Best Practices in Supportive Housing: Critical Time Intervention, Motivational Interviewing, Trauma-Informed Care

September 23, 2014 “Housing Virginia’s Most Vulnerable” Sarah Johnson, Chief Services Officer at ForKids, inc.

What is ForKids, inc.?

A nonprofit in South Hampton Roads with the mission of breaking the cycle of homelessness and poverty for families and children. We provide regional centralized screening and referral, emergency shelter, transitional housing, permanent supportive housing, and rapid re- housing to families coordinated with critical services such as case management, clinical services and educational advocacy.

Critical Time Intervention

Provides emotional and practical support during the critical time of transition and by strengthening the individual’s long-term ties to services, family and friends.

Phase 1- Transition

       Begins at program entry and focuses on assessment, rapport-building and goal-setting. Identify and encourage existing informal and formal supports.

Provide hands-on assistance to complete objectives while providing training for clients to do it themselves in the future.

Explore strategies for preventing a housing crisis from recurring Identify 2-3 goal areas to work on with client Make direct contact with landlord and other service providers. Weekly Case Management meetings 4

Types of Linkages

 Family and friends  Daycare providers  Landlords  Employers  Mental Health Support agency  Therapist  Medical professionals  Schools

Phase 3-Transfer of Care

 Revise service plan  Client utilizes linkages or demonstrates an ability to be self-sufficient  Ensure client has means/skills necessary to access other resources when they need them  Minimal intervention/direct assistance  Make sure you’ve found your replacement and the client begins to rely on them.  Monthly Case Management meetings

Implementation Troubleshooting

 What if my program isn’t 9 months long (or is longer)?

 If we don’t address all of the identified needs in the beginning, we won’t be able to move forward with housing or chaos will ensue.  There are very few other community agencies available or I’m not comfortable referring my clients to them.  I don’t want to get too far into my client’s personal business by communicating with family/friends.  I work with high barrier clients and they need the same level of intensive services the whole time they are in the program.

Training/Implementation Tips

     To get formalized training, go to criticaltime.org and/or contact Center for Urban Community Services or the Center for Social Innovation.

Make modifications to service delivery forms, such as progress notes, service plans and case summaries to match CTI concepts. Identify staff roles as per CTI (CTI Case Manager, Fieldwork Coordinator, Clinical Supervisor) Ensure that CTI refresher trainings are offered periodically and for new employees. Complete fidelity checklists and/or ensure that internal audits reflect efficacy to the model.

How does ForKids do it?

o o o o o All services staff were trained by CUCS and we participated in consultation for a few months as we started to utilize the model. New employees are trained by management staff in CTI and are provided with specific guidelines regarding FK implementation.

Assessment, Service Plan and Progress Note forms include consistent language. (ie Areas of Focus, Phases, Action Plans) Created a more structured partnership plan with “linkages” offering presentations from FK, inviting one agency a month to present to FK staff, and conducting “cross-training” sessions. Service Delivery sections of the file are reviewed for fidelity to the model.

Motivational Interviewing

A collaborative, person centered form of guiding to elicit and strengthen motivation for change.

How is Motivational Interviewing different?

o o o o o o We are not the expert, but the facilitator of discussion about change. Our job isn’t to tell people what to do, but to draw out the person’s own motivations and skills for change. We don’t have all the authority and the individual is empowered to take responsibility and use their own power to make change. Use of empathy is key. Let the client know you are able to see the world as they see it. The focus is on previous successes, not failures. Point out the mismatch between “Where we are and where we want to be.” We should “dance” not “wrestle” with the client. We’re not always right!

Implementation Tips

 Examine intake/assessment documents and consider a strengths-based approach and opportunities for open ended questions.  Reinforce “person-centered” language and asking questions rather than making demands.  Explore whether program guidelines/rules allow for independent choices and support, rather than forced change and threats.  Provide training consistently and regularly to all staff who interact with clients-even those who answer the phone.

How do we do it at ForKids?

 All new employees receive training focused on Motivational Interviewing as well as Customer Service.  Motivational Interviewing is also covered at least once a year as a refresher for all services staff.  We avoid discussing specific diagnoses in larger team meetings whenever possible, to prevent preconceived notions regarding a client’s abilities and potential for future success.  We focus on increasing incentives for positive behavior/behavior change rather than punishing for lack of progress or action.

Trauma-Informed Care

 Families and Individuals enter the homeless service system with significant histories (and often current) experiences of trauma and the crisis response and ongoing service delivery must be sensitive to their individual needs.

Establishing an environment that supports Trauma-Informed Care

       Ensure that provider responses are consistent, predictable and respectful-all staff, at all levels. Provide opportunities for clients to make daily decisions rather than demanding strict adherence to rules. Solicit and integrate client input into programming. Focus on recovery rather than pathology. Expect a lack of trust and demonstrate that you are trustworthy. Offer healthier alternatives to former, more destructive coping skills. Remember that children may manifest trauma or exposure to violence in different ways but also need to be supported and validated.

How do we do it at ForKids?

       Family Therapists on staff complete clinical assessments, including trauma checklists with all adults and children over 4 years old. Contract with an LPC for clinical supervision and consultation. Therapists use play therapy and art therapy as part of the assessment and intervention process for children. As much as possible, a strengths-based approach is used in assessment and service delivery. Clinical groups are offered utilizing the Wellness Recovery Action Plan model, advocating individual recovery and peer support.

Clients have choices regarding whether they participate in therapy and with whom. Clients are not given “violations” or required to attend sessions. For major events that expose staff to trauma, EAP Crisis Team is brought in for critical incident de-briefing.

Handouts provided

 Trauma-Informed Care for Children Exposed to Violence. Tips for Domestic Violence and Homeless Shelters.  Wellness Recovery Action Plan overview  Critical Time Intervention at ForKids  Sample Form Templates-Individvualized Service Plan, Progress Note, CTI Case Review  Best Practices in Supportive Services: Language Matters

Bibliography and Additional Resources

 criticaltime.org

 mentalhealthrecovery.com

 copelandcenter.com

 nrepp.samhsa.gov (National Registry of Evidenced Based Programs and Practices)  safestartcenter.org

THANK YOU!