Huh?
Dedicated to my pal Andy Burns who started a rather hilarious Facebook chat on how the next person who used the phrase “take it to the next level” was going to get punched in the taco.
Once communities started the job of organizing homeless and housing programs to operate services like a system instead of a collection of projects/programs, it has invited business jargon into human services unlike anything I have ever seen. What am I talking about?
I’m talking about a data-driven paradigm shift to create a win-win in the interface between the service users and providers. After some blue skying about how to make the process run smoother, what most communities found is that they had to double back to the parking lot to take another look for the obvious – assuming they still had the bandwidth to do so and leaving the kimono open didn’t reveal that the Emperor had no clothes.
Change initiatives like this are really about squaring the circle. It’s a fact that most CoC’s came to the realization that if they didn’t step up by the time the rubber hit the road they’d be facing a perfect storm. And anybody worth their salt knows that when you are facing stiff headwinds it is best to put the mirror shoulder high, focus on core competencies and stick to knitting. All of this may sound like a broken record to you, but this is the only way known to move the needle.
When that needle starts to move, hold onto your cookies. Coloring outside the lines is the only strategy that makes sense if you want to get the ROI you know that everyone deserves. Hard to know if that means more boots on the ground, but it does mean more synergies – and let’s just embrace that sometimes 1+1 has to equal 3. Who steps up to the plate in the community to make that happen, though, is really the $64,000 question. But let’s not confuse putting a stake in the ground with putting lipstick on a pig. If we don’t take a “ready, fire, aim” approach, “hope” will be confused with “strategy”.
You may feel like a hamster on the wheel in the early days, but before you know it, our hard work will make it feel like we’re drinking from a fire hose. If we do this right – and I know we will – we have to be prepared for this whole thing to go viral. Sure, we have to be prepared for some pushback – but let’s take it as a sign that people are just resisting change. Our juggernaut is going to take some basic blocking and tackling, but we have left no stone unturned in the idea department, and we have to believe from soup to nuts there’s nothing we aren’t ready for. Look into your heart of hearts and you can feel we have a winner here…once the loop is closed we can hang our hats on this important moment in our careers, and if we want to take it to the next level, everyone knows this is completely scalable.
Yup. Good luck with that. Whatever that is.
Bat Shit Crazy (And Other Common Excuses)
John, the support worker says, “I can’t help him. He’s bat shit crazy.”
Elaine, the case manager says, “He was in the army. He’s a trained killer. When he’s off his meds I won’t go near him.”
Tony, the case advocate says, “She’s always drunk. There’s no point trying to do a home visit if she’s smashed.”
Alex, the peer worker says, “Until he hits rock bottom like I did, there’s no point in even trying.”
Know what the problem I have with all of these? None of them are truly person-centered. Each one is an excuse of why not to serve someone. None of them exhibit the creativity and tenacity I expect to see in housing support programs if success is to be achieved.
It has been said that success is a lot like pregnancy. People want to congratulate you when you achieve it. But they don’t know how many times you’ve been screwed to get there.
No housing support process is perfect. But that doesn’t mean we can’t keep focused on success regardless of how many issues, missteps or barriers come up along the way. It is up to us to address and solve these issues to work effectively with our clients, not expect them to be someone they are not.
These and other excuses for not providing excellent service have been known to come up when I do training. I want to take just a few moments to dissect some of the critical steps that have to be taken to help ensure success in service delivery – whether that be helping people enter into housing or supporting them once there.
It is true that people have to provide informed consent to participate in a housing support program. Undoubtedly, some people with severe mental illness may have smaller windows of lucidity to enter into such a conversation. But that has more to do with us trying to find those opportunities rather than being consistently dismissive and thinking they will never be able to consent or actively participate.
When a person does have compromised mental wellness and is in the program, I also want to know what steps have been taken to help support the individual. Is the case manager trained on the Recovery orientation to effective service delivery? Do they know how to create a WRAP or DREEM with their client? Is there an up to date crisis plan in place? Has there been brokering and advocacy to community-based resources, from peer supports to mental health professionals?
All clients present potential risks to case workers, whether that is in community or doing home visits. Oh, and strangers present risks too in places like buses, night clubs, grocery stores, shopping malls, gas stations, rest stops, public parks, etc. It is up to us to practice impeccable community worker safety strategies and perform risk assessments that allow us to better identify what the specific risk may be and then determine the person, process or technology that will help lessen that risk. All human interactions come with some risks. It is also a fallacy that persons with mental illness are any more violent than the rest of society.
Some workers/organizations place a strong emphasis on their clients taking their medications. That is more about compliance than being person-centered, or in the case of mental illness, truly understanding or expressing empathy when it comes to psychotropic medications. Theside effects of some of the most common medications are quite astounding and vary from medication to medication. How comfortable would you be with things like weight gain, dry mouth, constipation, unusual dreams, muscle spasms, menstrual irregularity, lack of sexual desire, lethargy – or a host of other things that can greatly impact your day to day life? I’m not suggesting we should not be encouraging people to consider their medication options, but let us appreciate that it ain’t all sunshine and roses, and that you too – if you were in the same position – may be carefully weighing the impacts of the medications with its potential side effects.
When supporting someone who chronically uses substances like alcohol, I ask workers how they have changed their schedule to meet the needs of the client instead of unrealistically expecting sobriety at any point during the day? This is one of the reasons why a 9-5, Monday to Friday approach to doing this work really isn’t effective. Doing so implies that the people we are supporting can and will adjust their behaviors and daily cycles to our schedule. It may be that the person who drinks heavily needs you to come in the morning after they have had one or two to get rid of the shakes but before they are intoxicated. Or maybe they need you to come late in the afternoon or early evening after they have had a nap for their day drinks but before they ramp up for using in the evening.
And then there is good ol’ “rock bottom”. There is no commonly accepted clinical definition of “rock bottom”. People are capable of change regardless of where they are at in their behavior patterns. It is up to find ways to engage, without thinking any two people are the same. Being person-centered requires us to truly be focused on the individual; not to be comparing them to ourselves or other clients past or present.
Truth is, we can come up with effective strategies to succeed, or we can hide behind excuses to not properly perform the required job. I ask (beg?) housing support workers to embrace effective strategies. When success happens it no doubt will have come with some setbacks and missteps along the way…but success is still success nonetheless.
What My Dad Has Taught Me About Ending Homelessness
My dad is retired. He spent his career leading the chemistry department in a steel mill. Now his days are spent trying to figure out what cruise to go on with my mom; which species of bird is at his feeder at his home on Lake Huron; whether golf courses in Arizona or Florida are better; and whether or not the fish are going to be biting today.
The older I get (I have one of those milestone birthdays just around the corner) the more I appreciate the wisdom imparted to me by my father, and how that relates to ending homelessness. This past weekend he gave me two framed pieces that he hung in his office for decades. I never knew they existed before now. And one of them sums up my relationship with my father and my life’s work in a nutshell:
Creativity
The man who follows the crowd, will usually get no further than the crowd. The man who walks alone is likely to find himself in places no one has ever been before.
Creativity in living is not without its attendant difficulties, for peculiarity breeds contempt. And the unfortunate thing about being ahead of your time is that when people finally realize you were right, they’ll say it was obvious all along.
You have two choices in life: you can dissolve into the mainstream, or you can be distinct. To be distinct, you must be different. To be different, you must strive to be what no one else but you can be…
So, I raise a glass to celebrate my father for Father’s Day, and say:
Here’s to appreciating that every person served in homeless and housing services is different than the next. Each is a unique person. The uniqueness has to be appreciated if we are going to help people achieve their goals.
Here’s to deciding to find ways to end homelessness rather than continue to manage it. Do the same things, always get the same results. We have to do something different.
Here’s to days of loneliness and being misunderstood in the pursuit of that dream, from time to time, because sometimes trying to forge a new direction and approach in a creative way comes without support.
Here’s to letting go and allowing others to take credit for your ideas and hard work when it is necessary for them in believing it was obvious all along.
Here’s to being distinct in ideas, processes, use of data, presentation of the problem, and the outline of solutions.
Here’s to being different in how to talk about one of the most complex social issues of our time.
Here’s to achieving the me that I am meant to be, and striving to do that each and every day.
Here’s to the ones closest to us – like dads – that remind us that even though we may never get rich doing this sort of work, the richness comes from making society better.
Housing-Based Case Management
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 Treatment have it somewhat easier in the definition department. We can trace back to when it started. We know what it is and what it isn’t. We can measure fidelity to the preferred effective approach to practice. (Though here is the complicating factor…sometimes ACT is referred to as a subset of case management practice in the literature without “case management” being defined…but I digress.)
Chances are, many of the people your organization works with – especially episodic and chronic homeless persons – have encountered case managers before. They are seemingly everywhere in services that interact with people. Schools have them. Hospitals have them. Prisons/jails have them. Youth programs have them, as do programs for older adults. Developmental disability services have them. Addiction treatment has them. A bunch of community services have them. Oh, and it seems just about every facet of the homeless and housing service delivery system has them.
Enough background. On to how we need to define housing-based case management in the pursuit of excellence in housing supports and work on ending homelessness. I think every organization should have their own clearly defined outline of what case management services means to them and the people they serve. These are the sorts of things your definition should include with some commentary on each:
Professional – trained, educated people deliver case management services who have a solid foundation of practice and theory. If volunteers are involved, they should be professionally trained people working in a voluntary capacity. Well-intentioned, compassionate people without training and theory should not be delivering case management services. As I have said many times before, do not confuse having a big heart with having a big brain.
Active – sometimes when phrases like “meeting people where they are at” or “person-centered” becomes an excuse to be passive, as if both phrases mean that case managers have to wait for individuals/families to come to them. Nay, not so. The case manager must be active and deliberate. This ranges from preparing information to conducting home visits. Case management is proactive in its activity in the spirit of promoting greater independence. Sometimes being active means being persistent and using assertive engagement as necessary.
Empowers choice – case managers provide the service users they are supporting enough information to support that service user in making an informed decision on all matters related to life. Case managers do not make decisions for service users. Yes, this means service users will choose to do things that the case manager her/himself would not do. This may even be labeled a “mistake” by some. Well, a mistake is just another way of doing things…it is neither good nor bad; neither right nor wrong.
Objective – being objective is a struggle for just about anyone, let alone a case manager. Suffice to say, the people being supported will have a different world view…different values and perspectives on matters. Objectivity in practice requires case managers to have completed their own “values inventory” and know who they are as a person to be able to distance themselves/supportive being objective in their practice. Case management is not about having service users subscribe to the values, principles, thought processes or even spirituality of the case manager.
Organized – excellence in case management requires being highly organized. There is a strong sense of where every interaction with service users is headed and why. There is an assembly of resources and information to support this pursuit. There are objectives (usually three) established for every interaction with a service user. There is a documented case plan to provide a framework to where the interaction is going. Too often case managers rely on “check ins” or a relaxed conversational approach to engaging with service users on her/his caseload. This is not appropriate for keeping the conversation on track and moving forward with supporting greater independence over time.
Brokers and advocates – case management is a care structure. It is not the delivery of care itself. Too often case managers confuse their role as being counselor or therapist or crisis intervention worker or chaplain or nurse. No. The case manager helps the service user connect to the resources required based upon the assessed needs of the service user, where the individual/family is in their case plan, and the personal preferences of the service users.
Community-based/In Vivo – know where housing-based case management needs to occur? In housing. Plain and simple. You cannot deliver effective housing-based case management by having service users come to an office in a service provider environment. The best housing-based case managers are the ones that spend their days having effective home visits with service users that are prioritized based upon assessed needs and acuity, not tucked away in an office waiting for service users to come. Want to teach/model life skills? Don’ t expect people to sign up for courses in your organization and be successful in their personal life…teach and model it in their housing. Want people to do better at budgeting for rent, utilities and other life costs? Do so in an environment where it is tangible – their apartment. And so on. The only times of the day I really think case managers should be in an office is at the start of the day to get organized, lunch hour, and at the end of the day to document their day and get ready for the next day.
Working with people – case managers have to work with people, not for people. Case managers help steer towards resources and opportunities. They do not tell people what to do. They do not give advice. They do not see service users as subjects that they exercise power over. Service users are capable of making decisions on their own. Working with people instead of for them also helps distance case managers that somehow they are “employees” of the service user (perhaps you have encountered service users that tell their case manager that they are fired?).
Promoting greater independence – the greatest reward a case manager can ever experience is the service user that is stable in housing and does not need him/her anymore. All of the case manager’s work with a service user should ultimately focus on “how do I help this person/family get to a place where they don’t need me anymore?” Does that mean the individual/family is somehow healed or fixed? Nope. They will remain imperfect, perhaps even remarkably imperfect. News flash – you are imperfect too and likely stably housed. Imperfect people can and do remain housed.
Express empathy, not sympathy – the foundation of case management is not sympathy. Case managers cannot and should not feel sorry for the people they are working with. Instead, they must focus on a communication exchange that favors a greater appreciation of the service user’s life experience, thoughts, and emotions. From that empathy becomes a possible pursuit, and with empathy comes far less judgment or implicit/explicit desire to have the service user subscribe to the case manager’s own values, principles or beliefs.
Focused first on housing stability – we are not in the business of healing or fixing people. Yet so often case managers will think that somehow people have to get better or hit “rock bottom” before they are ready for life changes that will allow for success in housing. Can someone please provide me a clinical definition of “rock bottom”? Oh wait, there isn’t one. There is overwhelming proof outlined in peer-reviewed academic literature that people have a much greater likelihood at making significant life changes such as substance use AFTER they have the stability and security of housing, not before.
Solution-focused – a case manager can use their creativity, passion and skills to overcome barriers and focus on solutions, or they can come up with all of the excuses on why the case management intervention is not working, or why the person they are supporting has lost their housing repeatedly, or why health care or income supports or the justice system or family courts or employers or whomever makes life difficult/impossible for her/his service users. Perhaps my favorite excuse (I say sarcastically) is when a case manager tells me that there is no housing in their community and therefore they have a large caseload of people they can really do nothing with because there are no addresses that they can suggest for their clients to move into. Suck it up, buttercup – if there is truly no housing (highly unlikely) then really you shouldn’t have a job…no point paying you to do a job that you can’t do! (Which in my example means that there is affordable housing available in just about every community that has ever claimed to not have any housing…something we have proven time and again with the communities we work with.)
Process – case management is a process, not a destination. Because it is a process, while there are some progress milestones that we aim to achieve, it is impossible to have a singularly defined linear approach that is going to work the same for every single person in every single situation and life history. The process of case management, therefore, is one that requires the case manager to have a clear sense of where each person they are supporting is at in the journey so as to cater supports and resources to that specific state of where they are at.
Documented – case management is not something that is made up as you go along, nor does what is occurring in the relationship between the case manager and service user exist solely in the heads of the parties involved. Case management is a highly documented process – not just on where the service user has been, but also where they hope to be and how they intend to get there. Without documentation there is no accountability to the supports. Also, while I hope it never occurs to anyone, case management is a lawsuit waiting to happen (and lost) if there is not timely, accurate documentation of all that is happening and is intended to happen in the case management process.
Promoting change – I have said in various training workshops (called “Excellence in Housing-Based Case Management” if you are wondering) that I would love all “case managers” to go back and tell their boss that they want to change their job title to “Change Agent”. Because that is what we are asking case managers to be – agents, catalysts, champions and practitioners of change. If people are going to promote change, however, they need to know how change occurs, how people respond to change, how change becomes routine/practice, and how to respond when that which is being changed reverts to historic behavior. A case manager is not in the business of making “business as usual” cozier. A case manager is in the business of promoting positive change with each person they work with believing steadfastly that without change a return to homelessness and life instability is likely.
Catered to the needs of the individual/family based upon objective assessment – important in the case management process is not what the case manager thinks; it is important what they know. Often what we think is different than what we know. Knowledge is formed through an objective assessment that is grounded in facts. Using the most appropriate evidence-informed assessment tool for your case management work is critical if you are going to be an evidence-informed practitioner using data instead of hunches and anecdotes to drive forward towards lasting housing and life stability.
Non-judgmental – the people receiving case management services live a life different than the case manager. It is neither worse nor better. It is just different. When there is judgment (for example, “Tom isn’t housing ready!” or “Jill’s drinking is too out of control to be stably housed!” or “Charlie’s sabotaging his apartment!” or “Christine couldn’t solve a housing crisis if her life depended on it!”) the case manager loses the ability to truly figure out how best to offer supports and information to where people are at in their life journey. For the case manager to be successful, they must accept each person for who they are and where they are, and then provide options, information and choices that allow for stimulating change.
Neither crisis focused nor crisis driven – a case manager does case management. A crisis response worker deals with crises. A case manager that drops everything to respond to a crisis is no longer doing case management. And who is disadvantaged the most when/if they do? All of the other households on her/his caseload that they postpone meeting with to respond to the so-called crisis. Yes, everybody that is supported should have a crisis plan. Yes, case managers can respond after the crisis has subsided and update the case plan as necessary. BUT, the case manager is NOT the crisis response.
Not without conflict – being a case manager means being professional and cordial. It does not mean becoming the friend of each person on the caseload. People on the caseload do not have to like you personally; they simply must trust that you have the professional experience, training and wisdom to fulfill your half of the case management relationship. There will be conflict in a strong case management relationship. That doesn’t mean being a prick or being argumentative. It simply means that case managers will be transparent in acknowledging instances where they see discrepancies between what an individual/family says they want to achieve and what they are actually doing. Case managers should never mistake confidence in professional competency with being liked. Positive tension helps foster change.
Transparent – “nothing about us without us” is an often used phrase from the mental health personal advocates, and a good one to keep in mind and use in the case management relationship. Each person/family being supported in the case management relationship should know how to and have the right to have copies of every single assessment, note or piece of documentation pertaining to the case management relationship. They should be made aware of why certain information and options for decision-making are being presented and why for every step along the journey. If the case manager practices in a transparent fashion it will change (revolutionize?) how she/he completes case notes, the language used when documenting interactions, the perspective taken when performing assessments, when and how they organize case conferences, and how they engage from an objective-based perspective with each encounter with the households on his/her caseload.
The last reminder I’d like to provide is that people are not “cases”. People are people. Case management (the “case” that is being managed) is about activities, appointments, interactions with service delivery systems, and the like. Case managers do not manage people.
Hope this blog helps you form a good definition of case management for your community or organization. Keep this type of orientation towards the delivery of your case management services and success in helping people achieve greater housing and life stability is likely to increase.
What Does it Mean when Government Endorses a Housing First Approach?
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 this approach to service delivery.
Things that should not be happening that I see far too often in my travels:
Government touting that they have invested in a Housing First approach when they may have invested in a housing program, but not Housing First
Various government entities requiring communities to have a Housing First approach in their local housing/homelessness plans, but not providing any direction or definition of what it is they mean (or worse, asking people to provide an explanation of what “Housing First” will mean/look like in their community…um, that’s like asking a triage nurse in one emergency department to explain a litany of medical tests and screening they do to determine if someone has had a heart attack and the next hospital over interpreting the testing and screening for a heart attack as being able to read Winnie the Pooh, provide the patient a cuddle, and tickle their toes – and considering both to be valid/appropriate!!!)
Service providers bragging that they do Housing First, but conveniently ignoring some of the core concepts or parts of the necessary service orientation (for example, there is no such thing as a Sober-Living Housing First Program, nor is there such a thing as a Compliance Based Transitional Housing First Program…two examples from just the last month of travels)
Slapping the “Housing First” label on previously existing practices and just calling it something else
Reporting that anyone housed in a community was part of a “Housing First” approach, when Housing First is for a very specific type of individual/family
Lack of evaluation of whether what is being done is actually Housing First when it is called that
Service providers and CoCs convincing government reps that somehow they are unique and a true Housing First program will not work in their community, but that they will adapt the Housing First model in a way that works locally (see triage nurse example above)
Government rolling up data across communities to speak of investments in Housing First services, when there is tremendous variation of service delivery, many communities that are not actually doing Housing First, and somehow treating all as being the same
I’ll stop there. I don’t want this to turn into one of my rants.
I don’t want governments to stop promoting, endorsing or requiring Housing First. But, I want it to be done intelligently, with merit, and with expectations of being able to measure fidelity so that they can achieve the results of the investment that they were planning on achieving. Not doing so is simply a waste of our tax dollars. We can and should do and demand better.
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 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
Budget
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.