Transcript Liberty Healthcare: Interim Report

Core Elements of Permanent
Supportive Housing (PSH)
Ann V. Denton, M.Ed., Director, SSH TA Center, Advocates for
Human Potential, Inc., Austin, TX
Core Elements of PSH
The learning objectives for this session:
 Participants will gain knowledge about six core
elements of PSH.
 Participants will be able to see how to apply these
elements in daily practice.
SAMHSA Permanent Supportive
Housing KIT
SAMHSA has developed a Permanent Supportive Housing KIT.
– Developed through consensus among researchers, housing
providers, Federal partners and advocates.
– Released: April, 2010.
– Includes fidelity measures as self-assessment tools.
Core Elements of Permanent Supportive
Housing
These also are the dimensions of the PSH Fidelity Scale
(SAMHSA KIT)
– Choice
– Separation of housing from services
– Access to housing
– Decent, safe, and affordable
– Integration
– Services and supports
Core Element: Choice
Choice is essential to success in housing. If
individuals are “placed” in a setting that
does not meet their needs and
preferences, they are not likely to succeed.
Core Element: Choice
Choice is measured in terms of the extent to
which people are asked about their
preferences, can choose the type of
housing, and have a choice of housing units.
Core Element: Choice
To implement choice, staff must . . .
– Know a tenant’s legal rights;
– Be able to determine what type of housing
best meets the needs and preferences of the
consumer; and
– Know how to find and secure housing that
meets a consumer’s needs and preferences.
Core Element: Quality (Decent, Safe, and
Affordable)
What do we mean by
“affordable”?
Tenants/residents pay a
reasonable amount of
their income towards rent
and utilities.
Core Element: Quality (Decent, Safe,
and Affordable)
HUD affordability guidelines: 30 percent of
adjusted income for housing expenses.
– Reality - People on SSI often pay 60 - 80%
of their income towards housing that is
substandard.
Core Element: Quality (Decent,
Safe, and Affordable)
It is clear that Permanent Supportive Housing must
address the affordability problem or individuals
relying on SSI income will never be able to live in
housing units that they choose.
The most frequent solution is rental subsidies,
either tenant-based rental assistance or other
subsidies or assistance tied to units (e.g., tax
credits).
Core Element: Quality (Decent,
Safe, and Affordable)
Housing units must be decent and safe.
HUD’s standard of quality is its Housing Quality
Standards. HQS should be met by all
permanent supportive housing.
Core Element: Access to Housing
Housing is a scarce commodity in most
communities, and over the years, many service
providers have developed admission criteria
designed to reserve these scarce resources for
those “most likely to succeed.”
Core Element: Access to Housing
Often, housing programs have
eligibility criteria that require
that individuals demonstrate that
they are “ready” for housing.
Core Element: Access to Housing
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For people who are living in homeless shelters or on
the streets, typical housing readiness requirements can
be insurmountable barriers. Do these sound familiar?
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Taking medications unsupervised
Budgeting
Cooking (shopping, meal planning)
Negotiating transportation systems
Able to keep appointments (with some help)
Psychiatric stability
Sobriety
Willingness to comply with rules
Treatment plan requirements
Core Element: Access to Housing
However, research does NOT support this
practice.
Research shows that a readiness screen is not
predictive of success in housing.
Core Element: Access to Housing
Therefore, the most important eligibility criteria for
permanent supportive housing should be those
matters that would be required of any tenant
(ability to pay rent, for example).
Core Element: Access to Housing
The other access consideration is privacy. Who
holds the keys? Who controls access to the
unit? The tenant should control access to the
unit in the same way that typical tenants have
control over who may enter the unit.
Core Element: Integration and
Rights of Tenancy
Integrated housing units are defined as regular housing
units typical of housing units found in the
community and scattered throughout the
community.
Core Element: Integration and
Rights of Tenancy
How to tell if housing is integrated? Factors might include:
 Housing is located in regular residential areas.
 Housing is scattered site.
– Large, homogeneous congregate sites are in danger of
becoming “mini-institutions.”
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Housing is centralized, but with mixed populations in the
building or neighborhood.
– Avoid the creation of “mental health ghettoes.”
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Tenants participate in community activities and receive
community services.
Natural supports are encouraged.
Core Element: Integration and
Rights of Tenancy
Why integration? The Olmstead Supreme Court
decision interprets the ADA’s antidiscrimination provision to require the
provision of services in the “most integrated
setting.”
Core Element: Integration and
Rights of Tenancy
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Residents have full legal rights in a tenant-landlord
relationship.
Tenants are responsible to abide by the normal
standards of behavior/conduct outlined in a lease.
Housing is “permanent,” in that the length of stay is
determined by the agreement between the landlord and
tenant (not by participation in services).
Core Element: Integration and
Rights of Tenancy
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Tenant’s Rights
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Fair Housing Act covers discrimination.
Section 504 addresses accessibility.
ADA provides reasonable accommodations.
Olmstead mandates community integration.
Resources:
– Renter’s Rights from Legal Services of Northern
Michigan http://lsnm.org/rentersrights.html
– HUD’s office of Fair Housing and Equal Opportunity
http://www.hud.gov/offices/fheo/
Core Element: Functional Separation of
Housing and Services
There are several ways to conceptualize the
separation of housing and services:
 Legal separation between housing
management and service delivery
 Functional separation – distinct housing
and service staff roles
 Operational separation – extent to which
service providers are based off-site
Core Element: Functional Separation of
Housing and Services
Permanent Supportive Housing is most successful when
there is a functional separation between housing
matters (rent collection, physical maintenance of the
property) and services and supports (case
management, for example).
Case managers shouldn’t collect rent!!!
Core Element: Supports and Services
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What are supports?
– Mainstream supports
– Specialized supports
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(Provided directly or as referrals)
– Natural supports
Core Element: Supports and
Services
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Mainstream Supports
– Learn about benefit programs
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SSI
SSDI
TANF
Medicare/Medicaid
Utility assistance
Veterans benefits
– Resource: Resources for Training and Education in the KIT
Core Element: Supports and
Services
Helping tenants access benefits:
– Get an ID card – Social Security,
birth certificate, military service
record, etc.
– Get a formal psychiatric
assessment.
– Denials are common – provide
continual support during the
process.
Core Element: Supports and
Services
Natural supports - the social networks people
naturally have as members of a community
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Friends
Family
Faith community
Activity or hobby groups
Neighbors
Core Element: Supports and
Services
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Strengthening natural supports by helping
tenants return to work:
Explore the tenant’s desire.
 Explore possibilities.
 Help identify goals.
 Look into supported employment.
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Resource: http://mentalhealth.samhsa.gov/
Questions?