Core Elements of Permanent Supportive Housing (PSH)

1. Core Elements of Permanent Supportive Housing (PSH) Ann V. Denton, M.Ed., Director, SSH TA Center, Advocates for Human Potential, Inc., Austin, TX

2. Core Elements of PSH The learning objectives for this session: Participants will gain knowledge about six core elements of PSH. Participants will be able to see how to apply these elements in daily practice.

3. SAMHSA Permanent Supportive Housing KIT SAMHSA has developed a Permanent Supportive Housing KIT. • Developed through consensus among researchers, housing providers, Federal partners and advocates. • Released: April, 2010. • Includes fidelity measures as self-assessment tools.

4. Core Elements of Permanent Supportive Housing These also are the dimensions of the PSH Fidelity Scale (SAMHSA KIT) • Choice • Separation of housing from services • Access to housing • Decent, safe, and affordable • Integration • Services and supports

5. Core Element: Choice Choice is essential to success in housing. If individuals are “placed” in a setting that does not meet their needs and preferences, they are not likely to succeed.

6. Core Element: Choice Choice is measured in terms of the extent to which people are asked about their preferences, can choose the type of housing, and have a choice of housing units.

7. Core Element: Choice To implement choice, staff must . . . • Know a tenant’s legal rights; • Be able to determine what type of housing best meets the needs and preferences of the consumer; and • Know how to find and secure housing that meets a consumer’s needs and preferences.

8. Core Element: Quality (Decent, Safe, and Affordable) What do we mean by “affordable”? Tenants/residents pay a reasonable amount of their income towards rent and utilities.

9. Core Element: Quality (Decent, Safe, and Affordable) HUD affordability guidelines: 30 percent of adjusted income for housing expenses. • Reality - People on SSI often pay 60 - 80% of their income towards housing that is substandard.

10. Core Element: Quality (Decent, Safe, and Affordable) It is clear that Permanent Supportive Housing must address the affordability problem or individuals relying on SSI income will never be able to live in housing units that they choose. The most frequent solution is rental subsidies, either tenant-based rental assistance or other subsidies or assistance tied to units (e.g., tax credits).

11. Core Element: Quality (Decent, Safe, and Affordable) Housing units must be decent and safe. HUD’s standard of quality is its Housing Quality Standards. HQS should be met by all permanent supportive housing.

12. Core Element: Access to Housing Housing is a scarce commodity in most communities, and over the years, many service providers have developed admission criteria designed to reserve these scarce resources for those “most likely to succeed.”

13. Core Element: Access to Housing Often, housing programs have eligibility criteria that require that individuals demonstrate that they are “ready” for housing.

14. Core Element: Access to Housing • For people who are living in homeless shelters or on the streets, typical housing readiness requirements can be insurmountable barriers. Do these sound familiar? • Taking medications unsupervised • Budgeting • Cooking (shopping, meal planning) • Negotiating transportation systems • Able to keep appointments (with some help) • Psychiatric stability • Sobriety • Willingness to comply with rules • Treatment plan requirements

15. Core Element: Access to Housing However, research does NOT support this practice. Research shows that a readiness screen is not predictive of success in housing.

16. Core Element: Access to Housing Therefore, the most important eligibility criteria for permanent supportive housing should be those matters that would be required of any tenant (ability to pay rent, for example).

17. Core Element: Access to Housing The other access consideration is privacy. Who holds the keys? Who controls access to the unit? The tenant should control access to the unit in the same way that typical tenants have control over who may enter the unit.

18. Core Element: Integration and Rights of Tenancy Integrated housing units are defined as regular housing units typical of housing units found in the community and scattered throughout the community.

19. Core Element: Integration and Rights of Tenancy How to tell if housing is integrated? Factors might include: • Housing is located in regular residential areas. • Housing is scattered site. • Large, homogeneous congregate sites are in danger of becoming “mini-institutions.” • Housing is centralized, but with mixed populations in the building or neighborhood. • Avoid the creation of “mental health ghettoes.” • Tenants participate in community activities and receive community services. • Natural supports are encouraged.

20. Core Element: Integration and Rights of Tenancy Why integration? The Olmstead Supreme Court decision interprets the ADA’s anti-discrimination provision to require the provision of services in the “most integrated setting.”

21. Core Element: Integration and Rights of Tenancy • Residents have full legal rights in a tenant-landlord relationship. • Tenants are responsible to abide by the normal standards of behavior/conduct outlined in a lease. • Housing is “permanent,” in that the length of stay is determined by the agreement between the landlord and tenant (not by participation in services).

22. Core Element: Integration and Rights of Tenancy • Tenant’s Rights • Fair Housing Act covers discrimination. • Section 504 addresses accessibility. • ADA providesreasonable accommodations. • Olmstead mandates community integration. • Resources: • Renter’s Rights from Legal Services of Northern Michigan http://lsnm.org/rentersrights.html • HUD’s office of Fair Housing and Equal Opportunity http://www.hud.gov/offices/fheo/

23. Core Element: Functional Separation of Housing and Services There are several ways to conceptualize the separation of housing and services: • Legal separation between housing management and service delivery • Functional separation – distinct housing and service staff roles • Operational separation – extent to which service providers are based off-site

24. Core Element: Functional Separation of Housing and Services Permanent Supportive Housing is most successful when there is a functional separation between housing matters (rent collection, physical maintenance of the property) and services and supports (case management, for example). Case managers shouldn’t collect rent!!!

25. Core Element: Supports and Services • What are supports? • Mainstream supports • Specialized supports • (Provided directly or as referrals) • Natural supports

26. Core Element: Supports and Services • Mainstream Supports • Learn about benefit programs • SSI • SSDI • TANF • Medicare/Medicaid • Utility assistance • Veterans benefits • Resource: Resources for Training and Education in the KIT

27. Core Element: Supports and Services Helping tenants access benefits: • Get an ID card – Social Security, birth certificate, military service record, etc. • Get a formal psychiatric assessment. • Denials are common – provide continual support during the process.

28. Core Element: Supports and Services Natural supports - the social networks people naturally have as members of a community • Friends • Family • Faith community • Activity or hobby groups • Neighbors

29. Core Element: Supports and Services • Strengthening natural supports by helping tenants return to work: • Explore the tenant’s desire. • Explore possibilities. • Help identify goals. • Look into supported employment. • Resource: http://mentalhealth.samhsa.gov/

30. Questions?