1. Bringing Housing First Principles to the Home Visit Graydon Andrus and Margaret King DESC, Seattle, WA

2. Presentation Goals  Describe important aspects of the home visit from two service perspectives: Clinical Case Management and Supportive Housing  Explore meaning of “home” and how to use it therapeutically  Provide clear examples of basic tenets of the home visit  Illustrate connection between housing first, harm reduction and home visit strategies  Relate strategies to goal attainment and Recovery

3. Housing First Principles  Move-in without preconditions  Robust support services/assertive engagement  Continued tenancy not dependent tenant participating in services  Housing units targeted to most disabled and vulnerable  Embrace harm reduction approach to addictions (and other issues)  Residents have leases and tenant protections  May be implemented as either a project-based or scattered site model

4. “Home can be a room inside a house, a house within a neighborhood, a neighborhood within a city, and a city within a nation. At each level the meaning of home gains in intensity and depth…a place of security within an world, a familiar place within a strange world,…a place of autonomy and power.” -Kimberly Dovey

5. “We shape our dwellings and afterwards our dwellings shape us.” -Winston Churchill

6. “If we close our eyes, take a deep breath, and summon meaningful memories, we quickly notice that they are tied to a specific place.” -Sarah Robinson

7. “Home…a place of security in an insecure world, a familiar place in a strange world, a place of autonomy and power.” Judy and Pam

8. Environmental Psychology  New image

9. “Open and free, yet sheltering as a nest.” -May Sarton We depend on meaningful places

10. “My mind is not so clear when my place is messy…that’s why I have a cleaner come in.” -Mark

11. Why home visit?

12. Benefits of Home Visit  Helps build or restore client’s experience of home as place of solace and power  Opportunity to leverage these benefits in service of other goals (including ADLs)  Opportunity to shift power dynamic a bit

13. Role of the client’s home in the service relationship  Represents new possibilities  Meeting in the home helps embed positive associations in it  A little fanfare goes a long way- encouragement and pride of place

14. Single Site Housing First  The neighborhood  The building environment  The unit  The staff and neighbors

15. Close but safely distant  Staff play multiple roles  Services are robust but voluntary  Tricky boundary balancing  Housing staff and outside program staff have complementary roles- but takes deliberate attention and refining to optimize

16. Co.nun.drum: Noun: a confusing and difficult problem or question  Hoarding  Safety/harm reduction  Logistics of service partnering

17. Listen to the environment

18. Unit inspections  Predictable engagement opportunity, chance to assess ADLs and tailor services  Reinforces belief that residents deserve a safe, sanitary and friendly home  Asset management- required by outside funders

19. Hoarding

20. How much is too much?

21. Compassionate pragmatism: tireless creativity  Weekly donation run  Side-by-side cleaning  Cleaning for the client  Incentives and rewards  Lease enforcement

22. Harm Reduction  Evidence of use in unit  Sustaining a clinical focus  Impact on neighbors  When to focus on lease enforcement

23. Purpose of Home Visit  Continuous engagement/relationship building  Provides continuity of support and treatment  Assess/address threats to housing retention  Purposeful and goal directed  Largely based on consumer stated goals  Health care needs?  Skill building (medication management, budgeting, housekeeping, social, employment related)

24. Clinical Case Management in Housing First Context: The Backdrop  Limited knowledge of person  Respect boundaries, life rhythms  Be ready for surprises  Multiple roles as case manager

25. The Backdrop  Continual development of relationship  Power dynamic shifts  Does it feel awkward? Talk about it.  Housing context: single site/project based or scattered sites?

26. Home Visit to Assess The Person  How is the person today?  Their greeting  Clothing  State of Alertness  Mood  Changes from baseline?

27. Case Manager as Anthropologist  Be observant, not intrusive  Presence of dangerous objects/substances?  Risks to community within the building?  Neighborly relationships  Evidence of interests and pastimes – something to build on.

28. Collaboration with Supportive Housing Staff  Broadens base of support  Increased continuity and coordination of care  Shared workload  Invest time to build a service plan with goals that are meaningful to client  Establish clear communication practices

29. Collaborating With a Landlord or Property Manager  Development of partnership with landlord  Educate to reduce stigma & promote tolerance  Be available at critical times – you are an asset  Visit client routinely and check in with landlord or resident manager  Work with tenant to reduce most concerning behaviors (drug related, aggression, property destruction)

30. Frequency of Visits  Variation over time  Variable influencing frequency  Non-linear process  Minimum visits  Alternating with office visits? No office visits?

31. Therapeutic Opportunities  Possibilities in every encounter  Brief and woven into the conversation  Client driven  Motivational Interviewing well suited to situation

32.  Does tenant feel safe in room with you?  Presence of dangerous objects?  History of violence/aggression? Bring a buddy?  Meet in common area of building? Participant and Staff Safety