HUD VASH Housing Support Services

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Case Management

    MARCH 16, 2009

  Goals of Housing-Focused Case Management

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

Maintaining housing

Increase/stabilization of income

Regular school attendance

Less emergency interventions: ER visits,
hospitalization, incarceration, removal of children

   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

 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

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
 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
                       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.

 • Only people on the lease live there
              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
              Assessment Domains

 Connections to family and significant others
   Community supports

   Religion and spirituality

 Potential for and orientation to change
  Stages of Change

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

     Action / Relapse

   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
   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

 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
                      Engagement Strategies

   Introduce yourself and how you can be helpful (provide education about available

   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
Focused Housing Stabilization Services Planning

                    Focus on the
Limit the areas                           Relate all
                    most pressing
of intervention                        interventions to
                     needs that
                                       long term goals
                   impact housing

          Be aware this          Be mindful
           may not be a         about moving
          linear process         from crisis
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.
Components of the Housing Stabilization Plan

Client and Worker Role
• Designs plans for three month
• Reflects areas of the assessment
• Prioritizes areas for work
• Sets time frames for work to be
Components of the Housing Stabilization Plan

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

Develop protocols                            Identify Resources
   Job training                              Ryan White Program
   Unemployment Insurance                    State Children’s Health
   Social Security (SSA, SSI, SSDI)             Insurance
   Child Support Assistance                    VA Medical Services, VASH
   Public assistance, TANF                      Vouchers
   Medicare                                    TANF Transportation services
   Medicaid                                    Medicaid Transportation
   Food stamps                                 S+C , SHP, Section 8, Public
   WIC                                          housing, HOPWA
   Child Care subsidy (TANF)                   Chemical Dependency Services
   Domestic Violence Services                  Mental Health Services
   Veterans Administration                     Health Clinics with sliding scale
   Services for People with Physical           MRDD Services
      Evaluating the Housing Plan

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

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
                      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
 DV issues: Safety plan for family. Provide access to resources for
  trauma and depression issues ongoing
 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
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
   Cross Training, In-Services and Trainings
   If resident services available: work together
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
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
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
                 Other Adjustments

 Moving in
 Hoarding
 Loneliness
 Constant crisis
 Lack of money
 Being scared
 Leaving

 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
                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
        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
            Support: Case Conferencing

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
                       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

         Thank You!
     Housing Innovations
       Suzanne Wagner
      Tel: (917)612-5469