Transcript Key Issues in Managing PSH 4-30-2010

Key Issues in
Managing Permanent
Supportive Housing
Anne Cory
Corporation for Supportive Housing
April 30, 2010
www.csh.org
Introductions
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Introduce yourself:
– Name
– Agency
– Job Title
– Experience with supportive housing
– What do you hope to get out of today’s
training?
Introduction to CSH
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The Corporation for Supportive Housing is
a national nonprofit organization and
Community Development Financial
Institution that helps communities create
permanent housing with services to
prevent and end homelessness.
CSH Products and Services
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Project-Specific Financing and Expertise
to help create supportive housing
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Capacity Building
to strengthen and expand the supportive
housing industry
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Public Policy Reform
to build an efficient system for producing and
financing supportive housing
Define Supportive Housing
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A cost-effective combination of
permanent, affordable housing with
services that helps people live more
stable, productive lives.
Supportive Housing is for People
Who:
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Are chronically homeless
Cycle through institutional and
emergency systems and are at risk
of long-term homelessness
Are being discharged from
institutions and systems of care
Without housing, cannot access
and make effective use of
treatment and supportive services
Housing & Services
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HOUSING
– PERMANENT: Not time limited, not
transitional;
– AFFORDABLE: For people coming
out of homelessness; and
– INDEPENDENT: Tenant holds lease
with normal rights and responsibilities.
SERVICES
– FLEXIBLE: Designed to be
responsive to tenants’ needs;
– VOLUNTARY: Participation is not a
condition of tenancy; and
– INDEPENDENT: Focus of services is
on maintaining housing stability.
Supportive Housing Types
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Buildings developed or
rehabilitated as special
needs housing
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Rent-subsidized apartments
Mixed-income buildings
Long-term set asides
Single-family homes
Master-leased buildings
or units
Definition and
Overview
Elements of
Managing
Permanent
Supportive Housing
Elements of Managing Permanent
Supportive Housing
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Housing First
Voluntary Service Model
Harm Reduction
Coordination of Property Management
and Supportive Services
What is Housing First?
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The direct, or nearly direct, placement of
targeted homeless people into permanent
housing. While supportive services are to
be offered and made readily available, the
program does not require participation in
these services to remain in the housing.
The use of assertive outreach to engage
and offer housing to homeless people with
mental illness who are reluctant to enter
shelters or engage in services.
What is Housing First?
(continued)
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Once in housing, a low demand approach
accommodates client’s alcohol and
substance use, so that relapse will not
result in the client losing housing.
The continued effort to provide case
management and to hold housing for
clients, even if they leave their program
housing for short periods.
Housing First
 A housing first approach rests on two
central premises:
 The best way to end homelessness is
to help people move into permanent
housing as quickly as possible
 Once in housing, formerly homeless
people may require some level of
services to help them stabilize, link to
long-term supports, and prevent a
recurrence.
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Defining Housing First
Philosophies
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Safe, affordable housing as a right and a
prerequisite for effective services
Provide permanent housing opportunity as
soon as possible
Do not focus on “housing readiness” or sobriety
as a prerequisite
Facilitate easy access to housing
Housing stability is primary objective: services
support housing retention
Quality of life and well-being measure success
Core Elements of Housing First
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Crisis Intervention: Helps stabilize
participants while they are acquiring
permanent housing.
Permanent Housing Services: Helps
participants obtain permanent housing. Assist
with move-in and other costs associated with
becoming rehoused, including short-term rent
subsidy.
Case Management/Wraparound Services:
Helps to stabilize participants once they are
housed.
Housing First Strategies
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Assessment-based targeting
Assistance locating housing
Assistance with costs of housing
Housing is NOT time-limited
Tenants hold leases & have full rights
On-going case management to ensure housing
opportunity is stable
Service intensity dependent upon needs of
household – varies household to household
and over time
Housing First: What we have
learned
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Some homeless people cannot or choose not to
navigate the Continuum of Care. They do not or
cannot comply with program requirements and get
screened out or kicked out of shelters, day centers,
transitional housing programs
Homeless people/families who meet all the program
requirements can get “stuck” in transitional programs
because there is no exit—no affordable permanent
housing options are available.
People with serious psychiatric problems and/or
substance use can maintain stable housing without
going through stages in the Continuum of Care
approach; without being “housing ready”.
Consistent Findings
Housing + Services Make a Difference
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More than 80% of supportive housing tenants are
able to maintain housing for at least 12 months
Most supportive housing tenants engage in services,
even when participation is not a condition of tenancy
Use of the most costly (and restrictive) services in
homeless, health care, and criminal justice systems
declines
Nearly any combination of housing + services is more
effective than services alone
“Housing First” models with adequate support
services can be effective for people who don’t meet
conventional criteria for “housing readiness”
Supportive Housing: It Works
summary of key findings from a
range of studies
 ER visits down 57%
 Emergency detox services down 85%
 Incarceration rate down 50%
 50% increase in earned income
 40% rise in rate of employment when
employment services are provided
 More than 80% stay housed for at least one
year
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Start Up Challenges
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Accepting the Housing First approach – that the first priority
is to house people not fix them.
Accepting that some community resources will eventually
shift from crisis/emergency services such as shelters to
permanent housing
Accepting that services focus on maintaining housing, not
“treatment”
Selecting an appropriate site or locating landlords willing to
participate in the program
Recruiting landlords and maintaining good relations
Encouraging shelters and transitional programs to refer
clients immediately to minimize time spent in emergency
setting (rapid rehousing)
Hiring or re-training staff to play new/different roles, including
engaging tenants in voluntary services
Sustaining Housing First
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Biggest challenge is locating enough affordable housing
to meet the tenant demand
Requires at least one or probably several of the following:
 Housing subsidies –e.g. tenant based Housing Choice
vouchers or other forms of subsidy
 Developing strong relationships with landlords and
negotiating reasonable rents
 Focus on increasing tenant incomes so they can
afford to pay more rent
 Developing new affordable housing that is financed in
such a way that the rents are affordable to extremely
low-income tenants
Questions?
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Questions on Housing First?
Voluntary Service Model
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Definition:
– Housing is not contingent on
acceptance of services
– Does NOT mean services are not
offered/not important
– Engagement strategies are key
Supportive Services
in Voluntary Model
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Offer services tenants want and need
Market services to tenants
Be creative in engaging tenants
Be persistent in engaging tenants
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
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Care for immediate needs
Develop a trusting relationship
Provide services and resources
Connect to mainstream services and
social networks to maximize
independence
 Help people stay housed
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Supportive Services
in Voluntary Model
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Flexible
– Flexible in type
• Different tenants may need/want
different types of services
• Tenants may need/want different
types of services at different times in
their lives
Supportive Services
in Voluntary Model
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Flexible
– Flexible in intensity
• Some need/want many services
during first 6 months/year, then step
down
• Some need/want many services
during entire tenancy
• Some need/want many services
intermittently/episodically
Supportive Services
in Voluntary Model
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Flexible
– Flexible in delivery
• Where do tenants want to receive
services?
• How do tenants want to receive
services?
• From whom do tenants want to
receive services?
Voluntary Services Work
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Homeless Families Evaluations in
Minnesota and California
 2 programs with mandatory services
and sobriety requirements had a
housing retention rate of 70% after one
year.
 2 programs with voluntary services and
no sobriety requirement had a housing
retention rate of 95% at the one-year
mark
Supportive Housing/Voluntary
Service Strategies
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Assertive and patient engagement
– To overcome barriers resulting from isolation and
symptoms of mental illness or addiction
Trauma informed services
Establish trust
Recovery oriented
– Ask tenants where they want to be living and what
kind of work they want to be doing in 5 years
Practical support to meet basic needs and respond to
individual preferences and goals
Supportive Housing/Voluntary
Service Strategies (continued)
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Training and help with basic living skills, hygiene
Assistance with benefits including eligibility for
other (permanent) housing to meet changing needs
Mental health and/or substance use treatment
services flexible and available where people live &
when they need help
Enhancing motivation to change
– Re-engagement in services during relapse and
crisis
Linkages to primary health care
Voluntary Service Model
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Questions about voluntary service
model?
Harm Reduction
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Harm reduction is a set of practical clinical
strategies that reduce negative
consequences of drug use or other
activities, incorporating a spectrum of
strategies from safer use, to managed
use, to abstinence.
Harm Reduction Principles
 People have the right to make decisions about their
lives and actions. Harm Reduction is about
educating them to make the best decisions for
themselves.
 The user takes responsibility for his/her choices
and behavior.
 The individual sets his/her own goals in
collaboration with the service provider.
 There are no punitive sanctions for what someone
chooses to put/not put in his/her body.
 When we create punitive sanctions, people will lie.
 Incremental change is normal.
 Quality of life and well-being measure success.
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Some Examples of Harm
Reduction
 Methadone maintenance
 Following prescription protocols
 Support groups
 Education on drugs and drug
interactions
 Permanent housing with
voluntary services
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Harm Reduction
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Never underestimate the power of people
to make changes in their lives; and never
underestimate our ambivalence about
change.
Patt Denning
Harm Reduction Therapy Center
Successful Engagement
Strategies
 Be there from the start
 Use the lease itself as an engagement
tool
 Knock on the door
 Design engagement materials
thoughtfully
 Check in often: prevent isolation
 Learn what tenants like/want/need
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Successful Engagement
Strategies
 Provide needed resources, address
basic needs
 Encourage community building
 Employment goals
 Use violations of lease or house rules as
a trigger for engagement
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Motivational Interviewing
 A client-centered approach to help
people resolve ambivalence and make
change.
 A process of developing a relationship
with a person and building trust so that
we become influential toward positive
change.
 Motivation is fluid and can be
influenced.
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Motivational Interviewing
 Express Empathy - communicate respect
and acceptance.
 Develop Discrepancy - distinguish tenant’s
goals from current behavior and talk through
likely consequences of current behavior
(“predictables and inevitables”)
 Roll with Resistance - change your direction
or listen more carefully.
 Embrace Optimism - believe in the tenant’s
ability to change.
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Effective Communication
Techniques
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Ask Open-Ended Questions
Listen Reflectively
Summarize
Affirm
Empathize
Effective Communication
Techniques
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Review a typical day
Look back – life before “the problem”
Summarize what you hear/concerns
Explore pros and cons (present and
future)
 Normalize ambivalence
 Explore expectations of the change
and provide non-biased information
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From Cause to Response
 Cause
> Symptom > Behavior > Response
 Example
 Cause:
Alcoholism
 Symptom:
Intoxication
 Behavior:
Lost keys
 Immediate Response: Property management
keeps the key at the front desk
 Long Term Response: Services staff works with
the tenant, who then drinks less in order to take
better care of his/her things.
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Designing House Rules
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Emphasis on Behavior
Clear Purpose and Rationales Stated
“No Rules without Relationship”
Enforceable
Legal
Less is More
Tenant Input
Keep Current and Revise
Education of Tenants
Clear, Consistent Consequences
Lease Enforcement
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NOT “Anything Goes”
Quick, consistent response is critical
Balanced with concerns for safety
Incident reporting
Lease violation notices
Coordination with supportive services staff
Legal issues related to substance abuse
and lease enforcement
Eviction Prevention
 Eviction is a last resort only undertaken
in only the most extreme
circumstances
 Be able to document that all preventive
measures were taken
 Coordination with Supportive Services
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Eviction and Substance Use
 Difference between Clean and Sober
and Harm Reduction
 Tenancy laws are the same, whatever
you call your housing model!
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Harm Reduction
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Questions on Harm Reduction?
Coordination of Property Management
and Supportive Services
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One of the defining characteristics of
permanent supportive housing is the
coordination of property management and
supportive services to support the goal of
housing retention for tenants.
For effective coordination, it is critical to
have clear definitions of roles.
Traditional vs. Supportive
Housing Property Management
Traditional Rental Housing
Supportive Housing
The property manager makes
all decisions regarding
lease violations and
evictions.
The property manager is
solely responsible for low
vacancy rate and rent
collection.
The property manager works
with resident to make
payment plans.
Collaboration between property
manager and service
provider regarding lease
violations and evictions.
Property manager works with
service provider to maintain
a stable housing
environment.
Service provider involved with
payment plans, and
“contracts” to maintain
housing.
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Break time!
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Please be ready to start again
in 15 minutes
Coordination of Property Management
and Supportive Services
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Property management staff and supportive
services staff have shared commitments.
– Commitment to success of community and
each of the residents residing in the
building
– Commitment to coordinate communication
between services, management and tenant
organizations
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Mission-Driven Property
Management
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“Double Bottom Line”
Mission-driven property management practices
include…
– Development and enforcement of house rules
– Collaborative approaches to tenant selection
and screening, move-in, orientation, and crisis
management
– Resident councils
– Creation of job opportunities for tenants
– Record-keeping
– Evictions and problem-solving
Key Principle for Coordination
Establish Clear Roles
and Responsibilities
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Outline clear roles
Establish forum for discussing and renegotiating roles and responsibilities
Another Key Principle for
Coordination
Recognize Overlap and
Built-In Tension
between Roles
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Acknowledge compatible
and conflicting goals
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Compatible/Mutual Goals
– Ensuring the effective operations of the building.
– Providing safe, secure and affordable housing.
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Conflicting Goals/Tensions
– How to balance the needs of the individual tenant with
the needs of the entire community?
– When is it helping to support tenants’ independent
functioning and when is it enabling them?
– Advocating for tenant’s rights can threaten property
management functions, for example, creating tenants’
organization, which decides to withhold rent.
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Embracing Good Tension
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Respect the different roles of each
partner
Understand all roles are necessary and
important for a well-managed building
Acknowledge and use built-in tension
between roles and functions to ensure
stability and a sound asset
Roles and Challenges
How can we prevent this from happening again?
How can we help the resident keep their housing?
Social Services
I just want to help!
Property Mgt
Show me the money!
Find root cause
Are we going to have to evict?
Should we start processing applications?
Common Issue:
Resident can’t pay rent
Stabilization and planning
Identify services or agencies to assist
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Goal: Provide the residents the support they need
to reach their fullest potential and to keep the
building in compliance with funding sources,
physically, and financially.
Roles and Challenges
Social Services
I just want to help!
Property Mgt
Show me the money!
Common Goal:
Keeping Residents Housed
Blended Mgt requires that
we come in from all angles.
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Goal: Provide the residents the support they
need to reach their fullest potential and to keep
the building in compliance with funding sources,
physically, and financially.
Service Provider Role
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Design and implement the Supportive Services
Plan
Participate in applicant tenant screening and
help applicants address barriers
Engage tenants in services to support housing
stability and life goals
Serve as the tenant’s advocate with property
management
Help tenants define how they can comply with
property management requirements
Service Provider Role (cont’d.)
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Crisis management; assist in dealing with
disruptive tenants
Participate in community organizing
Participate in developing and revising House
Rules; help develop and implement
emergency policies & procedures.
Maintain records of services provided
Property Management Role
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Participate in the process of developing the
project design
Manage the rent-up process, including
marketing, outreach, interviews, and tenant
selection
Provide orientation to incoming tenants
Enforce the leasing agreement; coordinate with
the support services team and the tenant, to
address issues jeopardizing housing retention
Property Management Role
(cont’d.)
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Participate in community organizing,
including working with tenant leaders
Hire, train and supervise property
management staff
Routine maintenance and health and
safety issues
Overall fiscal management and accounting
responsibilities for project
Maintain compliance with government and
private funds and other regulatory or fiscal
compliance
Putting Principles into
Practice
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Develop an MOU or contract between partners
Develop a guiding principle statement that
spells out the working approach
Carefully select, train, support, and supervise
social service and property management staff
Develop written job descriptions with clearly
defined roles
Schedule regular communication
Give staff parallel status and authority
Outline written procedure for resolving
disagreements
Keys to Success
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Similar mission and goals
Have it in writing
Earn trust over time
Everyone contributes to the partnership
Clear and constant communication
In it for the long-haul
Sharing and collaboration
Mutual respect
Indicators of Effective
Coordination
Coordination of Property Management & Supportive Services
Core Indicators
Property management staff has a clear understanding of supportive
services, staff roles and responsibilities.
Supportive services staff have a clear understanding of property
management staff and/or landlord roles and responsibilities
Supportive services staff promptly notifies property management
staff when they observe safety or maintenance issues.
Property management staff and/or landlords know who to contact
when there is a tenant behavior related issue or need.
Services staff proactively address issues that may impact tenants’
housing stability, particularly in response to property management
and/or landlord concerns.
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Indicators of Effective
Coordination
Coordination of Property Management & Supportive Services
Core Indicators
There are regularly scheduled forums for property management
staff and supportive services staffs to discuss their roles, the
coordination of their efforts, current issues, and to address gaps in
services and operations.
Services staff advocates on tenants’ behalf with property
management and/or landlords when necessary and appropriate to
maintain tenants’ housing stability.
Property management and supportive services staff work together
to support eviction prevention practices including rent repayment
plans, procedures for addressing property damage, and harm
reduction (when applicable) to support resident housing stability.
Property management records are stored separately from
supportive services records.
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Roles and Responsibilities
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Areas of overlap between property
management and supportive service
delivery:
– Intake: tenant selection and interviewing
– Orientation of incoming tenants
– Rent payment and arrears
– Dealing with disruptive behaviors
– Procedures in crisis
– Tenant council
– Community building
Consider the Adjustments Tenants May be
Experiencing as They Move into Supportive
Housing
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Rent must be paid every month
Adjusting to a new neighborhood
Learning to or regaining the ability to live
independently
Neighbors may have special needs
Tenants (and their visitors) are expected to
follow the house rules
Socialization
Principles of Confidentiality
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Why is confidentiality important in supportive
housing?
What should be shared between property
management and supportive services?
What must be shared to effectively manage
supportive housing? Why?
What should NOT be shared?
Remember: Observable public behavior, casual
conversation (not in the course of a
professional service) is NOT confidential.
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Case Study
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A tenant has been the source of numerous
complaints from his neighbors, mostly for noise. He
is behind on his rent. The service team has been
trying to work with him but he has refused all
assistance. The tenant receives an eviction notice
and he goes in to talk to the management team. He
states that he got mugged and then missed his
entitlements appointment, which is why he is behind
on his rent. He tells the manager that he wants to
pay his rent and remain a tenant but he just has
bad luck. He says he has tried discussing these
things with service staff, but they are not helpful.
QUESTIONS FOR DISCUSSION:
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How should this situation be handled?
What is building management’s role?
What is social services’ role?
Where is there confusion or disagreement
about what to do or who should do it?
Next Training
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May 21, 2010
9 am to 1 pm
Same place
We will go deeper into addressing
behavioral issues effectively in this
coordinated model of housing
Questions?
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For more information:
– www.csh.org
– Anne Cory
• 510-251-1910 x 208
• [email protected]