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Rapid Rehousing Delaware HPC February 3, 2015

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1 Rapid Rehousing Delaware HPC February 3, 2015
Suzanne Wagner

2 Agenda Introductions Policy Context RR Definitions and Benefits
Progressive Engagement Housing Planning Housing Location Housing Stabiliyu Case Management Support Community Connections and Supports Wrap-up and Discussion Trainer 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 it Review logistics – restrooms, phones, food, water Timing: Introductions, Overview of CTI, The Evidence – approximately 1 hour and 30 min; 3-6 minutes per slide Example: % 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

3 Housing Innovations Began in 2009 Principals: Suzanne Wagner, Andrea White, Howard Burchman Senior Associate: Lauren Pareti Experience: Columbia University Community Services/CUCS & Burchman Terrio Extensive experience in: Developing, Operating and Evaluating Housing and Service Programs Implementing Evidence Based Practices (EBP’s) CoC Support and System Transformation Homeless Planning and Community Needs Assessments Operating Coordinated Access and Assessment Systems Staff Training

4 National Trends and Best Practices
HEARTH – Homeless Emergency Assistance and Rapid Transition to Housing Federal Strategic Plan (FSP), Opening Doors

5 National Trends End homelessness as quickly as possible and get people to permanent housing solutions through outcome driven approach Use Evidence-Based Practices (EBP’s) Expand Rapid Re-housing Target Permanent Supportive Housing for the most disabled people who have been homeless the longest Housing First as both a system and program strategy Lack of evidence that housing readiness increases chance of housing stability

6 National Trends - 2 Preserve intensive interventions for people with highest need Connect people to work, benefits and mainstream and community-based services and supports Transform systems and programs that are not effective and/or efficient

7 HEARTH 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.

8 Federal Strategic Plan (FSP) Goal
Transform homeless services to crisis response systems that prevent homelessness and rapidly return people who experience homelessness to stable housing.

9 Reduce Overall Homelessness
HEARTH Performance Measures Reduce Overall Homelessness Reduce the number of people who become homeless Prevention/ Diversion Reduce length of homelessness Rapid Re-Housing / Housing First Reduce returns to homelessness Housing Stabilization Support Increase employment and other income Housing Stabilization Other accomplishments related to reducing homelessness Example: Doubled up Thoroughness in reaching homeless population Count well Ensure all pops served The 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.

10 Rapid Exit and Rehousing
Main Goal – Rapid Access to Housing Focus on Relocation and Stabilization CoC funds can be reallocated to RR for Families Housing Shelter Source: NAEH Center for Capacity Building

11 Housing First Programmatic and systems approach that provides people with housing quickly and then providing services as needed Low barrier entry requirements and service rich environment Participant have choices about housing and services Housing is not contingent on compliance with services – Participants expected to comply with a standard lease agreement Provided with services and supports to help maintain housing Services and connections to resources provided post-housing to promote housing stability, stable tenancy and well-being

12 Housing Stabilization
Prevailing Model Emerging Model Employment Assistance Employment Assistance Day Care Day Care Shelter Housing Stabilization Shelter MH/SA Services Housing Placement MH/SA Services Family Supt Services Family Supt Services Turning the Continuum of Care Inside – Out? Source: Culhane, Homeless Assistance: A Paradigm Shift?

13 Rapid Rehousing Defined
Goal: Rapidly exit homeless individuals and families into permanent housing from the homeless system One-time/time-limited financial help with debts, security costs, rent and other housing costs Short term rental assistance up to 24 months – preferably in 3 month increments Housing location services Case management focused on increasing income, housing stabilization, connections to services and supports

14 Principles of Rapid Rehousing
Move from homelessness directly to housing Targeting “Just enough” Assistance Landlords are valuable resources Use case management and mainstream resources to keep tenants stable Source: HPRP Promising Practices in Rapid Rehousing – HUD OneCPD

15 Benefits of Rapid Rehousing
Cost-effective and proven strategy Keeps expensive PSH units for the most vulnerable Reduces the amount of time families remain in crisis of homelessness (it is trauma-informed) Helps communities leverage new partners and resources 60-75% of families enter from friends and family; About 50% return to same place they were before shelter

16 RR Benefits - 2 Addresses barriers homeless people face:
The cost of obtaining new rental housing Landlord discrimination Obtain permanent housing and stabilize quickly Change the focus of the emergency system from emergency placement to rehousing Open the back door – free up emergency shelter space

17 Rapid Rehousing Outcomes
Effective for large percentage of families Low cost per outcome High rates of exits to permanent housing Low rates of returns to homelessness

18 Exits 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 Families Though 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 including high housing cost urban areas rural areas, balance of states and both large and small continuums. Transitional Housing Rapid Re-Housing Shelter

19 Rate of Return to Homelessness w/in 12 Mos of Exit
Source: Data from 7 CoCs in 4 states that prepared Evaluators for NAEH in 2012 7 different communities returns to homelessness within 12 months of exiting programs to PH left = singles, right = families. Families: Rate of Recidivism from RRH Lower (less than half of TH Singles, slightly higher for RRH versus Transitional Housing; (remember however that significantly more persons exited to PH under the RRH model than TH) Singles People in Families with Children

20 Average Cost Per Exit for Families with Children
Source: Data from 14 CoCs from NAEH Performance Improvement Clinics in Cost per exit: Families Left: All Exits Right: PH Exits Conclusion: RRH has a lower cost per exit than TH in both charts If you look just at cost per PH exit: ES is more than 2 times more expensive than RRH TH is more than 5 times more expensive than RRH RRH 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 Exits Permanent Housing Exits

21 Lessons from VA Rapid Rehousing (SSVF)
Small amounts of assistance can be effective: Avg cost/household served: $2,410 Median length of assistance: 90 days Only 13% of RRH participants received assistance for >180 days 79% of participants exited to permanent housing 93% of families did not return to VA homeless programs (after one year) RRH can work for people with barriers to housing stability 76% of households had income of less than 30% of AMI 55% of Veterans served had a disabling condition Source: Impact and Performance of the Supportive Services for Veteran Families (SSVF) Program: Results from the FY 2013 Program Yr Source: 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.

22 What about TH? HUD :“Life After Transitional Housing”, Urban Institute, March 2010 Findings high and low barrier families did equally well for the most part More or less rules did not make a difference in outcomes What DID make a difference was time spent homeless… Longer time homeless, less likely to have own housing at exit HH w/more homeless episodes,  odds of not working and lower wages Bottom line – end people’s homelessness rapidly

23 Implementing RR using Progressive Engagement
Start with a small amount of assistance for a lot of people Add more as needed Rental assistance in 3 month increments Re-assess to determine continued need

24 What does Progressive Engagement look like?
Provide a minimal amount of assistance to all people Lists of vacancies, help funding a place to live, small amount of financial assistance Provide additional assistance as needed by the household Short term rental assistance, case management If at risk of losing housing More rental assistance and/or more CM If still at risk Longer tem RA and/or more CM If still at risk – maybe voucher or PSH

25 Example of Progressive Engagement
Housed Point of Entry RRH 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

26 Rationale for PE Nationally recognized practice in addressing homelessness Provides customized levels of assistance Preserves the most expensive interventions for households with demonstrated barriers to housing success Enables service delivery systems to effectively target resources

27 Rationale - 2 Based on research (or lack thereof) that we cannot predict who will need what type of intervention No validated predictive assessment instruments except for diversion Alameda County – similar outcomes for high and low barrier households People are resilient Resources are limited More information about barriers to housing stability when we see people in “real” housing

28 A word about Transitions……
New start Involve both loss and gain Stressful Can increase depression/substance use Unknown/uncertainty leads to fear Require re-alignment of daily schedule Trigger fears of failure Require support Trainer 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 empathy Content 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.

29 Rapid Rehousing Activities and Services
Housing Planning Housing Location Case Management and Housing/Tenancy Support Community Connections and Supports Layers other Evidence-Based and Promising Practices: Critical Time Intervention, Housing First, Person Centered Planning, Trauma-Informed Care

30 Housing Planning

31 Housing Planning Assessment of Housing and Homeless History
Assessment of Strengths and Barriers to Housing Stability Education on Tenancy Role and Housing Options Connection to Resources Core Concepts in Housing Planning Using Shared Decision Making Model Components of a Housing Plan

32 Assess Housing and Homeless History
Past housing experiences Current housing goals Experience as a leaseholder What they liked/didn’t like about previous housing How person/family became homeless Barriers to access and sustainability Ability to complete paperwork, view apartments, handle interviews

33 Assessment Domains Demographic Information Housing and Homelessness
Employment History Income, Benefits, Debts Legal Education History Family, Friends and Supports Physical and Behavioral Health Life Skills Summary: Barriers & Strengths Trainer Instructions: Go through the assessment with the trainees Need 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 domains Add section for each person in household Strengths – ensure that you discuss strengths with consumers – they can not always identify them. Feeling of competency motivates people. Good to catalog. Housing info Have 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. Employment What 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, Debt How 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 sharks Legal Forensic Hx – want to know parole, can be an advantage, want to know sex offender Hx for housing purposes. Treatment Providers Want 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. ILS CTI 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?

34 Education on Tenancy Rights AND Responsibilities
The lease lays out the structure to maintain tenancy In order to follow commitments people have to understand them Knowing what is expected allows people to plan The lease should be reviewed early and often Catching lease violations early will avoid a crisis

35 Expectations of Tenancy
Paying Rent Income, Financial Management, Subsidy Administration Logistics: check or money order, timeliness Maintaining Apartment Understanding and Meeting Cleanliness Standard, Managing Repairs Inspections Allowing Others the Peaceful Enjoyment of Their Homes Getting along with neighbors, Visitors Following rules re noise etc. Occupancy Only people on the lease live there

36 Connection to Resources
Connect with Resources needed to maintain housing Financial resources and plan to meet needs Services including children’s Supports both existing and new and plan to maintain housing and use of time Role of case management Accompany to resources including housing

37 Focused Service Planning
Limit the areas of intervention Focus on the most pressing needs that impact community stability Relate all interventions to long term goals Usually not be a linear process Help people move-away from crisis-driven lives Content Elaboration: Limit the areas of intervention – 3 areas based on most pressing needs that impact their ability to live successfully Crisis 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 options Crisis 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

38 Practice of Shared Decision Making
Recognize a decision needs to be made Identify the participants as equals View options without judgment Explore understanding and expectations Identify preferences Negotiate Share the decision Evaluate outcomes

39 Case management role in SDM
Structure regular care planning meetings Support/assist individuals to negotiate their needs Fully embrace strengths-based approach Assist person to identify his/her personal medicine Participate in evaluation of the outcomes Care manager can: • Develop skills of agenda setting, reflective listening, presenting advantages and disadvantages of options, collaborative decision-making Promoting the Dignity of Risk and Supporting Individual Choice We 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.

40 Components of the Plan - Goals
Goals set as a team of family and worker Focus on the issues that affect stability in the community – base on the current crisis and previous episodes of community instability Immediate and longer term goals clear Use the plan for the intervention Steps to reach goal clearly defined and measurable Longer term needs require connections to other resources. Trainers Instructions: Go over the form with trainees Content Elaboration: Set target date for each of the goals. Note CM role and participant role Understand 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 friends Treatment plans need to relate to long term goals and be relevant to consumer Goals must be tenant driven – people change behavior to get what they want.

41 Components of the Housing Plan
Participant/Tenant and Worker Role Designs plans for at least monthly in housing access phase and every month for the first months in housing Reflects areas of the assessment Prioritizes areas for work Sets time frames for work to be accomplished

42 Components of the Housing Plan
Resource Identification Clearly 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.

43 Evaluating the Plan Reframe setbacks as learning opportunities
Measure Success Uses documented steps to reach goal and benchmarks set Uses phases to gauge expectations and progress Identifies need to renegotiate goals and resources Reframe setbacks as learning opportunities

44 Housing Location

45 Housing Location Assessment of Needs and Preferences
Barriers to Housing Access Connections to Landlords Negotiating Barriers and Preferences Financial Requirements

46 Housing Needs and Preferences
Location Access to Transportation Proximity to Significant Others Proximity to Services and Community Resources Unit Size and Housing Density Amenities Special accommodations Pets Ideal v. acceptable, negotiable/non-negotiable

47 Financial Needs/Requirements
UP Front Needs Ongoing Needs Security Deposit First months Rent Utility Moving costs Furniture

48 Barriers to Securing Housing
Person’s ability to negotiate and complete process Locating acceptable housing Transportation Background checks conducted by landlords Credit Criminal background

49 Negotiating Preferences And Background Issues
Identify what is negotiable and what is not Let people dream a bit – what is their ideal, what do they have now, what would they accept See option available as step towards goal Background Problems Identify what is different now from when issue occurred Plan for not happening again Line up supports Practice discussing with potential landlords

50 Engaging Landlords Landlord Goals
Regular rent payment No problems Low turnover Explain support that case manager can provide Ask landlords for other landlords they know Be responsive

51 Housing and Tenancy Support

52 Housing Retention Re-Assessment Re-Education
Identifying Preferences: what is working, what is not? Any new needs and/or goals? Re-Education Assertive Outreach and Engagement by Worker Work with Landlords and Resources to Address Barriers to Housing Retention Case Study: Develop a plan

53 Re Assessment and Education
Re-assessment: needs, preferences and goals change once in housing Assessments evolve over time Home visits will provide additional information Link assessment to the lease and goal of housing retention Verify the information: check in with landlords on lease complaisance Review Obligations of Tenancy

54 Base for Communication
A thorough housing and homeless history A plan as to how each tenant will meet tenancy obligations Knowledge of tenants rights and responsibilities Resources to help address tenancy barriers

55 Working 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 monthly Focus on eviction prevention and use the structure of the lease to guide your interventions Negotiate a head of time a clear understanding of landlord process Visit the home often Probe for any threats to tenancy to prevent eviction Same expectations as everyone else. Structure in HF is the lease. If client says go away, keep offering services

56 Tenants Rights and Responsibilities
Know tenant’s and landlord rights and responsibilities State of Delaware Landlord Tenant Code: e/1f058f9cecf0e1bd85256f /$FILE/lanten.pdf Brochure – Delaware Landlord Tenant Code, Delaware Attorney General Landlord Tenant Code brochure.pdf ndlord%20Tenant%20Code.pdf

57 Connect to Resources Based on the assessment, identify new resources needed Engage tenants in a discussion as to whether current resources are working/not working Be in regular contact with resources to assess progress Identify new resources needed based on revised or new goals or barriers to retention

58 Example: 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?

59 Worker Role Providing assistance to help participants develop structure and purpose in their lives. Something to do during the day provides a framework and creates expectations Behaviors that interfere with housing decrease This gives another early warning system to prevent crisis Coordinate closely with resources Checking in with landlord, and all services and supports to ensure it is working and identifying glitches

60 Worker Role Eviction Prevention
The eviction process can be a process to preserve tenancy Negotiate with landlords before the eviction notice Landlords do not want to evict it is expensive See if they will accept payment plans If they will let you know about lease violations How much time will they give the tenant to correct

61 Non-negotiable factors
Harm Reduction Plan Harm Reduction Plan: Risk Options Factors in favor Factors against Non-negotiable factors Eviction: tenant has ‘guests’ in apartment, disturbing other tenants Go to friends house Solve landlord issue Meet goal to see friends Transportation issues Disruption must stop Find another location to socialize Would reduce impact on neighbors Would cost something Not welcomed Drinking, smoking may not be permitted Find a time to socialize that is less disruptive to neighbors Could have reduced impact on neighbors ‘Friends’ aren’t up and don’t want to socialize earlier Must always allow neighbors ‘peaceful enjoyment’

62 Community Resources

63 Involving Community Agencies
You need all resources available to support tenancy Tenant Lawyers: Train tenants and staff on tenants rights. Will provide support to tenants in the eviction process May assist to address debts interfering with housing Landlords: Assertive property management making the lease and enforcement clear Sending notices early and connecting with services

64 Involving Community Agencies
Treatment Resources: Having emergency treatment available in a timely manner Easy access to treatment on demand High quality, sustainable and flexible Provides consultation to staff on planning Family and Friends Often provides motivation for keeping the apartment May provide support to person addressing issue and barriers Provides a role for person in the community

65 Involving Community Agencies
Benefits providers: Increasing income May provide some emergency resources for rent arrears or utilities, damages Employment: May provide motivation to address barriers to tenancy Gives structure and purpose, role Provides income

66 Building Skills Educating on rights and responsibilities
Focusing on skills for adulthood for Children Modeling for each person/family to negotiate for services Trying it out and debrief Establishing regular check-ins to see if it is working Review cost and benefits – critical thinking Recognizing strong partners and good skills Renegotiate the relationship as necessary Reach for feedback on the RRH orker - opportunity to practice Content 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

67 Changing Expectations
Moving from crisis to planning May be from immediate to 15 minutes from now Critical thinking Using strategies and resources that work best for each person Structure and purpose Developing a structure and purpose to days outside the hospital Developing new or changed life roles From patient to tenant, family member, student, worker, advocate, artist Content 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

68 Crisis Planning At 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 tenancy What is the structure? What would work best in this situation? Who should be involved?

69 Supervisory Support Communication with Supervisors
Regularly scheduled meeting (preferably weekly) Review all people on caseload at least monthly Discuss participants that are at risk Lease violations or barriers to accessing housing People who have difficulty engaging Behaviors that interfere with housing and goals – brewing Identify behaviors that are not clear: Seems engaged but disappears, landlord complaining but do not see the behavior

70 Supervisory Support Participant who negotiated a payment plan
Identify things that have gone well Participant who negotiated a payment plan Someone who responded to landlord notice and accepted help in cleaning apartment Get support with landlords Landlord does not enforce the lease Landlord is overinvolved Get support with resources What is working and not working Seek out support in addition to meetings if needed

71 Connection to CTI Needs Assessment and Re-Assessment
Focused Housing Planning Intensive in the First 3 months (BCTI) Connection to Resources Connection with Landlords Skill development Structure and Purpose Moving from Crisis

72 Measures of Success Maintaining housing and not returning to homelessness Increase income Network of supports Less emergency interventions: ER visits, hospitalization, incarceration, removal of children, school truancy Structure, role and purpose in each person’s life Content 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.

73 Closing Connect housing stability to person’s aspirations and goals
Assist with transition to new role Build skills and knowledge in meeting lease obligations Help people move away from crisis - Crisis Prevention orientation Regularly probe for threats to housing and intervene early Maintain contacts with resources Build competence and confidence

74 Closing 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 them Trainings Steering Committee meetings Technical Assistance Available The Implementation Plan will be helpful for them to review

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