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CTI STEPDOWN Powered By Docstoc
					            STEPDOWN SERVICES WORKSHOP
                        NOVEMBER 2, 2011
Presented by CSH & Heading Home Hennepin:
                      StepDown Committee




                                            1
   Introductions
   Background on Best Practices
   Housing Stabilization Services: supporting
    practice
    ◦ Overview of HSS
    ◦ Using the Lease to Structure the Work
    ◦ Coordination of Support Services with
      Landlords/Property Management Services
    ◦ Connections with Mainstream Resources
   Applying the Practice Of CTI
   Case Examples
   Wrap up


                                                 2
   New federal directions (HEARTH and Federal
    Strategic Plan (FSP) and
   Evidence Based Practices (EBPs)
    ◦ Reduce length of time people spend in the crisis of
      homelessness
    ◦ Rapidly exit them from homelessness and access
      permanent housing
    ◦ Provide services in the home to achieve housing stability
      and prevent returns to homelessness
   Principles and practices of Housing First have
    been expanded to other homeless populations
    besides chronically homeless with success

                                                                  3
Principles and Practices with Applicability to Other
  Homeless Populations
 Immediate access to housing
 Low or no threshold for entry
 Single site or scatter site housing
 Harm reduction approach to substance use and
  other life issues
 Limited program requirements and case
  management service model
 Separation of housing and treatment/support
  services. Focus on housing stability
 Not “Housing Only”, must have services




                                                       4
   Housing First participants’ shelter use dramatically
    decreased after housing placement.
   The program increased the number of days and the
    continuity of health care coverage.
   The Housing First program contributed to a decreased in
    arrests in the 12 months pre- and post-placement. The
    decrease was not seen after only 3 or 6 months.
   Housing First participants experienced a decline in their
    average incidents of victimization in the 12 months pre-
    and post-placement.
   The Housing First program did not reduce the percentage
    of long-term or frequent shelter users.
   Placement into housing had a positive effect on
    participants’ feelings of safety and well-being.


                                                                5
   The Housing First program did not reduce the
    percentage of long-term or frequent shelter users.
   Placement into housing had a positive effect on
    participants’ feelings of safety and well-being.
   The transition to housing posed challenges related to
    new daily activities and a changing social
    environment.
   The location of initial placement for many
    participants was not the last.
   Participants noted their respective case managers
    provided a great deal of support before, during, and
    after the move into housing.
   Transportation was a significant challenge that
    affected prospects for jobs, access to health care, and
    general well-being for participants after placement.
                                                              6
                            7


   Critical Time Intervention (CTI) TI has been
    recognized an Evidence-Based Practice by the
    federal Substance Abuse and Mental Heath
    Services Administration (SAMHSA) and the
    President’s New Freedom Commission on Mental
    Health
   CTI is based on the research of Columbia
    University’s (Columbia Center for Homelessness
    Prevention Studies) work with the homeless
    individuals
   Point at which person moves into new housing
    provides a critical opportunity to make changes
                   www.criticaltime.org
   Individuals Leaving the Shelter System
   Frequent Users of Emergency Rooms
   Youth Leaving MH Residential facilities
   Families Leaving the Shelter and Transitional
   CTI team Providing Increased Support in First
    Year of Supportive Housing
   Step Down from ICM and ACT
   Integrated into the VASH Program


                                                    8
End each person’s homelessness permanently

Assist individuals to stabilize in housing

Assist people to secure/maintain stable income

Assist individuals to reintegrate into the community
Assist individuals to access and use mainstream
resources
Assist individuals to establish long term goals as a
motivator for change

                                                       9
Housing is the goal, the lease and each person’s
self-defined long term goals focus the work
Best predictor of the future is the past, get housing
history
Treatment/services are often resources to achieve
the goal, not the goal itself

Not always a linear process


“Assertive” landlord/property mgmt is necessary


                                                        10
   Provide services in the home and the
    community
   Ongoing assessments of housing barriers to
    prevent housing loss
   Connect with other mainstream and
    community-based services – benefits and
    services
   Connect with natural supports including
    spiritual



                                                 11
   Landlords and property managers to establish
    tenancy obligations and enforce them
   Focus on eviction prevention and use the
    structure of the lease to guide your
    interventions
   Coordinate Property Management and Social
    Services interventions
   Use Evidence-Based Practices EBP’s
    ◦ Critical Time Intervention
    ◦ Motivational Interviewing


                                                   12
Maintaining housing



Increase/stabilization of income (earned
and benefits)


Connections with services and supports to
prevent becoming homeless again


                                            13
   Assessment
    ◦ Goals
    ◦ Understanding Barriers to Housing
   Engagement on Common Goals
   Education
    ◦ Expectations of Tenancy, Lease and Housing Options
    ◦ Available Resources for Support
   Housing Stabilization Plans (aka “Service Plans”) and Services:
    ◦ Using treatment as a link to self-defined goals
    ◦ Using CTI as a tool
   Linkages and Coordination
    ◦ Landlords/Property Managers, Community, Services, Treatment
      Resources
   Evaluate progress


                                                                      14
Paying Rent
 • Income and financial management
 • Subsidy Compliance if applicable
 • Logistics: check or money order, timeliness
Maintaining Apartment
 • Understanding and meeting cleanliness standards
 • Inspections
 • Safety and managing repairs
Quiet Enjoyment
 • Getting along with neighbors
 • Visitors
 • Following building/unit rules and norms
Occupancy
 • Only people on the lease live there


                                                     15
   Don’t pay rent
   Violate rules e.g., noise
   Hoard or otherwise create health and safety
    hazard
   People move in who are not on the lease
   Engage in criminal activity
   Others??
   Need to monitor and assist in meeting
    tenancy obligations


                                                  16
 Limit the areas of                               Relate all
                      Focus on the most
intervention based                            interventions to
                      pressing needs that
on housing barriers                          keeping housing +
                        impact housing
    assessment                                long term goals



            Be aware this may
                                  Be mindful about
             not be a linear
                                  moving from crisis
                 process




                                                             17
1.   Housing Stabilization and Lease Compliance
2.   Income and Financial Management
3.   Family & Other Relationships
4.   Mental Health and Medical
5.   Substance Use and Misuse
6.   Life Skills
7.   Strengths and Potential for Change – how has
     person managed in the past?


                                                    18
   A safe place to live
   Work
   Enough money to live on
   Friends
   Valued status and a role in the community –
    purpose and structure
   Move from crisis
   Community
   A chance for their children
   “Dignity of Risk”
   5 Years from now?
Explore what each person’s choice means
 History (i.e. housing, employment, safety)
 How this person became homeless: what
  worked what didn’t
 How each person has managed in the past
 Preferences: what does the individual/family
  want
 Financial Issues
 Implications of disabilities or service needs
  and how this relates to goal
 Long term goals: how do they see their
  future?
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
 The Plan determines your interventions
Steps to reach goal clearly defined and measurable
Longer term needs require connections to other
 resources.



                                                      21
Tenant and Staff Roles
•Reflects areas of the assessment
•Prioritizes areas for work
•Sets time frames for work to be
 accomplished

                                    22
Mainstream Resource Identification
• Clearly defines resources needed to access and/or
  maintain housing including: income, benefits,
  credit repair, legal services, employment
  assistance, financial planning and management,
  access to medical services and child care,
  educational support, access to community based
  services such a schools, mental health, substance
  abuse, etc.


                                                      23
Measure Success
• Uses documented steps to reach goal
  and benchmarks set
• Uses phases to gauge expectations and
  progress
• Identifies need to renegotiate goals and
  resources

                                             24
   One of the goals is for individuals to be stably housed
    and in order to do so, they need to learn how to
    manage their tenancy obligations.
   One of the keys to achieving this goal is the active
    coordination between property management and
    support services staff, while maintaining the functional
    separation of these two staffs.
   Having separation of functions helps tenants learn by
    being treated no differently from any other tenant by
    the property management. (Don’t want to create
    alternate reality)
   Problems that threaten tenancy may motivate tenants to
    use services in order to keep their housing.
   Landlord has a key role in helping people
    understand their obligations and comply
    with them. (Assertive approach)
    ◦ Establish the expectations for the tenant
   The social services staff provide and
    arrange for services needed to maintain
    housing and also function as advocates for
    the tenant.
    ◦ Assist the tenant to meet the expectations of
      tenancy
27
   Hold tenant to the obligations of the lease
   Respond to problems in a timely way
   Contact case manager early on when
    problems first arise
   Provide written notices to tenants of rule,
    lease violations or late rent payment
    ◦ Ideally, cc the case manger
   Work with Case Manager to resolve barriers to
    maintaining unit.



                                                    28
   Landlord/tenant mediation services
    ◦ Funded as homelessness prevention
    ◦ Education for case managers as to legal
      requirements/process
   Use of the courts
    ◦ Stipulation process
   Planning for emergency resources
    ◦ Rent and Utility payment
   Housing plan to maintain tenancy
   Agreement on project goals: Assisting
    Tenants to Maintain Housing
   Acknowledge that the services are
    transitional but also will identify on-going
    supports
   Each is oriented to each other’s roles
   At least monthly communications focused
    on tenants compliance with lease
   Input and feedback from property
    management staff is sought and valued
   Support and acknowledge the
    landlord/property management role
There is often a great deal of confusion and frustration
around what information can be shared and what information
is confidential

EXAMPLES
Public display of intoxicated behavior: Public Information

Tenant disclosing a mental health diagnosis or medical
information: Confidential

Other CONFIDENTIAL information: Any information that is
obtained in the context of professional services is deemed
privileged information
   Develop a person focused resource list
   Identify Resources by Focus Areas and Tasks
   Review Resources in Current Use
   Add resources developed through work with
    tenants
   Identify Needed Connections
   Income, benefits AND services
   Using Client resource directories in each
    region

                                                  32
   Benefits and Entitlements including
    Emergency Assistance
   Financial literacy and credit repair services
   Employment Programs
   Education and Job Training Programs
   Legal Services
   Food and Nutrition Programs
   Children’s Services
   Clothing and Furniture Banks
   Health Clinics
   Dental Services
   Mental Health Services
   Substance Use Treatment Programs
   Counseling Services – Family, DV, Trauma
   Lists of AA and NA meetings
   Emergency Services – DV Hotline, Child Abuse
    and Neglect Reporting, Mobile Mental Health
    Services
   Social, Spiritual and Recreational
    Opportunities

                                                   34
   Public transportation
   Community centers
   Camps and employment programs for adolescents
   Libraries
   Civic associations
   Settlement houses
   Parks, recreational and sports facilities
   Places of worship
   Adult education, classes and workshops
   Tutoring and mentoring programs for children
   Arts organizations
   Clubs and hobby groups
   Ensure knowledge of them – directory, visits to
    programs, ask clients, goals and what they
    provide
   Introduce yourself and your agency, especially if
    there will be a lot of referrals
   Explain your role and what they can expect
   Attempt joint or coordinated service planning
   Gather and share history (with client’s consent)
   Accompany person to assist with engagement
    with new service
   Maintain regular contact and keep your promises


                                                        36
   Be Persistent, Patient And Reachable
   Provide information about the person that helps them to
    do their job
   Recognize Each Program Has Their Personal Service &
    Outcome Goals
   Ask About And Understand Expectations For Participants
   Be On Time For Appointments And Follow Up With Any
    Information They Require For Admission
   Understand How The Program Interacts With Your
    Client’s Health Insurance, Entitlements, Patients Rights
    To Services, & Other Collaterals
   Assure The Provider Of Your Involvement




                                                               37
   Educating on the process
   Helping tenants to negotiate for services and
    enlisting the services help
   Establishing regular check ins
   Recognizing strong partners
   Renegotiating the relationship as necessary
    Assists individuals and families to stabilize in housing by:
    ◦ strengthening people’s ties to community services, family, and
      friends
    ◦ the provision of a focused case management approach that is
    ◦ connected to each participant’s life goals.
   Time-limited (6-9 months)
   Three 3-month phases of decreasing intensity (transition to the
    community, try out, termination)-starts when moving into housing
   “Manualized” Intervention with Focused services (1-3 areas from 6
    assessment areas) based on threat to long-term housing stability
    and access to support (mental health, housing, substance misuse,
    life skills, financial, and family and other social supports)
                               www.criticaltime.org


                                                                        39
   Longitudinal: adapt to persons functioning over time
   Individual: care is planned with the individual and
    addresses particular needs
   Comprehensive: individuals can receive a variety of
    services related to their many needs
   Flexible: individuals are allowed to progress at their
    own pace
   Accessible: individuals are able to access services
    when they need them and in a way which is financially
    manageable.
   Communication: between person and case manager
    and service providers and among service providers
    involved in the person’s care
 Housing Planning
 Phase 1: Transition to the Community
    ◦ CTI begins
 Phase 2: Try-out
 Phase 3: Termination


   Phases 1-3 last approximately 1-3
    months each

                                         41
   Engagement
   Risk Assessment: Assess for any crisis situations
   Educate person about Housing Options they may be
    eligible for
   Provide direct services and assistance to link with
    resources as needed
    ◦ May include income, ID, and other concrete needs to access
      housing
    ◦ Addressing immediate needs
    ◦ May be linkages to needed care such as psychiatric, medical,
      dental or SA
   Housing Assessment


                                                                     42
   Assessment of new needs and resources
    ◦ Review assessment and revise based on current housing and
      lease compliance. Identify resources needed. Focus on
      community support, role and activity
   Housing Planning revision
    ◦ Review plan and revise based on priority area, immediate needs
      and current resources.
   Assistance in making linkages: meeting with the
    person and the resource if necessary
    ◦ Refine communication structures with landlord, services and
      other supports
   Skill building for community resources
    ◦ Provide education about rights, responsibilities, and
      expectations; model negotiation skills

                                                                       43
   Solidifying Linkages to Community Resources
    ◦ This might include: legal assistance, schools for
      children, religious/spiritual, community treatment and
      support options
   Promote independent living skills
    ◦ Ensure income in place, financial management, tenancy
      obligations, schedule and role
   Ensure communication support systems
   Regular meetings monitor progress and connections
   Developing longer term plan
    ◦ Look at non-immediate needs such as education
      planning, career goals, long term housing plans
   Continue to use MI techniques


                                                               44
   Fine Tuning Linkages
   Higher Level Skills training
    ◦ Focus on Negotiating Skills
   Plan to address housing risks as they arise
   Step down and let go- having other linkages
    take primary role
    ◦ Ensure needs are met, develop adjust linkages if
      needed
    ◦ Assess worker role going forward
    ◦ Develop formal plan with household and Linkages


                                                         45
   Some individuals may not be able to complete
    the program in nine months:
    ◦ We have not definitively identified who that group of
      individuals is
    ◦ CTI can be used as an assessment tool
    ◦ Identify longer term resources in the community
    ◦ Identify longer term rent subsidies in the community
    ◦ How does access to those resources get prioritized?
   Supervision:
    ◦ At least: weekly individual supervision, weekly team
      meetings with case conferencing
   Case Conferencing:
    ◦ Highlight best practices, identifies themes around
      barriers, highlights resources, provides clinical
      consultation
   Team Meetings:
    ◦ Team meetings have an informational, monitoring and
      support function, track where people are in the transition to
      and identify common barriers, share information and
      resources amongst team members, alert team to people in
      distress or crisis, identify best practices
   Training

                                                                      47
   Involve leaders
   Set shared aims
   Welcome everyone
   Self-conscious
   Non-linear
   Devolve control
   Manage knowledge with agility
   Reflective and responsive
   Sense- making
   Values asking
   Recognition economy
   Stimulate affection among members
   Ending homelessness takes a village
   New models and strategies
   New outcomes
   Building on the experience

   In order to achieve goals, must continue to
    evolve services and programs




                                                  49
   Thanks!



   contact:
   Andrea White
   Housing Innovations
   awhite@housinginnovations.us




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