Making The Change Serving Clients with High Barriers

Inspiration

�  Program History �  Transitional Housing �  Apply to enter shelter �  Exited for positive drug test, low participation, non

compliance, and late rental payment

�  Housing First Partners Conference �  Housing First and Systems Change, 3/ 11-14/2014

Housing First Models

�  Definition �  Housing First, which is distinct and separate from

"rapid re-housing", is a relatively recent innovation in human service programs and social policy regarding treatment of the homeless and is an alternative to a system of emergency shelter/transitional housing progressions.

Housing First Model

�  Rather than moving homeless individuals through different "levels" of housing, known as the Continuum of Care, whereby each level moves them closer to "independent housing" (for example: from the streets to a public shelter, and from a public shelter to a transitional housing program, and from there to their own apartment in the community) Housing First moves the homeless individual or household immediately from the streets or homeless shelters into their own apartments.

Housing First Model

�  Housing First approaches are based on the concept that a homeless individual or household's first and primary need is to obtain stable housing, and that other issues that may affect the household can and should be addressed once housing is obtained. In contrast, many other programs operate from a model of "housing readiness" — that is, an individual or household must address other issues that may have led to the episode of homelessness prior to entering housing.

Housing First Leadership

�  Leaders in Housing First Style Programs �  Bill Hobson - DESC, Seattle �  Sam Tsemberis – Pathways to Housing, D.C.

Practice Theory

�  Progressive Engagement

�  Motivational Interviewing

�  Stages of Change

�  Harm Reduction

�  Trauma Informed Care

All theories require service providers to first ask how can we support the client in maintaining their housing. Goals and life skills come second.

Progressive Engagement

�  Progressive Engagement is a nationally recognized best practice in addressing homelessness, which provides customized levels of assistance to families and preserves the most expensive interventions for households with the most severe barriers to housing success. Progressive Engagement is a strategy to enable service delivery systems to effectively target resources.

�  Onefamilyinc.org �  http://www.onefamilyinc.org/Blog/2011/11/21/innovation-in-the-spotlight-progressive-

engagement/

Progressive Engagement

�  Benefits of the Progressive Engagement model include:

�  Time to asses the families’ strengths and challenges – you don’t have to be able to predict beforehand how much assistance the family will need to be re-housed.

�  Scarce shelter and re-housing resources can be stretched to serve more families.

�  Less disruptions for the family. Families are not moving program to program to program, or even using different caseworkers. From their perspective, they stay a short period of time in shelter, and then are assisted to move into permanent housing. Their level of assistance may be increased or decreased, but their living situation is stable.

�  Onefamilyinc.org �  http://www.onefamilyinc.org/Blog/2011/11/21/innovation-in-the-spotlight-progressive-engagement/

Motivational Interviewing

�  Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior. MI is a goal-oriented, client-centered counseling (case management) style for eliciting behavior change by helping clients to explore and resolve ambivalence.

�  Motivation Interviewing is non-judgmental, non-confrontational and non-adversarial

�  Wikipedia �  http://en.wikipedia.org/wiki/Motivational_interviewing

Stages of Change

�  A model in health psychology which establishes that people move through various stages when they are trying to change behavior such as to stop drinking, smoking, or over eating.

�  Precontemplation

�  Contemplation

�  Determinations

�  Action

�  Maintenance

�  Termination

�  PsychCentral

�  http://psychcentral.com/lib/stages-of-change/

Stages of Change

system-concepts.com

Harm Reduction

�  Is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the right of people who use drugs.

�  Harm reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet drug users “where they’re at,” addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individuals and community needs, there is no universal definition of or formula for implementing harm reduction.

Harm Reduction

�  Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

�  Understand drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

Harm Reduction

�  Establishes quality of individual and community life and well-being not necessarily cessation of all drug use as the criteria for successful interventions and policies.

�  Calls for non-judgment, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

Harm Reduction

�  Ensures that drugs users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

�  Affirms drug users themselves as the primary agent of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

Harm Reduction

�  Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-bases discrimination and other social inequalities affect both people’s vulnerability to and capacity for effective dealing with drug related harm.

�  Does not attempt to minimize or ignore the real tragic harm and danger associated with licit and illicit drug use.

�  Harm Reduction Coalition �  http://harmreduction.org/about-us/principles-of-harm-reduction/

Harm Reduction Intervention

Trauma Informed Care

�  Is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.

�  Traumainformedcareproject.org

�  Practice that is grounded in the biology and psychology of human development and how environmental factors effect behavior at different stages of a person’s life. �  Trauma can effect people’s ability to self regulate, which

leads to negative coping strategies and prevents higher thinking or reasoning.

Generating Buy-In

�  Transparency

�  Weekly one-on-one supervision

�  Evolving Policies and Procedures

�  Promote Reflection on Theory, Model, and Policy

Why this is hard

�  Concerns for Safety �  Unpredictable �  Loss of control

�  Accountability/Enabling �  Flexibility �  Rules are made to be broken

Application

�  No exit happens without the offer of re-entry

�  Space of constant second chances

�  Initiating positive conflict �  Candid and honest conversations

�  Constant crisis management

�  Regular scheduled and unscheduled team meetings

Education

�  OC Links: Mental Health First Aid

�  National Associate of Social Workers

�  National Health Care for the Homeless Council

�  Think t3

�  Pathways to Housing: Housing First Institute

�  United States Interagency Council on Homelessness

�  Child Trauma Academy .org