Making Warm Handoffs Work
A warm handoff is a transition conducted between two members of the support team in the provision of homelessness and housing services. Usually the warm handoff (and the focus of this blog) occurs between the homelessness side of the system (outreach worker, shelter staff, navigator) and the housing side of the system (case manager, aftercare worker, follow-up worker, housing support specialist). That said, there are times when the warm handoff can occur between case managers (for example, a reshuffling of the caseload means the client is moved from one case manager to a new case manager). I want to explore ways in which the warm handoff can be improved upon for maximum success in the support process.
To start, a warm handoff should occur in front of/with the service recipient. We have to see the service recipient as a partner in the process of information sharing, the discussion of supports, reinforcing what is happening in their case plan, and providing an opportunity to provide clarification and ask questions in the process. The warm handoff is not something that happens behind the scenes. It is not something that happens to the service recipient – it is something that happens with the service recipient.
All parties should prepare for the warm handoff. It is not something that happens ad hoc, and it is something that does not go well when all parties are not prepared. The sending party (outreach worker, shelter staff, etc.) should have all documentation in order in HMIS and the file completely up to date with the likes of consents to release information, assessment results, etc. The receiving party (case manager, housing support specialist, etc.) should review all documentation in HMIS and where possible the file prior to meeting with the service recipient and sending party. They should write out the questions that they feel necessary to ask to get clarification in the transfer process. The service recipient should be briefed by the sending party on why the warm handoff is occurring, when it will occur, how it will occur, and what happens during the warm handoff. The service recipient should be encouraged to think about the questions they want to ask of the receiving party and any parts of their case plan they feel is necessary to comment on in the warm handoff process.
The warm handoff generally works best when it goes as follows:
The sending party, in consultation with the service participant and the receiving party, schedules the warm handoff.
The sending party, with appropriate consents in place, shares all information regarding the service participant with the receiving party.
The receiving party reviews information prior to the meeting and prepares any questions of clarification they want to ask in the meeting.
The sending party prepares the service participant for the warm handoff meeting. This includes things like reminding them when the meeting will occur, why it is occurring, and what happens during the meeting(s).
The service participant has the opportunity prior to the meeting to think about questions they wish to ask of the sending or receiving party and any clarification or additional information they wish to share.
When the meeting date and time comes along, the sending party calls the meeting to order. They introduce the receiving party, and then outline the amount of time allocated to the meeting and again outlines the purpose of the meeting.
The sending party reviews a summary of the work that has occurred with the program participant, assessment results, and their understanding of the service participant’s strengths, goals and opportunities for improvement.
The service participant is afforded the opportunity to respond to, add or amend what the sending party has shared. The sending party is primarily responsible for responding to the service participant at this juncture.
The receiving party then asks any questions of clarification followed by outlining how the support process will continue with them.
Again, the service participant is provided the opportunity to ask questions of clarification or respond to what the receiving party has outlined.
The meeting concludes with the receiving party primarily responsible for further contact, guidance and support of the service participant.
The warm handoff may take more than one interaction. Depending upon the complexity of the case plan and presenting issues of the service recipient, it can be beneficial to conduct the warm handoff over a series of shorter meetings rather than trying to do the entire process all at once. In these instances, the first meeting may be a simple, short meet and greet. The second meeting may be an opportunity for the sending party to outline and review all that they know and are working on. A third meeting may be an opportunity for the service recipient to ask questions of the sending and receiving party. The fourth meeting may be when the receiving party asks their questions of clarification. Or any variation thereof.
Once the warm handoff is complete, it is necessary for there to be a clean break where supports and planning are concerned. Sometimes the outreach worker or shelter staff thinks they are being helpful by following up with the program participant from time to time once the they have moved into housing. While well intentioned, this can be confusing to the service participant and muddy the waters of the case planning and support processes.
The warm handoff should be documented. It is our recommendation that the receiving party assume responsibility for the documentation given they are now the lead with the service participant. It is important that the content of the warm handoff is documented, not just that the warm handoff occurred. This can be an important reference point if there are later glitches in the support process.
Warm handoffs are likely to be increasingly important and essential to our work as coordinated entry continues to become more robust in its evolution. I hope these suggestions help improve the process in your community, keeping the interests of the service participant at the center of what and how we deliver the warm handoff.
8 Tips to Add More Harm Reduction Practices to Your Shelter
Harm reduction exists on a continuum. So, too, does the implementation of harm reduction practices in shelter. You can range from managed alcohol programs within shelter like the Shepherds of Good Hope in Ottawa (sometimes called Radical Harm Reduction) or smaller steps by providing access to shelter after having used alcohol or other drugs without precondition or things like breathalyzers. I am a big fan of shelters like Alpha House in Calgary which is one of the preeminent wet shelters I have ever visited and has integrated harm reduction into all that they do, as well as specialized harm reduction programs within larger shelters, like the Riverfront program at the Calgary Drop-in Centre. Not every shelter is ready to immerse themselves into a managed alcohol program like the Shepherds of Good Hope or fully integrate harm reduction into all that they do like Alpha House, but there are some tips and practices that can be followed to add more harm reduction practice to your shelter. Here are eight:
1. Self Bag Search
If you do bag searches, have the program participant open their bag for staff and provide visual inspection of contents rather than staff opening the bag or touching contents. This is a more dignified approach to bag inspections, while also decreasing inadvertent pricks from sharps if present.
2. Availability of Naloxone With All Staff Trained
To better respond to incidents of opioid overdoses, ensure that all staff within the shelter are trained and have easy access to naloxone. It can be the difference between life and death.
3. Amnesty Totes
When a person cannot safely store their alcohol or other drugs, and/or cannot safely store their needles, pipe or other equipment used, it presents safety risks like increased incidents of binge drinking and greater exposure to needles. By providing a confidential tote at entry for people to store whatever they want to store – which they cannot access while in the shelter – people have a safe place to store their alcohol or other drugs and related equipment.
4. Floor Mats
Mattresses on a bed frame or bunk beds can be hazardous to someone is greatly under the influence. By having some mats on the floor for people that are quite inebriated it is safer for preventing falls, and also easier to help people sleep in the rescue position.
5. Sharps Containers
The more accessible sharps containers are the more likely they are to be used. Outside and at various places inside the building are beneficial.
6. Safe Works
With access to free supplies, people who use can use more safely. Consideration can be made to making everything available from new needles and syringes to cotton pellets, pipes and brass screens to alcohol towelettes, bandages to acidifiers, condoms and lube to dental dams – and more. This is likely subject to the laws of your local jurisdiction and the comfort level of your organization. If you cannot offer these internally, consider developing a pamphlet outlining where and how in the community people can access the supplies they need that would reduce harm.
7. Focus on Housing
Housing is harm reduction. The evidence is clear that many harms are reduced and wellness improved when people have access to safe, appropriate and affordable housing.
8. Involve People Who Use Substances in Reviewing Your Shelter Policies and Procedures
“Nothing about us without us” is a good framing for better supporting people who use substances who stay in shelter. By asking people who use alcohol or other drugs to review your policies and procedures you may learn of ways to adjust your policies or procedures to be more responsive to substance users.
Gaining Input from Service Users: A New Opportunity
One of the challenges confronted by service providers is, “How do I get meaningful feedback from service users?”
Let’s assume first that you are a service provider that actually cares about what your service users think. You may have tried exit surveys or exit interviews. You may have tried sending follow up surveys to people once they moved into housing. If you are a shelter or drop-in center you may have tried consumer meetings and focus groups.
If you get feedback from consumers, chances are you know best from the two extremes: those who love your services/programs/staff and those that despise or have a beef with your services/programs/staff. What you don’t have a good mechanism for is getting feedback from Jane or John Doe person experiencing homelessness and a regular basis.
Enter Pulse for Good which is revolutionizing how service providers and government/funders get feedback on a regular basis from individuals and families that use homeless services. By installing customized kiosks, it is possible to gather the feedback necessary for service providers to tweak their programs and make changes big and small to have an impact on services. The use of the platform to date shows that not only will service users take the time to provide feedback, but that the feedback is meaningful and the analysis and improvements that can be made are powerful.
Pulse for Good was started by a half dozen dudes who work in the private sector and were accustomed to designing software solutions for the justice system, the federal government and the military. They wanted to do something good and worthwhile with their skills for the homelessness services industry. So, they created Pulse for Good.
Pulse for Good has installed kiosks and been completing the analysis of consumer feedback in six homeless service organizations since they began collecting feedback in April. Service providers and funders have been impressed. On average, organizations receive 5 – 10 responses daily from service users. This has resulted in improvements ranging from adding shower curtains to the starting of a job program to help staff and train homeless individuals in a soup kitchen.
By way of full disclosure, I sit on the Advisory Board for Pulse for Good. One of the reasons why I think Pulse for Good is a good product is because of the advisors they have assembled to help ensure the product is hitting the mark and reaching its aims. This includes current and former homeless individuals, as well as national homeless experts like Mark Johnston and Lloyd Pendleton, people involved in service delivery and academia.
If you are serious about feedback from your service users or the organizations you fund, and you want a successful platform for doing so, then I strongly recommend you check out Pulse for Good. It is not a free service. But you have to ask yourselves, what is the cost of not getting good feedback on the programs and services you are offering?
Eligibility Does NOT Equal Entitlement
Eligibility means the state of having the right to do or obtain something through satisfaction of the appropriate conditions (my emphasis added).
Entitlement means the fact of having a right to something; the belief that one is inherently deserving of privileges or special treatment (again my emphasis added).
There are subtle differences between the two. Just because you can have something when the conditions are appropriate doesn’t mean you have the fact of having a right or are deserving of privileges or special treatment. Put another way, lots of people are eligible for shelter, but that doesn’t mean they have the right to shelter (unless you live in a right to shelter jurisdiction). Or consider this: lots of veterans are eligible for SSVF, but that doesn’t mean it is their absolute right to get SSVF.
Why does any or all of this matter?
In the era of Coordinated Entry systems of support are being completely transformed. Prioritization challenges us to think through which people will be served in which order based upon two factors: 1) who is eligible for what; and, 2) who is entitled to what. When those two things get confused or treated interchangeably, the entire approach to prioritization gets messier than it need be. Furthermore, the order with which people get served changes as entitlement can trump eligibility.
It also matters because the experience of the end user is often framed by their own beliefs. Does a person who is homeless feel they are entitled to receive certain services in a certain order? Or does a person who is homeless feel they are eligible to receive services and the order will be influenced by other factors?
When there is confusion between eligibility and entitlement it can lead to frustration, anger and what seems like picking winners and losers in the service delivery matrix. For a system of care to work properly, though, we need service providers and end users to understand that discretion is inherently woven into how a community has prioritized service attainment. Discretion does not mean side doors or jumping the queue. What it means is that there has been a transparent manner by which the community has decided the order with which all people who are eligible will be served, which may take into account how entitlement fits when it is warranted to do so.
Taken too far, this can all sound exceptionally harsh – just because you can have something doesn’t mean you will get something. Nonetheless, it is this very transparency that makes it possible to defend why, say, a person who is chronically homeless will be served ahead of a person who is not chronically homeless even though they both may be eligible for the same housing program.
Do yourself a favor in your community and have discussions about eligibility versus entitlement as you tweak your coordinated entry systems, as you design your housing and support programs, and as you discuss service options with program participants. This won’t result in everyone being happy. But it will (hopefully) get people to a common understanding of how decisions are made regarding program access.
So, You Think You're a Low Barrier Shelter...Let's Check
Hey all - sorry I have been stingy on the blog lately. I am back and will be here regularly for your reading pleasure.
The conversation goes something like this:
Them: "We operate a low-barrier shelter."
Me: "What makes it low-barrier?"
Them: "We believe in Housing First."
Me: "But what does that look like in practice?"
And then they share with me. And I end up mortified. So here is a list of 10 things that really have no place in low-barrier shelters, though I have encountered them quite a bit lately in our shelter transformation work.
1. Criminal Background Checks - start doing criminal background checks or making people go to the police department for clearance prior to coming to the shelter and you are not low barrier. In some limited circumstances depending on the shelter location and/or all of the populations served within the shelter it may be prudent to know if people who are sex offenders are staying there, but that doesn't require criminal background checks or police station visits first.
2. Credit Checks - true story, a shelter that claimed to be low barrier did a check on the credit score of each household looking to enter the shelter and if too low were turned away from shelter. Then a week later I encountered another shelter that did the same thing. Let's be clear, high credit score does not equal low barrier.
3. Limiting Shelter to Those with Income - included in this category are shelters that charge program fees that claim to be low-barrier. As soon as you start charging people to be able to stay at your shelter they need income. As soon as you start requiring people to have income (which sometimes means jobs) you are not low barrier.
4. Making People Pledge their Motivation to Change - "I hereby solemnly swear that I am ready to change and will take any and all necessary actions to prove to staff and the community that my desire to change is real. I hereby further acknowledge that if I do not put my motivation into action I will be asked to leave the shelter." True story. Verbatim. Twice in the same community even though they were different, unaffiliated shelters. I think pledging that you will change is a barrier.
5. Ensuring People Show up at a Designated Location and Then are Bussed to the Facility - I want to get this straight...you are low barrier but you expect people to be organized enough to get to the one place in the community that you are going to send a bus that will pick people up and whisk them away to your secret shelter location and that any walk-ups will not be accepted or considered under any circumstance. Uh-huh.
6. Sobriety Checks - if you haul out the dipstick or the breathalyzer and call yourself low barrier I think you really are confused as to what low barrier means.
7. Having People Produce ID - NEWSFLASH People that are homeless frequently lose their identification. If you require people to produce an identification in order to be considered for shelter you have created a huge barrier.
8. Residency Requirements - anecdotally this one seems to be growing: we will only shelter our own (or our preference is for those that can prove residency here first). All people have the freedom of mobility across the country. Oh wait, unless you are homeless in some instances.
9. Mandatory (Life Skills/Budgeting,etc) Classes - you are not a low barrier shelter if you mandate that all shelter residents participate in predetermined classes, especially those that last weeks at a time. Offer some voluntary classes if you want. Maybe even make them housing-focused. But having mandatory classes is not low barrier.
10. Forced Labor Participation - when you require people have a job or require them to participate in your profit-generating industries as a condition of stay, you are not low barrier.
I fear that the term "low barrier" is/will be thrown around so much that it will lose meaning or require constant clarification. Kind of reminds me of the term "housing first" and how that has been bastardized over the years. So, let us stand up to programs that are not low barrier and call them out when they are not so we can have some fidelity to what low barrier actually means.
Motivating Teams When the Results Aren't What You Wanted
Ann Oliva takes over the blog again this week and shares her thoughts on motivating your team when the results being achieved are not what you wanted.
This last year has been one that brought a lot of changes into my life – new work, new priorities, new partners. But maybe most importantly I have had the privilege of having new types of conversations with people working on homelessness in communities around the country – and I have been overwhelmed by the acceptance and willingness of people to have me involved in their work.
As part of these interactions, I get asked questions about leadership and motivation that drive some introspection about the kind of leader I am. Thinking about these kinds of questions, I hope, will make me a better one in the future. Walking through them with Iain, and coming up with some collective thoughts about how to answer them, will definitely make me a better leader.
One of the toughest ones I have been asked recently was about how leaders can continue to motivate their teams even when the results of their work are not what they want. In other words, what does a good leader say to a team of people who, despite their best and brightest work, see the results of the PIT count go up or experience system failure?
I have to admit that I was disturbed by the question at first. I think that may be because my vantage point at the federal level gave me the opportunity to see positive change across the country in so many ways that it skewed my understanding. But I now clearly see that this is an issue that local leaders are struggling with every day. So I talked to Iain about it, and here are some of our thoughts on this important topic:
Homelessness can only be ended nationally when it is ended for every person who is experiencing it. Every time someone is placed into housing, or into a job, or into a service they want or need – you are indelibly impacting their life in a positive way. As a community, we need to remember this and raise it up when we need motivation to continue our work.
As a nation – and in most communities – the system that serves people experiencing homelessness is vastly different today than it was 10, 15, 20 years ago. I would argue that the shift from making people prove they deserve housing, to orienting our system towards the idea that all people deserve housing is fundamental and has made our nation and communities better. I would also argue that by working to remove barriers, valuing choice and equal access, acknowledging and addressing racial inequity and starting to work across systems we are making a difference. That difference, in these examples, is that we treat people with dignity and respect rather than trying to "fix" them. To me that is fundamental. It is important.
Motivation can be driven by how we react to both the wins and the losses. If we own our wins and celebrate them, then we need to own our losses and use them to make ourselves and our programs better. Losses can represent a lot of things – but in most cases we hope that losses represent a willingness to try new things and improve what we are doing. That is a good thing even if it doesn't always work out the way we want it to. So, we have to look at the totality of our work and find motivation in the journey and effort itself.
Motivation is personal – while a leader can be inspirational and use tools to motivate a team, they can't know or address the feelings of every team member. So it is up to each person working in our systems from the front line to the federal government to remember their "why." Why did you start in this work? Why do you keep getting up every morning and doing it? Sometimes your "why" changes, and that is ok. If it changes so much that you no longer want to keep doing it, is a change needed?
I am sure there are more answers to that tough question than these, but these are a start. In fact, I hope to hear more from you. In my travels I continue to be amazed by the people working in this field, and by the people who are served by our programs. I hope you all keep the hard questions – and the answers – coming.