IMPLEMENTATION OF HOUSING FIRST AT HOME/CHEZ SOI LESSONS LEARNED FOR ICM Addictions & Mental Health Conference, May 25, 2015
Download ReportTranscript IMPLEMENTATION OF HOUSING FIRST AT HOME/CHEZ SOI LESSONS LEARNED FOR ICM Addictions & Mental Health Conference, May 25, 2015
Slide 1
IMPLEMENTATION OF
HOUSING FIRST
AT HOME/CHEZ SOI LESSONS LEARNED FOR ICM
Addictions & Mental Health Conference, May 25, 2015
Slide 2
LINKED TO HOUSING FIRST
• Believing in recovery is hard
• Seeing harm reduction as a continuum
• Effects of trauma are everywhere
• Assessing risk keeps everyone safer
Slide 3
BELIEVING IN RECOVERY IS HARD
• The right to make mistakes and learn from them
• The client, not their worker, has the right to decide when they are “ready” for
housing
• Housing First is the foundation upon which other steps towards recovery can
be made
• This means supporting our clients through evictions, hospitalizations, detoxes,
or jail and being ready to help them find housing again, and keep learning
Slide 4
SEEING HARM REDUCTION AS A
CONTINUUM
• Harm reduction is any program or policy designed to reduce harms without
requiring the cessation of substances
• Abstinence and harm reduction are on a continuum of use
• The case manager provides information about real harms, and support to
reduce harms but ultimately it is the client’s choice
• Substance use has lead to problems in our clients’ tenancies, but often we
find that use decreases after being housed
Slide 5
EFFECTS OF TRAUMA ARE
EVERYWHERE
• Severely traumatized clients are challenging to engage.
•
•
•
•
Provide clear, firm boundaries
Provide access to concrete items (food, clothing, furniture)
Display genuine warmth
Be careful not to display “too much kindness” or clients may feel they ”owe
staff.”
• Staff need to work on pacing disclosures both for their clients’ safety but also
to protect themselves from vicarious trauma
• Don’t promise what you can’t deliver
• Be trustworthy
Slide 6
Slide 7
ASSESSING RISK KEEPS EVERYONE
SAFER
• Get as much collateral information on potential clients as possible—past
history is the best indicator of potential for violence
• Intake and initial work with client often done in pairs
• Double visits if risk increases
• Intuition vs. observation
• If aggression is heightened, give a bit of space, while ensuring community’s
safety
• Be creative in service delivery---in home visits, in public places, or back off to
phone support if unsafe to work in person
Slide 8
But Does It Work?
Slide 9
LESSONS LEARNED
• Charlie was a man in his 50s, of Metis background, who had lived both on
and off Reserve before moving to Toronto in his early 40s. He suffered from
fetal alcohol syndrome, was poly addicted, and due to many assaults and
aggression had burned most of his bridges with family and friends up north.
He was extremely choosey about where he wanted to live, and was very
specific about what kind of apartment he wanted. He fired his first worker
before he even looked at an apartment.
• How do you think he is doing now? How did we work with him?
Slide 10
SALLY
• Sally was someone who pushed all of her belongings in a shopping cart for
many years. She was in her 60s, but looked older. She shouted at anyone
who came near to her, hadn’t been on meds for many years, and had
multiple health issues. She could not live in a shelter, getting into too many
arguments with other guests, and was a loner. She told anyone she did talk
with that she believed she wasn’t going to live much longer.
• How do you think she is doing now? How did we work with her?
Slide 11
LARRY
• Larry had spent most of his adult life in jail. When he was referred to us
he had just assaulted shelter staff who hadn’t given him the TTC tokens
he had demanded. He was a very strong man in his late 30s, a loner on
the streets, who presented himself as a violent, angry person. He had
been very traumatized as a child by both the men and the women in
his life. As a teenager, a female staff in his group home had also
sexually abused him. He didn’t trust anyone and was actively smoking
crack when we met him.
• How is he doing now? How did we work with Larry?
Slide 12
3 “SUCCESSFUL” CLIENTS
Charlie
Larry
Sally
Slide 13
NOT ALL OF OUR CLIENTS HAVE
BEEN SUCCESSFUL
• Tony—successfully lived in his unit for 5 years but aggressive towards
women in building, fired all of his workers—what happened?
• Kathy—had her 5th child while in the program with us,
had gotten clean and sober and was keeping
this baby (previous 4 taken away by CAS)—
started relapsing—what happened?
Slide 14
NUTS AND BOLTS
• Intake suggestions
• Engagement phase
• Continuum of housing options
• client choice
• independent units
• supportive housing
• interim housing
• Roles of support persons
(with low client/staff ratio)
•
•
•
•
Housing support
Case managers
Peer support
Psychiatrist/G.P.
Slide 15
MORE NUTS AND BOLTS
• Team meetings
• Housing support—liaison with landlords, finding units, rent
subsidies make for greater choice
• Continuum of levels of support
• Proactive outreach
• Ability to bring specialized support to client
• 3X /week, double visits, once a month, phone support only
• “Maintenance”/discharge/graduation/returning
• Ability to provide “step up” and “step down” support with Cota
ACT
Slide 16
RESOURCES
• Https:///www.nfb.ca/film/at_home “Here at Home—Evicted” by Manfred
Becker
• http://socialsciences.uottawa.ca/crecs/eng/videos_tmw1-5.asp “Findings
for the At Home/Chez Soi Project in Canada” by Tim Aubry
• https://www.youtube.com/watch?v=pwdq2VWavtc “Housing First 5
Principles”
Thank you! Jo Lynn Connelly, MSW; [email protected]
Program Manager with Toronto North Support Services
Manager of the Toronto At Home ICM team since 2009
IMPLEMENTATION OF
HOUSING FIRST
AT HOME/CHEZ SOI LESSONS LEARNED FOR ICM
Addictions & Mental Health Conference, May 25, 2015
Slide 2
LINKED TO HOUSING FIRST
• Believing in recovery is hard
• Seeing harm reduction as a continuum
• Effects of trauma are everywhere
• Assessing risk keeps everyone safer
Slide 3
BELIEVING IN RECOVERY IS HARD
• The right to make mistakes and learn from them
• The client, not their worker, has the right to decide when they are “ready” for
housing
• Housing First is the foundation upon which other steps towards recovery can
be made
• This means supporting our clients through evictions, hospitalizations, detoxes,
or jail and being ready to help them find housing again, and keep learning
Slide 4
SEEING HARM REDUCTION AS A
CONTINUUM
• Harm reduction is any program or policy designed to reduce harms without
requiring the cessation of substances
• Abstinence and harm reduction are on a continuum of use
• The case manager provides information about real harms, and support to
reduce harms but ultimately it is the client’s choice
• Substance use has lead to problems in our clients’ tenancies, but often we
find that use decreases after being housed
Slide 5
EFFECTS OF TRAUMA ARE
EVERYWHERE
• Severely traumatized clients are challenging to engage.
•
•
•
•
Provide clear, firm boundaries
Provide access to concrete items (food, clothing, furniture)
Display genuine warmth
Be careful not to display “too much kindness” or clients may feel they ”owe
staff.”
• Staff need to work on pacing disclosures both for their clients’ safety but also
to protect themselves from vicarious trauma
• Don’t promise what you can’t deliver
• Be trustworthy
Slide 6
Slide 7
ASSESSING RISK KEEPS EVERYONE
SAFER
• Get as much collateral information on potential clients as possible—past
history is the best indicator of potential for violence
• Intake and initial work with client often done in pairs
• Double visits if risk increases
• Intuition vs. observation
• If aggression is heightened, give a bit of space, while ensuring community’s
safety
• Be creative in service delivery---in home visits, in public places, or back off to
phone support if unsafe to work in person
Slide 8
But Does It Work?
Slide 9
LESSONS LEARNED
• Charlie was a man in his 50s, of Metis background, who had lived both on
and off Reserve before moving to Toronto in his early 40s. He suffered from
fetal alcohol syndrome, was poly addicted, and due to many assaults and
aggression had burned most of his bridges with family and friends up north.
He was extremely choosey about where he wanted to live, and was very
specific about what kind of apartment he wanted. He fired his first worker
before he even looked at an apartment.
• How do you think he is doing now? How did we work with him?
Slide 10
SALLY
• Sally was someone who pushed all of her belongings in a shopping cart for
many years. She was in her 60s, but looked older. She shouted at anyone
who came near to her, hadn’t been on meds for many years, and had
multiple health issues. She could not live in a shelter, getting into too many
arguments with other guests, and was a loner. She told anyone she did talk
with that she believed she wasn’t going to live much longer.
• How do you think she is doing now? How did we work with her?
Slide 11
LARRY
• Larry had spent most of his adult life in jail. When he was referred to us
he had just assaulted shelter staff who hadn’t given him the TTC tokens
he had demanded. He was a very strong man in his late 30s, a loner on
the streets, who presented himself as a violent, angry person. He had
been very traumatized as a child by both the men and the women in
his life. As a teenager, a female staff in his group home had also
sexually abused him. He didn’t trust anyone and was actively smoking
crack when we met him.
• How is he doing now? How did we work with Larry?
Slide 12
3 “SUCCESSFUL” CLIENTS
Charlie
Larry
Sally
Slide 13
NOT ALL OF OUR CLIENTS HAVE
BEEN SUCCESSFUL
• Tony—successfully lived in his unit for 5 years but aggressive towards
women in building, fired all of his workers—what happened?
• Kathy—had her 5th child while in the program with us,
had gotten clean and sober and was keeping
this baby (previous 4 taken away by CAS)—
started relapsing—what happened?
Slide 14
NUTS AND BOLTS
• Intake suggestions
• Engagement phase
• Continuum of housing options
• client choice
• independent units
• supportive housing
• interim housing
• Roles of support persons
(with low client/staff ratio)
•
•
•
•
Housing support
Case managers
Peer support
Psychiatrist/G.P.
Slide 15
MORE NUTS AND BOLTS
• Team meetings
• Housing support—liaison with landlords, finding units, rent
subsidies make for greater choice
• Continuum of levels of support
• Proactive outreach
• Ability to bring specialized support to client
• 3X /week, double visits, once a month, phone support only
• “Maintenance”/discharge/graduation/returning
• Ability to provide “step up” and “step down” support with Cota
ACT
Slide 16
RESOURCES
• Https:///www.nfb.ca/film/at_home “Here at Home—Evicted” by Manfred
Becker
• http://socialsciences.uottawa.ca/crecs/eng/videos_tmw1-5.asp “Findings
for the At Home/Chez Soi Project in Canada” by Tim Aubry
• https://www.youtube.com/watch?v=pwdq2VWavtc “Housing First 5
Principles”
Thank you! Jo Lynn Connelly, MSW; [email protected]
Program Manager with Toronto North Support Services
Manager of the Toronto At Home ICM team since 2009