core elements of permanent supportive housing (psh)

Core Elements of Permanent Core Elements of Permanent Supportive Housing (PSH)Supportive Housing (PSH)

Ann V. Denton, M.Ed., Director, SSH TA Center, Advocates for Ann V. Denton, M.Ed., Director, SSH TA Center, Advocates for Human Potential, Inc., Austin, TXHuman Potential, Inc., Austin, TX

Core Elements of PSHCore Elements of PSH

The learning objectives for this session:The learning objectives for this session: Participants will gain knowledge about six core Participants will gain knowledge about six core

elements of PSH.elements of PSH. Participants will be able to see how to apply these Participants will be able to see how to apply these

elements in daily practice.elements in daily practice.

SAMHSA Permanent Supportive SAMHSA Permanent Supportive Housing KITHousing KIT

SAMHSA has developed a Permanent Supportive Housing KIT. SAMHSA has developed a Permanent Supportive Housing KIT. – Developed through consensus among researchers, housing Developed through consensus among researchers, housing

providers, Federal partners and advocates.providers, Federal partners and advocates.– Released: April, 2010.Released: April, 2010.– Includes fidelity measures as self-assessment tools.Includes fidelity measures as self-assessment tools.

Core Elements of Permanent Supportive Core Elements of Permanent Supportive HousingHousing

These also are the dimensions of the PSH Fidelity Scale These also are the dimensions of the PSH Fidelity Scale (SAMHSA KIT)(SAMHSA KIT)– ChoiceChoice– Separation of housing from servicesSeparation of housing from services– Access to housingAccess to housing– Decent, safe, and affordableDecent, safe, and affordable– IntegrationIntegration– Services and supportsServices and supports

Core Element: ChoiceCore Element: Choice

Choice is essential to success in housing. If Choice is essential to success in housing. If individuals are “placed” in a setting that individuals are “placed” in a setting that does not meet their needs and does not meet their needs and preferences, they are not likely to succeed. preferences, they are not likely to succeed.


Choice is measured in terms of the extent to Choice is measured in terms of the extent to which people are asked about their which people are asked about their preferences, can choose the type of preferences, can choose the type of housing, and have a choice of housing units.housing, and have a choice of housing units.


To implement choice, staff must . . .To implement choice, staff must . . .– Know a tenant’s legal rights;Know a tenant’s legal rights;– Be able to determine what type of housing Be able to determine what type of housing

best meets the needs and preferences of the best meets the needs and preferences of the consumer; andconsumer; and

– Know how to find and secure housing that Know how to find and secure housing that meets a consumer’s needs and preferences.meets a consumer’s needs and preferences.

Core Element: Quality (Decent, Safe, and Core Element: Quality (Decent, Safe, and Affordable)Affordable)

What do we mean by What do we mean by “affordable”?“affordable”?

Tenants/residents pay a Tenants/residents pay a reasonable amount of reasonable amount of their income towards rent their income towards rent and utilities.and utilities.

Core Element: Quality (Decent, Safe, Core Element: Quality (Decent, Safe, and Affordable)and Affordable)

HUD affordability guidelines: 30 percent of HUD affordability guidelines: 30 percent of adjusted income for housing expenses.adjusted income for housing expenses.– Reality - People on SSI often pay 60 - 80% Reality - People on SSI often pay 60 - 80%

of their income towards housing that is of their income towards housing that is substandard.substandard.

Core Element: Quality (Decent, Core Element: Quality (Decent, Safe, and Affordable)Safe, and Affordable)

It is clear that Permanent Supportive Housing must It is clear that Permanent Supportive Housing must address the affordability problem or individuals address the affordability problem or individuals relying on SSI income will never be able to live in relying on SSI income will never be able to live in housing units that they choose.housing units that they choose.

The most frequent solution is rental subsidies, The most frequent solution is rental subsidies, either tenant-based rental assistance or other either tenant-based rental assistance or other subsidies or assistance tied to units (e.g., tax subsidies or assistance tied to units (e.g., tax credits).credits).

Core Element: Quality (Decent, Core Element: Quality (Decent, Safe, and Affordable)Safe, and Affordable)

Housing units must be decent and safe.Housing units must be decent and safe.

HUD’s standard of quality is its Housing Quality HUD’s standard of quality is its Housing Quality Standards. HQS should be met by all Standards. HQS should be met by all permanent supportive housing. permanent supportive housing.

Core Element: Access to HousingCore Element: Access to Housing

Housing is a scarce commodity in most Housing is a scarce commodity in most communities, and over the years, many service communities, and over the years, many service providers have developed admission criteria providers have developed admission criteria designed to reserve these scarce resources for designed to reserve these scarce resources for those “most likely to succeed.”those “most likely to succeed.”


Often, housing programs have Often, housing programs have eligibility criteria that require that eligibility criteria that require that individuals demonstrate that they individuals demonstrate that they are “ready” for housing. are “ready” for housing.


For people who are living in homeless shelters or For people who are living in homeless shelters or on the streets, typical housing readiness on the streets, typical housing readiness requirements can be insurmountable barriers. requirements can be insurmountable barriers. Do these sound familiar?Do these sound familiar?– Taking medications unsupervisedTaking medications unsupervised– BudgetingBudgeting– Cooking (shopping, meal planning)Cooking (shopping, meal planning)– Negotiating transportation systemsNegotiating transportation systems– Able to keep appointments (with some help)Able to keep appointments (with some help)– Psychiatric stabilityPsychiatric stability– SobrietySobriety– Willingness to comply with rulesWillingness to comply with rules– Treatment plan requirementsTreatment plan requirements


However, research does NOT support this practice. However, research does NOT support this practice.

Research shows that a readiness screen is not Research shows that a readiness screen is not predictive of success in housing. predictive of success in housing.


Therefore, the most important eligibility criteria for Therefore, the most important eligibility criteria for permanent supportive housing should be those permanent supportive housing should be those matters that would be required of any tenant matters that would be required of any tenant (ability to pay rent, for example). (ability to pay rent, for example).


The other access consideration is privacy. Who The other access consideration is privacy. Who holds the keys? Who controls access to the holds the keys? Who controls access to the unit? The tenant should control access to the unit? The tenant should control access to the unit in the same way that typical tenants unit in the same way that typical tenants have control over who may enter the unit. have control over who may enter the unit.

Core Element: Integration and Core Element: Integration and Rights of TenancyRights of Tenancy

Integrated housing units are defined as regular housing Integrated housing units are defined as regular housing units typical of housing units found in the units typical of housing units found in the community and scattered throughout the community and scattered throughout the community. community.


How to tell if housing is integrated? Factors might include: How to tell if housing is integrated? Factors might include: Housing is located in regular residential areas.Housing is located in regular residential areas. Housing is scattered site. Housing is scattered site.

– Large, homogeneous congregate sites are in danger of Large, homogeneous congregate sites are in danger of becoming “mini-institutions.”becoming “mini-institutions.”

Housing is centralized, but with mixed populations in the Housing is centralized, but with mixed populations in the building or neighborhood. building or neighborhood. – Avoid the creation of “mental health ghettoes.”Avoid the creation of “mental health ghettoes.”

Tenants participate in community activities and receive Tenants participate in community activities and receive community services.community services.

Natural supports are encouraged. Natural supports are encouraged.


Why integration? The Olmstead Supreme Court Why integration? The Olmstead Supreme Court decision interprets the ADA’s anti-decision interprets the ADA’s anti-discrimination provision to require the discrimination provision to require the provision of services in the “most integrated provision of services in the “most integrated setting.” setting.”


Residents have full legal rights in a tenant-landlord Residents have full legal rights in a tenant-landlord relationship.relationship.

Tenants are responsible to abide by the normal Tenants are responsible to abide by the normal standards of behavior/conduct outlined in a lease.standards of behavior/conduct outlined in a lease.

Housing is “permanent,” in that the length of stay is Housing is “permanent,” in that the length of stay is determined by the agreement between the landlord determined by the agreement between the landlord and tenant (not by participation in services).and tenant (not by participation in services).


Tenant’s RightsTenant’s Rights– Fair Housing Act Fair Housing Act covers discrimination.covers discrimination.– Section 504 Section 504 addresses accessibility.addresses accessibility.– ADA ADA providesprovides reasonable accommodations.reasonable accommodations.– Olmstead Olmstead mandates community integration.mandates community integration.

Resources:Resources:– Renter’s Rights Renter’s Rights from Legal Services of Northern from Legal Services of Northern

Michigan http://lsnm.org/rentersrights.htmlMichigan http://lsnm.org/rentersrights.html– HUD’s office of Fair Housing and Equal Opportunity HUD’s office of Fair Housing and Equal Opportunity

http://www.hud.gov/offices/fheo/http://www.hud.gov/offices/fheo/

Core Element: Functional Separation of Core Element: Functional Separation of Housing and ServicesHousing and Services

There are several ways to conceptualize the There are several ways to conceptualize the separation of housing and services:separation of housing and services:

Legal separation between housing Legal separation between housing management and service deliverymanagement and service delivery

Functional separation – distinct housing Functional separation – distinct housing and service staff rolesand service staff roles

Operational separation – extent to which Operational separation – extent to which service providers are based off-siteservice providers are based off-site

Core Element: Functional Separation of Core Element: Functional Separation of Housing and ServicesHousing and Services

Permanent Supportive Housing is most successful when Permanent Supportive Housing is most successful when there is a functional separation between housing there is a functional separation between housing matters (rent collection, physical maintenance of the matters (rent collection, physical maintenance of the property) and services and supports (case property) and services and supports (case management, for example). management, for example).

Case managers shouldn’t collect rent!!!Case managers shouldn’t collect rent!!!

Core Element: Supports and ServicesCore Element: Supports and Services

What are supports?What are supports?– Mainstream supportsMainstream supports– Specialized supportsSpecialized supports

(Provided directly or as referrals)(Provided directly or as referrals)– Natural supportsNatural supports

Core Element: Supports and Core Element: Supports and ServicesServices

Mainstream SupportsMainstream Supports– Learn about benefit programsLearn about benefit programs

SSISSI SSDISSDI TANFTANF Medicare/MedicaidMedicare/Medicaid Utility assistanceUtility assistance Veterans benefitsVeterans benefits

– Resource: Resource: Resources for Training and Education Resources for Training and Education in the KITin the KIT


Helping tenants access benefits:Helping tenants access benefits:– Get an ID card – Social Security, Get an ID card – Social Security,

birth certificate, military service birth certificate, military service record, etc. record, etc.

– Get a formal psychiatric Get a formal psychiatric assessment.assessment.

– Denials are common – provide Denials are common – provide continual support during the continual support during the process.process.


Natural supports - the social networks people Natural supports - the social networks people naturally have as members of a communitynaturally have as members of a community– FriendsFriends– FamilyFamily– Faith communityFaith community– Activity or hobby groupsActivity or hobby groups– NeighborsNeighbors


Strengthening natural supports by helping Strengthening natural supports by helping tenants return to work:tenants return to work:

Explore the tenant’s desire.Explore the tenant’s desire. Explore possibilities.Explore possibilities. Help identify goals.Help identify goals. Look into supported employment. Look into supported employment.

Resource: http://mentalhealth.samhsa.gov/Resource: http://mentalhealth.samhsa.gov/

Questions?Questions?

core elements of permanent supportive housing (psh)

Documents

housing providers

type of housing

housing expenses

housing programs

secure housing

housing quality standards

choice of housing units

quality decent