PART EIGHT: Professional Works Gets Professional Results
Successful housing programs have a professional orientation. Well-trained staff deliver the housing program. Successful housing programs tend not to be those operated in a charity context where “well intentioned” is sufficient to get the job done. There is too much at stake, and generally too much complexity for a layperson without training to help a client achieve long-term sustainability.
I am not anti-charity. There is a time and place for it. And in fact it is often charitable organizations that hire the professional staff to deliver the housing program. The mistake, however, is when untrained staff are directly involved in client interactions. Truth is, it can do more harm than good.
With the properly trained staff, housing programs get better outcomes. Here are some of the essential ingredients for ensuring your housing program is provided by professionals who get professional results.
Start with the Right Job Description
I love to take a poll when I do training about whether the job people are in with their organization is exactly how it sounded on paper when they applied. My non-scientific polling results would suggest that between 90-100% of people in any given audience say the job is different than how it looked in the job description.
I encourage organizations to pull together professionally polished and accurate job descriptions for their housing staff team. (You can learn more about the staff compliment for a successful housing team here.) Be clear on the qualifications that you want. Talk about the caseload size and what you expect to be done. Use data to describe the population base that will be served and the outputs and outcomes expected. Don’t sugarcoat the experience, because it is hard, hard work.
There are certain fundamentals that I would expect a candidate to have knowledge of prior to joining a high-functioning housing program. These would include the following:
- Homelessness – history, context, local condition, causes, solutions, etc.
- Poverty – economic, social, relational, causes, solutions, etc.
- Health services – availability, access, major health conditions affecting persons who are homeless, etc.
- Mental health services – availability, access, major mental health conditions prevalent amongst homeless populations, etc.
- Addictions – cause of addictions, impact on behavior, responses to addiction (from prevention through to harm reduction), etc.
- Housing – availability, cost, subsidies available, rental process, working with landlords, etc.
- Income supports & benefits – application process, amount available, eligibility, budgeting on low income, etc.
- Justice and Corrections – links between homelessness and conflict with the law, post-incarceration housing, discharge planning, etc.
- Domestic violence – links between homeless and domestic violence, safe housing approaches, linking victim to appropriate therapeutic resources, housing abusers, etc.
- Children’s services (if working with families) – requirements of families, impact of household composition and housing needs, supporting access to parenting resources, duty to report, etc.
- Fetal Alcohol Spectrum Disorders – impact of FASD on decision-making and planning and behavior, linking to FAS resources, etc.
- Brain injuries – working effectively with persons who have brain injuries and the impact brain injuries can have on decision-making, planning and behavior, etc.
- Treatment protocols – understanding what treatment protocols are, how to work with medical staff, housing workers role in supporting treatment protocols, etc.
- Medication management – awareness of medications common to the health and mental health issues common amongst the population and the impact of the medications, medication access and storage, etc.
- Trauma – defining trauma, trauma informed service delivery, etc.
- Gender – understanding gender as self-defined, gender lens to service delivery, etc.
- Hoarding – detection, causes, effective strategies to organize possessions, etc.
- Life changes – working through the life cycle and changes in household composition, etc.
- Partying – causes of partying behavior, strategies to affect change so as to not negatively impact other tenants, etc.
- Stages of Change – from pre-contemplation through to relapse, candidates should be able to rhyme off all of the stages of change, the genesis of the concept, how it applies to housing support work, etc.
- Fundamentals of Case Management – understanding the history and core concepts of case management practices, client-centered and strength-based approaches to case management service delivery, documented service planning, etc.
As part of the housing team, while I would expect staff to have some understanding and technical proficiency in the areas outlined below, more exposure to how the organization delivers these skills in the context of the housing program can be necessary:
- Brokering – comprehension of the difference between direct delivery of services compared to brokering access to services for clients, etc.
- Advocacy – understanding when and how it is appropriate to advocate for a client, and the impacts of advocacy on the overall program, etc.
- Goal setting – how to work with clients for them to establish clear, measurable goals to work on relative to housing and life stability, etc.
- Documentation – when, where and how to document client interactions, how to store the information securely, who has access to documentation under what circumstances, etc.
- Individuals Service Planning/Case planning – process of establishing specific, measurable, attainable, realistic and timed elements of a plan that will improve housing and life stability, etc.
- Case conferencing – structure of pulling together other professionals and supports involved in the client’s case plan – as well as the client themselves – and the frequency, purpose and intent of doing so, etc.
- Risk assessment – how the worker/organization works with the client to understand the people, processes or technology that may be necessary to ensure that the client does not negatively impact the community or worker or vice versa
- Incident reporting – the documented process and information sharing protocol for when incidents occur involving clients, etc.
- Harm to self or others – understanding the signs and assessments completed when a client may pose a risk to themselves or others, etc.
- Conflict de-escalation and debriefing – understanding the strategies and techniques used to de-escalate conflict and how conflict is debriefed and learned from in the relationship with the client and across the staff team, etc.
- Cultural awareness, competency and sensitivity – an appreciation of the ways in which culture informs how clients engage in supports, set goals, deal with conflict, socialize, etc.
From a health & safety and legal perspective I always encourage organizations to provide very clear evidence that each member of the staff team has demonstrated mastery in the following:
- Community worker safety strategies – that each member of the staff team has been trained on how to increase their safety when working alone in the community; that there are adequate supervisory check-ins and awareness across the staff team of where people are at all times; and that each member of the staff team in each situation that they are in are cognizant of how to recognize potential risks and strategies to address those risks; etc.
- First Aid and CPR – that each member of the staff team has current certification in the application of First Aid and CPR
- Universal precautions – that each staff person knows how to use safety equipment as necessary when confronted with possible exposure to bodily fluids, and how to address risk factors appropriately
- Relevant legislation – that the relevant legislation to the work has been identified and that each staff member is provided opportunities to stay current in the requirements of the legislation and associated regulations
- Privacy and Confidentiality – that each staff member understands how information is collected, consents, storage of information, use of information and the proper procedures in the event that a third party (including police) request information or in the event that there is a privacy breach.
As a strong believer in evidence-based and evidence-informed practices, as part of a training plan, I would work towards ensuring professional excellence in the following at a minimum:
- Motivational interviewing
- Active listening
- Wellness Recovery Action Plans
- Assertive engagement
- Integrated Dual Disorder Treatment
- Supported Employment
- Illness Management Recovery
Professional people stay up to date in the main currents of thought and practice in their field. Training is one of the core ways of achieving this. While I appreciate it is not always practical, I do advocate that housing programs train as a team to ensure consistency throughout all of the staff.
High functioning housing programs have a training agenda set out a year in advance. There is a natural sequence to what people are expected to experience training at. When I help organizations set out their training agenda for the year, I also ensure that each one of the trainers is properly vetted and is aligned ideologically, strategically and operationally with what the organization is trying to achieve.
When helping to assemble a roster of trainers (outside of the training I deliver myself) I also look for trainers that understand adult learning strategies, are animated in their delivery and get trainees excited about learning. There should be well thought out content and take-aways for attendees.
Building consistency can also mean the use of highly skilled trainers on an ongoing professional development basis. Yes, it decreases diversity of messaging, but you can increase the quality of the training, relationship development with staff, trust building between trainee and trainer, and improve accountability for content delivery and improved professional practice based upon the content.
Given limited budgets, also approach the trainer in advance to see if you can tape them (audio or video). Some will allow it for free or a small fee on condition that you do not distribute it outside of your staff team.
In this day and age, not all training has to happen in person, and not all training has to take a half day, full day or multiple days. You may want to look for trainers that offer webinars through the likes of Go To Meeting or Go To Training or similar platforms, have podcasts, provide video materials, etc. This can make it a lot easier for scheduling and can also cut down on costs. I wouldn’t say exclusively to go this route, but it can and should be part of your overall approach.
The demonstrated competencies pertain to both the application of the knowledge base outlined earlier in this blog, as well as how the staff team adheres to the service orientation necessary for effective service delivery.
Competencies are further demonstrated in how the staff member participates in the weekly case review and the objectives that they set out relative to the client’s identified needs, as well as the long term housing stability and improved quality of life achieved by the clients that they are serving. Team Leaders have to get out of the office – both in a scheduled and unscheduled manner – to support and work with their staff team to see core competencies in action.
As a professional practice, I expect the team members to be reflecting on how they are delivering their work, their training needs to improve practice and what their own internal data is telling them about their performance. There is a substantial difference between those housing teams that take the time out necessary to think and communicate about how and what they are doing and how to get better at their work, and those that just show up each day. Deliberate time is needed on a regular basis to think about practice and improvements. It is something that needs to happen throughout the staff team – not just at the supervisory/management level.
When I deliver Team Leader training one of the things that I spend a good chunk of time on is trying to teach the skills necessary to have staff teams becoming more reflective on their practice. This includes things like having other organizations speak with your clients and provide feedback on your service delivery (if you just asked your clients yourself they are more inclined to tell you that you are awesome than having a neutral party ask), how to encourage creative thinking and problem solving, to how to focus during self assessment and reflection, and how and when to use internal data.
Professional programs require an investment of resources so that the staff members receive the remuneration appropriate for their skill set and outputs and outcomes expected of them. I can’t say what that scale is in this blog because there are significant regional variations based upon a number of factors.
In surveys we have done with various staff teams throughout the world the lack of appropriate compensation is usually in the top three negative issues for staff. It can lead to turnover or resentment amongst the staff team. Or organizations feel that they are merely training staff who then leave to better paying positions in mental health facilities, hospitals, government, school boards, etc.
More than once I have been part of processes where individual non-profits have been offered more money to bring the pay up within their organization to be on par with other organizations in the same city or to bring pay up across the entire city for housing programs only to have Boards of Directors decline because they feel it would upset their own internal pay grade. Frustrating to be sure for everyone involved. But in part, I would argue, is that more education is needed on why and how this work is professionally different than some other roles within the organization or community at large.
Ethics and Boundaries
I wish I didn’t have to write this section. In various cities, I have either encountered or been asked to help problem solve a number of these types of ethical and/or boundary issues. It ranges from clients being brought to the case manager’s home for dinner several times per week, to requiring clients to babysit the case manager’s children, to odd jobs around the case manager’s house, to case managers that hug their clients, to case managers that perform fellatio to help their clients relax prior to apartment viewings, to case managers that use sex as a reward for progress in the service plan, and even case managers that have married clients. You may be shaking your head right now. I hope you are disgusted and outraged. It happens far too often.
As professionals we need to hold ourselves to a strict moral code in our work. We need to understand and appreciate the power differential that exists, and that we are required to be stewards of impeccable service. We also need to have appropriate, non-punitive outlets for staff who begin to feel conflicted with their boundaries to safely speak with someone before they act out and cross the line.
Turning Work Off
Given the nature of the work, the professionals involved need to deliberately practice self-care. We need to support the professionals in the work to recover emotionally and mentally from all that is seen and encountered in the nature of the work. We need staff to be able to distinguish between their professional time and their personal time.
Some housing programs based upon the nature of the clientele may offer some type of rotating on-call support across the staff team. Sometimes this is appropriate, but not always. I most definitely do not support the suggestion that all housing case manager supports have to keep their work phone on all day and night if they are not compensated to be on-call. I do not support work emails or documentation occurring in the evening hours when people are supposed to be off of work and enjoying activities and relationships outside of work. People who do this type of work most definitely need a life outside of work. Otherwise burn-out, inappropriate choices, resentment, workaholism, etc. can set in and the staff team becomes dysfunctional and unable to appropriately support staff. Professionals know the importance of “turning work off” when the work day is done.
When we engage in professional practice we adamantly believe that there is value to our contributions to the lives of others…that our approach and training and skills result in something different than if people were solely served in a charity model. We must be able to demonstrate that the professional approach to work gets outputs and outcomes that are not attributable to chance – that there is a cause and effect relationship to the interventions that we support and the changes experienced in housing and life stability as a result.
We are accountable to the requirements of our job. As professionals we do not try to perform tasks outside of our area of expertise. We know when and how to integrate clients with other professional resources.
As professionals we look to our clients to provide feedback on the things that are working well and where they would like to see improvements. We look to our peers doing the same type of work to collaborate and share successful elements of practice rather than creating a monopoly of knowledge or a competitive culture across organizations.
As professionals we do not fear evaluation – we embrace it. Whether that is bringing in an outsider to examine and review the entire program from top to bottom, or having a “soft audit” across program areas within the same organization, what we want to do is instill a culture where there is viewed as helpful instead of threatening.
Successful housing program delivery is professional work. We need to appreciate, support and insist on professionalism across all organizations and staff delivering housing programs. The results will be improved greatly across the housing program as a result.[serialposts]
Iain De Jong has established, evaluated and trained dozens of housing teams in various jurisdictions around the world. Grounded in evidence, pragmatism and liberal use of wit and humor, Iain’s housing programs have demonstrated success in program excellence and meeting the needs of their intended client base. If you would like to know more about these specific activities or the training program specifically for Team Leaders, drop him a note at firstname.lastname@example.org