Presentation on theme: "Suzanne Wagner Andrea White Housing Innovations"— Presentation transcript:
1 Suzanne Wagner Andrea White Housing Innovations Housing Stabilization Services Peer Learning Session: Skills and Strategies for Successful Family Stabilization Hogan Center – College of the Holy Cross Tuesday May 31, 2011Suzanne WagnerAndrea WhiteHousing Innovations
2 AgendaIntroductionsBackground on Best Practices and Federal PrioritiesHousing Stabilization ServicesOverview of HSSUsing the Lease to Structure the WorkCoordination of Support Services with Landlords/Property Management ServicesConnections with Mainstream ResourcesCTI OverviewCase ExamplesWrap up
3 BackgroundNew federal directions (HEARTH and Federal Strategic Plan (FSP) andEvidence Based Practices (EBPs)Reduce length of time people spend in the crisis of homelessnessRapidly exit them from homelessness and access permanent housingProvide services in the home to achieve housing stability and prevent returns to homelessnessPrinciples and practices of Housing First have been expanded to other homeless populations besides chronically homeless with success
4 Federal PrioritiesNew CoC Performance Standards- HEARTH– “Homeless Emergency Assistance and Rapid Transition to Housing”Reduce Length of Time HomelessReduce Newly homelessReduce Returns to HomelessnessIncrease Permanent Housing ExitsIncrease/Maintain Income
5 Federal Priorities Federal Strategic Plan (FSP) – “Opening Doors” Retool the Homeless Crisis Response SystemMore Permanent Housing OptionsRapid RehousingPSHService Enriched HousingFocus on Employment and IncomeUse Mainstream Resources – income and servicesGet Kids in School
6 Commonwealth of Massachusetts HomeBase Working toward Family self-sufficiencyIncrease income;Enhance household budgeting and bank relationships;Invest in basic educational attainment;Advance school enrollment for all children; andPromote good tenancies through lease compliance.
7 Housing FirstPrinciples and Practices with Applicability to Other Homeless PopulationsImmediate access to housingLow or no threshold for entrySingle site or scatter site housingHarm reduction approach to substance use and other life issuesLimited program requirements and case management service modelSeparation of housing and treatment/support services. Focus on housing stabilityNot “Housing Only”, must have services
8 Progressive Engagement Emerging practiceDo basic and simple screening for housing barriersProvide a minimal amount of assistance to all peopleProvide additional assistance as needed by the householdBased on research (or lack thereof) that we cannot predict who will become homeless and instruments to determine need for services have not been validated.
9 CTI is an Evidence Based Practice Critical Time Intervention (CTI) TI has been recognized an Evidence-Based Practice by the federal Substance Abuse and Mental Heath Services Administration (SAMHSA) and the President’s New Freedom Commission on Mental HealthCTI is based on the research of Columbia University’s (Columbia Center for Homelessness Prevention Studies) work with the homeless individualsPoint at which person moves into new housing provides a critical opportunity to make changesBased on the research of Columbia University’s HomelessColumbia Center for Homelessness Prevention StudiesCTI has been recognized as a model program by both the federal Substance Abuse and Mental Heath Services Administration (SAMHSA)Does anyone know the name of any other EBPs?:Wellness Self Management (illness Management & Recovery (aka WSM)Assertive Community Treatment (ACT)Supported EmploymentIntegrated Treatment of Mental Illness and Co-occurring Substance AbuseFamily Psycho-EducationPsycho-Pharmacology Protocols & Guidelines
10 Themes of Housing Stabilization End family’s homelessness permanentlyAssist families to stabilize in housingAssist people to secure/maintain stable incomeAssist families to reintegrate into the communityAssist families to access and use mainstream resourcesAssist families to establish long term goals as a motivator for change
11 Housing Stabilization Services Housing is the goal, the lease and family’s self-defined long term goals focus the workBest predictor of the future is the past, get housing historyTreatment/services are often resources to achieve the goal, not the goal itselfNot always a linear process“Assertive” landlord/property mgmt is necessary
12 Key Ingredients for Housing Stabilization Provide services in the home and the communityOngoing assessments of housing barriers to prevent housing lossConnect with other mainstream and community-based services – benefits and servicesConnect with natural supports including spiritual
13 Key Ingredients for Housing Stabilization Landlords and property managers to establish tenancy obligations and enforce themFocus on eviction prevention and use the structure of the lease to guide your interventionsCoordinate Property Management and Social Services interventionsUse Evidence-Based Practices EBP’sCritical Time InterventionMotivational Interviewing
14 Housing Stabilization Services: Measures of Success Maintaining housingIncrease/stabilization of income (earned and benefits)Connections with services and supports to prevent becoming homeless again
15 Core Elements: Housing Stabilization Services AssessmentGoalsUnderstanding Barriers to HousingEngagement on Common GoalsEducationExpectations of Tenancy, Lease and Housing OptionsAvailable Resources for SupportHousing Stabilization Plans (aka “Service Plans”) and Services:Using treatment as a link to self-defined goalsUsing CTI as a toolLinkages and CoordinationLandlords/Property Managers, Community, Services, Treatment ResourcesEvaluate progress
16 Expectations of Tenancy Paying RentIncome and financial managementSubsidy Compliance if applicableLogistics: check or money order, timelinessMaintaining ApartmentUnderstanding and meeting cleanliness standardsInspectionsSafety and managing repairsQuiet EnjoymentGetting along with neighborsVisitorsFollowing building/unit rules and normsOccupancyOnly people on the lease live there
17 Reasons people lose housing Don’t pay rentViolate rules e.g., noiseHoard or otherwise create health and safety hazardPeople move in who are not on the leaseEngage in criminal activityOthers??Need to monitor and assist in meeting tenancy obligations
18 Focused Housing Stabilization Services Planning Limit the areas of intervention based on housing barriers assessmentFocus on the most pressing needs that impact housingRelate all interventions to keeping housing + long term goalsBe aware this may not be a linear processBe mindful about moving from crisis
19 Focus Areas of Assessment Housing Stabilization and Lease ComplianceIncome and Financial ManagementFamily & Other RelationshipsMental Health and MedicalSubstance Use and MisuseLife SkillsStrengths and Potential for Change – how has person managed in the past?
20 Components of the Housing Plan - Tenants’ Goals A safe place to liveWorkEnough money to live onFriendsValued status and a role in the community – purpose and structureMove from crisisCommunityA chance for their children“Dignity of Risk”5 Years from now?
21 Goal Based Assessment Strategies Explore what each family’s choice meansHistory (i.e. housing, employment, safety)How this family became homeless: what worked what didn’tHow each family has managed in the pastPreferences: what does the parent/family wantFinancial IssuesImplications of disabilities or service needs and how this relates to goalLong term goals: how do they see their future?
22 Components of the Housing Plan -- Goals Goals set as a team of clients and workerFocus on the issues that affect housing retention – base on what caused the current crisis and previous episodes of housing instabilityImmediate and longer term goals clearThe Plan determines your interventionsSteps to reach goal clearly defined and measurableLonger term needs require connections to other resources.
23 Components of the Housing Plan Tenant and Staff RolesReflects areas of the assessmentPrioritizes areas for workSets time frames for work to be accomplished
24 Components of the Housing Plan Mainstream Resource IdentificationClearly defines resources needed to access and/or maintain housing including: income, benefits, credit repair, legal services, employment assistance, financial planning and management, access to medical services and child care, educational support, access to community based services such a schools, mental health, substance abuse, etc.
25 Evaluating the Plan Measure Success Uses documented steps to reach goal and benchmarks setUses phases to gauge expectations and progressIdentifies need to renegotiate goals and resources
26 Using the Lease to Structure the Work- Rationale One of the goals is for families to be stably housed and in order to do so, they need to learn how to manage their tenancy obligations.One of the keys to achieving this goal is the active coordination between property management and support services staff, while maintaining the functional separation of these two staffs.Having separation of functions helps tenants learn by being treated no differently from any other tenant by the property management. (Don’t want to create alternate reality)Problems that threaten tenancy may motivate tenants to use services in order to keep their housing.
27 Case ExamplesBetty is always happy to see the case manager. They talk a couple of times a week. The worker helped her with the children’s school, gives her rides, and food pantry referrals. It is always something. Betty has no one else to help her. She has four children on her own. She lives from crisis to crisis. The worker feels they are making progress but Betty just has too much to deal with.
28 Key Roles – Landlord and Service Provider Landlord has a key role in helping people understand their obligations and comply with them. (Assertive approach)Establish the expectations for the tenantThe social services staff provide and arrange for services needed to maintain housing and also function as advocates for the tenant.Assist the tenant to meet the expectations of tenancy
29 Coordinating Social Services with Landlords/Property Managers Provide written program informationExplain role of CM as resourceProvide contact informationMeans to resolve issue so that tenant can remain in housingEngage in proactive coordination/communicationCheck in on some regular basis, preferably meet regularlyThere is some “natural” tension in the work
30 Assertive Landlord/Property Management Hold tenant to the obligations of the leaseRespond to problems in a timely wayContact case manager early on when problems first ariseProvide written notices to tenants of rule, lease violations or late rent paymentIdeally, cc the case mangerWork with Case Manager to resolve barriers to maintaining unit.
31 Resources to Support the Process Landlord/tenant mediation servicesFunded as homelessness preventionEducation for case managers as to legal requirements/processUse of the courtsStipulation processPlanning for emergency resourcesRent and Utility paymentHousing plan to maintain tenancy
32 Managing a Collaboration Agreement on project goals: Assisting Tenants to Maintain HousingAcknowledge that the services are transitional but also will identify on-going supportsEach is oriented to each other’s rolesAt least monthly communications focused on tenants compliance with leaseInput and feedback from property management staff is sought and valuedSupport and acknowledge the landlord/property management role
33 Sharing Information and Confidentiality There is often a great deal of confusion and frustration around what information can be shared and what information is confidential EXAMPLES Public display of intoxicated behavior: Public Information Tenant disclosing a mental health diagnosis or medical information: Confidential Other CONFIDENTIAL information: Any information that is obtained in the context of professional services is deemed privileged information
34 Mainstream and Community Resources Develop a family focused resource listIdentify Resources by Focus Areas and TasksReview Resources in Current UseAdd resources developed through work with tenantsIdentify Needed ConnectionsIncome, benefits AND servicesUsing Client resource directories in each region
35 Categories of Assistance Benefits and Entitlements including Emergency AssistanceFinancial literacy and credit repair servicesEmployment ProgramsEducation and Job Training ProgramsLegal ServicesFood and Nutrition ProgramsChildren’s ServicesClothing and Furniture Banks
36 Categories of Assistance - 2 Health ClinicsDental ServicesMental Health ServicesSubstance Use Treatment ProgramsCounseling Services – Family, DV, TraumaLists of AA and NA meetingsEmergency Services – DV Hotline, Child Abuse and Neglect Reporting, Mobile Mental Health ServicesSocial, Spiritual and Recreational Opportunities
37 Other Community Resources Public transportationCommunity centersCamps and employment programs for adolescentsLibrariesCivic associationsSettlement housesParks, recreational and sports facilitiesPlaces of worshipAdult education, classes and workshopsTutoring and mentoring programs for childrenArts organizationsClubs and hobby groups
38 Links to Mainstream Resources Ensure knowledge of them – directory, visits to programs, ask clients, goals and what they provideIntroduce yourself and your agency, especially if there will be a lot of referralsExplain your role and what they can expectAttempt joint or coordinated service planningGather and share history (with client’s consent)Accompany person to assist with engagement with new serviceMaintain regular contact and keep your promises
39 Working Effectively with Other Providers Be Persistent, Patient And ReachableProvide information about the person that helps them to do their jobRecognize Each Program Has Their Personal Service & Outcome GoalsAsk About And Understand Expectations For ParticipantsBe On Time For Appointments And Follow Up With Any Information They Require For AdmissionUnderstand How The Program Interacts With Your Client’s Health Insurance, Entitlements, Patients Rights To Services, & Other CollateralsAssure The Provider Of Your Involvement
40 Keeping Everyone in the Loop Educating on the processHelping tenants to negotiate for services and enlisting the services helpEstablishing regular check insRecognizing strong partnersRenegotiating the relationship as necessary
41 CTI: Critical Time Intervention Assists individuals and families to stabilize in housing by:strengthening people’s ties to community services, family, and friendsthe provision of a focused case management approach that isconnected to each participant’s life goals.Time-limited (6-9 months)Three 3-month phases of decreasing intensity (transition to the community, try out, termination)-starts when moving into housing“Manualized” Intervention with Focused services (1-3 areas from 6 assessment areas) based on threat to long-term housing stability and access to support (mental health, housing, substance misuse, life skills, financial, and family and other social supports)One) building long term supports and strengthening the person’s long-term ties to the community –this is really the bulk of the work as you’ll see in a minuteAnd also by providing critical emotional and practical supports during the critical transition time,
42 Essential elements Longitudinal: adapt to family functioning over time Individual: care is planned with the family and addresses particular needsComprehensive: families can receive a variety of services related to their many needsFlexible: families are allowed to progress at their own paceAccessible: families are able to access services when they need them and in a way which is financially and psychologically manageableCommunication: between family and case manager and service providers and among service providers involved in the family’s care
43 Phases of Housing Stabilization and CTI Housing PlanningPhase 1: Transition to the CommunityCTI beginsPhase 2: Try-outPhase 3: TerminationPhases 1-3 last approximately 1-3 months each
44 Housing Planning Phase EngagementRisk Assessment: Assess for any crisis situationsEducate person about Housing Options they may be eligible forProvide direct services and assistance to link with resources as neededMay include income, ID, and other concrete needs to access housingAddressing immediate needsMay be linkages to needed care such as psychiatric, medical, dental or SAHousing Assessment
45 Phase I: Transition to the Community Assessment of new needs and resourcesReview assessment and revise based on current housing and lease compliance. Identify resources needed. Focus on community support, role and activityHousing Planning revisionReview plan and revise based on priority area, immediate needs and current resources.Assistance in making linkages: meeting with the person and the resource if necessaryRefine communication structures with landlord, services and other supportsSkill building for community resourcesProvide education about rights, responsibilities, and expectations; model negotiation skills
46 Phase II: Practicing Phase Solidifying Linkages to Community ResourcesThis might include: legal assistance, schools for children, religious/spiritual, community treatment and support optionsPromote independent living skillsEnsure income in place, financial management, tenancy obligations, schedule and roleEnsure communication support systemsRegular meetings monitor progress and connectionsDeveloping longer term planLook at non-immediate needs such as education planning, career goals, long term housing plansContinue to use MI techniques
47 Phase III Step Down/Terminations Fine Tuning LinkagesHigher Level Skills trainingFocus on Negotiating SkillsPlan to address housing risks as they ariseStep down and let go- having other linkages take primary roleEnsure needs are met, develop adjust linkages if neededAssess worker role going forwardDevelop formal plan with household and Linkages
48 Contingency planningSome families may not be able to complete the program in nine months:We have not definitively identified who that group of families isCTI can be used as an assessment toolIdentify longer term resources in the communityIdentify longer term rent subsidies in the communityHow does access to those resources get prioritized?
49 Support for the Practice: Supervision At least: weekly individual supervision, weekly team meetings with case conferencingCase Conferencing:Highlight best practices, identifies themes around barriers, highlights resources, provides clinical consultationTeam Meetings:Team meetings have an informational, monitoring and support function, track where people are in the transition to and identify common barriers, share information and resources amongst team members, alert team to people in distress or crisis, identify best practicesTraining
50 Support for the Practice: Characteristics of Successful Teams Involve leadersSet shared aimsWelcome everyoneSelf-consciousNon-linearDevolve controlManage knowledge with agilityReflective and responsiveSense- makingValues askingRecognition economyStimulate affection among members
51 Case ExamplesThe Jones family has been living in their apartment for 6 months. The mother has had a hard time finding a job but she is trying. The children are doing well in school. They seem to have a lot of people in and out. You talked to Ms. Jones about this and she said she has a big family. The landlord calls you. He is ready to evict. He says that her sister has been living there and he has warned her three times. This is it. It is the first time you heard about it.
52 Closing Ending homelessness takes a village New models and strategies New outcomesBuilding on the experience of Regional Networks to End Homelessness Pilot ProjectsIn order to achieve goals, must continue to evolve services and programs