march 21, 2013 2:00-3:30 PM

1. Rescheduled Webinar: Progressive Case Management in SSVF Programs march 21, 2013 2:00-3:30 PM

2. John Kuhn, U.S. Department of Veteran Affairs SSVF National director’s UPDATE

3. What, Why and How: Overview of Progressive Case Management Marge Wherley, Abt Associates

4. What is “Progressive Case Management”? • A baseline level of case management assistance. • Intensity and/or duration of case management will be increased for an individual, but only if and when the baseline is shown to be inadequate for that person.

5. The Rationale • Efficiency: by avoiding more assistance than is required, the program can help more people. • Individualization: When a person shows s/he needs more help, that help can be provided. • Avoids false assumptions about disability and/or poverty: persons with those demographics do not uniformly require more intensive or longer-term assistance. • Effectiveness: Research, including random assignment to high and moderate levels of case management have not found differences in outcomes.

6. Core Concepts of SSVF • Housing First: Maintain or obtain permanent housing as soon as possible, without pre-conditions. • Crisis Response: Short-term intervention to quickly resolve a housing crisis. • Client Choice: The person in crisis has the choice of addressing or deferring life changes, utilizing referrals, etc.

7. Crisis Intervention Case Management • People experiencing a crisis normally go through periods of disequilibrium and equilibrium until they can return to a state of relative stability. This is highly stressful. • Crisis intervention aims to reduce the duration and intensity of disequilibrium and allow the person to return more quickly to their previous level of stability, reducing stress levels. • Stress has physical and psychological consequences, including an inability to focus on long-range goals, learn new information, or make changes that require self-control and willpower.

8. Defining Baseline in SSVF Case Management Tasks for Homelessness Prevention: • Identify barriers to keeping housing • Provide assistance with relocation if housing cannot be retained • Provide assistance with landlord negotiations, lease compliance, temporary financial assistance, etc. to retain or obtain housing • Provide short-term follow-up on issues related to housing (and income needed for housing). This includes making referrals the household needs/wants to reduce the likelihood of future crises.

9. Defining Baseline in SSVF Case Management Tasks for Rapid Re-Housing: • Identify barriers to keeping housing • Provide assistance with housing search, landlord negotiations, understanding lease compliance, temporary financial assistance, application for benefits, etc. as needed to obtain housing. • Provide short-term follow-up on issues related to housing (and income needed for housing). This includes making referrals the household needs/wants to reduce the likelihood of future crises.

10. Baseline Assessment Tenant Screening Barriers Rapid Re-Housing (always) and Homeless Prevention (when housing relocation is required) • Income and income history • Rental history • Criminal history • Credit history

11. Assessing Tenant Screening Barriers • Interview client (always) • Collect more formal information (highly recommended): Buy a tenant screening report OR Conduct a screening--obtain release of information and contact previous landlords, credit agencies, access criminal and eviction databases

12. Baseline Assessment Housing Retention Barriers Homelessness Prevention and Rapid Re-Housing • Income, ability to pay rent (even if severely rent-burdened) • General understanding of landlord and tenant rights and responsibilities, lease requirements • Ability to comply with the “social expectations” of renting

13. Assessing Housing Retention Barriers • Income: documentation for SSVF eligibility determination • Tenant Screening Report: suggests patterns that could be Housing Retention Barriers. • Interview: discuss red flag items on TSR • Home visits can identify potential HRBs • Checking in with the landlord may identify red flags of potential problems with lease, rent payment, or social expectations (complaints by other tenants).

14. Baseline Case Manager Interventions Retain or obtain housing through: • Negotiation with landlords • Payment of arrears… or housing search and housing start-up costs • Temporary rental assistance, if needed • Information or skill-building, if needed, to address identified Housing Retention Barriers • A strategy for increasing income • A back-up plan for resolving <potential> future housing crises (including inability to pay rent once assistance ends).

15. And…the Important “Soft Outcomes” • Helping households reduce their stress to <at least> pre-crisis levels • Helping households to repair the damage caused by the crisis (medical, employment, parenting, etc.), re-establish their pre-crisis routines, and strengthen their support system • Helping the household feel safer by having an emergency back-up plan • Helping the household feel more confident about the future by knowing steps they can take and referrals they can use to reduce their risks and achieve their hopes and dreams--when they are willing and able.

16. Why People Fail at Longer-Term Goals • The willpower and self-control needed to make life changes is like a muscle: it becomes exhausted by use. Self-control and longer-term goals are functions of the prefrontal cortex. • Stress—whether physical or emotional—essentially turns off the prefrontal cortex in favor of vigilance and rapid action. It’s a survival mechanism, controlled by specific hormones. • People’s self-control is determined by genetic factors, environmental experience, sleep, hunger, diet, chemical use and crisis situations. Self control is weakened by shame and also by success. It is strengthened by health, practice, meditation, controlled breathing.

17. When is Baseline Too Much? • “Deer in the headlights”: Body and brain are just in the wrong state for self-control • Person agrees to change but doesn’t follow through • Person shows impulsive, risk-taking behavior and/or anger/anxiety Reduce goals, avoid shame/guilt, identify normal stress reactions and recommend steps to decrease stress, increase health and willpower

18. When is Baseline Not Enough? • When the landlord reports continuing and serious violations of the lease or complaints by other tenants—to the point housing is still at risk. • When additional assistance is necessary to obtain longer-term financial assistance and/or service from another agency. Identify the specific case management assistance needed to achieve goals-- and the projected intensity/duration

19. When is the Crisis “Resolved”? • Household is current with rent and in compliance with lease • Landlord is willing to continue lease • Tenant can explain landlord-tenant rights and responsibilities* • Tenant can explain “social expectations of leasing” and how the household will meet these* • Tenant believes crisis is resolved and housing is stable • Tenant has a plan and referrals for increasing income • Tenant has referral information to pursue additional goals that are important to household’s future stability • Tenant has a plan for responding to future, predictable risks of a housing crisis (Emergency Plan B)

20. Planning for Progressive Case Management How long will it take to resolve the crisis? When do about 80% of participants reach the baseline expectations? How often does the case manager need to meet with the participant—initially and after the first weeks? What level of contact is sufficient to resolve the crisis for about 80% of participants? These are the baseline, which can be adjusted to respond to individuals who demonstrate they need more frequent or longer case management—or less intensity and duration of case management.

21. Designing Progressive Case Management in Your SSVF Program • Define minimum expectations for frequency of contact and expected duration of assistance • Define a process for increasing the baseline level of case management on a case-by-case basis when it is demonstrably inadequate to resolve the crisis • Design caseload sizes based upon baseline intensity and duration (as an average which can be over-ridden according to agency process)

22. Designing Progressive Case Management in Your SSVF Program • Define options for monitoring progress toward crisis resolution and identifying remaining challenges through tenancy and landlord contacts • Assure case managers understand landlord-tenant rights and responsibilities and the social expectations of leasing • Assure the agency has effective working relationships with community resources, particularly those related to increasing income

23. Case Manager Skills and Training • LANDLORD PERSPECTIVE: Knowing what landlords want; ability to create a win-win situation for both tenants and landlords • TENANCY SUPPORTS: Identifying level of tenant knowledge, skills; ability to teach needed skills “in vivo” (“in life”) • LANDLORD-TENANT RIGHTS AND RESPONSIBILITIES: Knowledge of applicable laws; ability to effectively help both landlords and tenants comply

24. Case Manager Skills and Training • STRESS: • Knowing how acute and chronic stress affects human behavior, emotions and health • Assessing the program participant’s stress reactions • Interventions that will reduce stress levels and how to apply these in a short-term, housing crisis program • Assessing the willingness and ability of the participants to take actions that will resolve the current crisis and contribute to non-recurrence

25. Case Manager Skills and Training • HOUSING PLANS: Short-term; a limited number of goals; actionable; consistent with the client’s preferences and current level of self-efficacy • REFERRAL RESOURCES: Housing alternatives; income-enhancing options; low-cost/no cost commodities and services • PERSONAL ATTRIBUTES: Good boundaries, good stress management skills, willingness to do whatever needs to be done, creativity, respect and support

26. Keeping Your Head Above Water • Understand the neurological limits of making multiple or significant life changes, particularly when a person is under stress • Challenge our tendencies toward cynicism when people cannot focus on anything but the immediate crisis • Develop pride in the importance of crisis intervention!!!!! It is a challenging and rewarding profession! Celebrate the short-term!

27. Kristina Hals, SSVF Technical Assistance referrals for IncomeKey to SSVF Progressive Case management

28. Crisis Response Paradigm of SSVF Implications for Referrals: • Sharpens focus on key referral arenas. • Narrows range of referrals to a hierarchy. • Prioritizes resolving immediate crisis. • Requires expert navigation of key arenas. • Creates imperative for referring externally.

29. Choice of Arenas for SSVF Referrals Will be: • Driven by consumer choice. • Framed by crisis response. • Key to integrating SSVF w/mainstream resources. • Focused on: • Maximizing income. • Accessing housing. • Accessing Veteran benefits/systems.

30. Our Focus Today: Income Maximization Referrals Why Focus on Income? • 1st order in the “progress” of progressive case management. • Primary for prevention and re-housing. • Some opportunities specific to: • Homeless. • Veterans. • Homeless Veterans .

31. Income Status of SSVF Participants Varying Profiles: • All are @ 50% Area Media Income – many @ 15%. • Some have zero income. • Income drop may have precipitated housing crisis. • Work histories include: • Employment barriers specific to Veterans. • Long and steady or intermittent work histories. • Informal work, flexible employment. • Job loss, terminations, lay off. • Lack of progress beyond transitional jobs. • Long term unemployed, discouraged workers.

32. Benefit Status of SSVF Participants Varying Profiles: • Never applied for public benefits. • Pending application(s). • Receive or applied/denied TANF/SNAPs. • Receive or applied/denied SSI/SSDI . • Receive or applied/denied to Vet’s “Pension”. • Sanctioned from TANF/SSI/SSDI/Vet Benefits.

33. Income for SSVF Crisis Resolution May Come From: • Work: temporary, day labor, transitional, etc. • Stipends: job training/intern programs. • GI Bill: stipend and housing allowance. • Public benefits (can combine with job). • Non-SSVF temporary financial assistance . • Child support - recaptured of unpaid. • Shared expenses via SSVF roommate(s) • Gifts (local charities, faith based groups).

34. Snapshots of Income Referrals Snapshots to Review: • Public-private Partnerships (for homeless job seekers). • “Jobs First” Programs (tied with rapid shelter exits). • Veterans Retraining Assistance Program (VRAP). • Homeless Veterans Reintegration Program (HVRP). • Homeless Veterans Supported Employment (HVSEP). • Veterans Workforce Improvement Program (VWIP) • Compensated Work Therapy (CWT). • Voc Rehab and Employment (VR &E) • Post 911 GI Bill Benefit. • SSI and SSDI. • Veterans Compensation Benefits. • TANF and SNAP.

35. Public-Private Job Partnerships for Job Seekers who are Homeless

36. “Jobs First” Programs Connected to Rapid Shelter Exits

37. Veterans Retraining Assistance Program (VRAP)

38. Homeless Veterans Reintegration Program (HVRP)

39. Homeless Veterans Supported Employment Program (HVSEP)

40. Veterans Workforce Improvement Program (VWIP)

41. Compensated Work Therapy (CWT)

42. Voc Rehab and Employment (VR&E)

43. Post 911 GI Bill

44. Supplemental Security Income (SSI) & Social Security Disability Insurance (SSDI)

45. Veterans Service Connected Compensation Benefit

46. Veterans Non-Service Connected Pension Benefit

47. Temporary Assistance for Needy Families (TANF)

48. Veterans Job Fairs • U.S. Chamber of Commerce: Hiring Our Heroes Job Fairs • Veterans Service Organizations: Hiring Fairs • National Veteran Small Business Conference: Hiring Fairs

49. Take Aways • Referrals for income are SSVF priority. • CM assessment must explore income options. • CMs must be systems navigators in: • Income opportunities for homeless job seekers. • Income options for Vets and Homeless Vets. • Public benefits. • First Steps: • Map all local income sources for SSVF. • Develop key contacts with sources or find local experts.

50. Questions • Visit SSVF Website for archived webinar. • Contact SSVF Regional Coordinators.