1. www.desc.org Compassionate Pragmatism: Introduction To Managing Difficult Behaviors in Housing WSCH 21 st Annual Conference Kennewick, WA May 11 - 13, 2011

2. www.desc.org Overview of DESC  emergency shelter  licensed mental health services  licensed chemical dependency services  supportive housing  high level of integration across programs

3. www.desc.org DESC Supportive Housing Union Hotel 1994 The Morrison 2001 Evans House 2007 Lyon Bldg. 1997 Kerner Scott House 1997 1811 Eastlake 2005 Rainier House 2009 Canaday House 2010 Scattered Sites 1995

4. www.desc.org What we believe  people want a place to live  people want to get better

5. Core convictions  housing is a basic human right  housing is not a reward for clinical success or compliance www.desc.org

6. “When I was at home I was in a better place.” www.desc.org - Touchstone in “As You Like It”, Shakespeare

7.  Targeted to the most vulnerable.  People are moved into housing directly from the street without preconditions of treatment acceptance or compliance.  Provider is obligated to bring robust services into the housing.  Continued housing is not dependent on participation in services.  Harm reduction approach rather than mandating abstinence.  Residents have leases and tenant protection under the law.  Can be implemented in either project-based or scattered site model. Housing First Principles www.desc.org

8. Selection Criteria  severe and persistent mental disorders  not connected to anyone  too disorganized to self-advocate  most at-risk on the streets Vulnerability approach Kerner-Scott House experience (1997)

9. Integrated services and property management  Integration of property management and service provision on same staff team  Service-rich  Community-focused  Safety-focused  Housing, not a program www.desc.org

10. Key Components: Assertive engagement www.desc.org

11. Assertive Engagement: Meeting people where they are  outreach  being useful  relationship building through practical assistance and empathy  not office-based www.desc.org

12. Open and honest dialogue Key Components: www.desc.org

13. Open and honest dialogue  with residents transparency about mission flexibility and forbearance compassion and empathy  on teams: daily staffing shared decision-making about response to incidents www.desc.org

14. Limited rules and requirements Key Components: www.desc.org

15. Limited Rules and Requirements  rules aren’t the solution  flexibility about behaviors is a type of disability accommodation www.desc.org

16. Flexible response to problems Key Components: www.desc.org

17. Flexible Responses to Problems  pro-active  individualized (care plans, crisis plans) www.desc.org

18. Dealing with problems www.desc.org

19. Social behaviors  communication  decorum  hygiene  cooperation www.desc.org

20. Room conditions  cleanliness  hoarding  damage  pests www.desc.org

21. Drugs  safety  traffic  dealing  intoxication

22. www.desc.org Violence  threats  fights  assaults

23. www.desc.org Responding to Violence  everything is negotiable  no pre-determined consequence  future-oriented  safety-oriented

24. www.desc.org Harm Reduction A set of non-judgmental strategies and approaches which aim to provide and/or enhance skills, knowledge, resources and support that people need to live safer, healthier lives. - Streetworks, 1997

25. “…when we get a person housed, good things happen.” www.desc.org -Tom Carr, former Seattle City Attorney (in context of 1811 Eastlake Project)

26. www.desc.org Harm Reduction is:  assertive and engaged  based on science, compassion, health and human rights  supportive of any positive change

27. www.desc.org Harm Reduction is not  a non-intervention, “anything goes” paradigm  “enabling”  passive

28. Harm Reduction in everyday life  helmets for bicyclists  seatbelts in motor vehicles  condom distribution  nicotine patches www.desc.org

29. More Harm Reduction  using clean needles  using with others instead of alone  switching to marijuana from a harder drug  cigarette monitoring  beer/alcohol monitoring  using beer versus hard alcohol or light beer instead of regular beer www.desc.org

30. Meeting people where they are For those that are homeless this means:  Literally: near their campsites, at shelters, in parks  Figuratively: by offering help and respect regardless of behaviors www.desc.org

31. Meeting people where they are  unclogging their toilet  helping them with their laundry  cleaning up their rooms  talking with them while they are under the influence www.desc.org

32. "The freedom to be wandering the streets, psychotic, ill, deteriorating and untreated, when there is a reasonable prospect of effective treatment, is not freedom, it is abandonment." --ACLU www.desc.org