www.desc.org

1. Compassionate Pragmatism: Introduction To Managing Difficult Behaviors in Housing WSCH 21st Annual Conference Kennewick, WA May 11 - 13, 2011 www.desc.org

2. Overview of DESC • emergency shelter • licensed mental health services • licensed chemical dependency services • supportive housing • high level of integration across programs www.desc.org

3. www.desc.org DESC Supportive Housing Union Hotel 1994 Scattered Sites 1995 Lyon Bldg. 1997 Kerner Scott House 1997 The Morrison 2001 1811 Eastlake 2005 Evans House 2007 Rainier House 2009 Canaday House 2010

4. What we believe • people want a place to live • people want to get better www.desc.org

5. Core convictions • housing is a basic human right • housing is not a reward for clinical success or compliance www.desc.org

6. “When I was at home I was in a better place.” - Touchstone in “As You Like It”, Shakespeare www.desc.org

7. Housing First Principles • Targeted to the most vulnerable. • People are moved into housing directly from the street without preconditions of treatment acceptance or compliance. • Provider is obligated to bring robust services into the housing. • Continued housing is not dependent on participation in services. • Harm reduction approach rather than mandating abstinence. • Residents have leases and tenant protection under the law. • Can be implemented in either project-based or scattered site model. www.desc.org

8. Vulnerability approach Kerner-Scott House experience (1997) • Selection Criteria • severe and persistent mental disorders • not connected to anyone • too disorganized to self-advocate • most at-risk on the streets www.desc.org

9. Integrated services and propertymanagement • Integration of property management and service provision on same staff team • Service-rich • Community-focused • Safety-focused • Housing, not a program www.desc.org

10. Key Components: Assertive engagement www.desc.org

11. Assertive Engagement: Meeting people where they are • outreach • being useful • relationship building through practical assistance and empathy • not office-based www.desc.org

12. Key Components: Open and honest dialogue www.desc.org

13. Open and honest dialogue • with residents • transparency about mission • flexibility and forbearance • compassion and empathy • on teams: • daily staffing • shared decision-making about response to incidents www.desc.org

14. Key Components: Limited rules and requirements www.desc.org

15. Limited Rules and Requirements • rules aren’t the solution • flexibility about behaviors is a type of disability accommodation www.desc.org

16. Key Components: Flexible response to problems www.desc.org

17. Flexible Responses to Problems • pro-active • individualized (care plans, crisis plans) www.desc.org

18. Dealing with problems www.desc.org

19. Social behaviors • communication • decorum • hygiene • cooperation www.desc.org

20. Room conditions • cleanliness • hoarding • damage • pests www.desc.org

21. Drugs • safety • traffic • dealing • intoxication www.desc.org

22. Violence • threats • fights • assaults www.desc.org

23. Responding to Violence • everything is negotiable • no pre-determined consequence • future-oriented • safety-oriented www.desc.org

24. Harm Reduction A set of non-judgmental strategies and approaches which aim to provide and/or enhance skills, knowledge, resources and support that people need to live safer, healthier lives. - Streetworks, 1997 www.desc.org

25. “…when we get a person housed, good things happen.” • Tom Carr, former Seattle City Attorney (in context of 1811 Eastlake Project) www.desc.org

26. Harm Reduction is: • assertive and engaged • based on science, compassion, health and human rights • supportive of any positive change www.desc.org

27. Harm Reduction is not • a non-intervention, “anything goes” paradigm • “enabling” • passive www.desc.org

28. Harm Reduction in everyday life • helmets for bicyclists • seatbelts in motor vehicles • condom distribution • nicotine patches www.desc.org

29. More Harm Reduction • using clean needles • using with others instead of alone • switching to marijuana from a harder drug • cigarette monitoring • beer/alcohol monitoring • using beer versus hard alcohol or light beer instead of regular beer www.desc.org

30. Meeting people where they are For those that are homeless this means: • Literally: near their campsites, at shelters, in parks • Figuratively: by offering • help and respect regardless • of behaviors www.desc.org

31. Meeting people where they are • unclogging their toilet • helping them with their laundry • cleaning up their rooms • talking with them while they are under the influence www.desc.org

32. "The freedom to be wandering the streets, psychotic, ill, deteriorating and untreated, when there is a reasonable prospect of effective treatment, is not freedom, it is abandonment." --ACLU www.desc.org

33. www.desc.org