Suzanne Wagner Andrea White Housing Innovations

1. Housing Stabilization ServicesPeer Learning Session: Skills and Strategies for Successful Family StabilizationHogan Center – College of the Holy CrossTuesday May 31, 2011 Suzanne Wagner Andrea White Housing Innovations

2. Agenda • Introductions • Background on Best Practices and Federal Priorities • Housing Stabilization Services • Overview of HSS • Using the Lease to Structure the Work • Coordination of Support Services with Landlords/Property Management Services • Connections with Mainstream Resources • CTI Overview • Case Examples • Wrap up

3. Background • New federal directions (HEARTH and Federal Strategic Plan (FSP) and • Evidence Based Practices (EBPs) • Reduce length of time people spend in the crisis of homelessness • Rapidly exit them from homelessness and access permanent housing • Provide services in the home to achieve housing stability and prevent returns to homelessness • Principles and practices of Housing First have been expanded to other homeless populations besides chronically homeless with success

4. Federal Priorities • New CoC Performance Standards- HEARTH– “Homeless Emergency Assistance and Rapid Transition to Housing” • Reduce Length of Time Homeless • Reduce Newly homeless • Reduce Returns to Homelessness • Increase Permanent Housing Exits • Increase/Maintain Income

5. Federal Priorities • Federal Strategic Plan (FSP) – “Opening Doors” • Retool the Homeless Crisis Response System • More Permanent Housing Options • Rapid Rehousing • PSH • Service Enriched Housing • Focus on Employment and Income • Use Mainstream Resources – income and services • Get Kids in School

6. Commonwealth of MassachusettsHomeBase • Working toward Family self-sufficiency • Increase income; • Enhance household budgeting and bank relationships; • Invest in basic educational attainment; • Advance school enrollment for all children; and • Promote good tenancies through lease compliance.

7. Housing First Principles and Practices with Applicability to Other Homeless Populations • Immediate access to housing • Low or no threshold for entry • Single site or scatter site housing • Harm reduction approach to substance use and other life issues • Limited program requirements and case management service model • Separation of housing and treatment/support services. Focus on housing stability • Not “Housing Only”, must have services

8. Progressive Engagement • Emerging practice • Do basic and simple screening for housing barriers • Provide a minimal amount of assistance to all people • Provide additional assistance as needed by the household • Based on research (or lack thereof) that we cannot predict who will become homeless and instruments to determine need for services have not been validated.

9. CTI is an Evidence Based Practice • Critical Time Intervention (CTI) TI has been recognized an Evidence-Based Practice by the federal Substance Abuse and Mental Heath Services Administration (SAMHSA) and the President’s New Freedom Commission on Mental Health • CTI is based on the research of Columbia University’s (Columbia Center for Homelessness Prevention Studies) work with the homeless individuals • Point at which person moves into new housing provides a critical opportunity to make changes www.criticaltime.org

10. Themes of Housing Stabilization

11. Housing Stabilization Services

12. Key Ingredients for Housing Stabilization • Provide services in the home and the community • Ongoing assessments of housing barriers to prevent housing loss • Connect with other mainstream and community-based services – benefits and services • Connect with natural supports including spiritual

13. Key Ingredients for Housing Stabilization • Landlords and property managers to establish tenancy obligations and enforce them • Focus on eviction prevention and use the structure of the lease to guide your interventions • Coordinate Property Management and Social Services interventions • Use Evidence-Based Practices EBP’s • Critical Time Intervention • Motivational Interviewing

14. Housing Stabilization Services: Measures of Success

15. Core Elements: Housing Stabilization Services • Assessment • Goals • Understanding Barriers to Housing • Engagement on Common Goals • Education • Expectations of Tenancy, Lease and Housing Options • Available Resources for Support • Housing Stabilization Plans (aka “Service Plans”) and Services: • Using treatment as a link to self-defined goals • Using CTI as a tool • Linkages and Coordination • Landlords/Property Managers, Community, Services, Treatment Resources • Evaluate progress

16. Expectations of Tenancy

17. Reasons people lose housing • Don’t pay rent • Violate rules e.g., noise • Hoard or otherwise create health and safety hazard • People move in who are not on the lease • Engage in criminal activity • Others?? • Need to monitor and assist in meeting tenancy obligations

18. Focused Housing Stabilization Services Planning

19. Focus Areas of Assessment • Housing Stabilization and Lease Compliance • Income and Financial Management • Family & Other Relationships • Mental Health and Medical • Substance Use and Misuse • Life Skills • Strengths and Potential for Change – how has person managed in the past?

20. Components of the Housing Plan - Tenants’ Goals • A safe place to live • Work • Enough money to live on • Friends • Valued status and a role in the community – purpose and structure • Move from crisis • Community • A chance for their children • “Dignity of Risk” • 5 Years from now?

21. Goal Based Assessment Strategies Explore what each family’s choice means • History (i.e. housing, employment, safety) • How this family became homeless: what worked what didn’t • How each family has managed in the past • Preferences: what does the parent/family want • Financial Issues • Implications of disabilities or service needs and how this relates to goal • Long term goals: how do they see their future?

22. Components of the Housing Plan -- Goals • Goals set as a team of clients and worker • Focus on the issues that affect housing retention – base on what caused the current crisis and previous episodes of housing instability • Immediate and longer term goals clear • The Plan determines your interventions • Steps to reach goal clearly defined and measurable • Longer term needs require connections to other resources.

23. Components of the Housing Plan

24. Components of the Housing Plan

25. Evaluating the Plan

26. Using the Lease to Structure the Work- Rationale • One of the goals is for families to be stably housed and in order to do so, they need to learn how to manage their tenancy obligations. • One of the keys to achieving this goal is the active coordination between property management and support services staff, while maintaining the functional separation of these two staffs. • Having separation of functions helps tenants learn by being treated no differently from any other tenant by the property management. (Don’t want to create alternate reality) • Problems that threaten tenancy may motivate tenants to use services in order to keep their housing.

27. Case Examples • Betty is always happy to see the case manager. They talk a couple of times a week. The worker helped her with the children’s school, gives her rides, and food pantry referrals. It is always something. Betty has no one else to help her. She has four children on her own. She lives from crisis to crisis. The worker feels they are making progress but Betty just has too much to deal with.

28. Key Roles – Landlord and Service Provider • Landlord has a key role in helping people understand their obligations and comply with them. (Assertive approach) • Establish the expectations for the tenant • The social services staff provide and arrange for services needed to maintain housing and also function as advocates for the tenant. • Assist the tenant to meet the expectations of tenancy

29. Coordinating Social Services with Landlords/Property Managers

30. Assertive Landlord/Property Management • Hold tenant to the obligations of the lease • Respond to problems in a timely way • Contact case manager early on when problems first arise • Provide written notices to tenants of rule, lease violations or late rent payment • Ideally, cc the case manger • Work with Case Manager to resolve barriers to maintaining unit.

31. Resources to Support the Process • Landlord/tenant mediation services • Funded as homelessness prevention • Education for case managers as to legal requirements/process • Use of the courts • Stipulation process • Planning for emergency resources • Rent and Utility payment • Housing plan to maintain tenancy

32. Managing a Collaboration • Agreement on project goals: Assisting Tenants to Maintain Housing • Acknowledge that the services are transitional but also will identify on-going supports • Each is oriented to each other’s roles • At least monthly communications focused on tenants compliance with lease • Input and feedback from property management staff is sought and valued • Support and acknowledge the landlord/property management role

33. Sharing Information and Confidentiality There is often a great deal of confusion and frustration around what information can be shared and what information is confidential EXAMPLES Public display of intoxicated behavior: Public Information Tenant disclosing a mental health diagnosis or medical information: Confidential Other CONFIDENTIAL information: Any information that is obtained in the context of professional services is deemed privileged information

34. Mainstream and Community Resources • Develop a family focused resource list • Identify Resources by Focus Areas and Tasks • Review Resources in Current Use • Add resources developed through work with tenants • Identify Needed Connections • Income, benefits AND services • Using Client resource directories in each region

35. Categories of Assistance • Benefits and Entitlements including Emergency Assistance • Financial literacy and credit repair services • Employment Programs • Education and Job Training Programs • Legal Services • Food and Nutrition Programs • Children’s Services • Clothing and Furniture Banks

36. Categories of Assistance - 2 • Health Clinics • Dental Services • Mental Health Services • Substance Use Treatment Programs • Counseling Services – Family, DV, Trauma • Lists of AA and NA meetings • Emergency Services – DV Hotline, Child Abuse and Neglect Reporting, Mobile Mental Health Services • Social, Spiritual and Recreational Opportunities

37. Other Community Resources • Public transportation • Community centers • Camps and employment programs for adolescents • Libraries • Civic associations • Settlement houses • Parks, recreational and sports facilities • Places of worship • Adult education, classes and workshops • Tutoring and mentoring programs for children • Arts organizations • Clubs and hobby groups

38. Links to Mainstream Resources • Ensure knowledge of them – directory, visits to programs, ask clients, goals and what they provide • Introduce yourself and your agency, especially if there will be a lot of referrals • Explain your role and what they can expect • Attempt joint or coordinated service planning • Gather and share history (with client’s consent) • Accompany person to assist with engagement with new service • Maintain regular contact and keep your promises

39. Working Effectively with Other Providers • Be Persistent, Patient And Reachable • Provide information about the person that helps them to do their job • Recognize Each Program Has Their Personal Service & Outcome Goals • Ask About And Understand Expectations For Participants • Be On Time For Appointments And Follow Up With Any Information They Require For Admission • Understand How The Program Interacts With Your Client’s Health Insurance, Entitlements, Patients Rights To Services, & Other Collaterals • Assure The Provider Of Your Involvement

40. Keeping Everyone in the Loop Educating on the process Helping tenants to negotiate for services and enlisting the services help Establishing regular check ins Recognizing strong partners Renegotiating the relationship as necessary

41. CTI: Critical Time Intervention Assists individuals and families to stabilize in housing by: • strengthening people’s ties to community services, family, and friends • the provision of a focused case management approach that is • connected to each participant’s life goals. • Time-limited (6-9 months) • Three 3-month phases of decreasing intensity (transition to the community, try out, termination)-starts when moving into housing • “Manualized” Intervention with Focused services (1-3 areas from 6 assessment areas) based on threat to long-term housing stability and access to support (mental health, housing, substance misuse, life skills, financial, and family and other social supports) www.criticaltime.org

42. Essential elements • Longitudinal: adapt to family functioning over time • Individual: care is planned with the family and addresses particular needs • Comprehensive: families can receive a variety of services related to their many needs • Flexible: families are allowed to progress at their own pace • Accessible: families are able to access services when they need them and in a way which is financially and psychologically manageable • Communication: between family and case manager and service providers and among service providers involved in the family’s care

43. Phases of Housing Stabilization and CTI • Housing Planning • Phase 1: Transition to the Community • CTI begins • Phase 2: Try-out • Phase 3: Termination • Phases 1-3 last approximately 1-3 months each

44. Housing Planning Phase • Engagement • Risk Assessment: Assess for any crisis situations • Educate person about Housing Options they may be eligible for • Provide direct services and assistance to link with resources as needed • May include income, ID, and other concrete needs to access housing • Addressing immediate needs • May be linkages to needed care such as psychiatric, medical, dental or SA • Housing Assessment

45. Phase I: Transition to the Community • Assessment of new needs and resources • Review assessment and revise based on current housing and lease compliance. Identify resources needed. Focus on community support, role and activity • Housing Planning revision • Review plan and revise based on priority area, immediate needs and current resources. • Assistance in making linkages: meeting with the person and the resource if necessary • Refine communication structures with landlord, services and other supports • Skill building for community resources • Provide education about rights, responsibilities, and expectations; model negotiation skills

46. Phase II: Practicing Phase • Solidifying Linkages to Community Resources • This might include: legal assistance, schools for children, religious/spiritual, community treatment and support options • Promote independent living skills • Ensure income in place, financial management, tenancy obligations, schedule and role • Ensure communication support systems • Regular meetings monitor progress and connections • Developing longer term plan • Look at non-immediate needs such as education planning, career goals, long term housing plans • Continue to use MI techniques

47. Phase III Step Down/Terminations • Fine Tuning Linkages • Higher Level Skills training • Focus on Negotiating Skills • Plan to address housing risks as they arise • Step down and let go- having other linkages take primary role • Ensure needs are met, develop adjust linkages if needed • Assess worker role going forward • Develop formal plan with household and Linkages

48. Contingency planning • Some families may not be able to complete the program in nine months: • We have not definitively identified who that group of families is • CTI can be used as an assessment tool • Identify longer term resources in the community • Identify longer term rent subsidies in the community • How does access to those resources get prioritized?

49. Support for the Practice:Supervision • Supervision: • At least: weekly individual supervision, weekly team meetings with case conferencing • Case Conferencing: • Highlight best practices, identifies themes around barriers, highlights resources, provides clinical consultation • Team Meetings: • Team meetings have an informational, monitoring and support function, track where people are in the transition to and identify common barriers, share information and resources amongst team members, alert team to people in distress or crisis, identify best practices • Training

50. Support for the Practice: Characteristics of Successful Teams • Involve leaders • Set shared aims • Welcome everyone • Self-conscious • Non-linear • Devolve control • Manage knowledge with agility • Reflective and responsive • Sense- making • Values asking • Recognition economy • Stimulate affection among members