Transcript Introduction - California Institute for Behavioral Health Solutions

Successfully Housing
People with Substance
Use Issues
Prepared by Clegg & Associates, Inc. (Seattle, WA)
Under contract with AIDS Housing of Washington, in
partnership with the Corporation for Supportive Housing
The research, development, and publication of this curriculum was funded by the
Housing Opportunities for Persons with AIDS (HOPWA) National Technical Assistance
Program in partnership with the U.S. Department of Housing and Urban Development’s
Office of HIV/AIDS Housing. The substance and findings of the work are dedicated to
the public. The author and publisher are solely responsible for the accuracy of the
statements and interpretations contained in this publication. Such interpretations do not
necessarily reflect the views of the Government.
2
Training Sessions
I.
Understanding the
Issues Your Tenants Face
II. The Housing Context
III. The Effective Tool Kit
IV. Separating the Personal
from the Professional
3
Session 1
Understanding the Issues
Your Tenants Face
4
Three Classes of Drugs

Stimulants (“Uppers”)

Depressants (“Downers”)

Psychedelics/
Hallucinogens
5
“Uppers”

Cocaine / “crack”

Amphetamines

Over-the-counter
stimulants

Nicotine
6
Physical Effects of “Uppers”

Constricted blood vessels

Increased heart rate

Increased blood pressure

Increased respiration
7
Behavioral Effects of “Uppers”

Confidence

Paranoia

Alertness

Aggressiveness

Euphoria

Anxiety

Irritability

Violence

Restlessness
8
“Downers”

Opiates/opioids

Sedative hypnotics

Alcohol
9
Physical Effects of “Downers”

Slowed respiration

Depressed heart rate

Decreased coordination

Sleepiness

Pain messages
blocked
10
Behavioral Effects of “Downers”

Diminished anxiety

Inability to concentrate

Euphoria

Sluggishness
11
Psychedelics/Hallucinogens

LSD

Marijuana

PCP

Ecstasy

Mushrooms
12
Physical Effects of
Psychedelics and Hallucinogens

Increased heart rate,
blood pressure,
and body temperature

Dizziness

Dilated pupils

Sweating

Visual distortion
13
Behavioral Effects of
Psychedelics and Hallucinogens

Impaired reasoning

Slow reaction time

Extremes of euphoria
and panic/paranoia

Delusions of persecution

Feelings of grandeur
14
Recognizing Behaviors –
Substance Use vs.
Mental Health Issues
15
The Cycle of Use
Abstinence
No use of legal or illegal drugs
Experimentation
Heavy Use/Drug Abuse
Curiosity and
willingness to act
Continued use regardless
of negative consequences
Social/Recreational
Chaotic Use/Addiction
Periodic use with no
established pattern
Compulsive behavior
Habitual
Established pattern
of use
16
Symptoms of Withdrawal

Seizures

Lack of energy

Sweating

Depression

Goose bumps

Flashbacks

Vomiting

Heavy cravings

Diarrhea

Erratic mood swings

Tremors
17
Stages of Change
Precontemplation
No awareness
Contemplation
Aware and
considering change
Maintenance
(including relapse)
Continuing
the change process
Preparation
Action
Thinking about taking
steps towards change
Modifying behavior to
overcome problem
18
Relapse – A Natural Stage
in a Recovery Process
19
Signs of Relapse








Arguing
Forgetfulness
Stress symptoms
Returning to old habits
Lack of self care
Moodiness or depression
Boredom
Euphoria
20
Relapse Triggers

Lack of or loss of a
support network

Troubled
relationships

Social pressure

Negative life events

Positive life events
21
Tenants
Every tenant brings a history,
a culture, and a set of
expectations and
behaviors

Personality
 Mental health
 Physical health
 Social history
 Ethnic/racial identity
 Housing experience
22
Drug and Alcohol Use
Creates Its Own Community
23
The Goal –
Keeping Tenants Housed
24
Session 2
The Housing Context
25
Applicable Federal
Laws and Regulations







Equal Protection Clause
Fair Housing Act
Americans with
Disabilities Act
Rehabilitation Act of 1973
Age Discrimination Act
HUD regulations
(including “One Strike”)
Confidentiality laws
26
Other Rules and
Regulations to Consider

State and local
landlord-tenant law

Local housing
authority regulations

Agency rules,
policies, and
procedures
27
Your Role in Compliance

Complying with the
Fair Housing Act

Ensuring reasonable
accommodation

Maintaining tenant
confidentiality
28
Resources - Housing

Emergency shelters

Transitional housing

Residential treatment
programs

Permanent housing

Populationspecific housing
29
Resources – Internal Team

Maintenance staff
HIV/AIDS specialists
Chemical dependency specialists
Mental health specialists
Case managers
Property managers
Landlords
Resource coordinators

Peer-to-peer workers

Supervisors







30
Resources – Service Providers

Mental health
providers/hospitals

Employment-related
services

Health care services

Educational services

Public benefits

Transportation

Substance use
treatment programs

Domestic violence
agencies

Child care/
foster care

Legal services

Criminal justice system

Food banks/
meal providers

Adult day care

Money management
services
31
Other Resources

Family

Friends

Faith-based organizations

Neighbors

Library

Internet
32
Qualities of an Effective Team









Clearly defined goals
Clearly defined roles
Relevant skills
Clear communication
Personal accountability
Unity of approach
Trust of tenants
and co-workers
Commitment to learning
Leadership
33
Keep the Lines of
Communication Open

Community service
providers

Off-site property
management
staff and landlords

On-site service staff
and property
management staff
34
Session 3
The Effective Tool Kit
35
Goals of Engagement

Care for
immediate needs

Development of trust

Provision of services

Connection to social
networks

Increased housing
stability
36
Engagement Strategies

Set the stage

Initiate your
engagement strategy

Sustain the
relationship

Maintain momentum
37
Tips on Engagement

Pace yourself

Focus on behaviors

Listen, observe,
and communicate

Be consistent
and reliable

Maintain realistic
expectations

Negotiate and
compromise

Use a non-judgmental
approach

Stay “up” when the
tenant is “down”

Emphasize strengths
vs. weaknesses

Celebrate the
smallest successes
38
Employment as an
Engagement Strategy
39
Motivational Interviewing –
An Engagement Tool
40
Five Principles of
Motivational Interviewing

Express empathy

Distinguish goals from
current behavior

Avoid arguing

Roll with resistance

Embrace optimism
41
The Role of Community

Creates a
vested interest

Fosters self
awareness

Develops self-esteem

Builds skills
42
Building Community

Welcome and
orient new tenants

Encourage,
support, and
reinforce
community norms

Offer group
activities

Develop leadership
qualities and peer
support
43
Understanding Assessment

Identify drugand non-drug-related
risk behaviors

Prioritize service needs
44
The Purpose of Assessment

Determine what you
need to know
to help the tenant
stay housed

Identify what you need
to know to protect the
stability of your other
tenants
45
Identify Stress Points

Economic/financial
issues

Health-related
concerns


Loss of
community/family

Psychological
stressors

History of violence

Spiritual voids

Lack of food or
other basic needs

Physical mobility
Parenting pressures
46
Key Issues in Assessment





Ability to meet
basic needs
Environmental and
behavioral triggers
Predatory
behaviors
Interests
Stability
47
Key Approaches in Assessment






Be clear and calm
about your purpose
Don’t fear being too
intrusive
Avoid yes/no questions
Avoid being manipulated
Be consistent
Ask about past
behaviors
48
Service Planning Fundamentals

Involve the tenant

Don’t generalize

Be realistic

Be creative and
willing to experiment

Develop
achievable goals

Network, network,
network

Avoid “splitting”/
triangulation

Have a “Plan B”
49
Health and Safety Checks
50
Conflict Resolution

Ask questions and listen

Define the problem

Brainstorm solutions

Evaluate options

Use behavioral contracts
51
Handling Crisis Situations

Calm the tenant

Listen carefully

Maintain personal
safety

Debrief

Receive training

Keep emergency
numbers at hand
52
Working with Tenants
at Risk of Eviction

Mobilize your
resources

Step up the intensity

Develop a behavioral
plan with the tenant

Communicate with
the tenant
53
Eviction as a Reality

Understand local
landlord-tenant laws

Follow legal procedures

Document behaviors

Be prepared to go to court

Learn to let go
54
Session 4
Separating the Personal
from the Professional
55
Professionalism Means:







Self awareness
Understanding your role
Reliability and consistency
Knowledge of resources
Commitment to learning
Teamwork
Understanding cultural
competency
56
Boundaries – Rules for Maintaining
a Professional Relationship
57
Warning Signs of Boundary Blur

Seeking out tenant
outside work

Tolerating aggressive
behavior

Anticipating
appointments


Disclosing considerable
detail about yourself
Diverging from formal
policies
and procedures

Taking responsibility for
the tenant’s success
Doing favors for
a tenant

Linking your
advancement to
tenant’s success


Accepting gifts
58
Formal Policies vs.
Informal Practice
59
Appropriate Boundary Crossing

Action directly relates
to housing or clinical needs

Professional literature
supports your action

Risk-benefit analysis
supports your decision
60
Tips for Self Care







Clarify expectations
Have realistic
expectations
Keep a sense of
humor
Celebrate small
successes
Roll with the
punches
Set limits
Recognize strengths

Learn to let go

Don’t get caught up
in sense of urgency

Don’t be a rescuer

Don’t try to be a drug
treatment expert

Don’t take it
personally

Don’t try to go
it alone
61