Presentation on theme: "Rapid Rehousing Delaware HPC February 3, 2015"— Presentation transcript:
1Rapid Rehousing Delaware HPC February 3, 2015 Suzanne Wagner
2Agenda Introductions Policy Context RR Definitions and Benefits Progressive EngagementHousing PlanningHousing LocationHousing Stabiliyu Case Management SupportCommunity Connections and SupportsWrap-up and DiscussionTrainer Instructions:Introduce yourself including name, position and experience.Ask trainees to introduce themselves. Ask each participant to say who they are working with, what they know about CTI and what in particular they want out of the session.Review the training schedule and agenda, so that everyone knows the plan.Review the packet so that everyone knows which material are in itReview logistics – restrooms, phones, food, waterTiming: Introductions, Overview of CTI, The Evidence – approximately 1 hour and 30 min; 3-6 minutes per slideExample:% of people you are working with who are recently discharged% of people you are working with who are homeless. Do they stay in shelters?% of people you are working with who stay with their families% of people who live in supportive housing / scatter site or single site% of people who live in a CR% of people who live in an adult home and board and care
3Housing InnovationsBegan in 2009Principals: Suzanne Wagner, Andrea White, Howard BurchmanSenior Associate: Lauren ParetiExperience: Columbia University Community Services/CUCS & Burchman TerrioExtensive experience in:Developing, Operating and Evaluating Housing and Service ProgramsImplementing Evidence Based Practices (EBP’s)CoC Support and System TransformationHomeless Planning and Community Needs AssessmentsOperating Coordinated Access and Assessment SystemsStaff Training
4National Trends and Best Practices HEARTH – Homeless Emergency Assistance and Rapid Transition to HousingFederal Strategic Plan (FSP), Opening Doors
5National TrendsEnd homelessness as quickly as possible and get people to permanent housing solutions through outcome driven approachUse Evidence-Based Practices (EBP’s)Expand Rapid Re-housingTarget Permanent Supportive Housing for the most disabled people who have been homeless the longestHousing First as both a system and program strategyLack of evidence that housing readiness increases chance of housing stability
6National Trends - 2Preserve intensive interventions for people with highest needConnect people to work, benefits and mainstream and community-based services and supportsTransform systems and programs that are not effective and/or efficient
7HEARTH Act Purposes – Sec. 1002(b) “to establish a Federal goal of ensuring that individuals and families who become homeless return to permanent housing within 30 days”HEARTH Act Purposes – Sec. 1002(b)The HEARTH Act makes it an explicit federal goal that people who become homeless quickly move back into permanent housing.
8Federal Strategic Plan (FSP) Goal Transform homeless services to crisis response systems that prevent homelessness and rapidly return people who experience homelessness to stable housing.
9Reduce Overall Homelessness HEARTH Performance MeasuresReduce Overall HomelessnessReduce the number of people who become homelessPrevention/DiversionReduce length of homelessnessRapid Re-Housing / Housing FirstReduce returns to homelessnessHousing Stabilization SupportIncrease employment and other incomeHousing StabilizationOther accomplishments related to reducing homelessnessExample:Doubled upThoroughness in reaching homeless populationCount wellEnsure all pops servedThe new performance measures are one of the most substantial changes made by the HEARTH Act, and they represent the standard that HEARTH will challenge us to meet and support us as we strive toward these goals. There are 7 measures and they are:Reduce overall homelessness. This is our primary charge, and all the other measures are related to this overarching goal.Reduce the number of people who become homeless This means reducing the overall flow of people into homelessness. We have to appropriately target homelessness prevention and diversion.Reduce the length of time people spend in homelessness. We need to reduce the time that people spend being homeless before they regain housing. The Preamble of the HEARTH Act sets a national standard that families and individuals who become homeless will return to permanent housing within 30 days. This means shelter stays of 3, 6, and 9 months are no longer acceptable.Reduce people’s returns to homelessness and stabilize them in housing, by connecting them with jobs and helping them increase their incomes.Other accomplishments related to reducing homelessness. While this will not be a top priority because it will not impact the number of people defined as homeless in the HUD definition, this measure allows us to perform activities stem the growth of homelessness in our communities and address the needs of people in unstable housing situations such as those living in doubled up situations and in motels.Finally, thoroughness in reaching homeless population. This simply means that we must count thoroughly and ensure that we are effectively reaching out to those who need assistance.
10Rapid Exit and Rehousing Main Goal – Rapid Access to HousingFocus on Relocation and StabilizationCoC funds can be reallocated to RR for FamiliesHousingShelterSource: NAEH Center for Capacity Building
11Housing FirstProgrammatic and systems approach that provides people with housing quickly and then providing services as neededLow barrier entry requirements and service rich environmentParticipant have choices about housing and servicesHousing is not contingent on compliance with services –Participants expected to comply with a standard lease agreementProvided with services and supports to help maintain housingServices and connections to resources provided post-housing to promote housing stability, stable tenancy and well-being
12Housing Stabilization Prevailing ModelEmerging ModelEmployment AssistanceEmployment AssistanceDay CareDay CareShelterHousing StabilizationShelterMH/SA ServicesHousing PlacementMH/SA ServicesFamily Supt ServicesFamily Supt ServicesTurning the Continuum of Care Inside – Out?Source: Culhane, Homeless Assistance: A Paradigm Shift?
13Rapid Rehousing Defined Goal: Rapidly exit homeless individuals and families into permanent housing from the homeless systemOne-time/time-limited financial help with debts, security costs, rent and other housing costsShort term rental assistance up to 24 months – preferably in 3 month incrementsHousing location servicesCase management focused on increasing income, housing stabilization, connections to services and supports
14Principles of Rapid Rehousing Move from homelessness directly to housingTargeting“Just enough” AssistanceLandlords are valuable resourcesUse case management and mainstream resources to keep tenants stableSource: HPRP Promising Practices in Rapid Rehousing – HUD OneCPD
15Benefits of Rapid Rehousing Cost-effective and proven strategyKeeps expensive PSH units for the most vulnerableReduces the amount of time families remain in crisis of homelessness (it is trauma-informed)Helps communities leverage new partners and resources60-75% of families enter from friends and family;About 50% return to same place they were before shelter
16RR Benefits - 2 Addresses barriers homeless people face: The cost of obtaining new rental housingLandlord discriminationObtain permanent housing and stabilize quicklyChange the focus of the emergency system from emergency placement to rehousingOpen the back door – free up emergency shelter space
17Rapid Rehousing Outcomes Effective for large percentage of familiesLow cost per outcomeHigh rates of exits to permanent housingLow rates of returns to homelessness
18Exits to Permanent Housing for Households with Children Source: Data from 14 Continuums in seven states that prepared Evaluators for NAEH Performance Improvement Clinics in% of Exits to PH for FamiliesThough they could not be with us today, the folks from NAEH who have been looking at national outcome data, comparing ES, TH, and RRH shared these slides.14 communities across the country.used data from communities that had good data on all of their providers in their system.represent a variety of geographic areas includinghigh housing cost urban areasrural areas,balance of states and both large and small continuums.Transitional HousingRapidRe-HousingShelter
19Rate of Return to Homelessness w/in 12 Mos of Exit Source: Data from 7 CoCs in 4 states that prepared Evaluators for NAEH in 20127 different communitiesreturns to homelessness within 12 months of exiting programs to PHleft = singles,right = families.Families: Rate of Recidivism from RRH Lower (less than half of THSingles, slightly higher for RRH versus Transitional Housing; (remember however that significantly more persons exited to PH under the RRH model than TH)SinglesPeople in Families with Children
20Average Cost Per Exit for Families with Children Source: Data from 14 CoCs from NAEH Performance Improvement Clinics inCost per exit: FamiliesLeft: All ExitsRight: PH ExitsConclusion: RRH has a lower cost per exit than TH in both chartsIf you look just at cost per PH exit:ES is more than 2 times more expensive than RRHTH is more than 5 times more expensive than RRHRRH is both more cost effective and has lower rates of recid than TH*******************************Again, each community reported information on all of their programs, all of their ES, TH and RRH programs for exits in a year and then PH exits. They then reported each programs total budget including operational, supportive service and administrative costs for each program. We then determine the average cost per each exit, no matter where the household exited. (read amounts from slides). Since the goal for each system is to exit persons to permanent housing, we then divided the total permanent exits from each system to determine the cost effectiveness of each system for exits to permanent housing. As you can see while the costs of both ES and TH dramatically increased when measured against PH exits, the cost of RRH changed very little, due to the high rates of success in exiting to PH.All ExitsPermanent Housing Exits
21Lessons from VA Rapid Rehousing (SSVF) Small amounts of assistance can be effective:Avg cost/household served: $2,410Median length of assistance: 90 daysOnly 13% of RRH participants received assistance for >180 days79% of participants exited to permanent housing93% of families did not return to VA homeless programs (after one year)RRH can work for people with barriers to housing stability76% of households had income of less than 30% of AMI55% of Veterans served had a disabling conditionSource: Impact and Performance of the Supportive Services for Veteran Families (SSVF) Program: Results from the FY 2013 Program YrSource: Impact and Performance of the Supportive Services for Veteran Families (SSVF) Program: Results from the FY 2013 Program Year (may 2014) FY 13 SSVF served 69K People 40K HH.
22What about TH?HUD :“Life After Transitional Housing”, Urban Institute, March 2010Findingshigh and low barrier families did equally well for the most partMore or less rules did not make a difference in outcomesWhat DID make a difference was time spent homeless…Longer time homeless, less likely to have own housing at exitHH w/more homeless episodes, odds of not working and lower wagesBottom line – end people’s homelessness rapidly
23Implementing RR using Progressive Engagement Start with a small amount of assistance for a lot of peopleAdd more as neededRental assistance in 3 month incrementsRe-assess to determine continued need
24What does Progressive Engagement look like? Provide a minimal amount of assistance to all peopleLists of vacancies, help funding a place to live, small amount of financial assistanceProvide additional assistance as needed by the householdShort term rental assistance, case managementIf at risk of losing housingMore rental assistance and/or more CMIf still at riskLonger tem RA and/or more CMIf still at risk – maybe voucher or PSH
25Example of Progressive Engagement HousedPoint of EntryRRH 1$RRH 2$$In a progressive engagement approach, these programs—RRH 1, RRH 2, and RRH 3—don’t have to be different programs. They can just be different levels of assistance provided by the same program. Also there’s no reason to have 3 levels as opposed 2 or 4 or 5.The benefits of this progressive engagement approach are many.You don’t have to be able to predict beforehand how much assistance a person will need to be re-housed.You can also stretch your limited resources farther.It prevents disruption for the household. They are not literally moving from program to program, or even using different caseworkers. From their perspective, they stay a short period of time in shelter, then are assisted to move into permanent housing. Their level of assistance may be increased or decreased, but their living situation is stable.This approach also has challenges. It means that as a community, you have to find ways to make your assistance fit around the people you are serving. For example, you will have to figure out how to set aside permanent rental subsidies for people that need them. You don’t want to put everybody on the waiting list at the beginning of the process. You want to have a pool of vouchers waiting for those for whom smaller amounts of assistance didn’t work.This also requires that the caseworkers are trained and can recognize when a person has achieved enough stability or when they will need further assistance.This progressive engagement approach is described in more detail in a supplemental document to the US ICH Federal Strategic Plan to End Homelessness:RRH 3$$$Subsidy/ PSH$$$$Source: NAEH Center for Capacity Building
26Rationale for PENationally recognized practice in addressing homelessnessProvides customized levels of assistancePreserves the most expensive interventions for households with demonstrated barriers to housing successEnables service delivery systems to effectively target resources
27Rationale - 2Based on research (or lack thereof) that we cannot predict who will need what type of interventionNo validated predictive assessment instruments except for diversionAlameda County – similar outcomes for high and low barrier householdsPeople are resilientResources are limitedMore information about barriers to housing stability when we see people in “real” housing
28A word about Transitions…… New startInvolve both loss and gainStressfulCan increase depression/substance useUnknown/uncertainty leads to fearRequire re-alignment of daily scheduleTrigger fears of failureRequire supportTrainer Instructions:Highlight what the experience is like for the client going through a transition.Important that trainees know that consumers need a lot of understanding and empathyContent Elaboration:Transitions are hard and this can’t be underestimated.There is often a lot of fear and uncertainty during transitions and this brings out different behaviors.Consumers need your empathy and your support – they will need to talk through their feelings.
29Rapid Rehousing Activities and Services Housing PlanningHousing LocationCase Management and Housing/Tenancy SupportCommunity Connections and SupportsLayers other Evidence-Based and Promising Practices: Critical Time Intervention, Housing First, Person Centered Planning, Trauma-Informed Care
31Housing Planning Assessment of Housing and Homeless History Assessment of Strengths and Barriers to Housing StabilityEducation on Tenancy Role and Housing OptionsConnection to ResourcesCore Concepts in Housing PlanningUsing Shared Decision Making ModelComponents of a Housing Plan
32Assess Housing and Homeless History Past housing experiencesCurrent housing goalsExperience as a leaseholderWhat they liked/didn’t like about previous housingHow person/family became homelessBarriers to access and sustainabilityAbility to complete paperwork, view apartments, handle interviews
33Assessment Domains Demographic Information Housing and Homelessness Employment HistoryIncome, Benefits, DebtsLegalEducation HistoryFamily, Friends and SupportsPhysical and Behavioral HealthLife SkillsSummary: Barriers & StrengthsTrainer Instructions:Go through the assessment with the traineesNeed to talk to trainees on how to ask questions, they don’t need a form in front of them always, they can ask in ways that are inviting for the consumers.It is important to note strengths and competencies in the assessment.Slide notes:CTI practice is to do assessment at each phase.May need to add sections for other members in the household to capture their information.Assessment domainsAdd section for each person in householdStrengths – ensure that you discuss strengths with consumers – they can not always identify them. Feeling of competency motivates people. Good to catalog.Housing infoHave you had a lease? Important, want to assess skill level. Evicted from PH? If Section 8, want to know this.Ask consumers what they have had trouble with in the past and what do they anticipate having this in the future.EmploymentWhat do you need to access employment?It is important to jump on employment as soon as you can so you don’t lose the chance. Reinforce the role and purpose. Not pushing people but offering the opportunity.Income, Benefits, DebtHow much money are you going to need to live on? Later, you will make a plan to reach the goal.It is important to maximize benefits, everyone wants to increase income. Everyone wants $.Talk to consumers about rep payee – cannot require rep payee but can talk about benefits of having it set up.Consumer will need to make rent payments and this can sometimes be a challenge. CTI worker is going to probe and also going to set up communication so that landlord will reach out to CTI worker early. Tell landlord know that we might be able to get 1 month back rent but not more than that so that is an incentive for them to warn early.Child support, credit card issues, rent bills, utility bills – might need a place where utilities are included, get credit scores since they may need to provide that, info on owing loan sharksLegalForensic Hx – want to know parole, can be an advantage, want to know sex offender Hx for housing purposes.Treatment ProvidersWant to be talking to people about what worked in past and what did not work. Most helpful pieces so that consumers can be evaluative with their treatment. Ask them about why they were hospitalized. Ask about consumers motivation to use services. Sometimes people go off meds once they leave shelter or hospital – good to have conversations pre-CTI. CTI workers need to work with docs on understanding meds and what will work for consumer during the transition.ILSCTI workers need to make own assessment and not just ask consumers. We all think that we are good housekeepers and organized. Need to observe and evaluate. Avoid the word “budgeting”. Focus on goal approach – ask consumers, how much do you need to live?
34Education on Tenancy Rights AND Responsibilities The lease lays out the structure to maintain tenancyIn order to follow commitments people have to understand themKnowing what is expected allows people to planThe lease should be reviewed early and oftenCatching lease violations early will avoid a crisis
35Expectations of Tenancy Paying RentIncome, Financial Management, Subsidy AdministrationLogistics: check or money order, timelinessMaintaining ApartmentUnderstanding and Meeting Cleanliness Standard, Managing RepairsInspectionsAllowing Others the Peaceful Enjoyment of Their HomesGetting along with neighbors, VisitorsFollowing rules re noise etc.OccupancyOnly people on the lease live there
36Connection to Resources Connect with Resources needed to maintain housingFinancial resources and plan to meet needsServices including children’sSupports both existing and new and plan to maintain housing and use of timeRole of case managementAccompany to resources including housing
37Focused Service Planning Limit the areas of interventionFocus on the most pressing needs that impact community stabilityRelate all interventions to long term goalsUsually not be a linear processHelp people move-away from crisis-driven livesContent Elaboration:Limit the areas of intervention – 3 areas based on most pressing needs that impact their ability to live successfullyCrisis is how people manage their life when they have no resources – tunnel vision, want to expand options and move from crisis to evaluation and have real optionsCrisis mode is not a good way to work – crisis takes over, reiterates that the way to get attention is going into crisis and we want to model NOT working in crisis
38Practice of Shared Decision Making Recognize a decision needs to be madeIdentify the participants as equalsView options without judgmentExplore understanding and expectationsIdentify preferencesNegotiateShare the decisionEvaluate outcomes
39Case management role in SDM Structure regular care planning meetingsSupport/assist individuals to negotiate their needsFully embrace strengths-based approachAssist person to identify his/her personal medicineParticipate in evaluation of the outcomesCare manager can:• Develop skills of agenda setting, reflective listening, presenting advantages and disadvantages of options, collaborative decision-makingPromoting the Dignity of Risk and Supporting Individual ChoiceWe need to recognize that the people we support are the experts on what they want while we are their partners in helping them get it. We need to have relationships where we share control and continuously support people in gaining as much control as is possible.
40Components of the Plan - Goals Goals set as a team of family and workerFocus on the issues that affect stability in the community – base on the current crisis and previous episodes of community instabilityImmediate and longer term goals clearUse the plan for the interventionSteps to reach goal clearly defined and measurableLonger term needs require connections to other resources.Trainers Instructions:Go over the form with traineesContent Elaboration:Set target date for each of the goals.Note CM role and participant roleUnderstand the previous crisis, you may ask, “what brought you to hospital?” so that you can address these issues and help prevent future crisis.Long term goals may be to reunite with family, make friendsTreatment plans need to relate to long term goals and be relevant to consumerGoals must be tenant driven – people change behavior to get what they want.
41Components of the Housing Plan Participant/Tenant and Worker RoleDesigns plans for at least monthly in housing access phase and every month for the first months in housingReflects areas of the assessmentPrioritizes areas for workSets time frames for work to be accomplished
42Components of the Housing Plan Resource IdentificationClearly defines resources needed to access and/or maintain housing including:Income, credit repair, legal services, employment assistance/support, financial planning and management, medical services, child care, educational support, access to community based services such mental health, substance abuse, recreation/socialization etc.
43Evaluating the Plan Reframe setbacks as learning opportunities Measure SuccessUses documented steps to reach goal and benchmarks setUses phases to gauge expectations and progressIdentifies need to renegotiate goals and resourcesReframe setbacks as learning opportunities
45Housing Location Assessment of Needs and Preferences Barriers to Housing AccessConnections to LandlordsNegotiating Barriers and PreferencesFinancial Requirements
46Housing Needs and Preferences LocationAccess to TransportationProximity to Significant OthersProximity to Services and Community ResourcesUnit Size and Housing DensityAmenitiesSpecial accommodationsPetsIdeal v. acceptable, negotiable/non-negotiable
47Financial Needs/Requirements UP Front NeedsOngoing NeedsSecurity DepositFirst months RentUtilityMoving costsFurniture
48Barriers to Securing Housing Person’s ability to negotiate and complete processLocating acceptable housingTransportationBackground checks conducted by landlordsCreditCriminal background
49Negotiating Preferences And Background Issues Identify what is negotiable and what is notLet people dream a bit – what is their ideal, what do they have now, what would they acceptSee option available as step towards goalBackground ProblemsIdentify what is different now from when issue occurredPlan for not happening againLine up supportsPractice discussing with potential landlords
50Engaging Landlords Landlord Goals Regular rent paymentNo problemsLow turnoverExplain support that case manager can provideAsk landlords for other landlords they knowBe responsive
52Housing Retention Re-Assessment Re-Education Identifying Preferences: what is working, what is not?Any new needs and/or goals?Re-EducationAssertive Outreach and Engagement by WorkerWork with Landlords and Resources to Address Barriers to Housing RetentionCase Study: Develop a plan
53Re Assessment and Education Re-assessment: needs, preferences and goals change once in housingAssessments evolve over timeHome visits will provide additional informationLink assessment to the lease and goal of housing retentionVerify the information: check in with landlords on lease complaisanceReview Obligations of Tenancy
54Base for Communication A thorough housing and homeless historyA plan as to how each tenant will meet tenancy obligationsKnowledge of tenants rights and responsibilitiesResources to help address tenancy barriers
55Working with Landlords Landlords and property managers establish tenancy obligations and enforce them.Set up communication structure and arrange for early warnings of any issues – reach out monthlyFocus on eviction prevention and use the structure of the lease to guide your interventionsNegotiate a head of time a clear understanding of landlord processVisit the home oftenProbe for any threats to tenancy to prevent evictionSame expectations as everyone else. Structure in HF is the lease. If client says go away, keep offering services
56Tenants Rights and Responsibilities Know tenant’s and landlord rights and responsibilitiesState of Delaware Landlord Tenant Code:e/1f058f9cecf0e1bd85256f /$FILE/lanten.pdfBrochure – Delaware Landlord Tenant Code, Delaware Attorney GeneralLandlord Tenant Code brochure.pdfndlord%20Tenant%20Code.pdf
57Connect to ResourcesBased on the assessment, identify new resources neededEngage tenants in a discussion as to whether current resources are working/not workingBe in regular contact with resources to assess progressIdentify new resources needed based on revised or new goals or barriers to retention
58Example: Retention Plan Mary and her children have been in housing for a month. On a home visit you notice that the other tenants are giving Mary the stink-eye. Mary has done well in housing and has been paying the rent. She struggles some with money but has been able to get resources to help. You worry about this new development. Mary explains sometimes she lets the children play in the hallway. They are noisy and too cooped up in the apartment. She knows it bothers some of the cranky neighbors but the landlord has not complained. What else is she supposed to do?
59Worker RoleProviding assistance to help participants develop structure and purpose in their lives.Something to do during the day provides a framework and creates expectationsBehaviors that interfere with housing decreaseThis gives another early warning system to prevent crisisCoordinate closely with resourcesChecking in with landlord, and all services and supports to ensure it is working and identifying glitches
60Worker Role Eviction Prevention The eviction process can be a process to preserve tenancyNegotiate with landlords before the eviction noticeLandlords do not want to evict it is expensiveSee if they will accept payment plansIf they will let you know about lease violationsHow much time will they give the tenant to correct
61Non-negotiable factors Harm Reduction PlanHarm Reduction Plan: RiskOptionsFactors in favorFactors againstNon-negotiable factorsEviction: tenant has ‘guests’ in apartment, disturbing other tenantsGo to friends houseSolve landlord issueMeet goal to see friendsTransportation issuesDisruption must stopFind another location to socializeWould reduce impact on neighborsWould cost something Not welcomedDrinking, smoking may not be permittedFind a time to socialize that is less disruptive to neighborsCould have reduced impact on neighbors‘Friends’ aren’t up and don’t want to socialize earlierMust always allow neighbors ‘peaceful enjoyment’
63Involving Community Agencies You need all resources available to support tenancyTenant Lawyers:Train tenants and staff on tenants rights.Will provide support to tenants in the eviction processMay assist to address debts interfering with housingLandlords:Assertive property management making the lease and enforcement clearSending notices early and connecting with services
64Involving Community Agencies Treatment Resources:Having emergency treatment available in a timely mannerEasy access to treatment on demandHigh quality, sustainable and flexibleProvides consultation to staff on planningFamily and FriendsOften provides motivation for keeping the apartmentMay provide support to person addressing issue and barriersProvides a role for person in the community
65Involving Community Agencies Benefits providers:Increasing incomeMay provide some emergency resources for rent arrears or utilities, damagesEmployment:May provide motivation to address barriers to tenancyGives structure and purpose, roleProvides income
66Building Skills Educating on rights and responsibilities Focusing on skills for adulthood for ChildrenModeling for each person/family to negotiate for servicesTrying it out and debriefEstablishing regular check-ins to see if it is workingReview cost and benefits – critical thinkingRecognizing strong partners and good skillsRenegotiate the relationship as necessaryReach for feedback on the RRH orker - opportunity to practiceContent Elaboration:Using Motivational Interviewing as you work on building skills.Consumers need to have something to do during the day and have connections in the community.Making sure that consumers are able to make appt, learning how to do it themselves.Encouraging critical thinking and decision making - are these supports working and addresses issues? If not, work what did not work and what should be changed?Case manager models behavior – case manager does it and consumers watch and then then do a debrief. If it did not work, debrief about why not.Make sure things are working and ask open ended questions to get answers.Teach consumers how to recognize strong community partners and to thank providers when they deserve it. Ex. write thank you notes, express gratitude – model that and teach consumers to do that.Nothing is forever – if people want to get another job or a new service, help them figure that out
67Changing Expectations Moving from crisis to planningMay be from immediate to 15 minutes from nowCritical thinkingUsing strategies and resources that work best for each personStructure and purposeDeveloping a structure and purpose to days outside the hospitalDeveloping new or changed life rolesFrom patient to tenant, family member, student, worker, advocate, artistContent Elaboration:Consumers are learning to make decisions for themselves. Case managers role is to guide and be active in the relationship. CTI is assertive. Ex. Consumer notes, “I don’t want to work on that goal.” Case manager might respond, “Let me tell you why I’m concerned….” The goal is for consumers to make informed decisions. Choice does not mean that case manger gives up. Case manager respects choice but balances it with giving info and sharing observations and insights. And, with the assertive case management, CTI worker keeps bringing up issues of concern when the opportunity presents itself.Parole & Landlords – meet with them, establish a relationship before a crisis happens
68Crisis PlanningAt a moment of calm it is often helpful to develop a crisis plan with individuals:Standard Crisis: Fire, Evacuation, Injury or Medical Emergency.Individual based on patterns:Psychiatric, Medical, Substance, Money, Conflict, Threat to tenancyWhat is the structure?What would work best in this situation?Who should be involved?
69Supervisory Support Communication with Supervisors Regularly scheduled meeting (preferably weekly)Review all people on caseload at least monthlyDiscuss participants that are at riskLease violations or barriers to accessing housingPeople who have difficulty engagingBehaviors that interfere with housing and goals – brewingIdentify behaviors that are not clear:Seems engaged but disappears, landlord complaining but do not see the behavior
70Supervisory Support Participant who negotiated a payment plan Identify things that have gone wellParticipant who negotiated a payment planSomeone who responded to landlord notice and accepted help in cleaning apartmentGet support with landlordsLandlord does not enforce the leaseLandlord is overinvolvedGet support with resourcesWhat is working and not workingSeek out support in addition to meetings if needed
71Connection to CTI Needs Assessment and Re-Assessment Focused Housing PlanningIntensive in the First 3 months (BCTI)Connection to ResourcesConnection with LandlordsSkill developmentStructure and PurposeMoving from Crisis
72Measures of SuccessMaintaining housing and not returning to homelessnessIncrease incomeNetwork of supportsLess emergency interventions: ER visits, hospitalization, incarceration, removal of children, school truancyStructure, role and purpose in each person’s lifeContent Elaboration:Data are important – this let’s us see what is happening and what the outcomes are.Data let us know what is working and what needs to be tweaked.Chose what to look at that makes sense and that you can measure.Only need a few outcomes that folks can see that they are working towards.
73Closing Connect housing stability to person’s aspirations and goals Assist with transition to new roleBuild skills and knowledge in meeting lease obligationsHelp people move away from crisis - Crisis Prevention orientationRegularly probe for threats to housing and intervene earlyMaintain contacts with resourcesBuild competence and confidence
74Closing and Discussion Trainer Instructions:Thank trainees for their time and participation.Ask trainees if they have questions, concerns, comments.Ask what other information they need to be successful at CTI.Let them know that they can contact you if they think of issues later.Remind them that this is a systems change at OMH and that OHM is invested in this and there is support for themTrainingsSteering Committee meetingsTechnical Assistance AvailableThe Implementation Plan will be helpful for them to review