Bringing Housing First Principles to the Home Visit

Bringing Housing First Principles to the Home Visit Graydon Andrus and Margaret King DESC, Seattle, WA

Presentation Goals Describe important aspects of the home visit from two service perspectives: Clinical Case Management and Supportive Housing Explore meaning of “home” and how to use it therapeutically Provide clear examples of basic tenets of the home visit Illustrate connection between housing first, harm reduction and home visit strategies Relate strategies to goal attainment and Recovery

Housing First Principles Move-in without preconditions Robust support services/assertive engagement Continued tenancy not dependent tenant participating in services Housing units targeted to most disabled and vulnerable Embrace harm reduction approach to addictions (and other issues) Residents have leases and tenant protections May be implemented as either a project-based or scattered site model

“Home can be a room inside a house, a house within a neighborhood, a neighborhood within a city, and a city within a nation. At each level the meaning of home gains in intensity and depth…a place of security within an world, a familiar place within a strange world, …a place of autonomy and power. ” -Kimberly Dovey

“We shape our dwellings and afterwards our dwellings shape us. ” -Winston Churchill

“If we close our eyes, take a deep breath, and summon meaningful memories, we quickly notice that they are tied to a specific place. ” -Sarah Robinson

“Home…a place of security in an insecure world, a familiar place in a strange world, a place of autonomy and power. ” Judy and Pam

Environmental Psychology New image

“Open and free, yet sheltering as a nest. ” -May Sarton We depend on meaningful places

“My mind is not so clear when my place is messy…that’s why I have a cleaner come in. ” -Mark

Why home visit?

Benefits of Home Visit Helps build or restore client’s experience of home as place of solace and power Opportunity to leverage these benefits in service of other goals (including ADLs) Opportunity to shift power dynamic a bit

Role of the client’s home in the service relationship Represents new possibilities Meeting in the home helps embed positive associations in it A little fanfare goes a long wayencouragement and pride of place

Single Site Housing First The neighborhood The building environment The unit The staff and neighbors

Close but safely distant Staff play multiple roles Services are robust but voluntary Tricky boundary balancing Housing staff and outside program staff have complementary roles- but takes deliberate attention and refining to optimize

Co. nun. drum: Noun: a confusing and difficult problem or question Hoarding Safety/harm reduction Logistics of service partnering

Listen to the environment

Unit inspections Predictable engagement opportunity, chance to assess ADLs and tailor services Reinforces belief that residents deserve a safe, sanitary and friendly home Asset management- required by outside funders

Hoarding

How much is too much?

Compassionate pragmatism: tireless creativity Weekly donation run Side-by-side cleaning Cleaning for the client Incentives and rewards Lease enforcement

Harm Reduction Evidence of use in unit Sustaining a clinical focus Impact on neighbors When to focus on lease enforcement

Purpose of Home Visit Continuous engagement/relationship building Provides continuity of support and treatment Assess/address threats to housing retention Purposeful and goal directed Largely based on consumer stated goals Health care needs? Skill building (medication management, budgeting, housekeeping, social, employment related)

Clinical Case Management in Housing First Context: The Backdrop Limited knowledge of person Respect boundaries, life rhythms Be ready for surprises Multiple roles as case manager

The Backdrop Continual development of relationship Power dynamic shifts Does it feel awkward? Talk about it. Housing context: single site/project based or scattered sites?

Home Visit to Assess The Person How is the person today? Their greeting Clothing State of Alertness Mood Changes from baseline?

Case Manager as Anthropologist Be observant, not intrusive Presence of dangerous objects/substances? Risks to community within the building? Neighborly relationships Evidence of interests and pastimes – something to build on.

Collaboration with Supportive Housing Staff Broadens base of support Increased continuity and coordination of care Shared workload Invest time to build a service plan with goals that are meaningful to client Establish clear communication practices

Collaborating With a Landlord or Property Manager Development of partnership with landlord Educate to reduce stigma & promote tolerance Be available at critical times – you are an asset Visit client routinely and check in with landlord or resident manager Work with tenant to reduce most concerning behaviors (drug related, aggression, property destruction)

Frequency of Visits Variation over time Variable influencing frequency Non-linear process Minimum visits Alternating with office visits? No office visits?

Therapeutic Opportunities Possibilities in every encounter Brief and woven into the conversation Client driven Motivational Interviewing well suited to situation

Participant and Staff Safety Does tenant feel safe in room with you? Presence of dangerous objects? History of violence/aggression? Bring a buddy? Meet in common area of building?