In the fourth part of the series we look at the sequence of events that needs to occur for housing programs to be successful.
PART FOUR: The 5 Essential and Sequential Elements
Regardless of the presenting needs and complexity of issues, housing programs always function best when housing is the first task to focus on. Throughout my travels I have seen far too great an emphasis on trying to get a case plan in place prior to getting someone housed…or getting the client into treatment first…or getting the client compliant with medication first – and I could go on. It doesn’t matter if you are a fan of Housing First or not – what is critically clear through the evaluations we have performed and my years of professional practice is that housing has to be the first thing worked on or else the rest of the tasks are not going to be successful in helping people achieve housing stability.
So, here are the 5 Essential and Sequential Elements of Successful housing programs.
- Focus on Housing Before Anything Else
- Create an Individualized Service Plan
- Increase Self Awareness
- Support Achievements in Self Management
- Allow the Client to Reframe/Rebuild One’s Life and Future
Now let’s look at the critical components of each one:
1. Focus on Housing Before Anything Else
We need to have a range of housing choices for people to consider. This will cover things like permanent supportive housing, scattered site market housing with supports, and perhaps things like well managed boarding homes or rooming houses or even secondary suites like basement apartments. After we have presented a range of choices and the client has selected a place and the lease is in place, the critical components for the housing to be successful (as a first step in a process) are:
Relationships – creating an environment of awareness about the relationships that the client has with others in their life and how those relationships may support or create conflict in keeping their housing. They may have family and friends that are supportive and healthy relationships that will make the reintegration process easier. On the other hand, they may have some pals from the street or shelter that they want to invite back to their place – maybe even offer them their floor or couch to sleep on. This may have deleterious consequences depending on how many of these folks we are talking about, behaviors and their relationship to the person we are supporting. We need to create the opportunity for meaningful conversation about relationships relative to maintaining housing.
Basic Needs – we never want someone to move into a place where the basic needs aren’t in place. On the day of the move in (and I stress “the day of” not “soon after”) the apartment should be furnished (preferably with furniture of the client’s choosing), there should be food in the cupboards and fridge and basic cleaning supplies should be in place. Meet these basic needs in the apartment and the client is going to be more inclined to stay in their place.
Supports – we should ensure that the client is aware of the supports available to them. In a lot of instances this is going to be a case manager of follow-up support worker of some kind. Regardless of the type of support, the client should know when and how to contact the person(s) who are providing support and what they can expect when they seek support. Given superintendents/landlords also play a support role to all tenants in their building, it is important than the client understand what the superintendent/landlord role is as well. We also need to distinguish crisis supports that may be available from case management and other types of less intensive supports that may be available.
Safety – all prospective places that people move into should be in habitable condition and be safe. Clients should have doors that they can lock to keep the world out if they so choose. They should also have windows that close so as to avoid intrusions that way as well. We want our clients to feel that their place is their home; that they can decide who they let into their home and who they keep out.
2. Create an Individualized Service Plan
AFTER the person is in housing is when the individualized service plan should be created (not before). My preference is to call it an individualized service plan rather than a case plan – but that’s just me. This is the document where the client outlines what they want to work on in partnership with their supports so that their housing remains stable. I don’t believe there is anything cookie cutter about these documents. I certainly don’t support a checklist type approach to pulling them together or putting in place predetermined/required goals that the client has never agreed to (SOAP BOX MOMENT – I may blow a gasket if I see another one of these documents where the agency has put sobriety, treatment or meeting with a psychiatrist in as a goal for the client when they have never agreed to wanting to achieve these things….but I digress).
Individualized service plans tend to work best when these have these components:
Life Stability – I like to see the goals and activities related to life stability to be situated in a context of housing stability rather than stand-alones. The reason for this is that I want to see people reflecting on how to sustainably stay in housing while they work on whatever other areas of their life they think are important to work on.
Meaningful Daily Activities – everybody should have things that they do to occupy their time that isn’t used by other service plan activities like meeting with doctors or income supports or those sorts of things. Worst thing is people who sit around with nothing to do and are completely socially isolated. We need to make a strong effort to increase awareness and opportunities for the clients that we serve that gets them into an environment ripe for community integration. Most often this will be most days of the week, ideally, and will provide good satisfaction and fulfillment – whether that fulfillment be emotional, spiritual, social, recreational, intellectual, etc.
Education and/or Employment – indeed education and employment may be types of meaningful daily activities that a client engages with. However, I keep these separate because of all that has been learned from the likes of supported employment and from different research that has occurred on recovery services that show these as two positive stand-alone components.
Connections with Other Systems – in many cases the people that we serve will also have connections with the likes of doctors, psychiatrists, parole officers, therapists and others. Given we don’t have control over these other systems, we need to focus our attention on connecting to these other systems in a way that works to the benefit of the people that we serve. This can take a range of approaches, but the advice I always provide is to have formalized brokered access to services rather than the system connections being a series of one-offs. Connecting at a policy and senior management level in addition to the operational level is preferred.
Social Awareness – to assist the people we serve in moving beyond their identity as a “formerly homeless person” we need to help create environments where they connect with people across a broad range of income strata and life experiences. We also want to create opportunities for people to potentially become more comfortable and confident in meeting with other professionals – like, say, biding time in a waiting room while waiting to be seen by a dentist.
3. Increase Self Awareness
Self-awareness calls for use of introspection skills and the ability to become attuned to one’s knowledge, values, opinions and beliefs. Self-awareness allows for “ownership” of these feelings and the ability to put into context what one beliefs relative to what others may think, the influences used by others and the environment within which one lives. I would argue that for many of the people we serve – especially those that have experienced long-term homelessness or long-term institutional living – that self awareness becomes compromised because they are socialized (or even forced) to think and behave in certain ways as a requirement for receiving services. Further, I would argue that some of the behaviors exhibited by the people we serve that seem to have negative consequences on their life in the past are directly related to imposed reduced self awareness.
Helping the people we work with increase their self-awareness requires focused attention on three components:
Self-Assessment – this is intuitive to many people, as a function of how we interpret a broad range of stimuli, the situation we are in and information we are presented with – and then determine the most appropriate behavior relative to the circumstances. Self-assessment is really an identity aspect of our personality. People who have been subjected to being told what to do for long periods of time rather than independent analysis of a situation can have their self-assessment skills compromised. Some of the people we work with will need help re-establishing the skills of reflection on circumstance and environment and thinking critically through the most appropriate responses to the various stimuli and emotions felt in the situation. Open ended questions related to specific circumstances are best for helping to build this skill set.
Triggers – this relates to understanding how certain responses or behaviors directly relate to various stimuli, emotions, situations or circumstances. A deeper understanding of the triggers that related to how and why they became homeless in the past can help with planning for greater housing stability on an ongoing basis. Reflecting on specific situations can be helpful for assisting our clients identify their triggers.
Confidence – reinforcing positive growth in self-assessment increased confidence. Confidence becomes important in calculated risk-taking in growth and personal change related to the individualized case plan. It can also help with emotional strength and resiliency, as well as problem-solving that still keeps housing stability at the center of deliberations of how to respond to various situations.
4. Support Achievements in Self Management
Self Management in this context refers to working collaboratively with a range of supports and information for more holistic and informed decision-making. This is linked to how one cares for oneself along various dimensions: emotionally, physically, spiritually, socially, intellectually, etc. Our role can be to provide support and education to the people that we work with to help them establish the means through which they can exercise self management. Of importance here is that we do not enter into a dependent relationship where we are somehow at the center of the decision-making structure. We want to encourage the individuals to seek out other resources and information to make decisions so that they can do so independently of us in the future.
There are three components to supporting achievements in self management:
Control – we want people to experiment with and exercise greater control in their own life. This relates to where and how they get information that relates to their decision-making, how they respond to the decisions they have made, which individuals they invite into their life to be part of the information collection process, etc. What we are trying to reinforce is that the client is in control of their service plan, their decisions, their own future.
Accountability – as an extension of exercising control, individuals should be in a position to accept greater accountability for the information they are using and the decisions that they are making. Because our service orientation is focused on the individual and we are not using any type of cookie-cutter approach, it becomes important for the individual to exercise self-accountability. Ultimately we want the people we work with to feel accountable for their successes, as well as when things did not go as planned. The accountability in the latter is how we can facilitate a discussion about what they can learn from the experience.
Optimism – exercising self management should lead to feelings of optimism. We want the people we serve to feel control over their lives and accountable for the decisions they are making, all with a feeling that the future (whether that is tomorrow, next week, next month or years from now) are worth looking forward to and working hard to make better. Optimism is fueled by meaningful reflection on what has been achieved. It is for this reason that we need to take time to also work with our clients to reflect on all that they have achieved, not just what still needs to be done.
5.Allow the Client to Reframe/Rebuild One’s Life and Future
As our work focuses on helping the people we work with achieve greater independence in their lives, this final Essential and Sequential Element is a tell-tale sign that all of the hard work put into change on the part of the client, and all of the case manager’s hard work put into support have created a place and time for transition.
There are four components to the Reframe/Rebuild phase:
Infrastructure – in this stage, the client will have a solid social and physical infrastructure. The social infrastructure refers to “natural” supports like family and friends that can help provide a safety net in the event that something goes awry in the future. The physical infrastructure refers to having security of tenure in their apartment. Further to this last point, they will have a standard lease, the ability to pay their rent on time and in full, and there are no significant concerns about their tenancy becoming compromised in the near future.
Relationship Management – in this stage, the client will feel a greater sense of control within their social networks – which people they let into their life and for what purpose. They will also have acquired the skills to manage the relationship with neighbors and their superintendent/landlord. We would expect them to appropriately manage relationships with professional supports as well, knowing which supports they are connecting to and for what purpose. Finally, they are exercising more independence and exhibiting greater direction in the relationship with their case manager that has supported them in housing. Tell-tale signs of this occurring are things like independent goal setting, action identification and task completion; personal advocacy for needs and services outside of the support workers assistance; decreased time and frequency of home visits without any negative consequences on housing stability.
Purpose & Identity – this is the magical moment where the client begins to see their identity as a housed person with future goals and aspirations, rather than as a previously homeless person. How they speak of themselves is more often in the present and future tense, rather than dwelling on the past. Moreover, they are most likely connected with opportunities and activities that they feel gives their life greater purpose.
Greater Independence – at this point, the client has become integrated with a range of supports and opportunities outside of the case management relationship. They have considerable life stability. They can seem to independently manage their tenancy – taking care of their apartment and paying rent. They have built a formal and informal support network. They focus on the present and the future. They have thought about what may possibly go wrong in the future and have developed a plan on how they will respond to possible scenarios while keeping their housing intact.
Following these 5 Essential and Sequential Elements to Success is a recipe for program excellence and will help more clients achieve fuller integration with the broader community, improved quality of life, enhanced wellness and a sense that the future is brighter. The length of time it takes to progress through these steps is informed by a range of factors relative to the complexity of the client’s needs and interests, to the availability of time and intensity of supports.
Iain De Jong has developed the 5 Essential and Sequential Elements based upon years of practice, research, program evaluation and working with a range of successful housing programs. It has taken him more than 10 years to distill the elements and sequence to these points, but feels it was well worth the effort and journey to finally get to a place that makes sense to practitioners, policy makers, funders and clients. OrgCode has used this framework to successfully make amendments to funding and program requirements in other jurisdictions, and can demonstrate improved outputs and outcomes as a result. If you’d like more info on these elements, feel free to contact him at firstname.lastname@example.org