Engagement Strategies: Service Delivery in Supportive Housing

1. Engagement Strategies:Service Delivery in Supportive Housing Joyce Grangent Senior Program Manager Corporation for Supportive Housing www.csh.org

2. Cultural, ethnic, and racial differences Gender and sexuality issues Mental Health History HIV/AIDS Other medical issues Domestic violence Criminal histories Long-term homelessness Development disabilities Histories of trauma Issues specific to women with children Much more! Every tenant brings a history, a culture, a set of expectations and behavior that can be shaped by such things as:

3. What else tenants bring • Housing history • Family history • Spiritual life • Survival skills • Social networks and support systems • Tolerance level for structures and rules • Behavioral history • Expectations and Preferences

4. A Clash of Agendas • The Homeless Person • Multitude of losses • Depth of mostly negative feelings • Unique and uniquely acquired strengths • The Professional Support Person • Duties and responsibilities • Product oriented • Caring (We hope!)

5. Resolving the Clash • Don’t create more losses • Understand the feelings • Uncover and build on strengths • Using strategies and techniques • Harm Reduction • Stages of Change • Motivational Interviewing • Reflective Listening

6. Engagement Strategies Engagement sets the stage for formal case management and treatment sessions where in-depth assessments, counseling, and referrals can occur on an individualized basis.

7. Goals of Engagement • Care for immediate needs • Develop a trusting relationship • Provide services and resources • Connect to mainstream services and social networks to maximize independence • Helping people stay housed

8. Effective Engagement • Create the proper physical environment • Respect, accept and support people • Develop active listening skills • Let the tenant’s goals drive the services offered • Help people make informed choices • Be consistent with repeated, predictable patterns of interaction • Engagement should be non-threatening

9. Effective Engagement • Effective engagement for people with mental health issues • Effective engagement for people with substance use issues

10. Engagement is a Process • Where we introduce tenant to services relationship • Explain our role • Find common ground to build on • Engagement is not an event • Does not happen overnight • Varies from tenant to tenant

11. Creative Engagement Strategies For Open: • Friendly • Listen • Maintain eye contact • Keep conversation light • Respond to humor

12. Creative Engagement For Closed: • Intrusive • Talk to much • Too opinionated • Lecture • Analytical • Demanding

13. Engagement for People With Mental Illness • Enhanced When: • Worker develops shared reality with tenant • Interaction is consistent • Worker allows tenant to exercise control in the interaction • Worker communicates his/her role clearly

14. Whose Goal Is It • Orient new tenants • Provide coordination among service providers • Develop buddy systems • Provide individual case management

15. Opportunities to Achieve Goals • Develop case management plan • Help with skill building • Coordination of mental, physical and substance abuse services • Assistance with medications and/or doctor appointments

16. Developing Trusting Relationships • Professional Relations • Goal is maintain housing • Information is confidential • We must set limits

17. In a Personal Relationship • Different goals with different people • We can gossip to friends • We don’t have to set limits

18. Enhancing Motivation for Change

19. Building Motivation for Change • Build Trust: Be consistent, trustworthy and honest • Get to know the person • Learn to recognize and Identify Emotions/Physical sensations of anxiety • Define the helping relationship

20. Working With Ambivalence and Resistance • Reactance Theory –helps to predict how people respond to the perceived loss of valued freedom • Reactance Theory states that it is natural for people to try to maximize control and choice

21. Why Tenants May Be Resistant • Afraid staff will tell them what to do • Don’t want to be controlled or lose the right to make choices • We view resistance as negative and part of tenants illness • Tenant is trying to maintain their independence/freedom

22. When Working with tenants Who Is Resistant • Avoid telling tenant what to do, instead present options • Explore both sides of an issue, one-sided focus increases reactance • Address one problem at a time-partner with tenant to set priorities and timelines for addressing them • Work with tenant where they are along spectrum of change

23. What if this is not working? • Steps to consider before terminating your clients • Discuss with Colleagues and Supervisor • Talk to clients about consequences/alternatives • Is there a way to negotiate the dispute? • Remember this is the only way for our folks to get permanent housing

24. Roadblocks to Listening • Directing- Do it this way • Warning- Creates fear or submission • Making suggestions-Tenant is not competent or judgment is not trusted • Persuade with logic- you need to stop drinking, or you may damage your liver • Shaming-Do you really want others to see you like this

25. Motivational Interviewing • Motivational Interviewing - is a way to get tenants to recognize and do something about problems • Useful with tenants who - are reluctant to change and ambivalent about ability to change • Intended to help resolve ambivalence and get tenant moving on path to change • Staff acts as change agent

26. Five Basic Principals To Motivational Interviewing

27. Express Empathy • Accurate Empathy • Not identifying with tenant instead seeks to understand what the tenant is saying without being judgmental, criticizing or blaming . • Acceptance lowers defenses and make tenant more open • Trying to “make” tenant change creates resistance and refusal

28. Develop Discrepancy • Listening patiently can help tenant see the discrepancy between their present behavior and goals • Gaining insight into discrepancy can help gain motivation to change (must remember what is said) • It should be the tenant who begins to fell safe enough to voice concern

29. Avoid Argumentation • Avoid expert trap • Arguing leads to negativity • Destroys alliance • Increases defensiveness.

30. Roll With Resistance • Resistance is not bad. • It’s normal and we should expect it • Go with it and don’t get into power struggle • It gives insight to guide our work

31. Support Self-Efficacy • Hope, optimism and self esteem are needed for change • Plant seed of believability • Reframe failures • Let’s figure out what didn’t work

32. “Life takes on meaning when you become motivated, set goals, and charge after them in an unstoppable manner.” –Les Brown

33. CSH Tools and Resources

34. CSH Resources • CSH website: www.csh.org • Institute website: www.csh.org/IL/institute • CSH Publications: www.csh.org/publications • Not a Solo Act • Developing the Support in Supportive Hsg • Toolkit for Developing and Operating Supportive Housing www.csh.org/toolkit2