Supportive Services for Veteran Families (SSVF) Webinar Series

1. Supportive Services for Veteran Families (SSVF)Webinar Series Housing First & SSVF March 15, 2012 Audio can be accessed through the following conference line: Conference Line: 1-866-266-3378 Passcode: 8224620015

2. Presenters John Kuhn, Acting National SSVF Director Melany Mondello, Technical Assistance Collaborative (TAC) Tom Albanese, Abt Associates Patti Holland, Technical Assistance Collaborative (TAC)

3. Webinar Format • Webinar will last approximately 2 hours • Participants’ phone connections are automatically “muted” due to the high number of callers

4. SSVF Hot Topics

5. Submitting Questions During the Webinar • We will be accepting and answering some questions today through the Private Chat feature of the webinar software. • Questions can also be submitted via email at SSVF@va.gov and they will be answered after the webinar is concluded. • Questions posed to SSVF@va.gov will be either answered individually or through the SSVF Frequently Asked Question and Answer resource.

6. Step 1: Click on the Private tab of the Chat box in the lower left corner of your screen. Step 2: Double-Click on the Leaders & Assistants text to open a new tab.

7. Step 3: A new tab will open after you Double-Click on the Leaders & Assistants name. Step 4: Type your question into the box on the bottom of your screen and hit Enter for the question to be sent. Step 5: Your question is now submitted and may be presented to the speakers if time allows.

8. Objectives • To review Housing First principles and approaches • To understand ways in which Housing First strategies can be applied in SSVF programs to optimize resources and performance

9. The Big (Federal) Picture

10. HEARTH Act: CoC Performance Indicators • Length of time homeless • Recidivism (subsequent return to homelessness) • Access/coverage (thoroughness in reaching persons who are homeless) • Overall reduction in number of persons who experience homelessness • Job and income growth for persons who are homeless • Reduction in first time homeless • Other accomplishments related to reducing homelessness

11. SSVF Relevance to CoC Performance

12. Housing First: Principles & Practice

13. Housing First Principles • Homelessness = housing problem • Housing = a right • Everyone is ‘housing ready’; programs must be ‘client ready’ • Consumer choice – services and housing • Permanent housing with one-time, transitional or ongoing services • Goal: immediate return to housing, link to resources • Focus first on housing, then contributing issues

14. Housing First Models • Prevention • Outreach • Emergency Shelter • Rapid Re-Housing (including “Transition-in-Place”) • often what TH programs do • Transitional Housing • Permanent Supportive Housing

15. Questions?

16. Housing First & SSVF

17. Housing First (and SSVF) Challenge: Provide the right resources to the right people at the right point in time for the right amount of time.

18. Housing First in Practice: Targeting Finding veterans who are imminently at-risk of literal homelessness or are currently homeless… • Prevention: • Greater certainty: identify at or near front-door of system • Establish priority referral process for persons diverted from shelter • Use ‘but for’ criteria – material conditions & circumstances • Lack other safe, appropriate housing options • Lack other resources or support systems to secure permanent housing

19. Housing First in Practice: Targeting • Targeted Prevention

20. Housing First in Practice: Targeting • Rapid Re-Housing: • Target within homeless system – partnerships with outreach, shelters, Safe Havens, HCHV, etc. • Systematic screening • Seek to ‘screen in’ or otherwise refer to more appropriate assistance to end homelessness • Veteran families who otherwise will remain in shelter or on street ‘but for’ SSVF assistance

21. Housing First in Practice: Targeting • Other promising practices: • Develop and train on standardized referral form • Conduct “in-reach” • Identify liaisons in other public agencies • Develop and distribute program materials • Considerations: • Is program ‘ready’ for clients? • For prevention, how do client characteristics compare with shelter client characteristics?

22. Housing First in Practice: From Crisis Response to Housing Stability Crisis Focus = No Housing (homeless) or Imminent Loss Two Step Process: Step One: Crisis intervention and resolution Step Two: Housing stabilization

23. Housing First in Practice: Crisis Response Step One: Crisis intervention and resolution • Crisis assessment • Triage & immediate housing plan Goal: Identify and address immediate housing need

24. Housing First in Practice: Crisis Response Crisis Assessment • Focus: Persons experiencing a housing crisis • Immediate needs may or may not be met • What are we trying to figure out? • Immediate & short-term housing needs and SSVF intervention to assure needs are met • Basic characteristics necessary to know who’s being assisted and immediate needs

25. Housing First in Practice: Crisis Response Crisis Assessment • Tool should be staff/consumer friendly • Scripted for consistency (science), but also serves as conversation guide (art) • Provides essential information to predict/prepare client for what will/should happen next • Staff training and supervision • Specify training content • Require/specify training/orientation period • Require/specify observation period as training component • Ongoing supervision involving review of completed assessments, problem solving and remedial training as indicated

26. Housing First in Practice: Crisis Response Triage & Immediate Housing Plan • Any safe, immediate housing options besides emergency shelter? • YES: then need essential info for immediate next steps • NO: then need essential info for shelter referral or admission • Plan for tonight and near-term: “predict & prepare”

27. Questions?

28. Housing First in Practice: Setting up Successful Tenancy • Housing based assessment • Landlord and subsidy rules and expectations • Knowledge of all possible resources and positives and negatives of each • Tenant and Landlord Rights and Responsibilities • Structures and support to allocate and access resources • Matching support and allocation to individual household’s needs

29. Housing First in Practice: Housing Stabilization Step Two: Housing stabilization Short-Term • Housing stability assessment • Housing stability plan (‘reasonable’) • Flexible SSVF services Goal: Identify and implement plan to maintain current housing or obtain new housing

30. Housing First in Practice:Housing Stabilization Housing Stability Assessment • Focus: Persons experiencing a housing crisis whose immediate housing needs are met • What are we trying to figure out? • Prevention: whether can be stabilized in current housing or needs relocation assistance • Additional characteristics and relevant background info (housing, health, AOD, education, etc.) • Barriers impacting ability to obtain/maintain housing • Tenant screening barriers (if need to obtain housing) • Retention barriers • Least amount of intervention needed to resolve prevent return to crisis

31. Housing First in Practice:Housing Stabilization Housing Stability Assessment Includes: • An exploration of the current housing situation • A discussion of the household’s preferences • Identification of household’s barriers to maintaining their current or new housing • The household’s skills, resources and resilience to overcome barriers

32. Housing First in Practice:Housing Stabilization Housing Screening/Retention Barriers: • Income and housing affordability • Criminal justice history • Credit history • Behavioral health issues • Housing history • Previous eviction • Previous non-renewal of lease • Landlord references

33. Housing First in Practice:Housing Stabilization Housing Stability Plan • ‘Reasonable’ plan to maintain housing in near-term and, if necessary, obtain new housing • Tied to overcoming identified barriers • Identifies what the program will provide (i.e. “just enough”) to address/resolve barriers • Services/support from other community resources that can help overcome barriers

34. Housing First in Practice: Housing Stabilization Step Two: Housing Stabilization Long-Term • Progressive plan to increase stability and prevent future crises • How to respond (‘predict & prepare’), where to turn for help • Service referral/linkage Goal: Identify long-term, progressive housing stability plan and assure linkage to community-based supports

35. Questions?

36. Case Study • Kenny is a 42 year old Veteran who called your program after hearing about it from a friend. Kenny separated from active duty in 2008 after serving for 6 years. He was honorably discharged. He married about 1 year before entering the service, and had two children. • He had difficulty adjusting after discharge. • He has skills as a mechanic, and has had a few jobs. He lost one job because the shop closed, and another because he began drinking more heavily and was fired. • In late 2009, his wife left him, moved with their children approximately 2 hours away, because he was not able to provide for the family and his drinking became intolerable for her. After this, his drinking escalated on and off, and he had trouble holding a job for longer than 3 months. Most of these jobs were as attendants at gas stations. • .

37. Case Study, continued • Kenny never pursued VA benefits or services since he blamed the army for the breakup of his marriage. • He has participated in AA off and on. When working, Kenny usually rented rooms in boarding home type settings or small efficiency units. On a few occasions he would sleep on the couch of an acquaintance he’d meet through AA meetings, bars or jobs. • This past year he began attending a local church on a more regular basis, and made some acquaintances. • This church is an active participate in the local Interfaith Hospitality Network, which provides emergency shelter for homeless families. Because of this, church volunteers have many positive connections with local landlords and employers. • With the referral from a church member, Kenny started working at a local Oil and Lube Auto shop approx. 7 months ago.

38. Case Study, continued • He also rented a room in the house of a church member. • He did well during this time, did not drink and attended AA meetings off and on. He also began having phone contact with his ex-wife and children. • However, this person made it clear to Kenny at the beginning that he would be selling the house within 6 months, and retiring to Florida. • Kenny did nothing to find a place of his own, choosing to ignore this pending change. When asked, he would just say he was ‘working on it’. • Kenny began to drink more as potential buyers for the house appeared. Three weeks ago, he was fired from his job for absenteeism. Kenny did not share this with anyone. • His boss made it clear that he was sorry to have to take this action, and hinted that if Kenny could ‘clean up his act’ he would consider rehiring him.

39. Case Study, continued • One week ago, Kenny lost his housing as was expected when the sale of the house closed. He had no money saved. • Because Kenny began to drink more as the time drew close when his friend would be moving, other members of the church were reluctant to let Kenny stay with them. • With no other option at this time, Kenny is currently spending nights at the local shelter. • Kenny is afraid he will wind up “homeless forever”. He mentions during his initial appointment that he thought he would soon be able to contact his ex-wife and see his children, but is now despondent that in his current situation, he won’t do that. • Feeling he was out of options, he has come to the SSVF program seeking assistance.

40. Polling Questions • If Kenny arrived at your SSVF program, after the initial screening that determined he met the criteria, would you? • Continue the intake and assessment process with intent to enroll him • Refer him to other services such as alcohol treatment and transitional housing, and let him know once he completes those programs he can come back if he stills needs assistance

41. Polling Question • If you enroll Kenny, how might you approach the initial Housing Stability Plan? • Secure housing and refer to substance abuse treatment; address employment after treatment • Secure housing, obtain work, and refer to substance abuse treatment • Secure housing, obtain work, discuss substance use and impact on housing and plan on how to address

42. Polling Question • You were successful in assisting Kenny to rent a small affordable efficiency unit and obtain a job at a local Auto Body shop. His TFA for rent is ending with this current month, and you have worked out a budget with him to cover his rent going forward. While many supports would be beneficial (including all those listed below), select one resource you think would be most helpful for Kenny as SSVF services come to an end. • Connection to VA healthcare services • Substance abuse and mental health treatment • Peer or self help support • To get back together with his ex-wife

43. Questions?

44. Housing First in Practice:Planning and Crisis Preparation • What has interfered with successful tenancy in the past? • Not just with individuals and households, but with all aspects • With the individual • With landlords • With housing subsidy resources • With housing settings • With neighborhoods • With systems

45. Housing First in Practice:Working with Tenants • Past and current history and connection with housing? • What factored into current situation? • Who and where do they go for help? • What are their problem solving strategies? • What are their unique signs of possible trouble? • Behavior patterns that impacted housing related to: • Medical, mental health and substance use • Cognitive abilities and limitations • Making and managing income and finances

46. Housing First in Practice:Working with Tenants • Housing is often the primary motivator for behavior change. • Stay focused on short and long term housing goal while addressing problematic behaviors. • Especially when there is a basis for a reasonable housing stability plan • Use harm reduction and motivational interviewing and enhancement strategies as foundation. • Harm reduction recognizes that some people always have and always will engage in behaviors which carry risks • Acknowledges these behaviors will occur yet recognizes the value in reduction of harm, no matter how imperfect • People can, and do make rational decisions about serious life issues while still using • Denial not actually denial. Product of shame, punitive sanctions and often conscious

47. Housing First in Practice:Working with Tenants • Motivational interviewing is an effective approach that helps people resolve ambivalence and resistance to change and that facilitates behavior change. • While initially developed with substance abusers, applies to any behavior change • Intervention needs to match stage of change. Programs often geared only towards action.

48. Housing First in Practice:Working with Tenants • Use principles of motivational interviewing within a housing context • Express empathy • Acceptance facilitates change; skillful reflective listening • Develop discrepancy • Awareness of consequences is important. Acknowledge and plan • Discrepancy between present behavior and important goals will motivate change • Help individual make argument for change • Avoid argumentation

49. Housing First in Practice:Working with Tenants • Roll with resistance • Do not oppose or argue for change • Reframe resistance to create new momentum • New perspectives are invited but not imposed • Support self-efficacy • Belief in the possibility of change is an important motivator • There is hope in the range of alternative approaches available • The individual is responsible for choosing and carrying out personal change

50. Housing First in Practice:Working with Tenants • Arrange self-help and peer support services early on • Veteran Service Organizations, Twelve-Step programs geared towards Veterans, local Vet to Vet initiatives, National Call Center for Homeless Veterans