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 it will result in a return to homelessness in the future. We can merely plan and act in our supports to decrease the likelihood of this happening. So when someone says to me, “If I stop supporting them they will lose their housing!” I always ask, “How do you know that?”
I don’t ask the question to be a jerk. I ask the question to see if their assumption is based upon a true assessment of need that has clearly defined components of higher acuity that require support for a specific duration of time. Most often, though, the statement on the part of the case manager is based upon a feeling or hunch – not an holistic assessment of acuity and needs at all.
Life (sh!t) happens. We all have ups and downs. It is how we help support and prepare our clients for these eventualities that matter. It is important that time is spent with clients brainstorming the things they think may go wrong with their tenancy and how they will respond if that occurs. If we don’t do this, we run the risk of “therapeutic incarceration”.
In any time-limited support program, it is incumbent upon the service provider to inform the prospective client before they begin with the program that the supports are time-limited. Important to this, however, (funders and policy wonks please pay special attention here) time-limited supports must ALWAYS be client-centered. For example, we may wish that households in Rapid Re-Housing do not need supports beyond six months, but some will; we may wish that scattered-site time-limited Housing First do not exceed 12-18 months, but in some cases that will be necessary.
The next thing we need to make sure occurs is solid case management that brokers and advocates for connections to other community resources. The housing case manager cannot and should not be the only support in the life of the individual or family. Nay, the case manager should actively be promoting, supporting, introducing, and accompanying clients to connections with other longer-term community supports… a peer support group; an AA meeting; a social club; a mental health therapist; a parenting resource center; a play group; employment training; etc. If these sorts of activities do not occur – directly related to client needs – the likelihood of a dependent relationship increases and the likelihood of the household being prepared to move on without the housing supports in the future decreases.
I recommend looking at some indicators of housing stability as part of the assessment of moving towards exit. Of interest:
- Has rent been paid for at least three consecutive months on time and in full?
- Have utilities been paid for at least three consecutive months on time and in full?
- Are there any outstanding damages to the unit that are likely to result in eviction?
- Has their acuity decreased?
- Is there any reason to believe the individual/family will need to be imminently re-housed because of a negative situation in their housing?
And we also need to be actively involved in comprehensive exit planning with clients well before the projected exit date from the program. For example, in a six month Rapid Re-Housing Program I would be introducing exit planning at about the three-month mark; with a 12 month Housing First Program I would be introducing exit planning somewhere between the 6-9 month mark. Proactive exit planning allows us to reinforce the notion that preparing for greater independence and community connections without the housing case manager is important. It also allows for earlier identification of the skill development opportunities that need to be paid attention to prior to exit.
So, starting well before the actual project exit date, recommend an Exit Planning tool that starts with a client’s perspective/responses to the following (you can email us for a copy of the tool if you want):
- The steps they will take to ensure their rent is paid on time and in full
- What they need to pay attention to in order to not get kicked out of their apartment
- Why they think they are ready to live with greater independence and without their Housing Support worker
- The areas in their life that they are still working on
- Signs that their housing is becoming unstable
- What they will do if their housing is becoming unstable
- Signs that their housing is unstable
- What they will do if their housing is unstable
- What they will do if the landlord ever asks them to leave the apartment
And the client’s self-assessment of their skill level to:
- Clean the apartment
- Go grocery shopping
- Pay rent
- Speak with the landlord
- Do laundry
- Pay other bills
- Be a responsible tenant
- Set goals & take action
- Problem solve with a level-head
- Keep emotions in check when frustrated/angry
- Follow crisis plans when necessary
- Make appointments & keep them
- Follow doctor instructions
- Follow psychiatrist instructions
- Take medicine
- Refill medicine
- Have fun without creating problems
- Fill the days with things that make me happy
- Invite guests over and know when to ask them to leave
- Seek out help when needed
- Keep the apartment
By introducing these matters long before the time of exit, we are better supporting and preparing clients for greater independence. We are investing in their interests and needs. We know the areas to work on together to increase the likelihood of success. We are getting set to let go. After all, the reason we provide supports isn’t about us…it’s about them. Do all you can to make the people you serve as successful as possible without needing you anymore – and celebrate that doing so was in part possible because of the great support and preparation that you were part of.