Suzanne Wagner Andrea White Housing Innovations Housing Stabilization Services Peer Learning Session: Skills and Strategies for Successful Family Stabilization Hogan Center – College of the Holy Cross Tuesday May 31, 2011 Suzanne Wagner Andrea White Housing Innovations

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

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

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

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

Commonwealth of Massachusetts HomeBase 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.

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

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.

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 Based on the research of Columbia University’s Homeless Columbia Center for Homelessness Prevention Studies CTI has been recognized as a model program by both the federal Substance Abuse and Mental Heath Services Administration (SAMHSA) Does anyone know the name of any other EBPs?: Wellness Self Management (illness Management & Recovery (aka WSM) Assertive Community Treatment (ACT) Supported Employment Integrated Treatment of Mental Illness and Co-occurring Substance Abuse Family Psycho-Education Psycho-Pharmacology Protocols & Guidelines

Themes of Housing Stabilization End family’s homelessness permanently Assist families to stabilize in housing Assist people to secure/maintain stable income Assist families to reintegrate into the community Assist families to access and use mainstream resources Assist families to establish long term goals as a motivator for change

Housing Stabilization Services Housing is the goal, the lease and family’s self-defined long term goals focus the work Best predictor of the future is the past, get housing history Treatment/services are often resources to achieve the goal, not the goal itself Not always a linear process “Assertive” landlord/property mgmt is necessary

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

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

Housing Stabilization Services: Measures of Success Maintaining housing Increase/stabilization of income (earned and benefits) Connections with services and supports to prevent becoming homeless again

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

Expectations of Tenancy Paying Rent Income and financial management Subsidy Compliance if applicable Logistics: check or money order, timeliness Maintaining Apartment Understanding and meeting cleanliness standards Inspections Safety and managing repairs Quiet Enjoyment Getting along with neighbors Visitors Following building/unit rules and norms Occupancy Only people on the lease live there

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

Focused Housing Stabilization Services Planning Limit the areas of intervention based on housing barriers assessment Focus on the most pressing needs that impact housing Relate all interventions to keeping housing + long term goals Be aware this may not be a linear process Be mindful about moving from crisis

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?

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?

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?

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.

Components of the Housing Plan Tenant and Staff Roles Reflects areas of the assessment Prioritizes areas for work Sets time frames for work to be accomplished

Components of the Housing Plan Mainstream Resource Identification Clearly defines resources needed to access and/or maintain housing including: income, benefits, credit repair, legal services, employment assistance, financial planning and management, access to medical services and child care, educational support, access to community based services such a schools, mental health, substance abuse, etc.

Evaluating the Plan Measure Success Uses documented steps to reach goal and benchmarks set Uses phases to gauge expectations and progress Identifies need to renegotiate goals and resources

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.

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.

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

Coordinating Social Services with Landlords/Property Managers Provide written program information Explain role of CM as resource Provide contact information Means to resolve issue so that tenant can remain in housing Engage in proactive coordination/communication Check in on some regular basis, preferably meet regularly There is some “natural” tension in the work

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.

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

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

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

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

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

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

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

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

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

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

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 One) building long term supports and strengthening the person’s long-term ties to the community –this is really the bulk of the work as you’ll see in a minute And also by providing critical emotional and practical supports during the critical transition time,

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

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

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

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

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

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

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?

Support for the Practice: 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

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

Case Examples The Jones family has been living in their apartment for 6 months. The mother has had a hard time finding a job but she is trying. The children are doing well in school. They seem to have a lot of people in and out. You talked to Ms. Jones about this and she said she has a big family. The landlord calls you. He is ready to evict. He says that her sister has been living there and he has warned her three times. This is it. It is the first time you heard about it.

Closing Ending homelessness takes a village New models and strategies New outcomes Building on the experience of Regional Networks to End Homelessness Pilot Projects In order to achieve goals, must continue to evolve services and programs