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