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Expansion of Housing First HUD-VASH & Homeless Veterans Solution-Focused Mark A. Engelhardt, MS, ACSW July 12, 2011 July 12, 2011 USF Dept. of Mental Health,

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Presentation on theme: "Expansion of Housing First HUD-VASH & Homeless Veterans Solution-Focused Mark A. Engelhardt, MS, ACSW July 12, 2011 July 12, 2011 USF Dept. of Mental Health,"— Presentation transcript:

1 Expansion of Housing First HUD-VASH & Homeless Veterans Solution-Focused Mark A. Engelhardt, MS, ACSW July 12, 2011 July 12, 2011 USF Dept. of Mental Health, Law & Policy

2 VA Housing First Initiative National Center on Homeless Veterans – USF-FMHI & Pathways to Housing (Sam Tsemberis & Juliana Walker) – Training & Technical Assistance National Center on Homeless Veterans – USF-FMHI & Pathways to Housing (Sam Tsemberis & Juliana Walker) – Training & Technical Assistance 13 VA HUD-VASH Programs identified to implement a Housing First Model 13 VA HUD-VASH Programs identified to implement a Housing First Model VAMC’s & Community Partners VAMC’s & Community Partners 2

3 What is Housing First? Sam Tsemberis Ph.D A person-centered approach designed to end homelessness and support recovery for people with mental illnesses A person-centered approach designed to end homelessness and support recovery for people with mental illnesses Housing First provides immediate access to permanent housing and support services and consumers are not required to participate in psychiatric treatment or attain a period of sobriety in order to obtain housing. Housing First provides immediate access to permanent housing and support services and consumers are not required to participate in psychiatric treatment or attain a period of sobriety in order to obtain housing. 3

4 Why Was Housing First Developed? 1992 To help people with mental illnesses who remained homeless over time To help people with mental illnesses who remained homeless over time “Are people homeless because they have a mental illness or for the same reasons as everyone else”? “Are people homeless because they have a mental illness or for the same reasons as everyone else”? Million Dollar Murray – Malcolm Gladwell Million Dollar Murray – Malcolm Gladwell Pathways to Housing, NYC Pathways to Housing, NYC 4

5 Housing First Evidence SAMHSA’s National Registry of Evidenced- based Programs & Practices (NREPP) SAMHSA’s National Registry of Evidenced- based Programs & Practices (NREPP) Publications Publications Housing Retention at 85% Housing Retention at 85% Reduction in service utilization, ER’s Jails Reduction in service utilization, ER’s Jails Improved Mental Health Improved Mental Health Reduction in Alcohol & Drug Use Reduction in Alcohol & Drug Use Cost Effectiveness Cost Effectiveness 5

6 National Vision U.S. Interagency Council on Homelessness U.S. Interagency Council on Homelessness “Opening Doors” – Federal Strategic Plan to Prevent and End Homelessness “Opening Doors” – Federal Strategic Plan to Prevent and End Homelessness 5 Year Plan to End Veterans Homelessness 5 Year Plan to End Veterans Homelessness SAMHSA – Evidence-Based Practices KIT (Knowledge Informing Transformation) on Permanent Supportive Housing SAMHSA – Evidence-Based Practices KIT (Knowledge Informing Transformation) on Permanent Supportive Housing 6

7 National Movement HUD has moved towards models that result in Permanent Housing and has conducted studies on Housing First HUD has moved towards models that result in Permanent Housing and has conducted studies on Housing First Hundreds of Communities across the U.S. have adopted Housing First as a primary strategy in their “10 Year Plans to End Chronic Homelessness” Hundreds of Communities across the U.S. have adopted Housing First as a primary strategy in their “10 Year Plans to End Chronic Homelessness” Housing First Movement (since 1992) Housing First Movement (since 1992) 7

8 Florida Legislature Florida Legislation – SB 1054 (2009) Florida Legislation – SB 1054 (2009) “The Legislature further finds that Housing First is an alternative approach to the current system of emergency shelter or transitional housing…to encourage (Fl.) homeless continuums to adopt the Housing First approach to ending homelessness for individuals and families” “The Legislature further finds that Housing First is an alternative approach to the current system of emergency shelter or transitional housing…to encourage (Fl.) homeless continuums to adopt the Housing First approach to ending homelessness for individuals and families” 8

9 Local Florida Communities Local Coalitions have “promoted” Housing First in their HUD Continuum of Care applications (New Hearth Act), yet may not clearly understand the core recovery principles, have access to immediate housing, staffing patterns and funding. Local Coalitions have “promoted” Housing First in their HUD Continuum of Care applications (New Hearth Act), yet may not clearly understand the core recovery principles, have access to immediate housing, staffing patterns and funding. Several localities have been successful Several localities have been successful Others have “pushed back” the concept Others have “pushed back” the concept 9

10 VA Housing First Sites Bay Pines – St. Petersburg, Fl. Bay Pines – St. Petersburg, Fl. New Orleans, LA New Orleans, LA Dallas, TX Dallas, TX Washington, DC Washington, DC Philadelphia, PA Philadelphia, PA New York City – Bronx & NY Harbor New York City – Bronx & NY Harbor Boston, MA Boston, MA Chicago, Ill Chicago, Ill Detroit, MI Detroit, MI Denver, CO Denver, CO Portland, OR Portland, OR San Francisco, CA San Francisco, CA Greater Los Angeles Greater Los Angeles 10

11 Veterans – Target Populations Long Term Homeless Long Term Homeless Living on the Streets, Shelters, Elsewhere Living on the Streets, Shelters, Elsewhere High Risk for Criminal Justice System High Risk for Criminal Justice System High Prevalence of Co-occurring Disorders High Prevalence of Co-occurring Disorders Complex Healthcare Problems & Trauma Complex Healthcare Problems & Trauma Veterans Strengths & Access to Benefits Veterans Strengths & Access to Benefits Outreach, Engagement & Peers Outreach, Engagement & Peers 11

12 VA Housing First Roll Out 50+ Dedicated Housing First Vouchers 50+ Dedicated Housing First Vouchers Reduction in Caseload Sizes Reduction in Caseload Sizes Option to Subcontract all or a Portion of the Program with Community Partners Option to Subcontract all or a Portion of the Program with Community Partners Increase Substance Abuse, Housing, Peer Specialists & Engagement with VAMC’s Increase Substance Abuse, Housing, Peer Specialists & Engagement with VAMC’s Emphasis on Field-based & Technology Emphasis on Field-based & Technology 12

13 Current Development Activity Data Analysis of Available Vouchers Data Analysis of Available Vouchers Timetable From Outreach to Housing including Public Housing Authorities Timetable From Outreach to Housing including Public Housing Authorities Housing Stock & Landlord Development Housing Stock & Landlord Development Start up funds and community resources Start up funds and community resources HUD-VASH Team Composition & Approach HUD-VASH Team Composition & Approach History of Referrals & Targeted Referrals History of Referrals & Targeted Referrals 13

14 Current Development Gradual Shift to Harm Reduction for VA Gradual Shift to Harm Reduction for VA Motivational Interviewing Techniques Motivational Interviewing Techniques Access to Co-occurring Services Varies among VAMC’s and Communities Access to Co-occurring Services Varies among VAMC’s and Communities Telemedicine in Rural Areas Telemedicine in Rural Areas Technology – Smart Phones, computers Technology – Smart Phones, computers Co-location in the community Co-location in the community 14

15 In the Context of Recovery Self-Direction (Housing Choices) Self-Direction (Housing Choices) Individualized & Person-Driven Individualized & Person-Driven Empowerment (Affordability) Empowerment (Affordability) Holistic Holistic Non-Linear Non-Linear Strengths-based (ability to Rent/Own) Strengths-based (ability to Rent/Own) Peer Support (Dual Recovery/AA, etc.) Peer Support (Dual Recovery/AA, etc.) Respect Respect Responsibility (Leases) Responsibility (Leases) Hope – Permanent Housing & Recovery Hope – Permanent Housing & Recovery 15

16 Key Change Elements Change from a Linear Housing Model Change from a Linear Housing Model Change in the view of those served Change in the view of those served Change in the goals of the system Change in the goals of the system Change in power relationships Change in power relationships Change in focus and locus of care Change in focus and locus of care Change in treatment culture Change in treatment culture Traditional Models to Contemporary Traditional Models to Contemporary 16

17 Housing Models Traditional Models Treatment First Treatment First Housing “Ready” (linear) Housing “Ready” (linear) Sober for a period of time 30 days to six months Sober for a period of time 30 days to six months Transitional – 6 months to 24 months Transitional – 6 months to 24 months Staff on-site; “supervised” Staff on-site; “supervised” Congregate living Congregate living Housing First Housing First Housing First Move-in with supports Move-in with supports No sobriety required, abstinence encouraged No sobriety required, abstinence encouraged Permanent supportive housing Permanent supportive housing Staff off-site, mobile, 24/7 access or on call Staff off-site, mobile, 24/7 access or on call Independent living Independent living 17

18 Housing First: Main Components Housing – Primarily Scattered site independent apartments rented from community landlords Housing – Primarily Scattered site independent apartments rented from community landlords Clinical Services – Treatment and support services provided by off-site Assertive Community Treatment Teams or Intensive Case Management “that makes house calls” Clinical Services – Treatment and support services provided by off-site Assertive Community Treatment Teams or Intensive Case Management “that makes house calls” 18

19 Values & Principles In the context of a positive relationship In the context of a positive relationship When consumers set their own goals When consumers set their own goals Receive support and are taught skills Receive support and are taught skills Have positive expectations for hope for the future Have positive expectations for hope for the future Obtain Permanent Housing Obtain Permanent Housing When people believe in their own recovery When people believe in their own recovery 19

20 Essential Ingredients Essential Ingredients Consumer Choice Philosophy Consumer Choice Philosophy Separation of Housing and Services Separation of Housing and Services Recovery-oriented Services Recovery-oriented Services Community Integration = “INCLUSION” Community Integration = “INCLUSION”  Fidelity Scales – Structure, Philosophy, Practices: “A Matter of Degree” and Quality Improvement 20

21 Consumer Choice Philosophy Philosophy Guides Practice Philosophy Guides Practice Housing First provides consumers an apartment of their own as a matter of right or need, not as a reward for treatment compliance Housing First provides consumers an apartment of their own as a matter of right or need, not as a reward for treatment compliance Consumer choice of housing, type, sequence (non-linear) and intensity of services Consumer choice of housing, type, sequence (non-linear) and intensity of services Harm reduction vs. strict sobriety model Harm reduction vs. strict sobriety model 21

22 Limits to Consumer Choice Practical and clinical Practical and clinical Availability to affordable housing Availability to affordable housing Local housing stock Local housing stock Weekly apartment visit Weekly apartment visit Person may be a danger to themselves or others Person may be a danger to themselves or others Legal Issues – Illegal activity, violence, etc. Legal Issues – Illegal activity, violence, etc. 22

23 Separation Housing & Services Housing & services are separate domains Housing & services are separate domains Different expectations and requirements for defining success Different expectations and requirements for defining success Clinical services are a treatment relationship Clinical services are a treatment relationship Housing is about responsibilities of tenancy (good neighbor, tenant, etc.) Housing is about responsibilities of tenancy (good neighbor, tenant, etc.) 23

24 Clinical - Housing Clinical “crisis” does not mean eviction or loss of housing Clinical “crisis” does not mean eviction or loss of housing Eviction from housing does not mean discharge from clinical services, continuing care, outreach, in-reach, self-help, or other recovery-oriented care Eviction from housing does not mean discharge from clinical services, continuing care, outreach, in-reach, self-help, or other recovery-oriented care Abstinence is not “required”, but is encouraged Abstinence is not “required”, but is encouraged Housing retention is a major goal Housing retention is a major goal 24

25 Landlords as Partners Landlord, tenant and program have a common goal = All want safe, decent and well managed (quality) housing Landlord, tenant and program have a common goal = All want safe, decent and well managed (quality) housing Agency/consumer ensures the rent is paid on time; damaged paid Agency/consumer ensures the rent is paid on time; damaged paid Team is responsive to landlords needs Team is responsive to landlords needs No rent loss for vacancies No rent loss for vacancies Public Housing Authorities are critical Public Housing Authorities are critical 25

26 Advantages of Using Existing Rental Market Quick start up Quick start up Multiple sites - scattered Multiple sites - scattered Ability to match consumers to neighborhoods Ability to match consumers to neighborhoods Flexibility in relocation Flexibility in relocation Normative settings (integrated) Normative settings (integrated) Social inclusion Social inclusion 26

27 Recovery-Oriented Recovery from mental illnesses and substance use/abuse is possible Recovery from mental illnesses and substance use/abuse is possible People can live full and independent lives in and “of the community” People can live full and independent lives in and “of the community” Role recovery – friend, family member, peer, employee, spouse, parent, sibling, church member, neighbor. Role recovery – friend, family member, peer, employee, spouse, parent, sibling, church member, neighbor. 27

28 Implications for Practice Instilling HOPE is crucial Instilling HOPE is crucial Relationship is foundational – eliminate “power’ differential and role distinction between provider and consumer Relationship is foundational – eliminate “power’ differential and role distinction between provider and consumer Key roles of peer support “on the team” Key roles of peer support “on the team” Meaningful social roles – beyond the “mental health system” = Citizenship Meaningful social roles – beyond the “mental health system” = Citizenship 28

29 Holistic Wellness Wellness Lifestyle Wellness Lifestyle Positive daily structure Positive daily structure Meaningful activity Meaningful activity Diet, exercise, access to primary care Diet, exercise, access to primary care Healing trauma (men and women) Healing trauma (men and women) Spirituality Spirituality Connection to others Connection to others 29

30 Service Delivery Service Delivery Assertive Field-based Interdisciplinary Team Approach Assertive Field-based Interdisciplinary Team Approach Intensive Case Management Intensive Case Management “Offer” to a range of clinical services “Offer” to a range of clinical services Co-occurring SAMH Co-occurring SAMH Vocational and Employment opportunities Vocational and Employment opportunities Peer Supports Peer Supports Healthcare benefits (Medicaid) – Medication Healthcare benefits (Medicaid) – Medication Housing Retention Housing Retention 30

31 Targeted Websites enter.asp enter.asp enter.asp enter.asp 31

32 Contact Information Mark A. Engelhardt, MS, MSW, ACSW Mark A. Engelhardt, MS, MSW, ACSW


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