Transcript HUD VASH Housing Support Services

Housing-Focused
Case Management
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REGIONAL CONFERENCE
NORFOLK, VA
MARCH 16, 2009
SUZANNE WAGNER
HOUSING INNOVATIONS
Goals of Housing-Focused Case Management
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Assist people to stabilize their housing arrangements
Assist people to secure stable income
Assist people to reintegrate into the community
Assist people to access and use mainstream resources
Assist people to establish and plan for long term goals
Measures of Success
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Maintaining housing
Increase/stabilization of income
Regular school attendance
Less emergency interventions: ER visits,
hospitalization, incarceration, removal of children
Jimmy
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Jimmy has been living in an encampment for the last four
years. He and his buddies cook together, drink together and tell
stories. Jimmy has a little money from the VA for a 30% service
connected disability. He used to pick up odd jobs and has skills
in construction. He hasn’t been felling so well lately and hasn’t
been able to work. He just got over pneumonia (his third bout
this year) and is feeling like he may be too old for this life. The
hospital social worker has suggested a housing program but he
knows he will never get in. She was nice but just didn’t
understand and what about his friends?
June and her children
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June has two children and no real place to stay. Her
mother helped her for a while but stopped when her
second child was born. She got some help from her
church, who got her a temporary hotel room. It’s too
much trouble to go to work and get the children to
school so they mostly stay in the room and watch TV.
She is worried she may have to ask the children’s
father for help. That’s not a good situation. She never
dreamed she would end up like this.
Housing Stabilization Services
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Using Techniques from Critical Time Intervention (CTI),
Motivational Interviewing and Stages of Change
Housing is the goal: treatment is never the goal
Treatment will sometimes provide the path to the goal
Long term services not crisis oriented
Not always a linear process
Core Elements:
Housing Stabilization Services
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 Assessment
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Goals
Strengths
Understanding barriers to housing stability
Use Stages of Change for assessment
 Engagement on Common Goals
 Education
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Expectations of Tenancy and Housing Options
Available Resources for Support
 Housing Stabilization Plan
 Linkages
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Community, Services, Treatment Resources
 Evaluate progress
Expectations of Tenancy
Paying Rent
• Income
• Financial Management
• Subsidy Administration
• Logistics: check or money order, timeliness
Maintaining Apartment
• Understanding and Meeting Cleanliness Standard
• Inspections
• Safety
• Managing Repairs
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
Assessment Domains
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 What each person wants: where they want to be in
5-10 years
 Housing History
 Income/Benefits
 Education and Employment
 Legal Issues
 Health, Mental Health, Substance Use and Misuse
 Parenting and Child Care
 Record Keeping
Assessment Domains
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 Connections to family and significant others
 Community supports
 Religion and spirituality
 Potential for and orientation to change
Stages of Change
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Provides a tool for assessment of where person
is in their awareness of problem behavior and
desire to change developed by Prochaska, DiClemente
and Norcross
Breaks down the process that people
typically move through to change a
problem behavior
Seen as a wheel and normalizes set
backs and repeating the process
Stages of Change
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Precontemplation
Contemplation
Preparation
Action / Relapse
Maintenance
Jimmy
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Jimmy wants a place where people do not bother him
He wants enough money to live on and to not have to hustle all the time
Jimmy left his family because he was no good for them
Jimmy lived in SROs for 20 years going from one to the other
He says the encampment is the best place he has lived.
He says when he is outside he feels closer to god
He once had his own roofing company and until recently worked pickup construction jobs
He does not consider himself homeless
Jimmy is worried about being sick so much; sometimes it is hard to
breathe
He is proud of his role as the head of the encampment
He worries about the other guys there
He has a record of assaults
He says if you get him housing he will not drink
June and her children
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 June wants a place where she and her children can feel safe; maybe with
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a backyard
June has a trauma history dating from childhood
She has never had anyplace she considers her home
She has never been responsible for an apartment
Junes relationship with the children’s father was abusive
She loves her children and they love her
She has the symptoms of depression and drinks to feel better
She has no income and has been fired from her job, has no benefits and
no health insurance for her children
She wants a chance for her children to get ahead
She is ashamed of being homeless but sees no way out
She draws comfort from her church
She does not believe you can help her
Engagement Strategies
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Introduce yourself and how you can be helpful (provide education about available
resources)
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Repeated, predictable, non-intrusive patterns of interaction
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Listen to felt needs
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Be aware of the difference between crisis needs and longer term needs
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Listen to what people want
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Respect boundaries
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Assess risk
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Be aware that people may tell you what you want to hear
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Allow people as much control as possible over interactions
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Go slowly things unfold over time
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Be patient and persistent
Focused Housing Stabilization Services Planning
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Limit the areas
of intervention
Focus on the
most pressing
needs that
impact housing
Be aware this
may not be a
linear process
Relate all
interventions to
long term goals
Be mindful
about moving
from crisis
Components of the Housing Stabilization Plan -- Goals
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Goals set as a team of clients and worker
 Focus
on the issues that affect housing
retention – base on what caused the
current crisis and previous episodes of
housing instability
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Immediate and longer term goals clear
Focus by phase
 Use the plan for the intervention
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Steps to reach goal clearly defined and measurable
Longer term needs require connections to other resources.
Components of the Housing Stabilization Plan
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Client and Worker Role
• Designs plans for three month
intervals
• Reflects areas of the assessment
• Prioritizes areas for work
• Sets time frames for work to be
accomplished
Components of the Housing Stabilization Plan
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Resource Identification
• Clearly defines resources needed to access
and/or maintain housing including: income,
voucher, credit repair, legal services,
employment assistance/support, financial
planning and management, access to
medical, child care, educational support, and
community based treatment and support
services such a mental health, substance
abuse, etc.
Resources and Referrals
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Develop protocols
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Job training
Unemployment Insurance
Social Security (SSA, SSI, SSDI)
Child Support Assistance
Public assistance, TANF
Medicare
Medicaid
Food stamps
WIC
Child Care subsidy (TANF)
Domestic Violence Services
Veterans Administration
Services for People with Physical
Disabilities
Identify Resources
 Ryan White Program
 State Children’s Health
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Insurance
VA Medical Services, VASH
Vouchers
TANF Transportation services
Medicaid Transportation
Services
S+C , SHP, Section 8, Public
housing, HOPWA
Chemical Dependency Services
Mental Health Services
Health Clinics with sliding scale
MRDD Services
Evaluating the Housing Plan
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Measure Success
• Uses documented steps to reach
goal and benchmarks set
• Uses phases to gauge expectations
and progress
• Identify need to renegotiate goals
and resources
HSS Plan: Jimmy
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Short Term Goal: Access Housing
Longer Term Goal: Recognition of his talents
Areas of Focus:
• Housing: Identify what his preferences are and what he might be
eligible for. Detail expectations of tenancy and plan to meet them
for each option. Include in preferences assessment of need to be
with group of friends
• Medical: Detail current medical needs and develop a plan to
access resources
• Income: Explore what Jimmy might be eligible for and assist to
apply
HSS Plan: June
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 Short Term: Access housing
 Long Term: a better life for her children
 Housing: Identify preferences and what Junes' family might be
eligible for and the requirements of each option. Include school
location as a preference question.
 Family: Assess if the school attendance puts this family at risk.
Support June’s role as a parent including assisting her to set up a
school program and transportation. Look at child care issues.
 Income: Identify what June and her children might be eligible
for. Assist to apply for benefits. Address employment issues
ongoing.
 DV issues: Safety plan for family. Provide access to resources for
trauma and depression issues ongoing
Working Together with Housing Providers
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 Landlord and Property Manager Priorities
 Keeping unit filled
 Rent Payment
 No trouble: follow community rules, don’t disturb neighbors
 Maintain Apartment
Communication Structures with Housing Providers
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 Clear guidelines about when to talk (monthly call
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or visit to landlord/ property manager)
Policies and Procedures for home visits, resolving
problems and role, emergencies, on-call
Address tenancy issues in team meetings and
supervision
Cross Training, In-Services and Trainings
If resident services available: work together
Property Management / Supportive Services
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 Using the structure of the lease
 The lease is the primary contact
 Property Management oversees lease compliance
 Supportive Services assists tenants to meet the requirements
and assume the benefits
 PM: Lease must be consistently enforced
 PM: Lease must be consistent with community standard
 SS: Assist tenants to understand the lease requirements
 SS: Provide assessment and support so that people can
succeed as tenants
 SS: Help people to connect to long term benefits of tenancy
Assistance to meet the expectations of tenancy
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 Drug and alcohol barriers to tenancy:
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PM: Consistently enforce the lease
PM&SS: Start early pay attention to noise complaints, visitor
problems, unit issues and late rent
Provide staff well trained in assessment and interventions
Work with people in the context of their goals
Focus on behaviors related to substance use rather than the use itself
and identify how they jeopardize housing stability
Use stages of change, MI, harm reduction techniques
Provide access to high quality treatment on demand
Avoid a crisis orientation
Recognize sobriety is rarely a one shot deal
Assistance to meet the expectations of tenancy
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 Psychiatric barriers to tenancy:
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PM: Consistently enforce the lease
PM & CM: Start early pay attention to rent arrears, night time noise
complaints, visitor problems, isolation and access problems
Provide well trained staff in assessment and interventions
Provide access to high quality psychiatric care and medications
Work with people in the context of their goals
Focus on behaviors related to mental illness use rather than the MI
itself and identify how they jeopardize housing stability
Use stages of change, MI, harm reduction techniques
Avoid a crisis orientation
Recovery is a process
Other Adjustments
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 Moving in
 Hoarding
 Loneliness
 Constant crisis
 Lack of money
 Being scared
 Leaving
Crisis
 Crisis rarely happens overnight
 Structure of Tenancy can alert to problems
 Have clear protocols in place for crisis management
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Housing: functional
Medical
Psychiatric
Behavior
Financial
Relating to safety: DV, Children
Family
Maintaining Housing
 Use the structure of the lease
 Clear expectations of Tenancy: break it down
 Information is key
 Relationship with the property manager or landlord
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is the foundation
Prevent Crisis
Use your resources
Assist person to see housing as an asset
Connect to long term goals
Support for the Practice: Supervision
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 At least: weekly individual supervision, weekly team
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meetings with case conferencing
Learn by doing: participating in assessments, going
on home visits and meeting with Veterans and their
families and case managers as needed
Managing caseloads and assignments, managing
phases and highlighting need for case conferencing
Identifying training needs and resources for
professional development
Providing support and perspective
Managing resources and access to services
Support: Case Conferencing
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Case Conferencing to improve implementation of the practice,
manage the phases of care and problem solve around barriers to
housing stability
May include clinical consultant
Supervisor identifies cases in each phase, highlights best practices,
identifies themes around barriers, highlights resources
Works with case managers to present and follow up on all case and
issues discussed
Support: Team meetings
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Team meetings have an informational, monitoring and support function
Track where people are in the transition and identify common barriers
Share information and resources amongst team members
Alert team to people and families in distress or crisis
Identify best practices
Follows structure format
Reviews every person in the program at least monthly
Support: Training
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 Provides new skills and resources to existing staff
 Orients new staff to the practice
 Topics Include:
 Orientation to the model of Housing Stabilization Services
 Supporting Interventions
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Stages of Change
CTI
Motivational Enhancement Techniques
Rapid Re-Housing
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Housing Location
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Working with Landlords: housing resources in your community
Developing Community Resources
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Discussion
Thank You!
Housing Innovations
Suzanne Wagner
[email protected]
Tel: (917)612-5469