ADAPTING CRITICAL TIME INTERVENTION FOR RAPID REHOUSING CTI

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ADAPTING CRITICAL TIME INTERVENTION FOR RAPID REHOUSING (CTI RRH) Dan Herman, Ph. D, Principal

ADAPTING CRITICAL TIME INTERVENTION FOR RAPID REHOUSING (CTI RRH) Dan Herman, Ph. D, Principal Investigator Carolyn Hanesworth, LCSW, Project Director Hunter College Silberman School of Social Work City University of New York

Project Partners • National Alliance to End Homelessness • Connecticut Coalition to End Homelessness

Project Partners • National Alliance to End Homelessness • Connecticut Coalition to End Homelessness • State of Connecticut Department of Housing • The Melville Charitable Trust (funder)

Background and Rationale • Case management for RRH recipients varies widely; success in improving

Background and Rationale • Case management for RRH recipients varies widely; success in improving long-term outcomes unknown • CTI originally shown to be effective in helping chronically homeless single adults maintain housing; this is first attempt to formally adapt for RRH recipients • Aim to provide a standardized best practice model to be employed across multiple settings, populations and locations

Study Design • Phase I: Preliminary Data collection (Summer 2016) • Literature Review •

Study Design • Phase I: Preliminary Data collection (Summer 2016) • Literature Review • Focus Groups • Phase II: Model Design/Implementation Planning (Fall 2016) • Phase III: Training for Seven Pilot Agencies in CT (Feb 2017) • Implementation readiness surveys • Phase IV: Pilot Implementation (Feb 2017 November 2017) • Agencies begin using model • Launch Community of Practice/implementation coaching • Build local expertise to sustain practice • Phase V: Process Evaluation/Model Adaptation (Feb 2017 ongoing) • Fidelity surveys • Focus groups • Individual interviews

Literature Review Findings • RRH reduces likelihood of shelter return in the near term

Literature Review Findings • RRH reduces likelihood of shelter return in the near term • Wellbeing is improved while housed • Modest income increases • Financial strain persists, work is precarious, rising income subject to benefits ‘cliff’ • Longer, more intense assistance associated with better outcomes • Older recipients (> 45) at higher risk of return to shelter • Little data describing or evaluating effective case management strategies

Focus Groups • Seven RRH providers (CT, DC, NY, NJ, CA) • Singles and

Focus Groups • Seven RRH providers (CT, DC, NY, NJ, CA) • Singles and families (3) • Singles only (3) • Families only (1) • Topics discussed • Case management strategy, protocols, service pathways • Availability and viability of community resources • Success and/or challenges in connecting clients to resources • Strategies for leveraging community partnerships • Progress on near-term goals • Client characteristics and how they interact with approach

Selected Focus Group Findings • Long term outlook for housing stability highly variable and

Selected Focus Group Findings • Long term outlook for housing stability highly variable and • • • depends on person and location Location of affordable housing may pose barriers to access to ongoing services & supports Persistent and multiple barriers to employment, including reduction in access to child care assistance (varies by state) Many community service providers unfamiliar with RRH program goals and methods Some service providers create/join community networks to leverage other resources (child care, mental health care) Providers may target chronically homeless rather than ‘crisis’ homeless for RRH services Most providers separate housing identification & placement process from case delivery of case management

CTI RRH Purpose To improve the client’s capacity to remain housed by effectively connecting

CTI RRH Purpose To improve the client’s capacity to remain housed by effectively connecting them with needed community services supports and helping them to attain greater economic stability

Core Components of Rapid Rehousing: Where does CTI fit? Rental & Move In Assistance

Core Components of Rapid Rehousing: Where does CTI fit? Rental & Move In Assistance Case Management & Services Housing Identification Quick Exit and Return to Permanent Housing

CTI RRH Key Elements • Six-month, three-phase model with a defined beginning, middle, end

CTI RRH Key Elements • Six-month, three-phase model with a defined beginning, middle, end • Emphasize active linking with services and supports that will persist after intervention ends • Separate case management services from financial assistance (may terminate prior to the end of CTI RRH or extend beyond it) • Limit focus to factors that directly influence housing stability, tailored to individual clients

Values • Strengths based • Individualized • Transparent • Culturally sensitive • Trauma-informed

Values • Strengths based • Individualized • Transparent • Culturally sensitive • Trauma-informed

Locate housing Transitio n Tryout Financial assistance Transfer

Locate housing Transitio n Tryout Financial assistance Transfer

The Role of the Housing Specialist • Housing identification and lease negotiation • Primary

The Role of the Housing Specialist • Housing identification and lease negotiation • Primary service provider during Pre-CTI phase • Performs much of the work in the Pre-CTI phase, but on call for future negotiations or other challenges/advocacy needs related to housing

Phase Activities Transition Try Out Transfer Months 1 -2 Months 3 -4 Months 5

Phase Activities Transition Try Out Transfer Months 1 -2 Months 3 -4 Months 5 -6 • Engage client • Assess client strengths & needs • Establish Housing Stability Plan • Provide emotional support as needed • Identify and begin linkage to services and supports • Continue assessment • Assume monitoring Add phase in Table Format of strengths & needs role • Evaluate support network elements • Adjust supports as needed • Encourage client selfadvocacy to maintain supports & resources • Ensure secure connections to services & supports • Terminate relationship

Pre-CTI Phase 1: Transition Phase 2: Try- Out Phase 3: Transfer Time frame/Intensit y

Pre-CTI Phase 1: Transition Phase 2: Try- Out Phase 3: Transfer Time frame/Intensit y of Contact Flexible 2 2 Months/Intense Moderate Weekly Bi-weekly 2 Months/Low Monthly Objective Housing Location/Move in; Begin CM Assessment and Housing Plan Complete Housing Plan; Identify Resources and connect client Monitor resource impact and client access Complete transfer of services to the community Action Steps Negotiate Lease Educate/Advocate Relationship Building Accompany client to appointments, follow up to ensure connection Make adjustments to plan in collaboration with client Meet with new service providers or others in the support system; reflect on work with client Potential Barriers Housing placement may be delayed due to multiple challenges Lack of resources; Client hesitant to engage Client may not be ready to assume rent; resources may be inadequate Both client and worker may have difficulty ending, especially if goals aren’t met. Strategies Take opportunities to teach/model housing location process; present services as a Do advance work of Empower client to creating resource do what they can on networks their own; create alternative plans if Reduce involvement gradually and inform client early on about the length and nature

Rationale Behind Prioritizing Focus areas • Limit areas of case management in each phase

Rationale Behind Prioritizing Focus areas • Limit areas of case management in each phase • Prevents work from becoming “spread too thin” • Minimizes crisis-driven case management activity • Focus areas are individualized and depend on population being served

Potential Focus areas • Income generation (benefits, employment) • Budget management • Survival needs

Potential Focus areas • Income generation (benefits, employment) • Budget management • Survival needs (food, clothing, furniture, etc. ) • Health & mental health • Child care • Transportation • Education • Family issues • Legal concerns

Staffing requirements • Modest caseloads (ideally <20; weighted) spread over phases • Workers may

Staffing requirements • Modest caseloads (ideally <20; weighted) spread over phases • Workers may be bachelors level • Regular group supervision by professional-level staff • Phase-specific case planning and recording forms strengthen model fidelity