Accommodating All Families: Addressing Substance Abuse 2011 National Conference on Ending Homelessness Devra Edelman Director of Programs Hamilton Family Center July 14, 2011

1 Rebuilding Lives ~ Ending Homelessness The mission of Hamilton Family Center is to break the cycle of homelessness and poverty. Through a Housing First approach, we provide a continuum of housing solutions and comprehensive services that promote self-sufficiency for families and individuals, and foster the potential of children and youth. Project Potential: Child and Youth Services Hamilton Family Emergency Center Hamilton Family Residences Hamilton Family Transitional Housing Dudley Apartments Supportive Services First Avenues: Housing Solutions

Hamilton Family Center ~ Core Philosophies Housing First Harm Reduction Trauma- Informed Services

Housing First Principles: Homelessness is first and foremost a housing problem and should be treated as such Housing is a basic human need and right to which all are entitled Families are more responsive to intervention and social service support once in permanent and stable housing People who are homeless or on the verge of homelessness should be returned to or stabilized in permanent housing as quickly as possible and connected to resources necessary to sustain that housing Everyone is valuable and capable of being a valuable resident and community member Residents, property managers, and service providers work together to integrate services into housing Client focused services Move homeless families into permanent, affordable housing as Rapidly as Possible Time-limited, home-based support services

Housing First Service Delivery Components Emergency services that address the immediate need for shelter or stabilization in current housing Housing, Resource, and Support Services Assessment which focuses on housing needs, preferences, and barriers; resource acquisition (e.g., entitlements); and identification of services needed to sustain housing Housing placement assistance including housing location and placement; financial assistance with housing costs (e.g., security deposit, first month’s rent, move-in and utilities connection, short- or long-term housing subsidies); advocacy and assistance in addressing housing barriers (e.g., poor credit history or debt, prior eviction, criminal conviction) Case management services (frequently time-limited) specifically focused on maintaining permanent housing or the acquisition and sustainment of permanent housing

Housing Assessment Matrix (HAM) Tool: Strategically targeting resources to maximize opportunities for homeless families Housing Assessment Matrix: latest-news/promising-practices/

Harm Reduction Service-delivery in a manner that promotes the increased overall health and well being of all while reducing the negative consequences of human behaviors. Focus on reducing the personal and societal harm created by substance use. Policies based upon on behaviors rather than substance use Goal to foster and encourage lasting therapeutic change Non-judgmental, non-coercive provision of services and resources Meet people “where they are at” Motivate change in a collaborative, empathic environment.

Harm Reduction at Hamilton Family Center Relationship building Encourage client to identify own needs – “Begin where client is” Remembering who the “expert” on the problem is and, whose problem it is Exploring options rather than prescribing Provide clients with a range of strategies, based on the principle of supporting any positive change Ensures the safety of all residents while at the same time recognizing that substance use in and of itself is not a reason for discharge, but rather may be an opportunity to review and revise plans and determine next steps. Goal of supporting the whole family and the overall well- being of all family members.

Trauma Informed Services To be a “trauma-informed” provider is to root your care in an understanding of the impact of trauma and the specific needs of trauma survivors. Avoid causing additional harm to those we serve / re- traumatizing clients. Help clients on their path to recovery. Becoming trauma-informed means adopting a holistic view of care and recognizing the connections between housing, employment, mental and physical health, substance abuse, and trauma histories. Providing trauma-informed care means working with community partners in housing, education, child welfare, early intervention, and mental health.

Trauma-Informed Services Trauma-informed Problems/Symptoms are inter-related responses to or coping mechanisms to deal with trauma. Shares power/Decreases Hierarchy. Homeless families are active experts and partners with service providers. Primary goals are defined by homeless families and focus on recovery, self-efficacy, and healing. Proactive – preventing further crisis and avoiding re-traumatization. Understands providing choice, autonomy and control is central to healing. Traditional Approaches Problems/Symptoms are discrete and separate. Hierarchical. People providing shelter and services are the experts. Primary goals are defined by service providers and focus on symptom reduction. Reactive – services and symptoms are crisis driven and focused on minimizing liability. Sees clients as broken, vulnerable and needing protection from themselves. Adapted from L.Prescott via K. Guarino

Principles of Trauma-Informed Services 1. Understanding trauma: Understanding trauma response and its triggers; Recognizing behaviors as adaptations; Identifying and reducing triggers to avoid re-traumatization. 2. Promoting safety: Safe physical environment; Emotional safety: tolerance for wide range of emotions; Critical to relationship building. 3. Engaging clients: “The process by which a trusting relationship between worker and client is established.” Reduces fear; builds trust; Long-term process. 4. Supporting client control, choice, and autonomy: Trauma survivors feel powerless; Recovery requires a sense of power and control; Relationships should be respectful and support mastery; Clients should be encouraged to make choices. 5. Sharing power and governance: Involve clients in decision-making; Equalize power imbalances. 6. Communicating openly: Respect client’s right to open expression; Discourage withholding information or keeping secrets. 7. Integrating care: Client symptoms and behaviors are adaptations to trauma; Services should address all of the client’s needs rather than just symptoms. 8. Ensuring cultural competence: “ Capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.” 9. Fostering healing: Instilling hope; Strengths-based approach; Future orientation.

Policies address Drug or Alcohol On-site & Behaviors Possession, use, sale, purchase or exchange of drugs, drug paraphernalia, alcohol or alcohol containers. Result of violation is immediate denial of service, with grievance procedure. All other rules behavioral based: threats, assault, theft, destructions, imminent danger, verbal abuse, physical discipline or neglect of children, etc. with penalty ranging from DOS to warning depending on violation.

Partnership with the Collaborative Court System Collaboration with San Francisco Dependency Drug Court prioritizes referred families who have child welfare involvement and have histories of substance abuse. Up to 10 DDC referred families accepted in the program at any given time (out of 20 total units). Other referrals continue to be accepted from: –Emergency Shelters –Domestic Violence Programs –Treatment Programs, etc. From 2008 through 2010, 80% of the families who entered the program had histories of child welfare involvement, substance use, mental health or other specialized needs (39 out of 49). 28 of these families had CPS involvement, 17 of whom were referrals from the Court System. Promising Practices: Family Transitional Housing - Collaborative Justice Partnership

Key Service Components Increased Judicial Supervision Integrated team provides support and wraparound services Intensive Case Management Supportive, but Structured Environment Accessible, appropriate treatment services Relapse Support Coordinated Responses to Family Needs –Substance Abuse Treatment –Behavioral Health Services –Parenting Support –Housing

Promising Practices: Transitional Housing – Collaborative Justice Partnership TRANSITIONAL HOUSING PROGRAM Case Manager / Housing Liaison Therapist Children’s Programming Developmental Screening Parent Education COLLABORATIVE JUSTICE COURT: Commissioner Coordinator Court-Appointed Social Worker CHILD AND FAMILY SERVICES Protective Services Worker INTENSIVE SUPPORT SERVICES Homeless Prenatal Program Team Manager Case Manager TREATMENT PROVIDERS Outpatient Services ATTORNEY’S AND COUNSEL Policy Counsel – City Attorney Parent’s Attorney

Challenges and Solutions Team provider perspectives often differ – some more focused on sobriety while others more focused on harm reduction; often “housing ready” versus “housing first” DDC clients are beholden to CPS requirements, which usually require sobriety – i.e. if there is a relapse, child custody is at stake; Program will not deny services due to relapse, but if children are removed, parents may become ineligible for program due to definition of a family. Key is collaborative communication regarding provider’s definitions of success and expectations and team decision making with the client involved HFC recently agreed to do basic drug testing on site (cotton swab) with caveat that results will not affect program eligibility (unless they lead to ineligibility for other reasons – such as child removal) Assessment of families for fit for transitional housing, versus need for permanent supportive housing, prior to entry is important (using HAM Tool) Considerations: increasing recovery focused services on-site (most are provided through out-patient programs currently); allow families time to stay in program and reunify if children are removed (currently 14 day allowance / increase would require negotiations with Human Services Agency)

Contact: Devra M. Edelman Director of Programs Hamilton Family Center x122