Programs for Permanent Supportive Housing: Evidence-Based Practices

1. Programspermanent supportive housing: Evidence Based Practices Cynthia Latcham B.A. Director of Programs & Services Anawim Housing

2. Shelter Plus Care 1 Serving individuals and families who had been homeless

3. Shelter Plus Care 2 Serving individuals who were chronically homeless

4. Homeless To Housing • Homeless to Housing started in 2015 and housed 22 chronically homeless individuals in 2017. • Anawim program manager provides case management services targeted to stabilize long-term homeless individuals. 33% 81% HOUSING STABILITY INCOME INCREASE

5. Housing Opportunities Program 1 & 2 • Anawim began Housing Opportunities Program (HOP) 1 in 2016 and HOP2 in 2017. • Together, these programs housed 76 chronically homeless individuals in Permanent Supportive Housing in 2017. • These programs are funded through HUD. • Program managers provide case management services in order to address housing stability.

6. PSH: Developing a Project • Funding- Anawim Funds through HUD CoC Competition • Agency Capacity • Accounting • Staff Hiring and training • Property Management training • Leasing • Iowa Landlord & Tenant Laws • Fair Housing • Documentation • Performance Measure Tracking • Landlord engagement and Leasing

7. Barriers to Implementation • Agency wide commitment to serve vulnerable populations. • Lack of internal accounting supports and software to support required federal audits • Property Management experience including leasing and Iowa Tenant/Landlord laws and property management software • Staff Capacity • Lack of variety in housing configurations and landlords. • Poor quality Housing Stock (HQS/ Rental Certificates) • Lack of commitment to Housing First as an EBP. • Inferior Centralized Intake process.

8. Program Entrance Criteria • All referrals are made through Centralized Intake (CI) referral process • CoC grant recipients have signed MOU with CI • Documentation of chronicity • Verified disability: Mental Health, SUD, HIV/Aids, Medically fragile or fleeing domestic violence* • Disability form signed by LISW, MD, PA, DO, AANP • Current SSI benefit award letter • Medical records including above diagnosis. • Not currently on sex offender registry • CI denial form based upon extreme situations

9. Evidence Based Practices: • Housing First • Motivational Interviewing • Trauma Informed Care • Critical Time Intervention • Assertive Community Treatment- Through Community Partners

10. Staffing and Training • 20:1 Caseload. • Program Managers with experience in Social Work, Employment Services, Mental Health, Substance Treatment or Human Services • On the job training in Property Management and Iowa Landlord & Tenant laws. • Staff attends community trainings on job development, Trauma Informed Care, Aces, Motivational Interviewing, etc. • Program Department operates as a case management team with all members offering experience in the form of formal and informal staffings.

11. Performance Measures • HUD Continuum of Care (CoC) Performance Measures- Collected through HMIS and reported through SAGE APR • Community • Length of time homeless • Length of shelter stays • Variety of programs (PSH,RRH,TBRA) • Point In Time Count (PIT) • Projects • Length of time housed • Increased income (earned and disability) • Connection to mainstream medical services • Exits to other permanent housing • Return to homelessness at 6 months and 2 years

12. Increasing Income • Through benefit cases: SSI/SSDI SOAR Training • Through Earned employment • Utilizing staff trained in job development • Utilizing community partners (EKD, Goodwill, PREP, DMACC) etc. • Challenges • With income comes the responsibility of paying rent (roughly 30%). • Documentation and rent calculations • Cliff effects

13. HUD PSH Budget • Rental Assistance including security deposits and damage • Cannot exceed Fair Market Rent (FMR) • Must be “Rent Reasonable” • Supportive Services • Includes Case Manager salaries. • Assessments: • Service Needs • Employment • Life Skills • Very minimal $ for Moving and Transportation Costs • 7% Administrative Costs- Admin costs associated with accounting for the use of grant funds • 25% Program Match • HUD will not increase budget due to market forces of rent pricing. Programs are expected to serve the original number of tenants/units regardless of grant funding.

14. What Is Match? • Cash or In-kind contributions by Anawim Housing and Community Partners including completed MOU • Anawim Housing must match $539,000 for current 5 HUD grants • Cash and In-Kind contributions eligible and outlined in 24 CFR Part 578 “the value of any real property, equipment, goods or services, provided the sub-recipient had to pay for them with grant funds. • Examples of In-Kind Donations: IHH, Path, SCL Services, SUD Treatment, Cleaning Supplies, donated housing goods • Must be documented and verified.

15. What is Housing First? • Homelessness is a housing crisis solved with housing • All people experiencing homelessness can achieve housing stability • Everyone is “housing ready” Providers need to be “Consumer ready” • Housing is therapy • People experiencing homelessness have a right to self-determination and be treated with dignity and respect. • Housing configuration and services are matched to the individual needs.

16. Maslow’s Hierarchy

17. Core Components: • No prerequisites to enter permanent housing • Low barrier admissions: Criminal Hx., SUD, Mental Health • Rapid and streamlined entry • Voluntary supportive service-offered diligently by program managers • Flexible and responsive to service needs tailored to individual • Tenants have full rights, responsibilities and legal protection • Prevention strategies for lease violations and evictions • Participants have a choice of housing configurations and locations • Applicable to both RRH and PSH projects

18. How does Housing First Work? • Case Management • Landlord Relationships • Housing Navigator • Prioritization • Harm Reduction • Community Collaboration • Creativity and dedication • Hard work

19. Evolution of Housing First in Polk Co. • Then: The most persistent received services • Now: Prioritization ensures the most vulnerable served first through • Then: First come-First Served • Now: Prioritization ensures those most in need are served first • Then: Agencies received one referral per 5 openings for PSH • Now: Referrals come from CI and off the prioritization lists • Then: Agencies could choose the easiest to serve • Now: The most vulnerable (based on SPDAT) are referred to programs resulting in programs serving those with the most barriers • Then: Case Management services were mandated and necessary to obtain housing • Now: Case Management is voluntary as are all services

20. Benefits of CI & Prioritization: • Standardized assessment (HMIS) • Ensures the most vulnerable in the community receive services first • Serve hardest to house before those with fewer barriers • Standardized referrals based on prioritization and without caseworker judgement. • Polk County CoC adopted the VI-SPDAT for individual, F-SPDAT for families; and the TAY-SPDAT for youth for the purposes or prioritization for shelters and housing programs. • Polk County currently has a wait list for all programs.

21. Successful Strategies • Relationship building leads to non-judgmental interactions • Unit transfers • Program staffing • Appeal process that is used to “reset” and is trauma informed • Community partnerships • Taking “Vacations” from units • Care planning and service goals are client driven • Payment plans and flexibility in rent payments

22. Effectiveness: • People being served have complex needs and co-occurring issues. • Decrease in use of expensive primary services. (ER, Jail, etc. • 90%+ remain in housing • Improved quality of life: • Address MH, SUD and health issues. • Reconnection with family and other supports • Return to their vision of life affirming activities • Cost Efficient • Data Driven • No end date to program means people can age in place (This creates a new set of problems: how to serve an aging population)

23. Housing First in Practice • Trauma Informed Intakes • Unit selection process • Full Circle Group – Addressing loneliness through Cultural Competency • Live In Aids • Housing Camp “friends” at the same time • Leveraging timing, author and delivery of notices • Taking “Vacations” from units • Creating opportunities for tenants to take care of health, mental health, outstanding warrants, Treatment without fear of loosing unit or place on program

24. Finding Creativity

25. Fidelity to Housing First • Quick test Assessment tools • Rigorous personal assessment • Rigorous department assessment • Rigorous agency assessment • Community wide commitment to Housing First practices

26. Lessons Learned • Flexibility and agility are essential in both management and practice • Team approach - Creativity and experience of the whole are an advantage • Sometimes despite our best efforts, we fail. • There are vast and varied solutions found within Housing First and harm reduction practices. Embrace the challenge. • Civilians will not understand the work we do. Support and humor of colleagues is helpful and fun. • Burnout is not inevitable

27. Case Management “Try to learn something about everything and everything about something” -Thomas Huxley We strive to be: • Stage Matched • Trauma Informed • Strength-Based • Person Centered

28. Stage of Change • Pre-contemplation: It’s not an issue-Don’t bug me • Contemplation: I am willing to discuss but I don’t want to change • Preparation: I am ready to start changing- but I need help to begin • Early Action: I have already begun to make changes but need help to continue • Late Action: I am working towards maintenance- but haven’t gotten there and need help • Maintenance: I am stable and I am trying to stay that way as life throws challenges at me

29. Case Management • Our Strengths: • Case management comes with housing • Low to no barrier-Just like the housing we provide • Case managers not restricted by billing • No Exit Date • Provides time for participants to engage at their own pace • Allows for case managers to forge trusting relationships • Reduces participant stress regarding hitting goals • Case Planning • Client driven-programmatic goals reached through being housed • Case plans are fluid and frequently change • Clients can focus on their version of a happy/successful life

30. Case Management cont. • Flexibility • CM can spend as much time with people as needed. We meet people where they are at. • Team approach utilized- We know each other’s participants and participants know us. Keeps us aware of community issues and provides for immediate case coverage when needed • We can be creative in our approaches to unique problems and can provide services to participants that would be challenging to find in community. • The Challenge: • Boundaries • Frequent participant staffing to ensure CM has proper support • Accepting participant choices

31. Case Management challenges cont. • Substance Use Disorder • Public Intox. charges and resulting fines and jail time. • Methamphetamine Use • No great treatment models • Tinkering/dismantling/damages/Hoarding • Criminal element-Manufacturing and Dealing • Guests and squatting • Meth Psychosis • Co-Occurring Disorders • Accessing Mental Health Services • Need municipal court and increased Drug court

32. Case Management cont. • Community Partnerships • What we can do for community partners. • Basic level needs of participants are met • We can get you in to see your people • Participants are easier to find when they are housed • What we are looking for from community partners. • Items that provide an added value • Increase frequency of contact when needed

33. Enabling

34. What is Harm Reduction? • A compassionate approach that addresses the harms caused by the risk-taking behavior without forcing clients to eliminate the behavior while not minimizing or ignoring the real and tragic danger and harm connected to risky behavior. • Building rapport and relationships- Non-judgmental communication • Motivational interviewing/ TIC/ wellness self-management • Progress often takes years and is not linear. • Mental Health- Low barrier mental health providers • Addiction-“safer” use. In DSM offer bleach kits- other communities offer needle exchange. Use in safe places. • How do you define success? • Challenges for Program managers in dual roles • Examples: The quartet housed/ The triplets housed

35. Landlords • Landlords are carefully matched with potential tenants • Tenants are carefully matched with open units • Scattered site model v. site based • Case Managers act as buffers • Well developed relationships • Standardized engagement • Crisis management & problem solving • The search for landlords never ends!!! • These programs do not work without landlords.

36. Collaboration in Community • Local Continuum of Care • Community works collaboratively to conduct planning and align resources to ensure a range of affordable and supportive housing options and models are available • Access to other services/entitlements do not require tx. or sobriety • Soft handoffs between partners • Ownership and buy in between agencies-We all have a part in keeping the most vulnerable people housed • Low barrier mental health providers • Law Enforcement • “Homeless tickets” • Point in Time Participation • Judicial/ Policy issues • Hospitals: Discharge planning • Private agencies

37. Systemic Problems • Mental Health resources: • Limited mental health respites • Loss of Mental Health facilities in Iowa • Criminalization of Mental Health • High utilization of Primary Services (Familiar Faces) • Lack of diversified housing stock within community • No SROs • Loss of YMCA and YWCA and “Half-Hotels” • The ever-present funding challenges • Ideological differences • Abstinence Vs. Harm reduction • Cross Sector communication (Silo effect) • Rural Services

39. Contact Information Cynthia Latcham Director of Programs & Services Clatcham@anawimhousing.org 515-564-6566