There’s No Place Like Home

1. There’s No Place Like Home 2018 SystemLEAD Capstone Group #2 Tammy Setliff, Tara Portee, Linda Mount, Nicole Gore

2. Presentation • What is Permanent Supportive Housing (PSH)? • Why is it important? • How often is it used as a discharge option? • What are the attitudinal and procedural barriers? • What are recommendations for removing barriers?

3. What is Permanent Supportive Housing (PSH)?

4. Traditional Approach Permanent Supportive Housing Transitional Housing Shelter Placement Homeless Treatment Compliance + Psychiatric Stability + Abstinence

5. PSH Approach Permanent Supportive Housing Group Home Community Residential Treatment Longer Term Institutional Care Less Restrictive to More Restrictive Setting

6. Permanent Supportive Housing Permanent supportive housing (PSH) is a national Evidence Based Practice for adults with serious mental illness. PSH combines affordable rental housing with supportive services to address the treatment, rehabilitative, and recovery support needs of participants.

7. Why is Permanent Supportive HousingImportant?

8. Permanent Supportive Housing • Improves Outcomes • Is Cost Effective • Complies with the Americans with Disabilities Act and Olmstead decision

9. How Often is DBHDSUsing PSH as a Discharge Option from State Hospitals?

11. Permanent Supportive Housing Survey • Anonymous • CSB Liaisons (CSBLs) • State Mental Hospital Clinical Social Workers (HCSWs)

12. Research Focus • Attitudinal Barriers • Procedural Barriers

13. Research Question What attitudinal and procedural barriers need to be removed in order to increase the use of Permanent Supportive Housing as a discharge option from State Mental Health Hospitals?

14. Top Four Barriers • Unnecessary Requirements • Client Choice Devalued • Discharge Time Pressures • Lack of Success Stories

15. Barrier - Requirements Some CSBLs and HCSWs believe that unnecessary requirements must be met before a client can be considered for a PSH placement. Survey Question: “Which of the following criteria are prerequisites for a Permanent Supportive Housing Placement?” • Independent Living Skills • Independent Medication Compliance • Income • Independent Means of Transportation • Ability to Hold a Job • Prior Experience with Independent Living • Strong Investment in Recovery

17. Treatment First Approach • Transitional Housing is a program that offers hope of permanence contingent upon displaying “housing readiness” • Housing Readiness can be equated with good behavior. • Housing is not a reward for good behavior

18. Need for Cultural Shift Success requires, “a responsible but determined willingness to take the risks needed to be socially inclusive of people with complex needs. It means being tolerant of failure- not every client given the opportunity gets it right the first time.” -Housing First

19. Barrier – Client Choice Devalued Some CSBLs and HCSWs believe that treatment team housing recommendations take priority over a client’s housing preferences. Survey Question: “Treatment team housing recommendations take priority over a client’s housing preference.” Only 28% of CSBL and HCSW respondents selected an answer signifying that this statement was rarely or never correct.

20. Need for Cultural Shift Paternalism and Fear Safety is the rationalization for elimination of freedoms and autonomy.

21. Recommendation DBHDSshouldpartnerwithasuccessfulPermanentSupportiveHousingProgramto developacomprehensivetrainingprogramforalllevelsofstafffromthefrontlinesto leadershiplevels.The programshouldincludetrainingtochangelong-heldattitudesof riskaversionandpaternalism.

22. Barrier – Time Pressures Survey Question: “Onceanindividualis deemeddischargeready,thereissufficienttimetohavehim/herplacedinPermanent SupportiveHousing.” 29% of all staff and only 6% of CSB discharge planners said they had enough time to place a client in PSH.

23. Identified Issues • Referral Received Late • Lack of Knowledge of Application Process • Lack of Time to Complete All Steps in the Housing Process

24. Recommendation DBHDS should convene a study group made up of all stakeholders to redesign discharge procedures to allow for the extra time needed to effect a PSH placement. The group should look at all possible avenues to streamline the process, including the possibility of maintaining independent apartments for use by clients who are in the process of securing PSH living arrangements.

25. Barrier – Lack of Success Stories Some CSBLs and HCSWs are not exposed to PSH success stories. Survey Question: “Myagencydoesagoodjob ofpromotingPermanentSupportiveHousingsuccessstories.”

26. Recommendation DBHDS should invest in a professionally designed marketing campaign to publicize PSH success stories, including a video of Virginia clients who describe in their own words what the impact of having their own home has had on their recovery.

27. There’s No Place Like Home

28. Conclusion Permanent Supportive Housing Group Home Community Residential Treatment Longer Term Institutional Care Less Restrictive to More Restrictive Setting

29. A life of possibilities for all Virginians Supporting individuals by promoting recovery, self-determination and wellness in all aspects of life. https://www.youtube.com/watch?v=AtZkb0WrR94&feature=youtu.be

30. Questions