Home to Stay

1. Home to Stay June 20, 2014 Presenter: Aaron Levitt, PhD Director, CUCS Institute

2. Introductions • Who’s in the room? • Trainer • Direct service workers? • Team leaders/supervisors? • Program managers/directors? • Other? • What do you hope to learn today?

3. Center for Urban Community Services • Direct services to more than 25,000 individuals and families annually in NYC Permanent Housing Transitional Housing Single Stop Street Outreach Psychiatric & Medical ACT Housing Consultation Case Mgt Consultation Reentry Support • Share knowledge with thousands of service providers across the nation annually through the CUCS Institute Training & Implementation Support Management Services Evaluation, Performance Improvement, and Research

4. Why is Home to Stay? • Rental subsidies are enough, aren’t they? • Homeless families vs. homeless singles • Chronic homelessness • Episodic homelessness • “Subsidy-resistant” homelessness

5. What is Home to Stay? • Provides intensive, time-limited support services to help families experiencing repeated episodes of homelessness: • move out of shelter • maintain housing • become self-sufficient

6. Agencies involved Funded by the Robin Hood Foundation in collaboration with NYC Dept. of Homeless Services (DHS) • Lead agency: CUCS • Partnership between four service agencies: • CUCS, Jericho Project, Women in Need, Community Solutions • Project serves 120 families point-in-time

7. Core Elements of the Model • Aggressive and rapid outreach while in shelter • Face-to-face contact within 10 days of referral • Multiple outreach attempts • Caseloads of approximately 15 families per case mgr FTE • Flexible scheduling responsive to families’ needs • Staff trained in/oriented around Motivational Interviewing • Critical Time Intervention (CTI) based case management model • Data-driven performance management

8. Core Elements – Motivational Interviewing (stance) • Client centered evidence based practice • A deliberately structured conversation about change • Example • Saving tax return income for rent

9. Core Elements – MI, cont. • Collaboration vs. Confrontation • Evocation vs. Advice • Autonomy vs. Authority

10. Core Elements – MI, cont. • Express empathy • Nurture self-efficacy • Roll with “resistance” (honor counter-change motivation) • Develop discrepancy

11. Core Elements – MI, cont. • OARS (active listening) • Open-ended questions • Affirmations • Reflections • Summaries

12. Core Elements – MI, cont. • DARN • Desire • Ability • Reason • Need • CAT • Commitment • Activation • Taking steps

13. Core Elements – MI, cont. • Example: A staff member was working with a family that had filed a tax return, and was already planning all of the wonderful things that they were going to buy with their money once it came in. The worker was able to work with the family to budget a portion of their tax return on one big ticket item, and even that item was not as big as they originally intended (32” rather than 55” TV). The staff member was then able to help them budget the rest of their tax return to not only move into housing, but also pay for a few extra months’ rent up front.

14. Core Elements – CTI (structure) • The Model - time limited case management • Designed to “bridge” transition from some institution to life in the community • Commonly a 9-month intervention (three 3-month phases) • Targeted work on a small number of goals (2 or 3) • Focuses on connecting with community resources (linkages) • Diminishing level of contact over the period of intervention

15. Core Elements – CTI, cont. • Home to Stay on the ground • Primary goals – increasing income, finding housing, connecting with community resources (education, mental health) • Continue to engage with family after placement (ensuring community linkages are working out, re-linking if necessary)

16. Core Elements – Data Driven Performance Management • Outcome Indicator: Income Family income target: 200% of market rent Assumes families will need to pay 50% of their income towards rent (federal affordability standard is 30%) Example: • Rent = $1K/month or $12K/year • Income target= $24K/year

17. Core Elements – Data Driven Management, cont. • Outcome Indicator: Housing • Safe • Decent • Honors client choice and community (especially children’s) • <= 50% income

18. Core Elements – Data Driven Management, cont. • Outcome Indicator: Graduations contract requirement: 120 graduations/year Definition: Housing Stability + Self-Sufficiency • Income at 200% of rent or client has a proven record of paying rent and expenses; and • Client shows no evidence of rent or utility arrears; and • Provider is confident that the client will be able to pay rent and expenses in the coming months; and • Community service linkages established

19. Outcomes with Disrupted Rental Subsidies • Results of modified randomized trial (138 H2S, 192 Controls)* • 73% of H2S families exited shelter with housing subsidies compared to 56% of controls • H2S families exited shelter more quickly and returned to shelter less frequently • H2S families spent fewer total days (376 days) in shelter than controls (449 days) *study conducted with families receiving subsidies and before introduction of CTI

20. Outcomes with No Rental Subsidies • Results of modified randomized trial (450 H2S, 870 Controls)* • H2S families took slightly longer to exit shelter • H2S families returned to shelter less frequently *study conducted with higher income requirements for enrollment, CTI-based approach, no subsidies

21. Frequently Asked Collaborating Provider Questions Home to Stay FAQ’s

22. Q: What kinds of things do Home to Stay case workers do for the families on their caseload? • A: The Home to Stay worker will collaborate with shelter staff and the family to create a person-centered service plan that is geared towards defining the family’s goals and obtaining self-sufficiency. Case workers provide emotional and practical support, advocacy, education, employment services, and planning services, and will work with the family to find resources in the community for long-term use.

23. Q: Do Home to Stay families still need to work with shelter staff? • A: Yes. Home to Stay case workers and shelter staff share a common goal of finding permanent housing for clients. Open communication between Home to Stay workers and shelter staff is an integral piece of this process.

24. Q: Who gets “credit” for the placement when a family connected with H2S moves into permanent housing? • A: Everyone! The shelter counts that exit toward its monthly outcomes. Home to Stay can count that exit as a graduation. Most importantly, the family has achieved a significant milestone and moved into a stable, permanent setting, a cause for collective celebration. • Home to Stay staff are eager to work with shelter staff to achieve our mutual goal of finding stable, permanent housing for our families.

25. Q: How can shelters be most helpful? • A: Help us get in touch with families referred to us as quickly as possible. The quicker we get in touch, the quicker we can start connecting the family with resources. • A: Let us know your experience working with these families. What has worked? What hasn’t worked? What are your recommendations? • A: Keep the lines of communication open. If something significant happens with the family, let us know. We’ll do the same! • A: Encourage your clients to continue to stay in touch after we enroll them, and even after they move out!

26. Collaborative Example 1 • Housing Specialist: • Pre-engagement in H2S – Followed up with the family to explain Home to Stay and our services, ensured that they came to the initial screening. • Post-screening – Continues to follow up with Home to Stay regularly to make sure that the family is making appointments. Emphasizes importance of participating in H2S to the family.

27. Collaborative Example 2 • Shelter Case Manager: • Sharing knowledge/experience - Case Manager knows that a client was difficult to reach, because the client didn’t have a phone. • Open communication - Case Manager checked in with Home to Stay worker after each meeting with the client to make sure communication was still open.

28. Collaborative Example 3 • Shelter Director • Quick Connections – Provides case manager and client contact information quickly. • Ongoing Support – Continues to check in with case managers regarding Home to Stay clients, keeps lines of communication open with Home to Stay staff.