Mar 242014
 

The first is a real word. The second one is made up. They are both related. The first is to have opinions outside of one’s area of expertise or knowledge. The second is to present opinions as facts when the opinion is not based upon fact. In the world of social change, both hamper and thwart efforts to be effective. Consider that most public policy is crafted and approved by legislators that do not have subject matter expertise regarding the matter that they are enshrining into law, funding, rights, etc. But they do have opinions. Regardless of what the public service may have put before them by way of data, research, experience of other jurisdictions, framing of pros and cons, financial impacts, etc., it is always the prerogative in a democracy for elected officials to deviate from the advice they are given and craft an approach based upon opinions alone. This is the wretched, recurring uhtceare moment for the skeptical empiricist that would rather see evidence drive us to discussion and deliberation rather than opinion. Examples: mandatory minimums do not deter crime, but we seem to have an opinion that they do so and legislators create more reasons and longer sentences; sobriety is not a precondition for success in housing, but we seem to still fund and support a litany of recovery services that masquerade as homeless services and reinforce a false notion that people can only remain housed if they are sober; countries that have a long history of [...]

Feb 102014
 

Ending homelessness is not anti-shelter. In fact, in many instances ending homelessness starts with shelter. Let me put this in a system context. First of all, your community (or your organization if you are a small shelter in a smaller or more rural setting) needs to start by keeping as many people out of shelter as possible when it is safe and appropriate to do so. Great shelter services start with seeing diversion as a service – not a denial of service. Next you need to understand who the people are that are seeking shelter. They’ll fit into one of three groups: people using shelter for the first time in his/her life; people with a history of episodic use; people that rely on shelters on almost a daily basis (perhaps when they are not in hospital or jail). Regardless of the group, the emphasis on getting out of shelter and into housing should be the same. But, the strategies to achieve that goal will be different. For example, most first time users of a shelter will get out with a very minimal amount of service or no services at all, whereas chronic users may need more in-depth supports to effectively get out of shelter and into housing. Right size your approach based upon need, not one-size fits all. Look carefully at the programming offered within the shelter. The intent of shelter is not to heal or fix people – it is to provide shelter. Remarkably imperfect people are great at [...]

Sep 302013
 

You’ll have to excuse me I’m not at my best I’ve been gone for a month I’ve been drunk since I left These so called vacations Will soon be my death I’m so sick from the drink I need home for a rest There is a certain crowd who would have read the above lines and immediately recognized them as lyrics to one of the greatest Spirit of the West songs to party to. It’s the sentiment of the song that I love – needing home for a rest after indulging beyond what might be considered a healthy consumption threshold. As far as I’m concerned any person can choose to drink or not drink. That is their business, not mine. As I have argued previously, sobriety is not a precondition for housing success. This doesn’t mean there won’t be some people that may choose to have sober living. I support that choice for people as well. I have many dear friends and professional colleagues that have found sobriety in their lives because it made sense to them. It also doesn’t mean that drinking doesn’t come with consequences. It does. For some people, the consequences are quite severe. But I will not judge because of an addiction. There remains no shortage of homeless programs out there where the consumption of alcohol or other drugs after a period of sobriety will result in immediate exit from the program – even eviction in most instances. Seems to me that people that are in [...]

Aug 192013
 

Is your community trying to move towards common assessment as part of coordinated access? You should be. In response to inquiries from a few avid blog readers (thanks!) here are some questions you should ask when your organization/community is choosing an assessment and prioritization tool. 1. Is it grounded in evidence? There is no shortage of ideas on what may be a good thing to assess when a homeless person or family seeks services. Unfortunately, too many communities come up with their own list (sometimes LONG list) of things to assess without those ideas actually being grounded in evidence of what works, and the main currents of thought and practice in service delivery. That which we think and that which we know are often two totally different things. Your assessment tool should be grounded in knowledge and data, not unsubstantiated thoughts or feelings. 2. Has it been tested? Given the assessment tool informs which type and intensity of service an individual or family may be offered, it is important to make sure the tool actually does the things that the designers of the tool thought it should do in the first place. This requires extensive testing and feedback in trial versions of the assessment tool. It also requires testing the tool against other potential tools and the use of no tool at all. 3. Has it been independently evaluated? Researchers and developers involved with the tool do an incredible amount of leg work to get the tool off the ground. [...]

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 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 022013
 

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 Four of this blog series on Wellness and Recovery, I focus on what we would expect people in housing that are experiencing recovery to say they are seeking from their housing support worker, and what is appreciated most from their housing support worker. These are generalizations, realizing that each person that experiences recovery does so differently and may have different priorities in their recovery process. Perhaps it goes without saying, but there is a large expectation that a housing support worker will help the person that is homeless and starting on the journey to recovery to help them find appropriate accommodation. Choice is a really important consideration in this process. Part of empowerment is having a voice [...]

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 252013
 

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 Two of this blog series on Wellness and Recovery, I want to focus on what exactly it is that people are trying to recover. There are twelve areas that need to be considered, each of which is outlined below: Roles – we all have different roles that we play in our lives…spouse, parent, employee, sibling, friend, worshipper, mentor, teammate, etc. Many people that experience compromised mental wellness have roles re-defined in ways than how they may like them. For example, they may remain a parent, but the roles of parenting may have been taken over by a spouse or grandparent during a patch of being unwell. For some, being dislodged from employment for periods of time has [...]

Apr 222013
 

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. There’s a story – I don’t know if it is true – about a guru in Eastern medicine visiting a Western teaching hospital. The guru is asked the difference between “illness” and “wellness”. Calmly, he goes to the chalkboard and writes the words “illness” and “wellness”. He goes on to say, “There is an ‘I’ in ‘illness’, but a ‘We’ in ‘wellness’.” Recovery is a very personal journey. It is a process. While elements of it have individual activities to promote awareness and confidence, there is a fair amount of inter-connectivity to others as recovery takes hold. I take comfort in connecting Recovery to the notion of Wellness…which allows me to distance conversations about a diagnosed mental illness from labels and [...]

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 [...]

Mar 262013
 

Can your community have short-term and long-term shelters? Sure. Should you? Absolutely not. Unless you have no desire to ever end homelessness. If that is the case – if you want homelessness to continue so that all shelter employees will have a job for life – try to make all of your shelters as long-term as possible. Heck – make them people’s homes and just call them shelters. Let people put up posters and personal knick-knacks around their bed. Give your long-term stayers special jobs like sweeping the floors or helping in the kitchen. Ensure that you have as much programming in your shelter as possible. I do not hate shelters. In fact, I think shelters are quite important. But as I outlined in a recent friendly video rant, I want shelters to perform their intended function – short-term, infrequent stays. They are intended for housing emergencies. A focus on helping people through rapid re-housing or housing first is NOT anti-shelter. It just means that shelters are places that people can get out of homelessness and into housing as fast as possible; not places where people are trapped or expected to stay long term. I know a lot of shelter providers were well intentioned as their program models evolved. Some of the things I have seen a lot of in my travels (and I figure I have been in over 200 homeless shelters): Employment programs in shelters. The thinking is that people can get the employment skills they need towards [...]

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 [...]

Nov 202012
 

This holiday season I am making a plea that well-intentioned people do more than make a financial contribution to a homeless serving agency, or donate a non-perishable food item to a food bank, or volunteer at a community meal. The spirit of giving this time of year is dandy, but I know that many people want to do more…they just don’t know what to do. Here are some ideas: Do something for the staff in non-profits working to end homelessness and support people in housing. These are the unsung heroes in each community. The general community does lots for their clients during the holiday season. But I’m asking you to do something tangible for the staff in these non-profits that support those clients day after day. These folks chose to work in a non-profit. For that, already, they should be commended, most often choosing (yes, choosing) a lesser wage in return for greater social good. You could: Send them a note signed by all the people you work with or socialize with or worship with (or all three) thanking them for what they do day in and day out. Get enough movie gift cards for all the full time staff so that they can be treated to a night out at some point during the year. Sponsor a thank-you lunch for them in, like, February. More impactful? Have all the people you work with serve them lunch. Create a mentorship collaborative or learning community with people who work in the [...]

Nov 052012
 

I have heard many well-intentioned service providers speak of Permanent Supportive Housing as the only housing option for persons that have experienced chronic homelessness. Permanent Supportive Housing is an important housing option for all communities to have, and many persons that have experienced chronic homelessness may choose this option. But let me repeat: may choose this option. Let us also be clear about chronic homelessness and use the HUD definition: An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more OR has had at least four (4) episodes of homelessness in the past three (3) years. The individual must have been on the streets or in an emergency shelter (not transitional housing) during these episodes. Where there is error is thinking that Permanent Supportive Housing, whether it is through a scattered-site model of supports or a congregate model of supports, is the only housing model that will work for people that have experienced chronic homelessness. That type of mentality reinforces a housing placement mindset rather than a housing choice mindset. If we believe in client-centered service delivery then we need to wrap our heads around what it means to offer meaningful choices, not on thinking we know what is best for the people that we serve. A 2007 study examined what Housing First means to people served through a Housing First program. It shows a very strong relationship between housing satisfaction and whether the individual felt they had a choice in [...]

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 [...]

Jul 232012
 

Home Making In the effort to end homelessness, it has been my experience – generally speaking – that getting chronically homeless people into housing is the easy part. Providing the supports to help them stay there is the harder part. Here are a few tips that frontline workers can consider when supporting people in their apartment unit to help with the transition of a blank apartment into a place that feels like home. Positive reinforce the housing choice. On the day of move in, meet the person moving in at least one hour before you are supposed to meet the superintendent for getting the keys and moving in. One, this will reduce the likelihood of the person disappearing. Two, if you are even earlier than you said you would be when you show up at the encampment of shelter, you can tell the person that you are early because you are so excited about them moving in. Before they set foot at the building, take the time to engage in positive reinforcement. Let the genuinely know that you think this is a great step for them. Let’s say the apartment is downtown and that was one of the most important criteria in the housing search, reinforce how amazing it is that you were able to find a place that was close to downtown. Let’s say they wanted a smaller place so that it would be easier to clean, before you set foot in the unit talk about how glad you [...]

May 302012
 

Do all chronically homeless people have health issues requiring permanent supportive housing? No. But the design and delivery of PSH needs to heed the health needs of chronically homeless people, while avoiding the pitfalls of a solely medical model in service delivery. Homeless individuals have poorer health than the general population[1]. However, these individuals with poor physical and mental health and substance use issues can achieve stable housing[2]. Research from Toronto indicates that 72% of people in a Housing First program report improved physical health once moved into housing; however, while people with longer-term homelessness were likely to report improvements in mental health after moving into scattered-site housing with supports, they were less likely to report improvements in physical health[3]. There are statistically significant differences in self-reported physical health and self-reported mental health amongst homeless people, with homeless people fairing worse than the general population[4]. Length of homelessness has a direct link to the severity of the health issues, with people experiencing homelessness 5 or more years much more likely to have chronic health issues, and multiple chronic health issues much more prevalent amongst those homeless for a long time[5]. This would seem to suggest that PSH should first focus on those that have been homeless for longer periods of time with co-occurring health issues rather than focusing solely on health issues in the assessment. The various types of specific health issues confronted by homeless people are numerous. For example, cardiovascular disease is more frequent than the general population[6], and [...]

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 [...]