Mar 172014
 

(My thanks to Johnny Mac in Rhode Island for introducing me to the phrase “Peddlers of Hope”, which I have gone on to use quite extensively in my training on effective housing-based case management.)   We are peddlers of hope. Hope for those who feel no ability to hope. Providers of hope who need a bit more to get to the next stage of recovery. Champions of tomorrows, not yesterdays. Our hope is not blind. It is not unrealistic. It is not a panacea for pain. Hope does not erase history, it merely provides the opportunity to recover and grow from it. Hope is not a promise, but it is less than delusional dream. It is the fuel that makes life turn out more positively than it currently is, anchored in who we are and the capabilities as a person. We can speak a language of hope because we have seen so many take brave steps out of catastrophe or excruciating illness to tackle the empty feelings in their heart. We can’t touch hope. But we know it exists. We can’t create one roadmap of how to turn hope into a journey towards better days. We know that hope lends itself to a person journey. We know that hope is more than just one thing. Hope is many things…a plan, a feeling, an attitude, motivation, belief in self, protection from more misery. What makes us a peddler is our desire to spread hope widely and universally.  We are persistent in [...]

Dec 162013
 

Last week, the blog looked at the first five things I learned this year. If you want to, you can get caught up by reading that blog first. Or you can just launch into items 6 through 10 of the 10 things I learned this year. 6.     Some communities get so much technical assistance that it smothers and cripples them. As the good folks at despair.com (they create de-motivational posters) suggest, there can be great money to be made in prolonging a problem. In my opinion, technical assistance is a resource that should not be squandered, but there are some communities deemed to be such high need that they get overwhelmed with technical assistance and no strategic support to hold it together in a way that makes any sense. The problem in those instances isn’t an absence of support. It is an absence of thoughtful, sequenced, strategic, targeted supports. And we also have to be careful that some TA is not creeping into other program areas that are outside the mandate. It is not the responsibility of the TA to resolve this; it is the responsibility of those that pay for the TA to get their act together. 7.     Some of the most innovative and effective things are happening in places that are not in the national/international spotlight. Medicine Hat has the best assessor on the planet in Jeff Standell. Ever heard of him or Medicine Hat? You should. I learn something from him every time we talk. Ever heard [...]

Nov 112013
 
Overwhelmingly Affordable Housing

192 units of housing. For as low as $25 per month. Seriously. It’s called The Tower. And it’s owned and operated by Crossroads Rhode Island in Providence. The Tower is 100% subsidized. This makes it possible for rents to be as low as $25 for individuals with $0 income, and others paying slightly more based upon her/his income (and only paying 30% of their income on housing). The balance of the subsidy comes either through Providence Housing Authority Section 8 or the State Rental Subsidy Program. When communities talk about having no housing for people that do not have an income, I wish they could learn more about housing opportunities like this one. The 9-storey building is about 100 years old. It was previously owned by the YMCA, and then came to be part of Crossroads’ housing portfolio. How did Crossroads secure this gem? The building was purchased from the Y in 2002.  At the time of the purchase, it was divided into condominiums, the Tower being one, 16 apartments being another, and the Crossroads Agency space being a third.  Funds to purchase and renovate the Tower and Apartments came from a variety of sources including LIHTC, HOME, and mortgage financing to name a few. On two floors of the Tower there are the 16 full, spacious apartments. They are complete with a full bathroom and full kitchen. The only condition to access these apartments is having a disability and have been formerly homeless. On all of the other floors, [...]

Jul 292013
 

Every summer, for almost a decade now, the Conference on Ending Homelessness put together by the National Alliance to End Homelessness in Washington, DC has been a highlight for me. It has become a tradition. It reinvigorates me. It teaches me. It reminds me why we do this work – day in and day out. There is no way to fully capture in this blog everything that was discussed at the conference. If you search the hash tag #naeh13 you can see the thread of some of the most dominant themes by some rather prolific tweeters. In this blog, I wanted to reflect on the top three things that I took away from the conference this year – which may also be of interest to those unable to attend: 1. Success is possible. It is inspiring to see the success of communities like New Orleans on track to end chronic homelessness. It is invigorating to see the results of the 100K Homes campaign, especially the 43 communities in the 2.5% club. It is refreshing to hear how communities like Grand Rapids and Cleveland made the necessary, but difficult, decisions to properly coordinate access into their homeless service delivery system. It is awesome to hear how organizations like UMOM in Phoenix transformed their resources to focus on serving people with higher acuity and many barriers to housing stability. And I could go on. For anyone who feels that the job of working to end homelessness is an impossible task, take the [...]

Jun 102013
 

Case management. I suspect service providers, funders, CoCs, policy wonks, elected officials and a whole whack of others have used the phrase or even deliver a case management service but have never defined what it means in their context. The problem with not defining what case management means for your organization and community is that it is open to gross misinterpretation if you don’t. It will be defined for you by others, probably implicitly, and likely incorrectly (or at least differently than how you internally defined it). I will spare you the full academic breakdown of the phrase. (You’re welcome.) BUT…I do want to cover the basics briefly from that perspective. There is no single defined history of case management in the literature. We can’t point to just one point in time and say “aha – that’s when case management started”. Because there isn’t a single defined history or point of origin, there is an absence of absolute consensus on what case management is (and isn’t). There also isn’t one dudette (or dude) considered (or at least universally accepted) to be the pre-eminent pioneer of case manager when it comes to housing and life stability. Want to complicate things further? Once you start adding qualifiers like “intensive” as in “intensive case management” things get even messier. Does it mean more time with people? Does it mean a smaller caseload? Both? How small of a caseload? How much time? More intensive compared to what – ”case management”? Interventions like Assertive Community [...]

Jun 032013
 

More and more I am seeing different orders of government – municipalities, states, provinces, federal – slip the words “housing first” or “Housing First” into their documents, policy briefs and contracts. I suspect (because I used to be one in a former life) there is a policy wonk that did some research, found the evidence of this approach to homelessness compelling, and advised political masters it was the bees knees. But does government know what it is asking/endorsing/requesting? Is what the policy advisor is recommended understood and translated well in the political arena? Do program designers that may have never delivered direct service at any point in their lifetime in this field really know what they are asking for? My experience suggests this is probably not the case. All of the evidence that pointed to this approach being a good one requires fidelity to practice of a true Housing First model, either through Intensive Case Management or Assertive Community Treatment. You can read my thoughts on this or listen to the podcast here or watch a video about it here. Truth is government should be demanding fidelity to practice in exchange for investment of resources. And government should be investing in the training to help service providers gain the knowledge necessary to fulfill the requirements of the practice. Not doing so is a gross injustice to homeless people, and will not yield the results (housing stability, cost savings, etc.) that were expected when the community went down the road of [...]

May 272013
 
When to Let Clients Go

In this blog I want to explore the transition of clients from being part of the active caseload in a time-limited housing support program to the point where they no longer need their housing case manager because they are connected to other community supports and their acuity has decreased. My experience – and through my travels this experience has been validated and shared by others – suggests that some of these thoughts may also be applicable to some individuals and families in Permanent Supportive Housing depending on the nature of the household, their length of time in PSH, and why they were first connected to PSH in the first place. You’ve worked your butt off to help an individual or family get to a place where their housing is stable in your housing support program. There are still matters in their life they are working on and they go through ups and downs. There are two main reasons why case managers continue to hold on to clients in these situations that I have experienced – a concern/fear that one of the “downs” in the “ups and downs” will de-stabilize their housing in the future; or, the good feeling of having a client in a solid place is so good that we don’t want to let go. We do not have crystal balls (well, not ones that actually allow us to see the future anyway). We have no way of knowing if someone will experience an adverse situation so intense that [...]

May 062013
 

When working with vulnerable populations, one of the unfortunate realities is that some clients will die. Death is part of life. Even when exercising professional boundaries, there is a bond formed with clients. With death, we need closure – even when a client is palliative and our work with clients was catered to the best possible end of life support. There are also pragmatic steps that must be considered in the event of a death that are best thought about and explained prior to a case manager or other staff member dealing with a client’s death. Not all deaths have the same response from workers and organizations and we need to acknowledge that. The violent death of a middle age client may stir up different emotions than an older client that has been receiving care for several chronic illnesses. A sudden death through something like a heart attack may have a different reaction than a drug overdose. The death of a child in a family that a case manager is working with may cause different feelings than a suicide. And so on. I am not suggesting that any particular cause of death is better or worse than another. It is just different. Even though a staff member may be professionally objective, personal values and perceptions may still influence how we process any particular death. Some communities have homeless memorials. There are different approaches to how the matter of death is considered in these memorials. In some communities it is just [...]

Apr 292013
 

I have a very personal connection to wellness and recovery as it relates to mental illness. If you haven’t read my older blog on living with depression, you can read it here. Or if you want to watch my video blog on mental illness and stereotypes that emerged in the wake of Sandy Hook, you can watch that here. Because I have a personal connection to wellness and recovery, I suppose it should come as no surprise that it is one of my favorite areas to provide training to housing case managers, and to help homeless serving agencies truly understand and embrace. This is a four-part blog that examines wellness and recovery in the process of supporting people in housing, and working to prevent homelessness from happening again to that person/family. In Part Three of this blog series on Wellness and Recovery, I want to focus on how support workers can promote recovery with the clients that they are engaged with, while supporting them in housing and life stability. There’s a catchy tune called Recovery by Frank Turner. While the song seems to focus more on addiction recovery (in my opinion) than mental health recovery, there is a stanza in the song that I love: If you could just give me a sign, just a subtle little glimmer Some suggestion that you’d have me if I could only make me better Then I’d stand a little stronger, as I walk a little taller all the time. Because I know you [...]

Apr 152013
 

When the movement started towards communities developing 10 Year Plans to End Homelessness, I was skeptical. Not because I didn’t think having Plans was a good idea. They harnessed a lot of great community energy. They started a national conversation in a way that had been absent. They focused attention on the issue of chronic homelessness in a profoundly new way. My skepticism came from the fact that most Plans, generally, did not talk about how the staff on the frontline and the programs within agencies would be trained to change in order to be successful at helping people get access to housing and maintaining housing. The Plans had lots of talk about housing first, permanent supportive housing and the like, but they didn’t hone in on what I thought at the time – and have had confirmed over the past several years – that there was no investment of time or resources to help teach people to actually do the thing expected from the Plan. If you tell a plumber that they are becoming an electrician overnight don’t be surprised if the house burns down. Now I find myself in a number of communities working on coordinated access and common assessment to improve intake processes and connecting the right person/family to the right intervention at the right time. I really love this work. I think it is the right thing to do for individuals/families seeking service, to improve efficiencies in the delivery of services, and to move towards a [...]

Jan 022013
 

Once an individual or family has been accepted into a housing support program, the support worker (aka case manager) must work to set the tone for successful home visits. This starts with the very first visit. Practicing the tips below consistently – right from the beginning – and communicating these expectations to the people you are supporting results in more focused interactions and better case management results. Be on Time & Stay on Time The home visit is a professional interaction with a client. For the home visit to be taken seriously and to reduce missed visits, from the very start it is critical that the support worker is on time. Time management and not trying to see too many clients in any given day is essential to ensure being on time more often than not. At the beginning of the home visit it is also important to outline how much time you have for the interaction that day. These will vary in length depending on the amount of material to be covered off during the visit. Once you lay out the time for the visit, do not exceed it. Outline Your Objectives for the Visit at the Beginning A home visit is a highly structured conversation in the case management process. It is NOT a matter of showing up, checking in or just seeing how they are doing. It is a purposeful meeting to advance the case plan. At the beginning of the home visit, remind the client of [...]

Oct 032012
 

A dozen times in the past few weeks I have found myself speaking about therapeutic incarceration. It has nothing to do with jails or prisons. It is about how some homeless and housing service providers treat their clients. I didn’t coin the term (see The Therapeutic Incarceration of Homeless Families Naomi Gerstel, Cynthia J. Bogard, J. Jeff McConnell and Michael Schwartz Social Service Review Vol. 70, No. 4 (Dec., 1996), pp. 543-572) though I wish I had. And it sounds like something I would say. When I use the term, I am talking about those non-profit (and sometimes government) programs that go out of their way to hold onto the households that they serve. They smother them with service plans more oriented on trying to heal or fix people that trying to house and support them regardless of their imperfections. They keep them in life skills programming, for example, refusing to talk about housing options until they have demonstrated success in the program. Or they have them stay in a compliance-based a transitional housing model. Or they keep providing case management services to them years from when they first encountered them, unfortunately (naively?), thinking that their supports are necessary to keep them housed. News flash – and it can suck to hear – that ain’t what the job is supposed to be. When it is more about our desire to hold onto people then it is wrong. When we think we can intervene to prevent any mistakes from happening, then [...]

Sep 212012
 

“I agree with prioritizing clients being a better practice than first come first, served, but I think our staff will have too hard of a time with that.” “I agree with focusing on housing stability before launching into a complete case plan, but our clients really need longer case management before they are ready to be housed.” “I agree with the idea of working with a smaller group of people really intensely to solve their homelessness, but our funders want to see high numbers of people we interact with.” “I agree that we should know the difference our program makes in people’s lives, but we don’t have the time nor are we required by our funders to track those types of changes.” “I agree that we should spend time talking about how to better work like a system, but our CoC thinks they already do that really well.” “I agree that we need to have an assessment tool, but youth are too different from other populations to be assessed.” “I agree that publicly reporting how we are doing relative to targets would be helpful, but our staff would freak out.” “I agree that we should offer person-centred services, but there are some administrative things that we are required to do that makes that impossible.” “I agree that we should be non-judgmental and meet people where they are at, but people need to be sober for at least 7 days before they can really make a decision about housing.” “I agree [...]

May 152012
 

A lot of the time I find “Housing First” and “Rapid Re-Housing” to be misused terms. Below I briefly outline the definitions and service components to each. When asked to assist organizations or communities realign their service delivery to be more effective or to evaluate their housing programs, this is the understanding of Housing First and Rapid Re-Housing that I try to generate awareness of in the community. As this is a blog and not a two or three day training seminar, I am focusing on hitting the high points. (Maybe some day I will find a publisher that will take me on to write the more exhaustive description, program examples, etc – but I digress.) As a philosophy housing first (intentionally a lower case “h” and lower case “f”) focuses on any attempt to help people who have experienced homelessness to access housing before providing assistance and support with any other life issues. In this orientation, the intervention of Housing First and Rapid Re-Housing both fit. Given housing is the only known cure to homelessness, the success comes with helping ideal candidates achieve the cure sooner rather than later. As an intervention Housing First is a specific type of service delivery. Delivered through Intensive Case Management or Assertive Community Treatment, fidelity to the core aspects of the service can be measured. Housing First is specifically not a “first come, first served” intervention. It intentionally seeks out chronically homeless individuals that have complex, and most often co-occurring issues, and serves [...]

Jan 032012
 

My thanks for the blog request on this specific topic. I’d be hard pressed to think of a housing support worker/case manager that deliberately tries to make the life of any client worse. People go into this type of work because they tend to want to help others. But I think we need to take time to reflect on when helping becomes hurting – even when it is unintentional…when our actions aren’t actually helpful at all. Understanding the differences between enabling our clients and supporting our clients is an important part of self-reflection as a practitioner and is an essential distinction to be made in the type of help we are providing to people. I look at support as the art and act of encouraging a person to achieve goals. It is the function of working with the clients we have the privilege of assisting, not working for them. We want the individual to deliberate before making decisions, have information to make informed choices, and to experience and understand the consequences of their actions. In a supportive relationship, we want our clients to accept full responsibility for their life – to increase their self-awareness and self-management to the point where they can reframe and rebuild their life. Through supportive relationships we are respectfully presenting opportunities – at times challenging opportunities – for positive life changes while increasing opportunities for growth, learning and awareness. I look at enabling as the act of encouraging or failing to prevent a person from engaging [...]

Nov 222011
 

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 [...]

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 [...]

Sep 142011
 

So you have a client that has engaged in case management supports with your organization, but they never seem to be around or seem completely unengaged when you do meet. They have high acuity. They likely have several complex issues and have experienced long-term homelessness. Is the fact that they are rarely around or seem completely unengaged sufficient to “cut them loose”? Should your organization move on to another person who is more eager to actively participate in what you have to offer? No. In this blog I talk about how to use assertive engagement appropriately to first engage with people who have accepted case management services and then become unengaged, as well as how to effectively engage with people who are homeless and do not seem interested in having a conversation about housing and case management. In a perfect world – heck, even in a lot of “normal” therapeutic environments – people seeking service come to a safe support environment. Appointments are booked. People are focused on the support and not distracted. People are sober and have taken medications. People have absolutely embraced that they want support and are going to work their butts off to get better. This is not the reality I work in. When working with a population with long-term street engagement, this is not the norm. Sometimes the best environment you get is an encampment in the woods or a dry spot under a bridge. In my career I’ve had to engage with people from [...]

Jul 192011
 

My last tweet from the conference claimed that #naeh11 rocked harder than KISS on a stadium tour. I stand behind that even as the days pass since the conference ended and reflection sets in and turns in part to wisdom. I think what made it rock for me this year was different than past conferences. From my vantage point there was a bit of an edge amongst conference delegates. The edge wasn’t defiance. It wasn’t even anger per se. It struck me that there was frustration. The source of the frustration? I heard over and over again the impact of the economy on local communities and state governments and decreased fundraising efforts. I heard over and over again about increasing demand for services. But I actually don’t think it was solely either or limited to both of those things. I think there are communities that entered into 10 Year planning fully committed to seeing homelessness ended. But now they see the 10 Year Plan sit on a shelf or the local leadership shift or the resources made unavailable. I think there are people and organizations that understand truly what effective approaches and evidence-based practices are and work hard to implement them, only to find other organizations still questioning Housing First, Rapid Re-housing, Critical Time Intervention, Harm Reduction, Trauma Informed Service Delivery and the like. They feel it is a constant, up-hill battle. I think that the misuse of phrases and terms is stoking the frustration. There was Sam Tsemberis – [...]