Nov 212011
 

PART SEVEN: Objective-Based Home Visits

Successful housing programs require case managers/housing support workers to visit their clients in their homes. You can’t have a successful housing program by having clients only come to your office. You can’t do it over the phone or by text message or email. Home visits are absolutely critical.

A common mistake that case managers make is to show up at a client’s home and say, “How are you today?” This type of open-ended question takes the conversation and purpose of the visit off the rails from the start. Yes, I want case managers to care about the welfare of their clients. Yes, I believe in conventional niceties in society. But I have very specific reasons for wanting Objective-Based Home Visits to be structured differently.

During the weekly case review meeting (as discussed in an earlier blog in this series) I want each case manager to identify the three objectives that they have for their next home visit. Each of these three objectives must be related to goals and anticipated outcomes identified in the individualized service plan. Some of these objectives may also be related to facilitating change with the client that is being supported. The objectives selected week to week will be directly related to the amount of time that the case manager and client have set aside for the meeting, as well as where the client is at in their service plan journey.

A conversation when a case manager shows up to conduct a home visit may open up with something like, “Iain, good to see you today. As we talked about last time, we have 30 minutes for this visit and I want to make sure we talk about ways that you can go about remembering your keys when you leave the apartment, make an appointment with Dr. Smith about your back pain and discuss the Fall Fair this weekend, which I think you might have a lot of fun attending.”

What this does is set the agenda for the interaction in a conversational style. Sure, the client (in this fictitious case surprisingly named Iain and spelled identical to my name) will have the opportunity to bring up other matters as time allows. The close of the meeting should also bring with it the opportunity for the client to talk about how they are doing, and at least in broad-strokes for the case manager and client to agree on what the objectives are for the next visit, as well as the day and amount of time needed for the next meeting.

At times, shorter meetings with smaller objectives may be appropriate. For example, “Iain, good to see you today. As we talked about last time, we have 10 minutes together for this visit and I want to follow-up to see if you mailed the postcard to your mom that you were planning on sending, drop off some information on free recreation programs at the community center that you may want to think about going to, and schedule a time with you to go grocery shopping together on Friday.”

And, of course at other times there will be longer meetings with some larger objectives. For example, “Iain, good to see you today. As we talked about last time, I have set aside an hour for us to spend together today to help you plan for your upcoming supervised visit with your son, complete some forms to apply for the disability benefits that you wanted to try and get, and schedule a time for later in this week for us to go to the library.”

By no means mandatory, but I have found that for longer meetings it can be helpful to have some activities to do while having the discussion about the other items. Depending on specific client situations, it can be a great opportunity to teach and model other skills. For example, the case manager and client could do a load of dishes together or do some general tidying or water plants or make some meals that can be frozen while discussing the objectives for the visit. Just ideas – and it will depend on what is appropriate in each different client scenario – but it can be disarming for the client and create a natural discussion environment while also increasing the benefits of the longer interaction. Plus, it can make the time go by quicker for everyone involved.

There are other benefits to Objective Based Home Visits as well.

Objective Based Home Visits improve time management for both case managers and clients.

For the client, when they know in advance when the visit is going to occur and how much time is going to be required they can schedule it in amongst other activities that they may be engaged in. It is my experience that clients miss fewer home visits when they know not only when it is going to occur, but how long it is going to take. For the case manager, they can better schedule their days in advance on what is achievable. Maybe the case manager wants to group together visits in the same part of the city on the same day. Maybe the case manager functions well when, say Mondays and Fridays are spent with a series of quicker visits and Tuesdays, Wednesday and Thursdays are best used for more in-depth visits. With about 20 people on a caseload at various stages of moving towards greater independence, this time management piece alone can be the difference between burning out or staying balanced for a case manager.

Objective Based Home Visits increase accountability and make it easier to measure progress.

Because the objectives are set out in advance of the meeting with the client, and because they are recorded as part of the weekly case review meeting, it is a lot easier to track whether these objectives relative to the case plan goals and intended outcomes are being met. It helps ensure ongoing progress relative to change and support in the client’s life. This type of measurement and accountability also allows the client to more easily see and feel that they are making progress. It can also help Team Leaders in coaching their case management staff to success in client interactions.

Objective Based Home Visits help ensure that the housing support program does not become a crisis support program.

Too many times I have seen what are supposed to be case management staff scrambling from one hot button issue to another with clients that they are supposed to be supporting in a case management function, not as a crisis support worker. I would argue that this happens for three reasons:

  1. when the client entered the program it was not adequately explained to them how the case management services work and the structure of home visits;
  2. without using objective based home visits and the time management elements associated with it there are some clients seen less frequently, which can create an environment where things can go off the rails without support;
  3. it has not been explicitly explained to clients that this is a support service where there are goals set out and objectives for each interaction, and they therefore erroneously think the program has a crisis service element.

To be clear, there are great crisis services that do phenomenal work, and they are an important service to have in a community; however, the housing support program with its structured case planning and objective-based home visits is not a crisis service. Case managers should not be de-railed by crises. They should be able to plot their week out in advance, knowing which clients they are going to see at what times and what the objectives are for each interaction with those clients.

Objective Based Home Visits provide clearer direction for moving towards greater independence over time, and assists in moving through plateaus.

Related to accountability, the Objective Based Home Visit helps create an environment where there is steady progress in the service plan support process. The intent of providing supports is to promote greater independence over time. Does that mean that everyone will achieve complete independence? No. But in the case management process we can increasingly work towards helping the clients integrate with other community supports. We do not want there to be a culture of dependence created between the case manager and the client.

Even with the best case managers and most motivated clients I have seen instances where clients seem to reach a plateau in making progress towards greater housing stability and improved life stability. It has been described to me as “the case management stopped working”. We don’t want clients to experience relapse because of the frustration of feeling “stuck”. We also don’t want them to drop out of the support program as a result of their frustration. Objective Based Home Visits can be of tremendous assistance in these instances, as it allows for a multitude of strategies, actions and ideas that all remain connected to the service plan, but which encourage and allow for creativity.

When Assertive Engagement techniques are necessary, Objective Based Home Visits can help structure the conversation and get the supports back on track.

Assertive Engagement techniques are necessary in some instances when working with clients. One of the most powerful techniques that can be used when breaking through the support barriers that precipitated the need to use Assertive Engagement techniques is the use of an objective-based approach – even when/if the exchange with the individual is not at their home. Too often I have seen case managers pretty much scold their clients for being disengaged when they employ Assertive Engagement techniques. I would say that is unfortunate. Whether you are locating the client at a coffee shop or drop-in center or bottle depot or wherever in the use of Assertive Engagement, I would still focus the conversation the same… “Iain, good to see you and I am glad were able to connect with each other today. Now that we have found each other, let’s spend ten minutes scheduling a time when we can both commit to meeting at your apartment, talk about the three things we should focus our time on when we meet at your apartment, and I want to give you some information for you to look at about a new free dental clinic that opened up.”

Objective Based Home Visits can help encourage meaningful daily activities and improve healthy social networks.

One of the very positive results of an Objective Based Home Visit approach is that it has proven to be very effective at helping clients engage in meaningful daily activities outside of the service plan activities. This includes things like community events, libraries, engaging at a local college, social clubs, volunteering, engaging with places of worship, etc. If a client is experiencing social isolation (which can result in them choosing to leave their apartment) the objective-based approach creates an environment where the case manager can suggest and assist with structuring other opportunities for the client. This allows the client to also (re)create a healthy social network, which is critical for ongoing informal supports.

 

As this blog has gone to great lengths to demonstrate, home visits are not a casual check-in. Nor is each home visit intended to be a marathon session that addresses every issue under the sun. The Objective Based Home Visit approach provides important structure to working effectively with clients, balances the objectives relative to time availability, moves away from a crisis orientation in service delivery and improves connectivity with the case manager as the client works towards achieving greater independence. The Objective Based Home Visit approach allows for a “small wins” approach to be taken in the service plan process, and is naturally aligned with demonstrating ongoing progress in the service plan process incrementally.

Iain De Jong teaches half-day seminars in person and through the web on improving service delivery to clients through the use of Objective-Based Home Visits. Home visits generally have proven to be necessary for successful housing programs. Making sure there are three objectives per visit provides a structure and focus that brings it to the next level. If you have questions or would be interested in learning more about Objective Based Home Visits, drop Iain a note at idejong@orgcode.com

 

About Ali Ryder



You can contact Ali Ryder at aryder@orgcode.com.

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