1. www.desc.org Risk Management In a Housing First Context Greg Jensen DESC Seattle, WA Conference On Ending Homelessness Yakima, WA May 21, 2014

2. www.desc.org “ The penalty for education is self-consciousness. But it is too late for ignorance.”

3. www.desc.org What Housing First Programs Do Well In Managing Risk  Housing people who would otherwise remain homeless and at risk of dying or exhibiting out of control b/x in community.  Helping people living with major problems stay housed.  Responding to client crises and restoring clinical stability after a crisis.  Keeping community safe.  Reconnecting client to community through work/volunteering.

4. www.desc.org What Housing First Programs Do Less Well In Managing Risk  After a critical incident involving a HF participant, taking a step back and asking: Why Didn't That Work?

5. www.desc.org What Factors Increase Risk for DESC Housing First Programs? Internal Factors That Increase Risk:  Mission  Housing First Standards

6.  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 Standards

7. www.desc.org External Factors That Increase Risk  Homelessness Leads to Contact With: – Law Enforcement – Criminal Justice System – Hospitals  Difficulty Accessing Needed MH/CD treatment, due to disorganization, homelessness.

8. www.desc.org Summary of Internal and External Factors  Can’t control all of the factors that increase risk  Have to accept risk as part of doing Housing First  Therefore, programs must – Take responsibility and – Prepare for risks

9. www.desc.org Before Housing First...Who Accepted the Risk of Caring for Clients Living On Streets with Behavioral Health Disabilities?  Families  States  Hospitals  Jails  Emergency Shelters  Other Congregate Care Settings (group homes, etc.)  Cities/Municipalities  Organizations serving homeless population

10. www.desc.org What Are the Risks? I njury to residents, community, and staff Public safety risk where programs are sited Financial liability for tragedies involving residents in our care Damage to agency reputation, loss of community support Loss of future housing opportunities for Housing First clients. Further stigmatization of homeless persons living with major behavioral health disabilities. Agency risk also puts others at risk: funders, City, County, State, etc. Others?

11. www.desc.org How to Assess Risk:  Managerial/Supervisory Oversight – Pluses & Minsues  Risk Management Committee – Structure & Purpose  Safety Committee  Risk Assessments  Critical Incident Debriefings  Risk Champion

12. www.desc.org Role of Risk Champion  Challenge Assumptions Through Inquiry – Inquiring Minds Want To Know  Be A Limit Tester! – Find Out What Is Possible/Impossible  Raise Questions After Significant Crisis: Why Didn't That Work?  Be Prepared to Change Course When Conditions Change or Risk Increases or Decreases

13. www.desc.org Role of Risk Champion  Balance Risk Tolerance with Mission.  When Facing Increased Risk, Seek Out Innovation.

14. www.desc.org A Housing First Risk Management Approach  Embracing and preparing for risks clients present.  Can’t be true to Housing First Standards without taking risks.  No silver bullet.  There will always be situations you can’t predict.

15. Thank You www.desc.org e-mail DESC at info@desc.org www.desc.org