Transcript Promising Practices and Impacts of Permanent Supportive Housing

Accommodating All Families:
Addressing Substance Abuse
2011 National Conference on Ending Homelessness
Devra Edelman
Director of Programs
Hamilton Family Center
July 14, 2011
[email protected]
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.
Hamilton Family
Emergency Center
First Avenues:
Housing Solutions
Project
Potential:
Hamilton Family
Residences
Child and Youth Services
Dudley Apartments
Supportive Services
1
Hamilton Family
Transitional Housing
Hamilton Family Center ~
Core Philosophies
Housing First
Trauma-Informed
Services
Harm Reduction
Housing First Principles:
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Homelessness is first and
foremost a housing problem
and should be treated as such
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Housing is a basic human need
and right to which all are entitled
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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
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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
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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:
http://hamiltonfamilycenter.org/
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.
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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
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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 wellbeing of all family members.
Trauma Informed Services
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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 / retraumatizing 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
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Traditional Approaches
Problems/Symptoms are inter-related
responses to or coping mechanisms
to deal with trauma.
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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.
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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
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Understanding trauma: Understanding trauma response and its triggers;
Recognizing behaviors as adaptations; Identifying and reducing triggers to
avoid re-traumatization.
Promoting safety: Safe physical environment; Emotional safety: tolerance for
wide range of emotions; Critical to relationship building.
Engaging clients: “The process by which a trusting relationship between
worker and client is established.” Reduces fear; builds trust; Long-term
process.
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.
Sharing power and governance: Involve clients in decision-making; Equalize
power imbalances.
Communicating openly: Respect client’s right to open expression;
Discourage withholding information or keeping secrets.
Integrating care: Client symptoms and behaviors are adaptations to trauma;
Services should address all of the client’s needs rather than just symptoms.
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.”
Fostering healing: Instilling hope; Strengths-based approach; Future
orientation.
Policies address Drug or Alcohol On-site &
Behaviors
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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.
Promising Practices:
Family Transitional Housing - Collaborative Justice Partnership
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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.
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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
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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
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Substance Abuse Treatment
Behavioral Health Services
Parenting Support
Housing
Promising Practices:
Transitional Housing – Collaborative Justice Partnership
COLLABORATIVE
JUSTICE
COURT:
Commissioner
Coordinator
Court-Appointed Social Worker
ATTORNEY’S AND
COUNSEL
Policy Counsel – City Attorney
Parent’s Attorney
CHILD AND FAMILY
SERVICES
Protective Services Worker
TRANSITIONAL
HOUSING PROGRAM
Case Manager / Housing Liaison
Therapist
Children’s Programming
Developmental Screening
Parent Education
TREATMENT PROVIDERS
Outpatient Services
INTENSIVE SUPPORT
SERVICES
Homeless Prenatal Program
Team Manager
Case Manager
Challenges and Solutions
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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
415-409-2100 x122
[email protected]
www.hamiltonfamilycenter.org