Engagement Strategies:

Service Delivery in Supportive Housing

Joyce Grangent

Senior Program Manager

Corporation for Supportive Housing www.csh.org

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Every tenant brings a history, a culture, a set of expectations and behavior that can be shaped by such things as:

Cultural, ethnic, and racial differences

Gender and sexuality issues

Mental Health History HIV/AIDS Other medical issues Domestic violence

Criminal histories Long-term

homelessness Development

disabilities Histories of trauma Issues specific to

women with children Much more!

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What else tenants bring

Housing history Family history Spiritual life Survival skills Social networks and support systems Tolerance level for structures and rules Behavioral history Expectations and Preferences

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A Clash of Agendas

The Professional Support Person

– Duties and responsibilities

– Product oriented– Caring (We hope!)

• The Homeless Person

– Multitude of losses– Depth of mostly

negative feelings– Unique and uniquely

acquired strengths

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Resolving the Clash

Don’t create more losses Understand the feelings Uncover and build on

strengths Using strategies and

techniques– Harm Reduction– Stages of Change– Motivational

Interviewing– Reflective Listening

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Engagement Strategies

Engagement sets the stage for formal case management and treatment sessions where in-depth assessments, counseling, and referrals can occur on an individualized basis.

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Goals of Engagement

Care for immediate needs Develop a trusting relationship Provide services and resources Connect to mainstream services

and social networks to maximize independence

Helping people stay housed

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Effective Engagement

Create the proper physical environment Respect, accept and support people Develop active listening skills Let the tenant’s goals drive the services

offered Help people make informed choices Be consistent with repeated, predictable

patterns of interaction Engagement should be non-threatening

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Effective Engagement

Effective engagement for people with mental health issues

Effective engagement for people with substance use issues

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Engagement is a Process

Where we introduce tenant to services relationship

Explain our role Find common ground to build on Engagement is not an event Does not happen overnight Varies from tenant to tenant

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Creative Engagement Strategies

For Open: Friendly Listen Maintain eye contact Keep conversation light Respond to humor

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Creative Engagement

For Closed: Intrusive Talk to much Too opinionated Lecture Analytical Demanding

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Engagement for People With Mental Illness

Enhanced When:– Worker develops shared reality with tenant– Interaction is consistent– Worker allows tenant to exercise control in

the interaction– Worker communicates his/her role clearly

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Whose Goal Is It

Orient new tenants Provide coordination among service

providers Develop buddy systems Provide individual case management

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Opportunities to Achieve Goals

Develop case management plan Help with skill building Coordination of mental, physical and

substance abuse services Assistance with medications and/or doctor

appointments

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Developing Trusting Relationships

Professional Relations Goal is maintain housing Information is confidential We must set limits

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In a Personal Relationship

Different goals with different people We can gossip to friends We don’t have to set limits

Enhancing Motivation for

Change

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Building Motivation for Change

Build Trust: Be consistent, trustworthy and honest

Get to know the person Learn to recognize and Identify

Emotions/Physical sensations of anxiety Define the helping relationship

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Working With Ambivalence and Resistance

Reactance Theory –helps to predict how people respond to the perceived loss of valued freedom

Reactance Theory states that it is natural for people to try to maximize control and choice

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Why Tenants May Be Resistant

Afraid staff will tell them what to do Don’t want to be controlled or lose the right

to make choices We view resistance as negative and part

of tenants illness Tenant is trying to maintain their

independence/freedom

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When Working with tenants Who Is Resistant

Avoid telling tenant what to do, instead present options

Explore both sides of an issue, one-sided focus increases reactance

Address one problem at a time-partner with tenant to set priorities and timelines for addressing them

Work with tenant where they are along spectrum of change

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What if this is not working?

Steps to consider before terminating your clients Discuss with Colleagues and Supervisor Talk to clients about consequences/alternatives Is there a way to negotiate the dispute? Remember this is the only way for our folks to get

permanent housing

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Roadblocks to Listening

Directing- Do it this way Warning- Creates fear or submission Making suggestions-Tenant is not

competent or judgment is not trusted Persuade with logic- you need to stop

drinking, or you may damage your liver Shaming-Do you really want others to see

you like this

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Motivational Interviewing

Motivational Interviewing - is a way to get tenants to recognize and do something about problems

Useful with tenants who - are reluctant to change and ambivalent about ability to change

Intended to help resolve ambivalence and get tenant moving on path to change

Staff acts as change agent

Five Basic Principals To Motivational

Interviewing

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Express Empathy

Accurate Empathy – Not identifying with tenant instead seeks to

understand what the tenant is saying without being judgmental, criticizing or blaming .

– Acceptance lowers defenses and make tenant more open

– Trying to “make” tenant change creates resistance and refusal

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Develop Discrepancy

Listening patiently can help tenant see the discrepancy between their present behavior and goals

Gaining insight into discrepancy can help gain motivation to change (must remember what is said)

It should be the tenant who begins to fell safe enough to voice concern

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Avoid Argumentation

Avoid expert trap Arguing leads to negativity Destroys alliance Increases defensiveness.

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Roll With Resistance

Resistance is not bad. It’s normal and we should expect it Go with it and don’t get into power struggle It gives insight to guide our work

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Support Self-Efficacy

Hope, optimism and self esteem are needed for change

Plant seed of believability Reframe failures Let’s figure out what didn’t work

“Life takes on meaning when you become

motivated, set goals, and charge after them in an unstoppable manner.”

–Les Brown

CSH Tools and Resources

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CSH Resources

CSH website: www.csh.org Institute website: www.csh.org/IL/institute CSH Publications:

www.csh.org/publications– Not a Solo Act– Developing the Support in Supportive Hsg– Toolkit for Developing and Operating

Supportive Housing www.csh.org/toolkit2