6.7 intensive service interventions for people with disabilities
DESCRIPTION
Presented by Devra Edelman.TRANSCRIPT
Intensive Service Interventions for People with
Disabilities: Helping Families Stabilize & Thrive
2011 National Conference on Ending Family Homelessness
Devra EdelmanDirector of Programs
Hamilton Family Center
February 11, 2011
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• Overview:
• Who are Intensive Service Interventions for? • Targeting services
• Where are Intensive Service Interventions Provided • Program Types
• How are Intensive Service Interventions Provided?• Core Philosophies
• What are Intensive Service Intervention models? • Promising Practices
Intensive Service Interventions for People with Disabilities:
Helping Families Stabilize & Thrive
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Circumstances: History of Homelessness Housing History Credit / Debt History Immigration Status Young Head of Household Current or Past Involvement
in Child Welfare Past Institutional Care Recent Traumatic Life Event
Challenges: Mental Health Issues Substance Abuse Issues Physical Disabilities Chronic Health Issues
(including HIV/AIDS)
Intensive Service Interventions for People with Disabilities:
Helping Families Stabilize & Thrive
WHO are Intensive Service Interventions For?
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Intensive Service Interventions for People with Disabilities:
Helping Families Stabilize & Thrive
• Family Needs identified through in-depth application and assessment process, including:• Service provider referrals, • Family interviews,• and the use of an assessment tool, such
as HFC’s Housing Assessment Matrix (HAM).
• Housing Options / “Fit” May be:• Market Rate Housing• Short-term Rental Assistance• Medium-term Rental Assistance• Affordable Housing• Deeply Subsidized Housing• Transitional Housing Program• Permanent Supportive Housing
Assessment Indicators include: Income level History of Homelessness Housing options Lease History History of Evictions Age of Primary Caregiver Mental Health History Substance Use Criminal Justice Barriers Temporary Financial Strain Recent Trauma Child Welfare History Education Level Work Experience Work Inhibiting Disabilities Income Plans Family Composition Transportation Barriers Child Care Barriers Income Sources
Assessing Needs / Program Fit
Assessment & TargetingTransitional Housing or Permanent Supportive Housing?
TRANSITIONAL HOUSING:Possible indicators for TH can include: History of homelessness: Episodic Lease History: Primary caregiver has never held a
lease in his/her name Need for outpatient mental health services in past
12 months; Recently completed substance abuse program
and/or self-identified substance abuse; need for outpatient recovery / maintenance
Age of primary caregiver: Young head of household, 18-24 w/children or pregnant
Household member has experienced issues related to domestic/intimate partner violence in past 12 months
Child Welfare: Household has involvement w/child welfare in past 12 months
Household has children currently separated from family by CPS, reunification is planned; or family has reunified in last six months
Education Level: No adults in household have a high school diploma or equivalent
Criminal Background: An adult in the household has been arrested or convicted of a felony
One or more adults in the household cannot work 30 or more hours /week because of childcare needs;
PERMANENT SUPPORTIVE HOUSING:Possible indicators for PSH can include: History of homelessness, meets definition of
chronic homelessness History of evictions: two or more evictions on
their record or an eviction from a previous permanent supportive housing placement
Mental health services: Inpatient treatment within past 12 months
Substance abuse services: Inpatient, intensive outpatient, or detox treatment within last 12 months or untreated substance abuse
Work experience: No adults have worked 30 or more hours a week in the past three years
Work inhibiting disabilities: Inhibits client from working 20+ hours per week
Criminal Background: An adult in the household has been convicted of a felony
Other possible considerations can include recent DV, recent involvement w/CPS
Network of support
Housing Assessment Matrix (HAM) Tool:Strategically targeting resources to maximize opportunities for homeless families
Housing Assessment Matrix:
http://hamiltonfamilycenter.org/
latest-news/promising-practices/
Intensive Service Intervention Components
“Therapeutic” Housing:– Direct therapy services– Therapeutic Consultation for Staff– Wrap-Around / Collaborative Services– Linkages among Housing, Services and Supports– Parent-Child Interaction / Family Focus– Children’s Programming / Enrichment– Intensive Case Management– Safe Environment (Physical & Emotional)– Individualized Family Action Plan– Choice within Structure
Core Philosophies for Providing Intensive Service Interventions
Housing First
Harm ReductionTrauma-Informed Services
Housing First
Housing is a basic human need and right
Families are more responsive to intervention and social service support once in permanent and stable housing
Everyone is valuable and capable of being a valuable resident and community member
Outreach should be targeted to reach the most vulnerable
Residents, property managers, and service providers should work together to integrate services into housing
Client focused services
Move homeless families into permanent, affordable housing
Rapidly
Time-limited, home-based support services
Housing First
Shelter Services Short-term Crisis
Intervention and stabilization Linkages and referrals Advocacy Assessment and Service
Plan: short and long term goals and objectives
Employment Services Money Management
Housing Services Targeted Housing
Assessment Linkages and referrals to
housing resources Spending Plan and budget Move-in assistance Home-based Support
Services Eviction Prevention
Trauma Informed Services
To be a “trauma-informed” provider is to root your care in an understanding of the impact of trauma and the specific needs of trauma survivors.
Avoid causing additional harm to those we serve / re-traumatizing clients.
Help clients on their path to recovery. Becoming trauma-informed means adopting a holistic view
of care and recognizing the connections between housing, employment, mental and physical health, substance abuse, and trauma histories.
Providing trauma-informed care means working with community partners in housing, education, child welfare, early intervention, and mental health.
Trauma-Informed Services
Trauma-informed Problems/Symptoms are inter-related
responses to or coping mechanisms to deal with trauma.
Shares power/Decreases Hierarchy. Homeless families are active experts and partners with service providers.
Primary goals are defined by homeless families and focus on recovery, self-efficacy, and healing.
Proactive – preventing further crisis and avoiding re-traumatization.
Understands providing choice, autonomy and control is central to healing.
Traditional Approaches Problems/Symptoms are discrete and
separate.
Hierarchical.
People providing shelter and services are the experts.
Primary goals are defined by service providers and focus on symptom reduction.
Reactive – services and symptoms are crisis driven and focused on minimizing liability.
Sees clients as broken, vulnerable and needing protection from themselves.
Adapted from L.Prescott via K. Guarino
Harm Reduction
Focus on reducing the personal and societal harm created by substance use.
Policies based upon on behaviors rather than substance use
Goal to foster and encouraging lasting therapeutic change Non-judgmental, non-coercive provision of services and
resources Meet people “where they are at” Motivate change in a collaborative, empathic environment.
Promising Practices: Early Childhood Mental Health Initiative / Therapeutic Alliance for Children
Objective: To provide onsite, accessible, culturally competent mental health consultation to homeless and formerly homeless families and their young children, as well as to the staff providing services. Includes a mix of direct treatment and consultation services that meet the needs of children, parents, and program staff.
Services include:– Mental health support and education for parents– Onsite individual and group mental health treatment for
children and their parents– Child Developmental Screening (ASQ and ASQ-SE)– Training, case consultation, and emotional support for
program staff– Program consultation– Outreach and referral
Mental Health Initiative Improves Homeless Children’s Emotional Well-Being
Mean baseline and follow-up scores on DPH-Screening Tool Homeless Initiative (n=27)
4.00
2.63
2.14
2.522.78
3.68
2.22
1.54
2.07 2.11
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
Aggressive/Defiantproblems
Attention Deficitproblems*
Withdrawn** Anxious/Depressed EmotionallyReactive*
Baseline
Follow-up
** p < .05
* P <= .06
The DPH Child Care Screening Tool, used as an outcome measure supports the decrease in Internalizing problems (Withdrawn and Emotional Reactivity), and also suggests changes in the Externalizing problem of Attention Deficit-related problems.
Program staff feel more confident working with clients
Dealing with parents' mental health problems
4.00
4.86
1
2
3
4
5
6
7
1 2
Dealing with children's mental health problems
3.94
4.90
1
2
3
4
5
6
7
1 2
How would you rate your skills dealing with [children/ parents] with mental health problems?
Highly skilled
Not skilled at all Before consultant
After consultant
Before consultant
After consultant
Both changes represent statistically significant gains
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Partnership with the Court System• Collaboration with Dependency Drug Court and Behavioral Health Court
prioritizes child welfare / substance abuse and behavioral health / criminal justice referrals
• Up to 10 DDC and 5 BHC referred families accepted in the program at any given time.
• Other referrals continue to be accepted • Emergency Shelters• Domestic Violence Programs• Treatment Programs, etc.
• From 2008 through 2010, 80% of the families who entered the program had histories of child welfare involvement, substance use, mental health or other specialized needs (39 out of 49).
• 28 of these families had CPS involvement, 17 of whom were referrals from DDC (16) or BHC (1).
Promising Practices:Family Transitional Housing - Collaborative Justice Partnership
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Promising Practices:
Family Transitional Housing - Collaborative Justice Partnership
DDC / BHC Key Service Components
• Increased Judicial Supervision• Integrated team provides support and wraparound services• Intensive Case Management• Supportive, but Structured Environment• Accessible, appropriate treatment services• Relapse Support• Coordinated Responses to Family Needs
• Substance Abuse Treatment• Behavioral Health Services• Parenting Support• Housing
Promising Practices: Transitional Housing – Collaborative Justice Partnership
ATTORNEY’S AND
COUNSEL
Policy Counsel – City Attorney
Parent’s Attorney
TREATMENT PROVIDERS
Outpatient Services
INTENSIVE SUPPORT
SERVICES
Homeless Prenatal Program
Team Manager
Case Manager
CHILD AND FAMILY
SERVICES
Protective Services Worker
COLLABORATIVE
JUSTICE
COURT:
Commissioner
Coordinator
Court-Appointed Social Worker
TRANSITIONAL
HOUSING PROGRAM
Case Manager / Housing Liaison
Therapist
Children’s Programming
Developmental Screening
Parent Education
Contact:
Devra M. Edelman
Director of Programs
Hamilton Family Center
415-409-2100 x122
www.hamiltonfamilycenter.org