A Low-Barrier Approach to Permanent Housing Stability and Retention Housing First A Low-Barrier Approach to Permanent Housing Stability and Retention D. Cheré Bradshaw, LMSW Community Alliance for the Homeless TN-501 CoC Training April, 27th 2018

Housing First: The History Traditional supportive housing required sobriety and psychiatric treatment to qualify for housing. One time or small mistakes can lead to evictions, thereby leaving clients with no services or housing A study of 28 HUD programs in 1999 showed 2/3 returned to homelessness – “coercion” model when housing is only offered as a reward for participation. This approach left the most vulnerable still outside without services or ability to gain housing

Housing First: The History (Cont.) Pathways to Housing Founder and CEO Sam Tsemberis opened in 1992 in NYC and started Pathways to Housing First. Paradigm shift in supporting clients in the pursuit of their own goals by housing them first, services second 2007 – SAMHSA adopts HF into the National Registry of Evidence Based Programs; 2010 – USICH unveils HF as a core strategy. Today over 100 cities have replicated the HF Model with 20+ years of scientifically proven success.

Transitional/ Group Housing Housing First was created to offer an alternative to traditional services approach Social Housing/ Independent Housing Transitional/ Group Housing Level of independence Hostel/ Shelter Homeless Treatment compliance + psychiatric stability + abstinence 4

Immediate and Direct Access + Supports Social Housing/ Independent Housing Transitional/ Group Homes Shelter/ Hostel Ongoing, flexible support Supports must match client needs Homeless SOCIAL INCLUSION & COMMUNITY INTEGRATION 5

Multi Faceted Method Proven Approach Proven Approach Principles and Beliefs Intervention and Actions Core Components and Community-Wide Elements Proven Approach Principles and Beliefs Multi Faceted Method Intervention and Actions Core Components and Community Wide-Elements

Principles and Practice of Housing First Choice in Housing and Services Separation of Housing and Support Services Array of Services (Service meet Needs) Recovery Orientation Principles and Practice of Housing First

Defining Housing First Housing First is an approach to quickly connect an Individual or Family to housing without preconditions or barriers to entry. Follows a belief that no one needs to be “Housing Ready” and instead everyone can be move in ready A philosophy that housing is the foundation for life improvement and stability. Believes people need basic necessities such as food and a roof over their head before they can effectively start working on other needs such as mental health, substance abuse treatment, employment, etc.

Housing First Fundamentals: Home. Support. Success. 1 Low barrier to entry 2 Safe, decent, and affordable housing 3 Housing is not conditioned on services 4 Results lead to housing stability and personal recovery Housing First Fundamentals: Home. Support. Success.

Housing First Principles and Beliefs Housing is a basic human right Housing and service delivery are separate Services are formulated using client choice and emphasizes self-determination, with modifications or refusals made at any time. Clients are treated with respect, compassion, and dignity, while services embody a recovery orientation and harm-reduction approach.

Core Components: Minimizing Prerequisites to Entry Eligibility is not determined by: Sobriety or completion of treatment programs. Income Poor credit, rental history, or most criminal convictions Willingness to participate in program

Core components: Flexible and choice driven Housing and service goals are highly tenant-driven Goals should emphasize engagement and problem-solving over therapeutic interventions Nonjudgmental communication and encouragement for clients to better themselves is utilized, but change/compliance is not required. Programs should be tailored to fit the clients’ needs, not for the client to “fit the program”

Key Elements in Practicing Housing First Motivational Interviewing Stages of Change Harm Reduction Informed Services Trauma Informed Care Key Elements in Practicing Housing First

Collaboration: Encourages change Evocation: Intrinsic motivation Autonomy: Right to self-determination Motivational interviewing PREPARING PEOPLE FOR CHANGE WILLIAM R. MILLER AND STEPHEN ROLLNICK Handout 1. Effective Communication Techniques to Support Motivational Interviewing

Stages of change James Prochaska, PhD. , and Carlo DiClemente, PhD Stages of change James Prochaska, PhD., and Carlo DiClemente, PhD. identified stages that people progress through as they make a behavioral change.

Stages of change

Pre-contemplation Contemplation Action Maintenance Relapse Stages of change Stage Intervention Pre-contemplation Contemplation Action Maintenance Relapse Offer assistance, roll with resistance Validate and respect. Help tenant “tip the balance” Support right-sized steps. How is this working? Reinforce behavior change A natural part of the process Adapted from Prochaska JO, DiClemente CC, Norcross JC (1992). In search of how people change. Applications to addictive behaviours. Am Psychol 47:1102. Handout 2. Stages of Change

HARM REDUCTION  The Harm Reduction philosophy prioritizes housing stability among persons who have experienced homelessness and who may be facing disabilities. Although recovery from mental health and substance abuse disorders is always the goal, harm reduction acknowledges that persons may be at different places along the continuum of behavior change.  Harm reduction focuses on meeting tenants where they are and assisting them to set and achieve goals. Services focus on helping tenants stay housed by managing problems that interfere with their ability to meet the obligations of tenancy, such as paying rent.

HARM REDUCTION Tenants also are encouraged to explore obstacles toward their goals in an open and non- judgmental atmosphere in which they can contemplate costs and benefits of receiving services addressing their special needs. This way, staff does not alienate tenants or cause them to begin a dishonest game of hiding their drug use, psychiatric symptoms, etc. Like any other tenant, tenants receiving services using this philosophy must still pay rent and comply with the terms of their lease. In working with tenants to reduce harm, it may be helpful to understand the stages of change model. Workbook: http://www.heretohelp.bc.ca/sites/default/files/you-and-substance-use-stuff- to-think-about-and-ways-to-make-changes.pdf Booklet

Trauma informed care A trauma-informed approach to the delivery of behavioral health services includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations. It involves viewing trauma through an ecological and cultural lens and recognizing that context plays a significant role in how individuals perceive and process traumatic events, whether acute or chronic. TIC involves vigilance in anticipating and avoiding institutional processes and individual practices that are likely to retraumatize individuals who already have histories of trauma. It upholds the importance of consumer participation in the development, delivery, and evaluation of services. 

Housing First: A critical engagement tool Engagement with clients is essential to set the tone of the client-provider relationship and the tone for the method of services provided to clients Strengths-based approaches help to empower clients Help clients develop self-determination to encourage client-driven motivation Hand out 3. Engaging Tenants in Voluntary Services Hand out 4. Engagement Case Studies

Property/Housing management and support service staff Blended management in supportive housing Role of housing manager? Role of the support service staff? Handout 5. Coordinating Property/Housing Management and Services Handout 6. Maintaining a High-Quality Physical Environment (Discussion)

Housing first and tenant responsibilities Housing First does not remove tenant responsibilities Housing is a transition period for clients and should be understood that many new obligations and responsibilities will be needed from clients that they may not be used to Tenant have a standard lease Tenant rights and responsibilities are similar to any rental agreement: if the agreement is violated there are consequences Clients should understand consequences that come from repeated violations and subsequent evictions Handout 7. Sample Rent Repayment Pledge Handout 8. Housing Retention Conference Guidelines and Policy