1. 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

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 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.

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
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

10. 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

11. 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

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
Maintaining housing
Increase/stabilization of income (earned and benefits)
Connections with services and supports to prevent becoming homeless again

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
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

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
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

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

24. 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.

25. 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

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
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

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)
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,

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
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

51. 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.

52. 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