 Hello everyone and welcome to the first recording of one of our EMC-DVA webinars. This time we address the responses to homelessness in Europe. There is a well-documented association between being homeless and being vulnerable to drugs-related problems and substance-in-general related problems. In addition, during the COVID-19 emergency, the problems of those that could be confined in their places because they didn't have a home were very seriously perceived. For these reasons we decided to explore these types of responses. We identified three organisations based in the northern, center and southern of Europe, namely Finland, Belgium and Portugal. We asked these guests to describe their project and also to discuss what are the barriers and facilitators factor and conclude with some lessons learned. All these projects adopted some type of housing first approach and approach that foresee the provision of house as a first step to respond to homelessness. We will hear in one hour and a half webinar directly from their voice, their experiences. Towards the end of the webinar our guests will reply some questions from the audience and our director will provide some conclusions. Thank you. Before that, some two years before that, I was working as a social worker in a smaller local city in Kortrek in the east of Belgium, but now I am in the coordination. So if it's possible for the next slide, housing first in Belgium, we started as an experiment in 2013 in a way to see if it was possible that housing first should work in Belgium. And we started with a small experiment, five cities, two Dutch-speaking cities, Brussels as the central city and two French-speaking cities. And after two years, the experiment was already a success and there was, there was joy in some other cities. So we came a little bit bigger and then in 2016 we ended it with very great results. We saw that it was possible to house people with severe needs and to support them in their housing search. And we see that we had a success rate of 93% next to the housing as usual as we say it, where we could only have the half of the people who were helping with support. Next slide. Now we are already seven years later and we have supported over 850 clients. So that's really a big advance we had. And we are still having a success rate of 86% of people who are staying after two years still in their houses. And we see also a small number, one on fourth of these clients can live on a very independently way in their housing. After some years, it's not in six months that we can manage it but we see that people who had been in the housing first experiment that after some years we are trying to let them be as independent as possible. Yes, next slide. There's our little country in the middle of Europe with the different local projects. So the numbers in Brussels, there are four projects but in the other cities there are more or less one project each. In total we are with 250 active clients we are working with so each program of each city is more or less on his own is independently. So there are some accents that can differ between one or other projects. Yes, next project it will be I think more interesting for you to see. We had some discussions last year about our success rate and there were people who were saying yes it's easy if you take all the people who are not causing a lot of troubles and you house them then you will have a lot of success. So we asked our projects on the profile of their clients so we asked them about the day, the years they spent on the street before they had access to a house of the project. And we see that a lot of them more than 90% of them are in had been two years or longer at streets before they had the house of housing first so that's very high. And that's on the problems they received that addiction to alcohol or to drugs is almost 10% who don't have problems with addiction so it's mostly everyone in the project has some problems with alcohol or drugs. It's not only drugs use it's also very big problem of alcohol, mostly related to the loneliness but I will speak of that later on. Next to mental problems and and also, yeah, physical problems you can you can move to the next slide I will look at the time so I had to go on. Next thing next experiment where we are now working on and which I find it very interesting to talk about is our experiment reconnect like we started seven years ago with an experiment to see if housing first was possible. Now we are starting off. We are busy with an experiment we are almost a year busy with it to see if we can add to housing first projects, someone who's we call it a reconnection coach. Someone who's free to look with clients how to find reconnection with the neighborhood with family with work processes. So that's a social worker or someone who's helping the clients to see what they can do to find activities to go in group. It was a very interesting thing the lagazette you see in the middle is a newspaper that is first was written by social workers but now is written with a group of people clients who are writing little text writing poems, writing love songs for one another, giving tips to where to find free meals where to go out to do activities. We had some really nice groups works also but then we had some very strange corona thing that going on so everyone is now in his own house, which is very sad because they cannot be group work anymore. But we try to keep up contact with our clients through the individual way through the cell phone through what's up and so on. And we find it very important for people because they say you're the only one I hear in throughout the week because there's no one who is concerned about me there's no one looking at me. Everyone is before his own television screen and no one is scaring for each other so it's very important to to have that connection that's still going on. That's for my first presentation. Thank you very much. I would ask the same question to Christiana so a brief introduction to your project and if there are relevant things for drugs related problems and any lessons we learned from COVID-19 Christiana. Thank you. So hello everyone. First of all I will thank to the MCDDA for this opportunity and I also want to compliment the rest of the speakers and the people who took this time to listen and to share this moment with us. So I will start with our program. Christiana is an NGO with 20 years of experience working with vulnerable groups in outreach settings, providing harm-election and other services for approximately 2,000 people per year. Today I will present one of its projects that is called ELMACASA which was in first which is a housing first program for people who experience chronic homelessness and use drugs. So our program is running since 2013. It provides immediate access to independent, permanent and scattered apartments, combined with off-site support and community-based services. Scattered housing is really the key to enable people to take part in the community as any other residents with daily life interactions with neighbors, the use of community services and etc. In this program there are no preconditions so any chronic homeless people could engage in the program. A person who uses drugs in a problematic way or not will refuse psychiatric treatment or medication, has no documentation, Portuguese nationality or he's in an irregular situation, has time in prison or not, has pets or not, so basically everyone is welcome here. Based on harm reduction, we need to build people where they are and start the support process from that point. Helping people gradually gain control over harmful behaviors and at the same time encouraging them to connect and use addiction treatment, mental health services and other services. So in this approach tenants are their own makers, decision makers and they drive the process from themselves. They are invited to select the neighborhood and the apartment where they want to live, accordingly with the available choices obviously, and determine how and when support and community services will be delivered to them. The main goal of this program is to support its tenant to not return to a homeless situation and also aims to support the recovery, which begins with encouraging their choice and their self determination. Next slide please Melisandre, thank you. So most referrals to this program are made by shared outreach teams which work directly on the streets with people who use drugs and with problematic use of drugs and alcohol. These teams do the same routes and schedule every day which promotes relationships of proximity and trust. The only screen you do in this program is made to ensure that the most vulnerable are the ones with the most problematic which are selected and admitted. So the most vulnerable and the ones with the most problematic drug use are the first one to be admitted. Along with long histories of isolation and totally loss of trust in services, most of our tenants have problematic use of heroin, cocaine, benzodiazepines and or alcohol. So part of them inject and because our veins are destroyed for this repeated trauma, some use the neck, groin, legs and eventually they develop localized infections. Infections diseases like tuberculosis, HIV, HCV, non-medicator are also very common in this population. So we have our tenants have spent in time 30 years approximately on the streets. Okay, now I go briefly through some results. Here we compare tenant situation before and after their integration. These results comprise data for all the 100 tenants integrated in the program for eight years with an exponential increase in the last year. When we observe this data at this stage, we see that after entering the program, approximately 30% stopped using drug and or alcohol. We also see improvements in linkage to drug treatment and linkage to opioid substitution treatments. In this slide we see that 100% reduced consumption, so lowering their dosage. Most of them also passed to small kingway of consumption, reducing injection associated risks. And of course setbacks happen, relapses happen, but usually people don't return to their initial standpoint. So it's obvious for us the pathway of recovery in every moment. Approximately 50 more engaged with healthcare services and between 60 to 85% more adhered to medication and or psychiatric demands. In terms of social services. Most of our tenants have a social worker and financial support after entering the program approximately 30% develop or restore family ties and this is a very important aspect. Of course, for us this are inspired results as long with the most important of all that is 90% of the tenants who engage in the program did not return to their previous situation. COVID-19 pandemic brought us challenges and we need to adapt ourselves. So goods and medication were delivered to high risk tenants and we need tenants who were in confinement, proclatic isolation or some positive cases. Staff articulated with host programs to provide methadone home delivery. Staff home delivered a septic material to inject and smoke to reduce kids ranges aluminum foil spy forever when necessary. And in case of people with severe alcohol consumption alcohol was provided when meet. Some of them have also started low threshold from a logical treatment before they were house which they continue doing afterwards. Naloxone continue to be made available for staff and tenants. And I want to highlight one aspect with a big impact that was temporary suspension of tenants meetings that compromises the way tenants engage with the program and they take advantage of it. These meetings are moments of exchange experiences approach common difficulties. Develop social tools and the greater sense of advocacy. So these moments appears it's it's there are priceless moments they appear as a source of meaningful life. And we need to suspend it. Share project scale up in more 90 houses during the first wave of of COVID pandemic. And we also took this opportunity not not in a mean housing first project but we also took this opportunity to present another project for a managed alcohol program, which basically combines housing with management and supply of regular doses of alcohol as the harm reduction strategy. So this program have had been approved during 2020. However, a fixed place for its implementation is not available yet. Thank you. Thank you very much, Christiana. And now we would like to pose the same question to ask the same questions to our northern colleagues, Elina and Jonas. So if you can briefly describe your program, how this relates to drugs related problems. And if there is anything from COVID 19 emergency, we need to bear in mind for the future. Thank you. Little innovations that we have from it. So we have also the housing first idea in here Finland and it started from the project 2008 2011. It was called get your name on the door. So after that we have been participating with the housing first program. I myself have been working these kind of units eight years from now and two years ago. 2018, we saw that we need to do a little changes on our housing first program. And I was just wondering how can I put this in English. So I just started thinking it's about seeing, feeling and healing. So we saw that our customer, we didn't reach them as good as we should. And then we started this program, we call it housing first 2.0. So we have been participating this with our customers and workers now like two years. And the results are very promising. So we are reaching people better. So we have to change the ways we do work, the places that we work so we can sit together. COVID 19 did bad for this program because now we can sit together and play guitar. But the idea is that we are really planning everybody something to do. When you wake up in the morning, you need a place to go. You need to be important. You need to be needed. Today when I came in this unit, we are in Helsinki now. In this big unit, we have about 100 people living in this unit. And I was walking in the street. There is so much snow everywhere. So it was very hard to get here like two kilometers from my house. So when I came here to this unit, I saw two guys sitting and smoking. I know those guys, I was, hello guys, what are you doing? Why are you just smoking? Why aren't you at work? And they were sweating because they have done all the snow job in this area. And that's the point. You are important. You need to be working or studying. We have kitchens we do put together, but it's a bigger issue in Finland. We still have 4600 homeless people right now and it's very, very cold here. So you can't really stay on the streets at night. It's impossible. So we have so much to do. This program has just started. We are doing this in whole Finland. So we have everybody working together. It's not just us in Blue Ribbon. We have so many very, very good people. People who know this area have been doing this work for years. But our customers is the first. So now we are collecting the ideas and material from our customers all the time. So we do everything together. We do nothing. Just one. That's why we are together here now. Because we always need another person to do this. So this program 2.0. You can read it from internet, but we are just charging this. So we are so, so very, very happy if you like to collect ideas with us and plan together how we can. It started because I was hearing Gert and Kristjana who were talking. So we have so many same things that we are all the time doing. And it would be great to just have a new idea and think how we can do this better, how we can make this really, really work. But Jonas now is very aware of the COVID situation. So Jonas will tell you something about that. I'm working as a nurse here in New Ribbon Foundation in Finland. And just the only practical things. We have COVID-19 emergency team. They are meeting together quite regularly following the Swedish government's guidelines and some specialist guidelines as well. And you know, only keeping masks. Everybody, employees, our clients are keeping masks. Keeping distance and breakfast in the morning. Earlier it was many people at the same time, not just only one at each. So practical things because the one thing is that maybe our clients doesn't watch so much television or information from newspapers. So we have to meet them and keep distance and keep this very basic, these things all the time. Not too complicated at the moment. Risking that COVID-19 virus, minimized risk. Not so innovative maybe, but you know, we have to do basic things and keep it simple and clever. Thank you very much for this important call to simplicity. I will now leave the floor to Alessandra for the following questions. Yes. So I think thank you for this introduction to your programs. We are already listening a bit of the challenges. I think the next two questions are at least for me very important because go down into more of the details of the implementation. And the first one is about the barriers or facilitators associated with implementing your program. So Gert, first up with you. Thank you. It was very interesting to hear about the program in Portugal and Finland also and indeed there are some, a lot of similarities. So I think we will each one give you some pieces of the puzzle to put them together. I found that there were some aspects I wanted to talk about. First is the lack of affordable housing. We see that as a really big problem. It's not easy to find a good house and convince house owners rent to people with severe problems or with house care benefits. So I think that's the problem in Belgium and that's a problem everywhere in Europe. We have a small stock of social housing. So everyone is looking to the social housing to solve that problem. But even there there's a long waiting list and not every board of social housing is willing to provide a priority to the housing first client group. The second challenge is the fidelity of the model. I already told you that in Belgium we have the look and the opportunity that each project is independently. So we have a lot of variations on the team which provide a very wide aspect of solutions. But there's also the question of the fidelity to the program. And there we see that there is one third of the project that is, as we say, very creative in a way of being. So if it goes to independent living, there are some projects who say, yes, we would like to go to independent living, but there's a lot of clients who are still living in the same building. And we see that it's problematic sometimes. And it goes a lot of time in discussion about who has stolen the washing products and who has took the meat out of the refrigerator and so on and so on and so on. And we say there's a lot of energies going to that discussion and it's not really housing first as we would like it to be. We see other projects who are very successfully. And so they keep on making new clients and now they have a lot of clients and not as many social workers as they would like. So there's a problem in how many clients one social worker should follow. And it's very nice to see that housing first is successfully, but we are a bit successfully on that way so that everyone wants to be in the housing first project and it's not easy to limit that. So that's a discussion we are working on and it's not so easy. The next thing is the innovation. So we see a lot of things happening. We looked in the chat and saw some questions about that also. So we have our reconnection coach I spoke already about. That's one way for a new way of innovation. We see also not so much in the Flemish part, but a lot in Brussels and the Walloon part. There is in some project there is someone who's called himself housing catcher. And that's one person who is really focusing on finding houses for the clients and to communicate between house owners. So there is a problem about being taxed of paying the rent or a problem with the neighborhood or some other discussions. This person can follow this discussion and can help. So it's not the individual worker of the client who has to focus also on that. So we think a very interesting thing to do. And then we are trying, but it's still very, we have one project who is now starting to peer working. We would like to invest more on that also, but that's also a question of money and about can we provide that in the services that there are peer workers connected to the programs that they can support clients and support social workers. So that's on innovation. And then the communication between governments and local entities. You can move on to the next slide. I once made that little building. It's very important to have a good implementation on the field on the local community. But it's also important to have local strategies, local funding and national strategies and national funding. If you have only implementation on the fields without no local funding, you are a bit working on your own. If you have only local funding and strategies, but no national support, it's only, so you need both, you need on the three levels, you need very good communication between that. And for the moment in Belgium, we are working on that aspect very strongly. We have the luck that in the new governments on the different regional levels, everyone is saying, oh yes, housing first, it works. Oh yes, housing first. It's very important. We have to provide more on housing first. And it's important to speak to one another because it's like a game of tennis. You always put the ball to the other side and then the ball comes back. So who will take up responsibility? Who will take up for the different aspects of the, for the different aspects of the program. So that's a work we are trying to do. And then the next slide, and then I think that's a slide from our Finnish colleagues. We're saying Finland, that's the paradise. Also, it's very cold, but we should go, we should look at Finland for more than one reason. The blue, the blue part of the graphics, it's the amount of homeless people were on the street. So you see in 20 years it has halved the amount of people on the street. And how did they do it? That's the red part of the graph. That's by building and by providing a lot of houses for single clients or for small houses for people. So it's important to provide social housing or housing in general for homeless people. You cannot help them if there are no houses that are free to give them. Okay, so for so far my presentation. Thank you, all very sensible ideas and challenges in there. So Christiana, same question to you from your side. You've presented a lot of data, but in terms of barriers and facilitators, if you can tell us something more about that. Okay, let's stop maybe. Thank you. Thank you. That's the one. So I will start with facilitators. We work in a model with a track record of success. This program is grounded on a widespread methodology with a track record of success and in chronic homelessness resulting in better housing retention at a quick pace with significantly lower costs for what the use of community-based services instead of onsite services highly contributes in our opinion. Since its pilots, Elma Casa-Lijoalzing first has been focusing its intervention of the cases known as the impossible to housing. And until now, approximately 90% of these impossible to housing people did not return to their previous situation of homeless. So this has a big impact. Along with these results, she had invested in advocating the impact of this methodology near to political decision makers. And I'm talking about different political parties, consular, the mayor, the president, inviting them to meet the program and talk with the tenants. Some of them recognize that they were not well informed and considered impossible to house people with a long history of homelessness and problematic drug use before they could see it in firsthand. After this experience, most of them change their opinion and start supporting housing first in technology. At the moment, housing first was integrated in Lisbon Municipal Plan as a strategy to eradicate chronic homelessness. This plan was fast-tracked during the first wave of COVID-19 pandemic and financial support for 300 independent houses were made available, added to the previously 80 that we have on the city. So this methodology was also replicated in other Portuguese cities and are now being discussed in the parliament, the possibility to turn it into a national policy. Our experience on harm reduction. So harm reduction in proximity is in shared DNA. The staff work in proximity with tenants, building respect and warm relations. This is the most efficient facilitator for us and is the most efficient facilitator in all situations that could happen in the program like this since engagement until crisis management. Other important facilitators are peer specialists. We have peer specialists in our team in all projects of Xher. The presence of a peer specialist helps maintaining a client-driven approach like reducing the risk for a relapse into a more medical model practice, the kind of us and them model. And, on the other hand, offered trust and creates hope in the possibility of recovery in ways that other staff cannot do. So for us, this is the main facilitators about the barriers. AOMA Council was in first is mainly funded by Lisbon City Hall and Portuguese social security, which combined is less than 80% of program total cost. So the program receives annual funding approval that is not enough to pay it. The housing first model requires a very specialized and supervised practice, which is difficult to build and keep with this unstable funding situation. For this reason, we are continuously pursuing private sources and short-term and long-term funding about housing speculation. So all houses come from Lisbon's private rental market, where property speculation is a reality, with housing prices scaling up and they need to compete with the touristic sector. High rents are not only difficult for the program maintenance, but also make it more difficult for tenants to graduate for the program and rent their own apartment. We rely on long-term relations with landlords and we use some competitive advantage to attract new ones, like one-year-old rent payments, the institution credibility and, most important, 24 hours available team to deal with housing crisis. The last area I want to talk about is about tenants without documents or migrants. So in some cases, tenants in an irregular situation face barriers assessing health care, documentation regularization or assessing social benefits. In this case, this program supports tenants in overcoming these difficulties through the establishment of partnerships with community-based services and by supporting them in the defense of their own rights, sometimes with the help of voluntary lawyers. And it's all for now. Thank you. Excellent. Thank you very much, Christiana. And so the same question to you, Elina and Jonas. So barriers and facilitators, though, for the implementation of your program in Finland. Yes, well, I have to start from the barriers. So what we have been seeing a few years, it is very hard for people who are living in housing crisis, who are living in housing first unit like a few years and starting to get the lives together and feeling better and doing things right. It is very hard to move on from the unit, even that we just told that we have been making new buildings and houses and we're still in Helsinki. We have empty houses and homes, but you just can't reach those. So it is very hard to go on. And also the one problem is when you want to stop using drugs, it's getting better and better. Correct me, Jonas, if I'm not right for erection, but it is sometimes hard to get some help for your drug problem when you want it. So that is a problem in here in big cities sometimes. So usually it's like I want to stop using, you should get on to taxi and to the institutes to stop using drugs. Of course we all know that it doesn't go like that, but also it has been hard. Now it's getting better, hard to get the authorities to come our unit to work with us. So we need so many people to work with us when somebody wants to start working, somewhere we need to collect the group so we can start everything right and the customer knows what to do tomorrow and what's happening next and who is responsible for anything. So that has been hard also. And even now with this COVID situation, it has been of course harder because sometimes when the customer is willing and wanting to see people, people don't want to see you because of this situation. So that's unfair because when you do everything right, sometimes people move. And first day they ask what should I do to get own apartment, not this housing first unit. I want to live in your next door. So then we tell that when you do this and this and this and we help, we have this road to change and all the right tools. So people are working on the road of change and doing everything right. And then asking where is my apartment and we are just, oh my God, we don't have that yet. So that's unfair situation too. It's too much bureaucracy here in Finland as well. And if you have some kind of client who can manage himself doing such a lot of things in very good, very bad shape. So much in Cali for example. And we can see that there is no sense that you can't be here anymore because we can't support you as much as we should. Then we are trying to get the person to the place which is more treatment place. But they don't want to take it because they think it's our case, it's your case. And there is social workers, there are our unit and there are surgery as well. And you know the ball is going from myself to other people and so on. So it's maybe too much bureaucracy as well here in Finland in some cases. Yes, even in the older drug user or alcohol problem it is very hard to go to move to nursing home when you are so old that you can't use anything. So we are just here because we take everybody but it's not unfair when you need more support like the cases in the shower. We help here, of course we have to because we help everybody. But it's not fair because it would be better to live in a unit with more support when you are getting older. And quite often we have to tell the other partners that this is not healthcare unit and they don't understand it. They think we can do search operations, brain searches work here. Yes, just so. But it's hard. I'm sure. Thank you for that. So I think we can move to the finishing line of our conversation with the third question. And this is finishing on a positive note, I would say. Thank you. Thank you for the questions, Lurt. On your side about your implementation about the barriers you face, the solutions you found or that you will found and that you want to share with our audience. So once again, Gert, with you. Yeah, three things I want to say very shortly that we have some time for the questions also. First of all, it's a work in progress. So I think the housing first will be never at his end or never be completed. As long as there are people on the street, we still have to work further and there will be always challenges. So it's not that we can say, oh no, we have ended our program. We can answer all questions and we are where we are. Secondly, it's there's no impossibility. Possibility means that we cannot predict at forehand which group or which people will have success in the housing first. We have seen people with severe problems who were very successfully in keeping their house and living on a better way. And we have seen people where we thought, oh, this could be very easily. This is going very nice in the beginning who had a lot of problems to keep their apartment to stay in their houses. So it's very hard to predict on behalf of a group to say this will work and this will not work. So on the other hand, don't try to define groups and to say, oh no, that group is not good or that group that will not work. I think housing first is a solution for people with severe needs and just try it and you will see how it works. Secondly, and that's not something I found. It's something I picked up from our Scottish friends. It's the word stickability. The Scottish are already 10 years in housing first and they had a very nice report and that's one of the things I remember from it. Stickability is the way to stick to your client and to keep in touch with the persons you follow. It's about loving them. It's about keeping contact. It's about being present. The support has to be long lasting. We know it has to be flexible. It has to be accountable. All those very words we know. But you don't have to worry about clients that are not keeping up with the organisation who drops out. You have to worry about your colleagues or yourself or your organisation who's not keeping up with your clients and that's for me a very important lesson and something that makes really the difference between a housing first service and all the other good services who are providing to people. But when it comes to keeping up with clients, to stick to clients, then we are from housing first. I can say we are doing that next level thing that others sometimes will fail to do. So that's for me the most important thing. Excellent, thanks a lot. Cristiana? So what we have learned over these eight years of experience, some ideas I will share with Geert. So effective responses need to be grounded on the lived experience of people and to address clients' priorities. This is a big important lesson in our perspective. Housing is a priority survival and meet the primary needs of the refugee, safety and others. Treating first model as well as abstinence only approach was developed from the clinician's perspective rather than from the people with lived experience in homeless and problematic drug use. The second idea is that housing also gives the grounds to managing consumption. So it is easier for a person to manage consumption in a protective context where basic needs are assured. We should not ignore that substance consumption and its numbing effect can be a coping mechanism to deal with a traumatic experience of homelessness. And each person has their own goals and through recovery starts with a choice and self-determination to pursue them. And this is the difference between our person and other kind of approaches. Next slide, please. Geert said housing first services can house most people who have experienced chronic homelessness with success. However, a small percentage which appears to be consistent through the literature will have difficulty achieving housing stability. However, it is impossible to predict with confidence the individual characteristics associated with housing instability. And this reason justified trying housing first with all eligible persons, people. So, of course, it is important to understand the importance of housing stability should be considered. In the aspect of tackle homelessness and all its human and financial costs, we need to think and implement an integrated strategy. And this integrated strategy will need to be considered in the context of housing stability. In the context of housing stability, housing needs to be considered. And this integrated strategy will need to think in a strong community-wide prevention of homelessness and its main driver, that is poverty, increasing social support and affordable housing. The second point is long-term solutions focus on supporting individual journey towards recovery in a client's perspective and community integration. A third point will be quality shelters and easy access. And I'm talking about without strict preconditions and for emergencies only. Supporting labour market integration and the last point, improvement in data collection to assess the real extent of homelessness and its consequences is also important. So, the last but not the least tenants should be the leading advocates for housing first. And I'm talking about the community-wide approach to bringing their lived experience while attending meetings with political decision makers or conferences in the community. They really are our best partners. And I think this is the main idea. Thank you. Thank you, Christiana. Really excellent idea. And then last but not least, the next question to answer. So, I think the most important thing we need to remember that when you are in homeless or you have addiction problem, it is a bigger problem than you can never see when you look at somebody's face or anything. So, it's a deeper problem. So, when you want help, it takes time. So, you can't do anything in six months or in one year, that's impossible. I don't know if we have been on a diet or start trying exercising a new program. You collapse all the time. Mondays are bad. So, you really need to understand the main problem. Also, one thing that I want everybody working in this area, because Gert and Christiana, you already told so many things that we can agree. So, I'm not going to say that again, but we need to be rolling stones. We need to roll everything all the time. And we cannot rest until we have no homelessness in this world. But that doesn't mean that you don't need to rest once in a while, because you need to rest. You need to sit back. You need to consider to meet new people. You need to talk about it. You can save everybody. And you don't have to try, but you need to roll all the time in this world. We'll learn that we are rolling together in this situation. When we are rolling, we get the new ideas. And new ideas are never bad. You can try it and you can go wrong. Even if you never try, you can never find something new. So, you're not... I agree. You're not a crease. Thank you for this round of answers. I think many of you have already answered some of the questions that were asked in our questions and answers point. I will try to summarize some of the questions. For example, one is about the label housing first. Someone asks if you think that the implementation considers also all the work you are mentioning on psychosocial supports, social worker. Or if there is a risk that is considered as it should be. I don't know if any of you would like to comment on this. Yes. Christiana. I just want to say that housing first is not just housing. And this is an important message. Housing first is housing with support. Housing with a connection to community services. And the fidelity of the model is so important because of these aspects. I think Geerts talked about that. And it's very important to maintain these principal aspects. And they are related with scattered housing with working with the impossible to housing population. This is our target group. This is a project that brings is a harm reduction project. So the relationship are really, really important in this methodology. People who implement this need to really believe in this proximity approach, this close and respectful relations with clients. With client capacity to choose because this will permit the person to return to the community and to feel really integrated. Gert, would you also like to comment because the questions were addressed to Christiana and you mainly on this topic. I would agree with Christiana. I would agree with Christiana. I would agree with Christiana. I would agree with Christiana. When I started in housing first as coordinator, I said housing first is giving houses to homeless people who are with very high needs. I say housing first, it's crucial, but it's only a part. It's also about sport and about recovery and about giving a new future to people. It's like giving someone who needs glasses to see, giving them a car and not giving them glasses to help them. He's doing accidents. We have to take back the car. No, it's about giving people a car and glasses to see. It's very important to take care of people. It's very important to look for support and to continue that support. I also try to answer the question in the chat about how long do you stay in a project of housing first. It's as long as needed. As long as needed there will be support and there will be coaching. Of course, that depends from situation to situation. It will start with a very high need support with several meetings once in a week. When it goes better, it will be easier and smoother. There will be one meeting a week or one meeting once in a month. But when there is a problem, when there are problems with the neighbourhood, there can be support once again. It's very important to see that. It's not only giving people a house and then leaving them to their own. That's not what we want to be. But the housings also are very important. If you don't have a house, you cannot start. You can have really good support. But supporting people once and doing their best and have to wait months or maybe years to finally have a house. That's also a very big problem. Another group of questions is about the alcohol harm reduction Christiana mentioned and more in general about the harm reduction interventions related to drugs. I'm trying to summarize groups of questions. I would like to join on this point. I don't know if I understood the question that is only about the managed alcohol program or the strategies in housing first project. I put together questions. I think they are related to harm reductions related to drugs. You mentioned something on alcohol and there is a specific question on this. So about the strategies to tackle these drug use. The first one is housing. Just housing because a person in a situation of homeless and in almost absolute social exclusion find it more difficult to manage their consumption. And it makes it easier to manage this consumption after entering the house. Sometimes the team does not do anything and we see that the person start reducing consumption. The other one that is a strategy also is relationship. So stuff must put in place. Everything needed to establish this respectful and warm relationship to demonstrate a real commitment with a person. We believe in the person and it makes it easier for the person to believe in itself. Then we have importable and network of services. So in 2001 this Portuguese decriminalization was set the field for implementation of important community-based responses. And in this set of responses we have a lot of proximity responses included. So this network facilitates to refer a person to a low threshold method program or other host, a treatment team or a therapeutic community. So it's easier to connect the person with these community services. Then these aspects of harm reduction that I was talking about before and we implement these harm reduction strategies on the house. We deliver this septic material. We talk about how co-hold and we help the person to manage this consumption. It's all the approach that we do to drug consumption is very open approach. And we see that most of the people do this way. They start to implement consumption with more in more hygienic conditions to use and to change material and then to connect to the services and in the end the person could manage his or her consumption. So it's a way and it takes time and it takes respect for this space. Can I ask? Sorry, Christian. I don't know if I answer it. I made it a very broad question. Elina, would you like to add a comment? We skipped you in the first question about if there are any drugs related harm reduction interventions linked to your project. Also, when we are practicing with this problem of using, we started offering you possibilities to make something else. So when you wake up in the morning, you can get totally wasted or you can get just a little bit wasted. So you can go to work so when you are needed and you have promised example for Jonas or me that we have a meeting tomorrow morning at 10 o'clock, you don't want to come and waste it because we need to do something special. So when you have every day, you have something special to do, you are not so wasted, you will maybe use a little bit different drugs or not so much and some customer just told me I have been working in this kitchen like four days tomorrow is my day off and tomorrow I will be so wasted that you don't want to see me tomorrow. So we say, see you after that I was like, oh my God, this is great. Of course you need a day off because you have been doing everything so well. So it's been important being like everybody else just life. We don't need you to change. You can be yourself. You can make your choices by yourself. That's all about motivation to make changes about drugs and alcohol. I can say that now you have to quit your alcohol using your drug, drug using one. It has to come from your inside yourself and have a small motivation and maybe then a bigger motivation and when I see that moment, you know, a small moment that our client is interested for example, going to the rehab or methadone treatment, to support her or him, go to forward. That's a small moment. Thank you. I picked a question because I think it's an interesting perspective. Do you notice any gender differences in your access to your intervention? Gert, would you like to start? Have you thought of it? Gender issues not exactly, but we see that a lot of homeless are male. So most of the clients are single male clients. There are some women also. I think it's 80, 20% so there's a little on women. If that was the question. Yes, it was the question. Cristiana, do you notice any gender difference, more affluence from men or women? Yes. We have less women. As Gert said, we saw this difference. We see this difference on the streets. We have more men on the street. In the program, our women are normally younger with a long experience in a home situation, but younger and most of them with a long history of trauma. So for us it's a target group that we need to approach because the risk is higher for women and we need to have a trauma-informed approach when we are connecting with these women. Elina, any comment on your side? We have more men who are more homeless than women, but maybe the numbers of women are not so, we don't know exactly because maybe they are living in other partners or people's houses. But maybe the most of them are men and now the new thing is that younger people are growing up numbers of homeless without houses. It's growing up all the time. Younger and younger people, they are dropping out from the system somehow and it's very sad at the moment. It's also easier to get trucks from the streets and it used to get beer from the market now you can just it's cheaper to buy trucks. So that's a problem that is growing and that is the main reason why younger and younger people are better shaped and they can't live in normal houses. So that's like it's growing up this group. Thank you. There are still many questions, many interesting and specific questions that we will keep diverting to our speakers afterwards. And now I would like to leave the floor to Alexis for his concluding remarks. Thank you Alexis. Thank you Marika. Well first I would like to thank again Cristiana, Elina, Jonas and Geert also Alessandra, Marika but also Amparo and Marco. I think it was very interesting. I see we have a lot of questions, a lot of very interesting points. I'm not going to summarize because there were too many things but just a few things I would like to highlight or insist because those are things we are supporting also as the European drugs agency in the advice or support we give to the member states and to the EU institutions. The first is I think one of the most innovative things that happened last year because of COVID is the support to services without preconditions. I can tell you 30 years ago I met my first street worker. It was quite a surprise for young clinical psychologists like me because first of all I could not meet that person in the normal office. And then I met also Dutch street workers. They were not even working. They were running in the street so I had to run with them. And I remember I was there to speak already 30 years ago about HIV, AIDS and drug use and the street workers they rejected me because they say, we don't care about HIV and I was a bit shocked because we care about the people and the key priority of the community. So it's not a surprise that what has been said by the three speakers and I think reflected also by some of the questions or the comments is the fact that we need to focus on the need of the people without precondition. And I think it was not, I think it was Christiana or Elina referring to the fact that it was also a moralistic approach that if you were not clean from alcohol or drugs in any case it's like you did not deserve any access to help. And it was also a way for people from some of the centers to protect themselves because I think they were they did not feel prepared and it was not always the centers were not equipped both in staff but also in training for building ofvi which brings me to the next point which is the extreme vulnerability of people and the homeless when the crisis there have been more homeless or webinars in the surveys, in the online focus groups, my meeting with some of you, including Widunath from Spain, saying, you need to encourage the authorities to tell them, don't cut the social services, and don't cut the specialized services. But we need both. A big part of the help that was provided, or is provided today, is in a combination of the different services. I think what is also new, if I compared with 10 years ago, is the fact that there is more harm reduction approach. And it goes together with the fact that there are no programs where we don't ask for preconditions. It's the fact that we have learned to uphold, to put on hold our judgments and try to deal with people, to take them like other brothers and sisters, human beings like us. That's the start. There is no improvement if we don't start with that. And I think what has been impressive also is the number of shelters that have been opened. I remember I've seen an experience in Spain. I think it was in Barcelona of another shelter without preconditions. In Athens, they managed during the pandemic to create a new center. So that's very important. Another initiative, a need that was highlighted by our three speakers today, is the fact that we need to bring the services together. But we need to be patient or client-centered. Already patient, it illustrates wait. You have to wait. So I think it's better to use the term client. And this means that we need to have more initiatives like here in Lisbon, the team of Dr. Rui Marinho in the Hospital Santa Maria, they have moved the unit working on the testing and treatment of EPSI to the prison, because it was not possible to bring the prisoners from the prison to the service. This is how we can make a difference. And this is how we can help continue to make improvements. I think one of the last points I wanted to highlight is the fact that we face also in some cases an aging population. And I can imagine that what we see in some documentary, in some national TV channels is that because of the economic rises, you see more older people who are losing their house. They may find themselves also in the streets. So even if it is not because of any substance use, it can become a bigger problem. I really like the concept of stickability developed by your Spanish or Scottish colleagues. So I think we, Marika and her team, they should continue to work on it. And I would like to finish because I think it was a Christiana who said that tenants are the best partners. I think what is the key is not something we have just discovered last year with COVID. But what is interesting in some cases, authorities mostly at local level, they start to understand that we are talking about human beings and we need to trust them as partners in the relationship and in the work. So I think that's the key message. We need to continue to work. And I would like to say that at CMCDDA we are preparing a new initiative to further support you and the innovations in the field. So my call to you is send us your suggestions. Tell us how, in line with what we started last year with the webinars, also maybe a topic for one of the next webinars, all we can meet your needs to better identify and get access to innovations. And we are going to, we are working on the proposal and we will launch a new initiative in the coming months as soon as possible. So thank you very much. You help us to be more useful. That's how it has to work.