Housing Based Case Management Linking Services to Housing Stability

1. Housing Based Case Management Linking Services to Housing Stability Roanoke, VA April 30 – May 1, 2007

2. HOPWA Regulations 574.310: “The Grantee shall assure that qualified service providers in the area make available appropriate supportive services to the individuals assisted with housing under this subpart.”

3. HUD Notices – STRMU “Grantees are required to conduct an ongoing assessment of the housing assistance and supportive services required by participants To meet this requirement, Grantees may direct Sponsors to develop housing services plans for all beneficiaries …”

4. New 2006 Emphasis Unique Housing Resource Transparent Results Understood by public Transformative Changing people’s lives Improving program

5. HOPWA Outcome Assisted households will: Have been enabled to establish or better maintain a stable living environment in housing that is decent, safe and sanitary Reduce risk of homelessness Improve access to health care and supportive services – reduce disparities

6. Benefits to Clients A better housing situation – more appropriate to needs Impact on health status through improved housing and access to care Reduce disparities in access to care

7. HOPWA Performance Goal By 2008 over 80% of HOPWA program clients will be in stable housing For competitive grantees, HUD expects at least half of beneficiaries will have stable housing during operating year

8. Funding Sources for Service Planning Two potential sources through HOPWA: Housing Information Services (574.300(b)(1)) Case Management Services (574.300(b)(7))

9. Key Components of Housing Plan Determine housing needs and preferences Identify eligibility for housing assistance Supportive services needs to maintain housing stability Eligibility for mainstream assistance Establish access to care Decrease risk of homelessness

10. Housing Focused Case Management Educate on all available housing options Identify skills and support needed to maintain chosen housing options and access to care Housing stability is key service goal

11. Responsibility for Plan Developed jointly by participant /case manager Participant develops own goals and commits to accomplishing them CM identifies resources including: other providers, housing programs, benefits Plan is updated on regular basis or when participant ’s condition/needs change

12. How Plan Assists HOPWA Program Components – STRMU Documents risk of homelessness Documents temporary nature of the crisis Creates a framework for addressing ‘conditions’ that gave rise to emergency Establishes time frame to achieve stability within 21 week assistance period Allows time to plan for and arrange longer term housing assistance, if needed Can avoid repeated 21 week cycles of assistance Shows relationship of assistance to access to care

13. Rental Assistance Document need for assistance Assure that supportive services needs are met Identify any resources, skill deficits or services needs that could lead to lack of housing stability or interfere with access to care. Identify mainstream rental assistance opportunities for long term support

14. Facility Based Housing Identify need for specific assistance Address program requirement that adequate supportive services be provided Help to develop plans to leverage supportive services and health care Maintain stability in housing by addressing resident needs

15. Supportive Services Only Ensure a connection between HOPWA funded services and housing stability access to care and homelessness prevention. Plan can assist in leveraging services, allowing HOPWA to be directed toward housing assistance

16. Stages in Developing Housing Services Plan Engagement /Needs Identification Assessment Goal Setting and Housing Planning Evaluation and Plan Updating

17. Engagement Establishing clear communications Active listening Non-judgmental Meeting client where they are Capitalize on interest in housing: provide information, encourage client to make the choice May require multiple encounters to develop working relationship

18. Assessment Emergency needs Homeless? Medical/mental health crisis Domestic violence Risk of family separation Child care/safety

19. Assessment – 2 Housing needs Currently homeless Cannot afford current housing Inappropriate or sub-standard housing Not accessible or presenting other health related problems

20. Assessment – 3 Housing Preferences Immediate needs Household size/composition Location considerations Long term goals Homeownership? Named tenant on lease Family reunification

21. Assessment – 4 Housing History Ever been homeless History of eviction or problems with tenancy Ever had lease in own name Positive references from prior landlord Experience of living independently

22. Assessment – 5 Issues that could impact ability to be housed Criminal justice background Prior offenses Currently on parole/probation Credit problems Poor credit history Bankruptcy

23. Assessment – 6 Other issues related to housing instability Co-Occurring disorders Mental health issues Connection to care/services Able to manage care Able to manage symptoms

24. Assessment – 7 Other issues (continued) Substance use/abuse Use history and how it interferes with maintaining housing Awareness of relapse patterns Interest in treatment/sobriety Problem solve as to how to reduce harm

25. Assessment – 8 Other issues (continued) Illness/disabilities HIV confidentiality Special housing needs related to disability Equipment/furnishings Live-in personal care attendant Location requirements related to accessing health care/services

26. Assessment – 9 Family or Social Network Positive contributions Counter loneliness Financial support Other assistance Negative contributions Drug use Violence Anti-social behavior

27. Assessment – 10 Daily living skills and resources for housing stability Self-Care Transportation Negotiation and Mediation Skills Maintaining an Apartment Financial Literacy Managing Nutrition

28. Assessment – 11 Income and access to benefits Sources of income Receiving any benefits Eligible for any mainstream programs Expect to receive benefits in the future

29. Assessment – 12 Family and social supports Connections to family Other significant people Intent to reunify with children or family

30. Assessment – 13 Domestic Violence Any history (survivor or perpetrator) Orders of protection (current or in the past) Any special housing needs arising from DV concerns?

31. Assessment – 14 Histories that might exclude from housing Fire setting /Arson Criminal History for Violence Sex Offender History of Eviction Bad Credit

32. Assessment – 15 Employment Work history Currently employed? Skills/education for potential employment Prior job training experience Likely earnings profile

33. Goal Setting/Housing Planning Housing Preferences STRMU / TBRA / Facility Based Unit Size Location Housing type SRO Supported housing Independent Tenure (lease/own)

34. Housing Stability Related Goals Income Earned income goals Benefits sought Education/Skills Goals Degree related Job training

35. Supportive Services Required Access to primary care Behavioral health needs Mental Health Substance Use Child care/support needs

36. Goal Setting Client establishes goals for Housing to be obtained Maintaining housing / Preventing homelessness Income/employment Independent living skills an resources Health care Family and/or community connections

37. Plan for Achieving Goals Key Elements: Time frame Specific outcome to achieve Support needed to achieve goal Tasks to be accomplished by client and CM

38. Role of Case Manager Identify assistance needed to accomplish plan Skills or Resource Budgeting and Income Support Negotiating Health Care or Behavioral Health Working with Landlords Encourage client to develop future oriented goals

39. Evaluation and Plan Updating Purpose Identify changes in circumstances that could impact plan Health status Family composition Income/employment Behavioral health needs Amended plan also includes time frames and client/CM responsibilities

40. Intervals for Updating Plan Whenever significant changes occur in client’s status If receiving time limited HOPWA services (STRMU or capped TBRA), at least 30 days prior to change in HOPWA support Otherwise, every 6 months

41. Working with Landlords Engagement Pro-active outreach (landlord associations, newspapers, knocking on doors) Introduce yourself and how you can be helpful Be persistent and reachable Know fair housing law Responding to needs Recognize that they own the property Be patient and persistent

42. Working with Landlords Assessment of what is needed Rent payment Maintaining apartment Allowing quiet enjoyment Keeping apartments filled Assistance with problem tenants

43. Working with Landlords Provide Education What services do you have available Knowledge of tenancy expectations Positive experiences with other landlords Make a plan Try starting slowly Re-evaluate