Transcript What is the Matrix? - Homelessness Resource Center

Contra Costa County
Self-Sufficiency
Matrix Project
Case Manager Training
October 29, 2007
What Is the Matrix?
• The Self-Sufficiency Matrix is a tool designed to
be used by program staff to strengthen the
quality of services provided.
• The Matrix is designed to give an overview at a
point in time of the level of challenge each client
is experiencing in areas in which the client is in
crisis and the level of power the client may have
in areas in which they are thriving.
Purpose of the Matrix
• The Matrix is designed to assist the Case
Manager:
 In identifying areas of concern that may be
impediments to the client achieving stabilization;
and
 In developing the client’s individual service plan.
Purpose of the Matrix
• The Matrix is designed to assist the
Agency:
 In identifying repeated areas of concern that may prove to be
obstructions to clients and assisting in the development of
resources or techniques targeting these areas of concern;
 In identifying case load capacity for each Case Manager at
any point in time, thereby facilitating the assignment process
of new clients;
 In evaluating overall service provision; and
 In case conferencing.
Purpose of the Matrix
• The Matrix is designed to assist the
Continuum of Care:
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In collecting data;
By becoming one of many tools used in evaluating programs;
In identifying providers’ best practices;
In identifying technical assistance needs;
In maximizing efficiency and effectiveness of programs; and
In identifying areas in the continuum that are lacking or
insufficient.
Introduction to the Matrix
Introduction to the Matrix
• The Matrix is designed as a measurement tool,
similar to a thermometer, to be used in
assessing factors that influence the lives of
clients.
• The tool is used best when gauging the stress or
lack of stress in accessing resources or
addressing challenges.
Introduction to the Matrix
• The Matrix
allows you to
take the
“temperature”
of your client
on 20 different
issues, called
domains.
• Domains include:
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Housing
Rental History
Food
Health Care
Health
Mental Health
Substance Abuse
Income
Credit
Employment
Life Skills
Legal
Child Custody
Childcare
Mobility
Community Involvement
Adult Education
Children’s Education
Family Relations
Identification
Introduction to the Matrix
• For each Domain, you will give the client a score of 1-5
with:
 1 indicating the client is thriving in that area,
 3 indicating the client is stabilized in that area and
 5 indicating the client is in crisis in that area.
• If a Domain is Not Applicable to your client (e.g.
childcare if the client does not have children) or you do
not know and cannot find out your client’s status in that
Domain, you would give the client a zero for that
Domain.
Using of the Matrix
• The objective of using the Matrix is not to
‘rate’ our clients but to provide a
professional subjective measurement of
the level of crisis the client is experiencing
or how the client is thriving at a specific
point in time.
Using the Matrix
• The Matrix will not replace traditional activities
but will be used in conjunction with current
methods of assessment and evaluation.
• The Matrix cannot be inclusive of all particular
issues or concerns that arise for any individual
client.
• No one fits exactly into any particular
classification.
Matrix as a Case Management
Tool
• When you complete the Matrix with your
client, it can be an easy visual way for you
and your client to see which areas are
causing the most stress in your client’s life.
Using the Matrix To Create an
Individual Service Plan
• Having completed a Matrix, you and your
client can create an Individual Service
Plan that addresses all of your client’s
needs.
Completing the Matrix
• A Matrix should be completed on the following
clients:
 For Interim Housing/ Emergency Shelters: every adult client
 For Multi-Service Centers: every adult client who is receiving
case management services
 For Transitional and Permanent Housing: every adult client
• For households with more than one adult, a
Matrix should be completed on every adult in the
household.
Completing the Matrix
• The Matrix should be completed with the
client present. If this is not possible, the
case manager may decide to complete the
matrix without the client present.
Matrix Completion Schedules
• For all programs, a Matrix should be completed on each
client as soon as is reasonable but in any case, within
30 days of entry.
• In addition, a matrix should be completed:
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For Interim Housing/ Emergency Shelters: at exit
For Multi-Service Centers: at exit
For Transitional Housing: every six months and at exit
For Permanent Housing: every twelve months and at
exit
Matrix and Returning Clients
• For returning clients, the same Matrix
should be used if the individual returns
while the case file is still open at the
agency. If the case file has been closed, a
new Matrix should be completed.
Completed Matrix Documents
• The Matrix is a screen in the HMIS, and should
be completed in the HMIS as will be discussed
at a later training.
• It is acceptable to complete a “paper” Matrix and
then transfer the answers into HMIS.
• The documents may be used to calculate the
Case Manager’s case-load capacity and to chart
the overall effectiveness of services by
incorporating progress factors and final
outcomes to assess program results.
The Matrix
The next section of the training is about the
Matrix itself.
Filling Out the Matrix
• Looking at the Matrix….
• If a domain doesn’t apply to your client, enter a
zero.
• To find the current status average, add all 20
domains and divide that number by the number
of domains that you scored from 1-5 (that is, the
number of relevant domains).
• If you use the electronic version of the excel
document, it will do the math automatically, you
just need to enter how many domains were
relevant to your client.
Matrix Categories
• There are two different types of domains in the Matrix:
Resources and Issues.
• Resource domains apply to all clients and
measurements are gauged according to their level of
access to or possession of a particular item.
• Issue domains are not applicable to all clients. However,
a client who does not have a connection to a particular
issue is generally further removed from Crisis than
someone who is dealing with one of these areas.
Resource Domains include:
Housing
Food
Health care
Income (earned
or benefits)
Employment
Life skills
Childcare
Mobility
Community
involvement
Adult
Education
Identification
Issue Domains include:
Health
Mental health
Substance abuse
Legal
Child custody
Overlapping Resources/ Issues
• Certain domains may overlap both
resources and issues and can be
evaluated from either or both perspectives.
• Example: Rental history may be a valuable
resource to one client and involve complex
challenges for another client.
Overlapping Resources/ Issues
• Example: A child’s education may be
viewed as a resource in one case (the
child now has a stable school, etc). A
different client may have a child who
requires assessments or is chronically
missing school. These concerns for this
client will increase the household stress
and can impede progress in other areas.
Overlapping Resources/ Issues
• Categories that may overlap issue or
resource perspectives include:
Rental History
Credit
Children’s Education
Family Relations
Domain 1: Housing
• Crisis (5) = Homeless or At Risk
• Thriving (1) = Paying market rate rent in
unsubsidized permanent housing
• The placement in between 5 and 1 should
consider multiple factors, including the
impact of maintaining housing on the
household budget.
Housing Examples
• Client in subsidized housing who is making the rent
payment but is unable to handle any other basic needs
(transportation, food, childcare, etc) without assistance is
not as stabilized in their housing as someone who can
handle these other concerns in their budget.
• Interim Housing/Emergency Shelter = no higher than “4”
• Clean & Sober and Transitional Housing = no higher
than “3”
• Permanent Supportive Housing = no higher than “2”
Housing
Is the client homeless or at imminent risk of losing housing?
Yes
No
5
Is the client living in Interim Housing or paying less than 50% of market rate rent?
Yes
No
4
Is the client living in Clean & Sober or Transitional Housing or
paying 50% to 80% of market rate rent or 30% to 50% of the household’s income for rent?
Yes
No
3
Is the client living in Permanent Supportive or subsidized housing and
paying 80% of market rate rent or 30% of income without critically impacting other basic needs?
Yes
No
2
Is the client living in permanent unsubsidized housing without rent interfering with other basic needs?
Yes
1
Domain 2: Rental History
• Crisis = Person has multiple evictions
• Thriving = Person is securely in
permanent housing
• The ranges in between are to gauge how
much the client’s rental history may impact
their ability to secure permanent housing.
• A subjective approach can be used to
move the rating through the scale.
Rental History Examples
• A person who had 2 evictions ten years ago but
established acceptable rental history in between
might be recognized as a “2” or a “3”
dependent on the length of the positive rental
history.
• A client who has positive rental history that is for
less than 6 months might move down the scale
where a client with 5 years (recently) of
acceptable rental history might move up the
scale because of longevity.
Rental History
Does the household have multiple evictions?
Yes
No
5
Does the household have one eviction or no rental history?
Yes
No
4
Does the household have a poor rental history?
Yes
No
3
Does the household have limited rental history?
Yes
No
Has the household secured permanent housing?
Yes
1
2
Domain 3: Food
• Crisis = Client has no control over her
food access
• Thriving = Client can purchase any food
items she wishes without affecting her
budget
Food Examples
• Households who are relying on Food Stamps
have little actual control over their access to food
and should not be rated above “4”.
• Households who are not on food stamps and
rely on others to provide 30% or more of their
food should also be considered no higher than
category “4”.
Food Examples Cont’d
• Clients who are providing most of their
food with a small amount of assistance (a
few times each month) would generally be
considered a “3”.
• Households that are providing all of their
food without significantly impacting any
other basic need would be considered a
“2”.
Food Examples Cont’d
• Another factor to consider is whether the
food a client is able to access is healthy or
extremely basic.
• A family that has food to eat that is limited
to two or three items (e.g. potatoes, cereal
and beans) should not be considered past
a “4” even when they are purchasing the
food.
Food
Is the household without food or method to prepare it?
Yes
No
5
Is the household reliant on food stamps or consistent assistance for food
or does the household eat limited types of food?
Yes
No
4
Does the household require a small amount of consistent assistance with food?
Yes
No
3
Can the household provide its own food without assistance but must make choices about what to buy?
Yes
No
Can the household choose to purchase any food it desires?
Yes
1
2
Impact
Domain 4: Health Care
• Crisis = Clients who have no insurance
and need medical attention
• Thriving = Households where all
members are covered and co-pays or
other costs are not impacting the budget
Health Care Examples
• Households with MediCal or SCHIP should not
be considered above a “3” since these are
limited resources.
• All other situations should be considered
reflecting on the difficulty or strength of the
household’s specific situation.
• The current health of any particular family
member could impact the amount of stress that
a family is facing.
• The need for surgery or other expenses could
impact the stress level of the household.
Health Care
Is the household without medical coverage and in immediate need of services?
Yes
No
5
Are some members of the household without medical coverage
or does the household have difficulty accessing services when needed?
Yes
No
4
Are some members of the household on MediCal or SCHIP?
Yes
No
3
Is the household covered by health insurance but has difficulty covering out-of-pocket expenses?
Yes
No
Is the household covered by affordable, adequate health insurance
and can it handle any out-of-pocket expenses?
Yes
1
2
Domain 5: Health
• Crisis = Terminal or serious conditions
• Thriving = Households where all members are
currently healthy
• There are households with family members who
are disabled that may be considered Thriving
because they have connected to all the support
systems that they require and there is no impact
on the day-to-day activities of the family unit.
Health
• This is an extremely fluid category and would not
generally address the brief illnesses that all
households experience such as colds or flu, but
might address temporary conditions that will
impact a family for several months.
• Each situation should be assessed by the Case
Manager gauging the impact on the family’s
stress level and ability to function in day-to-day
activities.
Health
Is the household currently dealing with a terminal or severe chronic condition
that impedes day-to-day life?
Yes
No
5
Is the household dealing with a disabling or severe chronic condition that presents challenges
to daily life, but has identified some support services and is resuming normal activities?
Yes
No
4
Is at least one household member suffering from a disabling or severe chronic condition
but support systems are being implemented and the household is completing normal functions?
Yes
No
3
Is the household implementing support systems to deal with acute short term conditions
and enable the household to resume most normal activities?
Yes
No
2
Is the household experiencing no health concerns or are all support systems
needed to deal with a chronic or disabling condition in place?
Yes
1
Impact
Domain 6: Mental Health
• Thriving = Clients who have been diagnosed
with a severe mental health concern but have
used a managed system of care to control their
condition and are able to function without being
impacted by their condition
• The rating for this category is based on
observations of behavior that are impacting or
not impacting a client’s ability to move forward.
• This category does not apply only to diagnosed
individuals.
Mental Health
• This domain should not be used in any way to
diagnose or assess any mental health issue.
• A client who does not have a diagnosis may
exhibit behaviors that indicate they are impacted
by even temporary mental health concerns. The
factors that are being examined center around
the amount of impact the apparent condition is
having in their day-to-day activities and
relationships.
Mental Health
Is the client a danger to self or others or experiencing severe difficulty in day-to-day life
due to psychological problems?
Yes
No
5
Is the client experiencing recurrent mental health symptoms that affect behavior
or persistent problems with functioning due to mental health symptoms?
Yes
No
4
Is the client experiencing mild, transient symptoms with only
moderate difficulty in functioning due to mental health problems?
Yes
No
3
Is the client experiencing minimal symptoms with only slight impairment in functioning?
Yes
No
2
Is the client experiencing good or superior functioning in a wide range
of activities with rare or no symptoms?
Yes
1
Domain 7: Substance Abuse
• Crisis = Current abuse that has incapacitated
the individual’s ability to function
• Thriving = Clients that have no history or have
remained in control of their recovery
• The gauging of this category is predominately
where the Case Manager identifies if the
household is impacted by this issue.
Substance Abuse Examples
• A single mother who claims to have no history of
use but exhibits behavior that indicates that she
has addictive behavior issues might not be
considered Thriving, but considered to fit a
higher category of crisis.
• Other forms of addiction that may impact a
household (gambling, shopping) to the point of
disrupting normal functions should be rated in
this category.
Substance Abuse
Is the client severely dependent on drugs or alcohol
and may require institutional living or hospitalization?
No
Yes
5
Is the client dependent on drugs or alcohol
with use resulting in avoidance or neglect of essential life activities?
No
Yes
4
Does client show evidence of persistent or recurrent social, occupational, emotional, or
physical problems related to use?
No
Yes
3
Has the client exhibited any behaviors that might be associated with relapse mode?
No
1
Yes
2
Domain 8: Incomeearned or benefits
• Crisis = Households with no income
• Thriving = Households that have sufficient
income to meet all of their needs and still save
money
• Placement in other categories is dependent on
how the income is serving to meet the
household’s basic needs.
Income
Does
Is the
thehousehold
householdwithout
withoutany
anyincome
incomeatatall?
all?
Yes
No
5
Is the Is
household’s
the incomeincome
inadequate
inadequate
for thefor
household
the household
to meet
tobasic
meetneeds?
basic needs?
Yes
No
4
Can the household meet basic needs with a subsidy?
Yes
No
3
Does the household
sufficient,
discretionary
Can the household
meet basic have
needs,
but not additional
needs?
income and is the household able to save?
Yes
No
Yes
No
2
1
Does the household
have sufficient, discretionary income and is the household able to save?
Yes
1
Domain 9: Credit
• Case Managers should assess this
category by the degree of positive or
negative impact credit and financial skills
has on the client’s ability to move forward.
Credit
Does the household have damaged credit with existing debts that have not been addressed?
Yes
No
5
Does the household have no credit or excessive debts that exceed annual income
and/or engage in spontaneous or inappropriate spending?
Yes
No
4
Is the household starting the process of repairing its debt and/or engaging in appropriate spending?
Yes
No
3
Is the household paying off debts on a regular basis and
does it have sustainable income to continue until debts are paid but credit it not yet repaired?
Yes
No
2
Has the household repaired credit and established new credit,
started a savings or credit account and is household income well-managed?
Yes
1
Domain 10: Employment
• Clients who are not seeking employment
could be rated in this category or it could
be skipped for them.
• Basic rating for this should be based on
how stable the employment is and how
effective it is in meeting the household’s
needs.
Employment
• Factors that should be considered are: whether
the client has no long term plans to ever seek
employment; if the client is one of two adults in a
household that has other income; or if the client
is impacted by an inability to seek employment.
• Ratings should be assigned looking at the
impact on the household’s ability to gain full
control of their basic needs.
Employment
Does the client have a job?
Yes
No
5
No
4
Does the client have a full time job?
Yes
Does the client have a full-time job with adequate pay and benefits?
Yes
No
3
Does the client have permanent job with adequate income and benefits?
Yes
1
No
2
Domain 11: Life Skills
• Gauging the areas between Crisis and Thriving in this
Domain should incorporate how much the functioning of
any individual or household is challenged by a lack of
skills or empowered by a strong grasp of the tools they
need to succeed.
• Some clients have incredible organizational skills and
can maintain a structured and healthy household even in
a shelter while others do not know where to start or how
to manage basic activities.
Life Skills
Is the client unable to meet basic needs such as hygiene, food, and other activities of daily life?
Yes
No
No
Yes
5
Can the client meet Does
a few the
but client
not allhave
needsa full
of daily
timeliving
job? without assistance?
Yes
No
No
Yes
4
Can
thethe
client
meet
most
but not alljob
daily
living
needspay
without
assistance?
Does
client
have
a full-time
with
adequate
and benefits?
Yes
No
No
Yes
3
Is theDoes
clientthe
ableclient
to meet
basic needsjob
of with
livingadequate
without income
assistance,
not beyond?
haveallpermanent
andbut
benefits?
Yes
No
No
Yes
2
Is the client
1 able to provide beyond basic needs of daily living for self and family?
Yes
1
Domain 12: Legal
• Crisis = Clients with outstanding legal issues
(dependent upon the severity of the issues)
• Thriving = Households that have no outstanding
legal issues
• Factors that should be considered in gauging
this category would be the severity of the legal
issues (one ticket compared to thousands of
dollars in tickets OR needing to file a restraining
order vs. multiple felonies on a client’s record.)
Legal
Does the client have current outstanding tickets or warrants and/ or multiple felonies?
Yes
No
5
Does the client have current charges, trial pending, and/or noncompliance with probation/parole?
Yes
No
4
Is the client on probation or parole but fully compliant?
Yes
No
3
Has the client successfully completed probation or parole within the past 12 months
with no new charges filed?
Yes
No
Has the client had no active criminal justice involvement
for more than 12 months and/or no felony history?
Yes
1
2
Impact
Domain 15: Mobility
• The range between Crisis and Thriving should
be determined by factoring in accessibility,
reliability, legal compliance (insurance, licenses,
registrations) and the impact to the client’s
budget.
• Clients who rely only on public transportation
should not be considered above a “4” since the
control they have over their mobility is limited.
Mobility
Is he client without access to transportation, public or private?
Yes
No
5
Does the client only have access to public transportation or unreliable, unpredictable or
unaffordable transportation (e.g. no car insurance, no drivers’ license)?
Yes
No
4
Does the client only have access to limited and/or inconvenient transportation
and/or is the client licensed but minimally insured?
Yes
No
3
Does the client only generally have access to transportation to meet basic travel needs?
Yes
No
Does the client have access to readily available and affordable
transportation with adequate care insurance?
Yes
1
2
Domain 16: Community
Involvement
• This category predominately is a gauge of
the socialization skills and current social
function of the client.
• The range from Crisis to Thriving is
determined by: how connected the client is
to others, impediments to the client
becoming more connected, and the scope
of the client’s connection.
Community Involvement
Examples
• A client who is actively involved in the recovery
community but withdrawn in their interaction in the other
community aspects of their life (neighborhood, school,
faith organizations, workplace, etc.) would not be rated
as thriving.
• Mono-community involvement could be an indication of a
different type of isolation and does not necessarily
demonstrate knowledge of how to connect and interact
with others.
• Generally individuals with the skills to develop and
maintain community relationships will have a variety of
connections to groups that fall in their circle of
community.
Community Involvement
Is the client in crisis or survival mode?
No
Yes
5
Yes
4
Is the client socially isolated?
No
Does the client lack knowledge about ways to become involved in the community?
Yes
No
3
Does the client have some community involvement but have barriers to full involvement?
Yes
No
2
Is the client actively involved in the community, including multiple groups?
Yes
1
Domain 17: Adult Education
• The rating for this category is generally as
defined in the Matrix.
• Crisis = Anyone who does not have a GED/
diploma and is experiencing literacy problems
• Thriving = Not necessarily determined by the
type of education/training the client has but how
vocationally prepared the client is due to such
education/training.
Adult Education Examples
• A client with a Masters Degree in a limited or
highly competitive profession may be far less
prepared to access employment than an
individual who completed a training to acquire a
Class A Drivers License.
• The education/training resource should be
examined for the accessibility to a living wage
occupation that it provides.
Adult Education
Does the client have a high school diploma or GED?
No
Is literacy a serious barrier to employment?
Yes
No
4
Does the client have the education/literacy skills to function effectively in society?
Yes
No
3
Has the client completed education/training needed to become employable?
Yes
1
No
2
Yes
5
Impact
Domain 19: Family Relations
• This category is designed to evaluate the support
relationships that are or are not in place for a client.
• The term family should be used as the client might
identify the term.
• Family members are individuals who provide primary
support to the client and are very connected to the client.
• This domain is generally not an evaluation of recent or
current relationships but of relationships that are likely to
be in place ten years from now.
Family Relations
Is the client lacking in necessary support from family and friends or is abuse or neglect occurring?
Yes
No
5
Is the client’s family and friends supportive but lacking the ability or resources to help
or do family members not relate well to each other?
Yes
No
4
Is the client receiving some support from family and friends and/or
are family members seeking to change negative behavior and learn to communicate and support?
Yes
No
3
Is the client receiving strong support from family and/or friends,
but client is not expanding support network or household communication is not always open?
Yes
No
Does client have a healthy, expanding support network
with a stable household with consistently open communication?
Yes
1
2
Domain 20: Identification
• Crisis= Client has no identification
documents at all
• Thriving= Client has all relevant
identification documents
Identification
Is the client without any form of identification?
Yes
No
5
Does the client only have limited forms of identification and/or
is the client unable to access benefits or housing with current identification?
Yes
No
4
Is the client without reliable identification but has secured the
documents necessary to apply for identification documents?
Yes
No
3
Does the client have only one reliable identification document?
Yes
No
Does the client have all identification documents s/he needs?
Yes
1
2
Impact
Child-Related Fields
• A few categories that are not completed for all clients
are: Child Custody, Children’s Education and Childcare.
• These areas are to be completed only for adults in
households with custodial care of minor children.
• Exceptions: The single parent who does not have
custodial care of their child but is impacted by any or all
of these three areas because they have a vested interest
and devote a substantial amount of their focus to
concerns that surround their children.
Domain 13: Child Custody
• This category only applies to clients with children
who are connected to their children.
• A client who has children but has not seen their
children and is not necessarily interested in
pursuing a reconnection would not be rated in
this category.
• Any parent who is connected or interested in
being connected should be rated in this area.
Child Custody
• Crisis = Parents who have lost custodial
care or visitation
• Thriving = Parents that have never lost
custody or have completed a CFS
involvement
• The gauging of this category is based
upon the stress level of the situation and
the level of focus it is impacting in a
client’s life.
Child Custody
Does the client not have custodial care of one or more minor children due to legal processes?
Yes
No
5
Is the client facing current pending legal actions to remove custodial care of one or more children?
Yes
No
4
Is the client currently CFS involved or
involved in legal action that jeopardizes continued custodial care?
Yes
No
3
Has the client completed a legal case or is in the last month
of CFS involvement with custodial care projected as outcome?
Yes
No
2
Does the client have no CFS involvement or has the client completed CFSS reunification process?
Yes
1
Domain 14: Childcare
• This category only applies to clients with
custodial care of minor children who required
supervision.
• Crisis = No childcare
• Thriving = Ability to select and pay for any
childcare of choice
• Factors to consider between crisis and thriving
are primarily the financial concerns and the
variety of accessible childcare available.
Childcare
Is the client unable to access needed childcare?
Yes
No
5
Does the client only have access to unreliable, unaffordable, or inadequate childcare?
Yes
No
4
Does the client only have access to limited, affordable, subsidized childcare?
Yes
No
3
Is the client able to access limited chocies of reliable, affordable, unsubsidized childcare?
Yes
No
2
Is the client able to select quality childcare of choice without financial assistance?
Yes
1
Domain 18: Children’s
Education
• This category only applies to clients with
children who are connected to their
children.
• Parents who are connected to their
children but do not have custodial care
may or may not be impacted by this
category dependent on the scope of their
involvement.
Children’s Education
Are any of the household’s eligible children not enrolled in school?
Yes
No
5
Are any of the household’s eligible children enrolled but not attending classes?
Yes
No
4
Are all of the household’s children enrolled in school but
one or more child is only occasionally attending classes?
Yes
No
3
Are all of the household’s children enrolled and attending
with parent participation, but with only marginal grades?
Yes
No
2
Are all eligible children passing all classes with the parent(s) involved at school?
Yes
1
Data Entry into HMIS
• This will be addressed in a training next
Spring.
Questions
• If you have questions about the matrix and its
use in Contra Costa County, please contract
Piper Ehlen at HomeBase at 415-788-7961 ext
304 or [email protected].
• If you have questions about using the Matrix with
HMIS, please contact Kimberly Baello, HMIS
Systems Administrator, Contra Costa Health
Services at 510-220-9406 or
[email protected].