Housing-Focused Case Management

1. Housing-Focused Case Management Regional Conference Norfolk, VA March 16, 2009 Suzanne Wagner Housing Innovations

2. Goals of Housing-Focused Case Management

3. Measures of Success

4. Jimmy

5. June and her children

6. Housing Stabilization Services

7. Core Elements: Housing Stabilization Services • Assessment • Goals • Strengths • Understanding barriers to housing stability • Use Stages of Change for assessment • Engagement on Common Goals • Education • Expectations of Tenancy and Housing Options • Available Resources for Support • Housing Stabilization Plan • Linkages • Community, Services, Treatment Resources • Evaluate progress

8. Expectations of Tenancy

9. Assessment Domains • 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

10. Assessment Domains • Connections to family and significant others • Community supports • Religion and spirituality • Potential for and orientation to change

11. Stages of Change

12. Stages of Change

13. Jimmy • 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 pick-up 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

14. June and her children • June wants a place where she and her children can feel safe; maybe with 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

15. Engagement Strategies • Introduce yourself and how you can be helpful (provide education about available resources) • Repeated, predictable, non-intrusive patterns of interaction • Listen to felt needs • Be aware of the difference between crisis needs and longer term needs • Listen to what people want • Respect boundaries • Assess risk • Be aware that people may tell you what you want to hear • Allow people as much control as possible over interactions • Go slowly things unfold over time • Be patient and persistent

16. Focused Housing Stabilization Services Planning

17. Components of the Housing Stabilization Plan -- Goals • 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 • Immediate and longer term goals clear • Focus by phase • Use the plan for the intervention • Steps to reach goal clearly defined and measurable • Longer term needs require connections to other resources.

18. Components of the Housing Stabilization Plan

19. Components of the Housing Stabilization Plan

20. Resources and Referrals Develop protocols Identify Resources • 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 • Ryan White Program • State Children’s Health 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

21. Evaluating the Housing Plan

22. HSS Plan: Jimmy

23. HSS Plan: June • 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

24. Working Together with Housing Providers • Landlord and Property Manager Priorities • Keeping unit filled • Rent Payment • No trouble: follow community rules, don’t disturb neighbors • Maintain Apartment

25. Communication Structures with Housing Providers • Clear guidelines about when to talk (monthly call 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

26. Property Management / Supportive Services • 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

27. Assistance to meet the expectations of tenancy • Drug and alcohol barriers to tenancy: • 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

28. Assistance to meet the expectations of tenancy • Psychiatric barriers to tenancy: • 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

29. Other Adjustments • Moving in • Hoarding • Loneliness • Constant crisis • Lack of money • Being scared • Leaving

30. Crisis • Crisis rarely happens overnight • Structure of Tenancy can alert to problems • Have clear protocols in place for crisis management • Housing: functional • Medical • Psychiatric • Behavior • Financial • Relating to safety: DV, Children • Family

31. 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 is the foundation • Prevent Crisis • Use your resources • Assist person to see housing as an asset • Connect to long term goals

32. Support for the Practice: Supervision • At least: weekly individual supervision, weekly team 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

33. Support: Case Conferencing

34. Support: Team meetings

35. Support: Training • 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 • Stages of Change • CTI • Motivational Enhancement Techniques • Rapid Re-Housing • Housing Location • Working with Landlords: housing resources in your community • Developing Community Resources

36. Discussion Thank You! Housing Innovations Suzanne Wagner suzanne.wagner@earthlink.net Tel: (917)612-5469