a signal of our seriousness in asking the question. It certainly wasn’t the key factor.”

The items purchased with personalized budget funds have included a wide variety: a television; cell phones; temporary accommodations; clothing; a pair of athletic shoes; and a second-hand trailer in a campground on the English coast. The latter cost more than the allotted 3,000 pounds, but the average amount spent was only 794 pounds ($1,250) per person. In contrast, an article in The Economist noted estimates of annual state spending on rough sleepers per person as 26,000 pounds ($41,100) in health, police, and prison costs annually.

Howard Sinclair believes that the key factor in making the strategy work is the long-term support offered to participants. While many of the interactions between the support person and the participants do not require large investments of time, continuity is critical. The ideal caseload, he said, is fifteen to twenty clients per support worker.

“Traditionally, services are designed so that a person gets picked up from the street and delivered to the door of a hostel, and then someone takes over the person’s care. When a person leaves the hostel for a flat, someone else takes over care. You get passed along the line. In this program, one person goes with you all along the line.”

After so many years sleeping outdoors, many of the participants found it difficult to know what they would need to change. They required help just imagining material things or services that might work for them. In the cases of the people who had spent decades in the streets, they sometimes needed accommodations with a balcony, or a small garden, somewhere they could lay down a mattress to sleep in the open air from time to time, according to Sinclair.

This approach holds promise for people with substance use issues as well, Sinclair said. While drug testing is not required for participants, and they are not prohibited from taking a drink, a willingness to seek help with substance abuse problems is occasionally required as part of the conditions for participating.

“In some cases we’ve taken people straight from the streets into their own flats. We’ve said to people that they must work with us to deal with their particular problems and move toward going into rehab. We take a harm-minimization approach. We will not ask people to abstain, but we’ll work with them on addressing their dependencies.”

Read an evaluation of the City of London’s personalized budget pilot to learn more.

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2011
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