Planning for Success throughout Phases of Housing Stability

Part Nine: Planning for Success throughout Phases of Housing Stability

My pal (and Founding Partner of OrgCode), Dr. John Whitesell, has reinforced in me over the past dozen years the usefulness of the Sigmoid Curve to represent change, growth and development within people and organizations. He has also ingrained in me the ability to chunk the S-Curve into three main phases: Formative; Normative; and, Integrative.

While appreciating that everyone experiences housing support services somewhat differently, John and I meticulously went about trying to typologize various client characteristics in program phases relative to the S-Curve. Upon review of a whack of case files, interviews with staff in some highly successful housing programs, interviews with dozens of clients, mining of various data sets and reflecting on my own experience in creating and leading a rather successful housing program, we arrived at the following broad-stroke phases as experienced by the client, and as supported by the case manager:

Stage Client Characteristics What the Case Manager Should Do & Expect
Formative
  • Period of adjustment in being housed and becoming oriented to the new environment and supports
  • Characterized by new learning and adaptation
  • Goals and priorities more likely to shift
  • More likely to be pre-contemplative or contemplative in many areas of individualized service plan
  • Changes to social network are common
  • May feel a sense or urgency or panic to be “normal” or “do the right things”, yet more likely to miss appointments
  • Often emotionally unpredictable
  • Expect unpredictability & do not be frustrated
  • Focus on small wins
  • Drop by
  • Ask exploratory probing questions about future
  • Expect more teaching and modeling
  • Expect longer visits or more frequent shorter visits
  • Be clear about what is in scope for their help and what clients need to do on their own
  • Appropriately challenge
  • Stimulate early stages of change discussion
  • Use active listening & motivational interviewing
  • Create the individualized service plan with the client
  • Use of assertive engagement is more likely
  • Create a client-centered crisis plan
  • Assess and address risks through people, processes or technology
  • Introduce the concept of exit planning from the program
Normative
  • Characterized by development and growth
  • Active engagement in goal setting; sees results of goals
  • Learning strategies to deal with adversity
  • Will assert greater independence in setting and attending appointments
  • Routines starting to set in
  • Increased awareness of triggers and situations
  • Be prepared to address clients who relapse in any areas of their case plan—those that feel they are stuck, as well as those so elated by progress they feel like they can “go it alone” now
  • Acknowledge success and begin to decrease frequency of visits
  • Talk about strategies to deal with conflict and adversity
  • Keep the client stimulated with new opportunities
  • Have client engage in their own research about options relative to the service plan
  • Begin to use visual tools more to show progress changes
  • Start adding more details to exit plan
  • Use active listening & motivational interviewing
  • Update service plan
Integrative
  • Skill mastery and greater independence
  • Independently sets goals and puts actions into place
  • Improved confidence and self-esteem
  • Sustainable links to other community supports as necessary
  • Has strategies for dealing with adversity and conflict
  • Has knowledge and skills to independently manage tenancy
  • Reinforce and respect client autonomy
  • Use visual tools to show client progress over time — graphs, bar charts, etc.
  • Review challenging scenarios and ask client how they will respond when these situations come up in the future
  • Reinforce and increase connectivity to “mainstream” opportunities and services
  • Update service plan – which should indicate most/many activities as solely being within the client’s domain to undertake
  • Complete, review and operationalize exit plan

The key is to use the understanding of stages of change and objective-based home visits to assist clients in moving through the program stages.

You may also have noticed reference to things like the Crisis Plan and the Exit Plan, as well as Risk Assessment. If you want copies of any of these sorts of documents, drop me a note at idejong@orgcode.com

And there are, of course, other tools and techniques that you can put into place through each phase of the program to help track progress and work on increased success. Some of my favorites (click on any of them if you want more information from the source documents) include:

If we plan for success, have a sense of what to expect along the journey of housing and life stability, support appropriately without coercion or misguided expectations, use tools & strategies to increase the likelihood of success and remain focused on the major outcome of helping people achieve greater independence over time, more success will be had.

Iain De Jong has considerable experience helping organizations better understand how to support clients in moving from one phase to the other, and thinking about resource allocation and time management of staff in supporting clients in each of the phases. Feel free to drop him a line or ask questions idejong@orgcode.com

Prioritizing Who Gets Served Next Matters – The Service Prioritization Decision Assistance Tool (SPDAT)

When I led the largest Housing First program in North America, one of the things that bothered me was that we had no defensible way to prioritize who we served next. We dabbled with different instruments and had some stellar research thanks to folks like Toby Druce – but couldn’t quite put our finger on exactly how to prioritize who got served next and why. At least not in a defensible, reliable, consistent and valid way.

Sure, there are some awesome instruments out there like the Vulnerability Index used by Common Ground and now the 100k Homes Campaign (and we are big fans of both); the Camberwell Assessment of Needs; the Outcome Star; the Denver Acuity Scale. But none of these were a perfect fit for the type of Housing First program that I was leading or other Housing First programs that I was familiar with.

One of the first things I started working on when I made the move to OrgCode was to develop the right tool for determining who should get served by what type of housing intervention and why. Being the nerd that I am, I took an inventory of all existing tools that I could get my hands on – hoping that I had just missed something in my previous work. No point re-inventing the wheel. Truth is, not much with credible overlap other than the ones previously mentioned – and even then, too many limitations or shortcomings.

I found a small number of communities and individual practitioners willing to work with us in developing a proper assessment tool for Housing First. Dedicated professionals were found who would implement our drafts, provide detailed feedback, tell us about the associated client interactions and the like. The process was amazing. Repeatedly in the draft stage we heard over and over again how the SPDAT was making them look at their practice differently – from intake through to case planning through to discharge.

In the end, the final version of the SPDAT examines 15 main components for each client. Those 15 components provide a baseline at intake and are tracked throughout the case planning process. The 15 components are:

  1. Self Care & Daily Living Skills
  2. Meaningful Daily Activity
  3. Social Relationships and Networks
  4. Mental Health & Wellness
  5. Physical Health & Wellness
  6. Substance Use
  7. Medication
  8. Personal Administration & Money Management
  9. Personal Responsibility & Motivation
  10. Risk of Personal Harm/Harm to Others
  11. Interaction with Emergency Services
  12. Involvement in High Risk and/or Exploitive Situations
  13. Legal
  14. History of Housing & Homelessness
  15. Managing Tenancy

By using the SPDAT throughout the case planning process, it helps case managers in focusing their attention on those areas where clients are in pre-contemplation or contemplation, and to some degree preparation. It also ensures an ongoing client-centred and strength-based approach to service delivery. Finally, for those clients that are visual learners or have limited literacy and numeracy, the SPDAT provided the opportunity to visually demonstrate their movement – and momentum – in various dimensions of their case plan.

Version 1 of the SPDAT was implemented with thousands of clients across North America. After a year, we asked all practitioners to provide input on how to make the tool better through a detailed survey. After analysis of their comments we tested Version 2 extensively and finally launched the Version 2 in March 2011. Whereas Version 1 was focused exclusively on Housing First, Version 2 now takes into account Rapid Re-housing and more general Housing Help services as well.

There have been several interesting findings relayed to us from people and entire communities using the SPDAT:

  • Practitioners have been able to make significant transitions from jumping from one crisis to another to planned, logical service delivery through the SPDAT;
  • Many frontline workers resist the SPDAT for the first few weeks before they finally realize that it improves their job and interactions with clients;
  • Improved housing choices are put on the table for clients – from independent living through to permanent supportive housing;
  • Some of the people that previously staff may have thought were really high acuity turn out not to be – and the reverse is also true;
  • Local service managers and researchers really love how the SPDAT data allows them to meaningfully engage in advocacy, brokering and research and explore other areas for program improvements which are based upon evidence, not hunches or anecdotes;
  • Team Leaders indicate that they are better able to match the client to the staff person with the right skills to meet their needs; and,
  • Client outcomes (not just outputs) have significantly improved.

So far in addition to the thousands of clients and dozens of communities & organizations using the SPDAT we have had one Province seek permission to use it and integrate it with their data system, and two States that are in initial discussions with us to make it a standard in service delivery (tres cool!). The tool has also been shared at National Alliance to End Homelessness Conferences in the US and distributed to Service Managers throughout Canada.

The tool has been tested and used with a wide range of populations: youth; substance users; persons with serious and persistent mental illness; Aboriginal people; older adults & seniors; newcomers; families; childless couples; ex-offenders; and people leaving institutionalization. We are confident that given the huge implementation and reliability that the SPDAT represents considerable potential in helping to end homelessness.

The SPDAT is free. No gimmick. No bull. Free. It is our way of giving back. Any organization that chooses to use the SPDAT will get free updates in perpetuity. The only thing we ask is that practitioners are trained on how to successfully use the SPDAT the way it was intended. And even then, training is provided at a very reasonable cost to make the tool as accessible as possible, including webinars and in person workshops.

If you would like to talk more about the SPDAT, get a FREE copy of it or chat about how it can be implemented in your organization or community, please let me know idejong@orgcode.com or 416-698-9700 ext. 2