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HomeMy WebLinkAboutohcc-best-practices-in-providing-hnts-and-htss-june-2023Best Practices in Providing Housing Community Supports Housing Transition Navigation, Housing Deposits & Housing Tenancy and Sustaining Services 1.Housing Transition Navigation Services (HN) 2.Housing Deposits (HD) 3.Housing and Tenancy Sustaining Services (HTSS) What services will be covered today? Housing Community Supports (HCS) Provider Manual -Version 2 -1/30/2023 (acgov.org) Housing Transition and Navigation Services: Intake, assessment and planning Tenant needs and assessment Individualized Housing Support Plan Developing housing support crisis plan Housing Community Supports (acgov.org) Housing Supports Plan Template Form -Housing Supports Plan -3/23/2023 (acgov.org) Uploading the Housing Supports Plan into HMIS HCS-HMIS-Job Aid-Uploading-HSPs.pdf (acgov.org) Housing Community Supports (acgov.org) Housing Transition and Navigation Services: Securing resources for housing Obtaining ID’s and other core documents Accessing benefits (SSI, etc.)Identifying and securing rental assistance/housing voucher https://homelessness.acgov.org/homelessness-assets/docs/home-stretch/home-stretch-housing-match-documentation-checklist.pdf Housing Community Supports: Medi-Cal Enrollment Steps: How To -2/9/2023 (acgov.org) Home Stretch Housing Match Documentation Checklist https://homelessness.acgov.org/homelessness-assets/docs/home-stretch/home-stretch-housing-match-documentation-checklist.pdf Housing Transition and Navigation Services: Housing search Reviewing options Completing housing applications Engaging and educating property management Facilitating transportation for housing search Housing Transition and Navigation Services: Move-in Obtaining reasonable accommodations/ environmental modifications Identifying and securing resources to cover security deposits and other one-time expenses Ensuring unit is safe and ready for move-in Communicating with property management and organizing details of move Housing deposits: One-time expenses Can be used for security deposit, utility set-up; first and last month rent; and other one-time expenses related to move-in Services and goods for health and safety (e.g., pest eradication, air conditioner, etc.) For details, please review page 12 of: Alameda County Community Supports Provider Manual Housing Tenancy and Sustaining Services: Assessments & Service Planning Reviewing Individualized Housing Support and Housing Crisis plans Updating to reflect current needs Modifying to address recurring barriers Understanding & documenting a client’s unique need for continuing authorized services and modifying their service plan to address current barriers © All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH. Housing Tenancy and Sustaining Services: TSS Evaluation in HMIS Housing Tenancy and Sustaining Services: Education and collaborative support Educating on tenant rights and responsibilities Coaching on maintaining relationships with property management Coordinating with property management to identify potential issues Housing Tenancy and Sustaining Services: Eviction prevention Providing early identification and intervention for behaviors that may jeopardize housing Advocacy and linking with community resources to prevent eviction Resolving disputes with property management and neighbors Other activities identified in housing crisis plan Housing Tenancy and Sustaining Services: Maintaining stable housing Assisting with lease compliance and household management Securing benefits (e.g., SSI) and assisting with housing recertification Providing independent living and life skills Health and safety visits Documenting Services Progress Notes for Tenancy Supports Services © All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH. Documenting Need for Services (Medical Necessity) Client needs the service based on assessment Clear connection of service plan goals to the assessment Writer must explain the rationale and “tell the story” of why writer’s assistance will be of help Reader must understand the service rationale Progress notes are tied to service plan goals Type and frequency of services is appropriate to interventions and goals Technical Elements of a Billable Progress Note •Date of entry •Date the service was provided •Start and End Times and/or length of time spent May be electronic or paper Location/type of contact •**Automatically included from client’s HMIS profile Client Name and ID** •Client response, progress, changes •Service is linked back to goals in service plan •Next steps/appointment date and time Service name and description •Name of provider,signature and title of service provider Authentication Green=not required but best practice Medicaid Documentation for Medical Professionals (cms.gov) Refer to Appendix 11 in Provider Manual for details How to approach & deliver services to reflect Evidence Based Practices (EBPs) 1:25 Caseload Requirements for: Ensuring staff availability Tailoring for complex & unique needs Relationship building & trust Traveling & working in community settings Meeting documentation requirements Avoiding compassion fatigue Staff with Lived Experience of Homelessness PEERS CAN WORK ALONE OR AS PART OF A TEAM OFFERING HOPE, EXPERTISE AND THE EXPERIENCE OF RECOVERY. REQUIRES INTENTIONAL AND INCLUSIVE ORGANIZATIONAL SUPPORT ELIGIBLE FOR MEDICAID BILLING FOR BEHAVIORAL HEALTH SERVICES Advancing Health Equity through Skilled Peer Workforce CSH_Advancing-Health-Equity.pdf Housing First Trauma- informed Care Harm Reduction Motivational Interviewing Best Practice Approaches in Fidelity Tools Housing First Approach Immediate access to permanent housing with no housing readiness requirements. Consumer choice and self-determination. Recovery orientation. Individualized and client-driven supports. Social and community integration. Safety Trustworthiness Peer support Collaboration Empowerment Cultural Humility & Responsiveness Trauma Informed Care Approach Harm Reduction Principles Source: Midwest Harm Reduction Institute Incorporates practical and comprehensive strategies Individuals have a voice Focus on reducing harm, not specific behavior No pre-defined outcomes Harm Reduction Principles Source: Midwest Harm Reduction Institute Accepts an individual's decision to engage in risky behaviors. Individuals takes responsibility for his or her own behavior. Individual is treated with dignity. How would you utilize these Harm Reduction components? Support gradual, non-linear change Emphasizes self-determination Encourage honesty Empower individuals Build upon successes Reduce stigma Foster Individual growth What is Motivational Interviewing ●“A collaborative, person-centered form of guiding to elicit and strengthen motivation for change” (Rollnick, 2008) ●Intended to help clients explore and resolve ambivalence ●Staff act as change agents while minimizing resistance and enhancing intrinsic motivation ●Uses stages of change to help meet clients where they’re at Motivational Interviewing is Trauma Informed •Emphasizes respect and empathy for the client, promotes harm reduction and cultural humility. SAFETY – •Utilizes reflective listening and empathy to build rapport. TRUSTWORTHINESS – •Focuses on self-efficacy and autonomy of the client. CHOICE – •Approaches client with curiosity, open-ended questions and support rather than judgment or shame. COLLABORATION – •Affirms the client and builds on strengths to enhance skill development and elicitation of change. EMPOWERMENT – Motivational Interviewing is Trauma Informed Putting It All Together A Case Study in Services and Best Practices © All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH. Meet Mary 61-year-old black woman Unhoused for 3 years after leaving a violent relationship History of early childhood traumatic experiences Avoids emergency shelter (dislikes being around so many people and sharing sleeping and toileting areas) Diagnosed with PTSD two years ago after being attacked while sleeping in a park Currently living at an encampment with 3 other people who helped to fight off her attacker Meeting #1: Intake, planning and assessment •Jeff schedules a 4 PM appointment with Mary at his office. •He wants to do an intake and assessment with her and start her individualized housing support plan. •At the office he can use his PC and give her some materials. •Unfortunately, Mary does not show up to the appointment. How would applying Evidence Based Practices improve the situation? Applying EBP’s: Intake, planning and assessment Prioritize immediate access to housing Do not add extra steps or barriers to process-meet client where they are at. Provide a sense of control by allowing person to drive goal planning and decision making Empower clients to choose their own goals Establish a relationship and gain trust Housing First Care Harm Reduction Motivational Meeting #2: Securing resources for housing •Jeff asks Mary where she wants to meet. She chooses a safe space where she sleeps. •They figure out what she will need to obtain an ID, which she hasn’t had since losing her housing. •They discuss other benefits she may be eligible for and next steps to apply. Jeff calls the SSI benefits expert at their agency, and they plan to meet next week. •While in the past, Mary has always resisted being added to the community queue for Coordinated Entry, Jeff listens to her concerns and what is most important to Mary to feel safe and heard, Jeff then takes time to clearly explain the process to her. Mary agrees to start a Coordinated Entry assessment. •Jeff pushes Mary to seek MH treatment for her PTSD. Mary gets frustrated with this suggestion because she doesn’t see what this has to do with finding housing. Applying EBP’s: Securing housing resources Focus on first obtaining only documents/benefits needed to access housing Facilitate communication within and among service providers and systems Meet people where they are at—do not require individuals to apply for benefits or seek treatment if they are not ready Approach with respect and empathy toward individual Housing First Care Harm Reduction Motivational Meeting #3: Housing search •Using online resources and connections within his agency, Jeff found a few options for Mary for housing. He brings some info on these options to review with Mary at the meeting. •Mary is reluctant at first. She wants to stay in her current neighborhood, even though it’s mostly out of her price range. She and Jeff discuss how they can work to build her resources once she is in housing and possibly move back here. •Mary agrees to check out one of the options, and they start the online application process immediately. She wants a unit on the 2nd floor, because she feels unsafe on the ground floor due to past trauma. Jeff says she shouldn’t be picky and might have to take what she can get. At this point, Mary shuts down and seems less talkative. •Jeff wants to set up a time with Mary to drive to the building and take a tour. Mary is nervous about taking this step towards housing, so Jeff suggests starting with a drive by, rather than a tour. Mary agrees. •After the meeting and with Mary’s permission, Jeff calls the landlord and talks to him about Mary and the program. Jeff begins the application process and works with Mary by her tent to complete it. Applying EBP’s: Housing search Lead with the person’s preferences and hopes. If their preferred housing is currently not feasible, prioritize safety and work with them to make a long-term plan to get where they want. Consider how past traumatic experiences may impact housing options. Provide a sense of control by allowing person to drive goal planning and decision making Work with the individual to identify how the type of housing and location may or may not impact substance use. Help individuals explore and resolve ambivalence towards housing Housing First Care Harm Reduction Motivational Meeting #4: Move-in •Mary’s housing application was accepted! •Jeff works with Mary to go through a move-in checklist to help her prepare. •Mary is concerned about building and unit security. She is hoping that she can get an extra lock on her door. Jeff says that they can figure that out later, but Mary seems worried and continues to return to it throughout the meeting. •They identify a few one-time costs that need to be covered and begin the process to update the Housing Supports Plan for items to purchase that will help Mary set up her household •Jeff works with Mary to develop a plan for addressing any extra mental health needs she may have around the time of the move. •Jeff helps Mary to call the landlord to confirm the move-in date and arranges help for Mary to move her belongings from her tent to her new apartment. •They end by reviewing some of the community resources in the area that Mary may want to connect to and make a plan to go look at the nearby grocery store and laundromat the next time they visit her new neighborhood. Applying EBP’s: Move-in Ensure tenants have a lease and all the rights and responsibilities of tenancy Address safety needs impacted by past traumatic experiences (e.g., adding extra door locks) Keep person informed about all aspects of the move Talk honestly about how the move-in process may trigger certain responses to stress. Use to encourage self-efficacy and understand needs and concerns during the move-in process Housing First Care Harm Reduction Motivational Meeting #5: Housing Deposits •Jeff works with Mary to determine what, if any, funds she has to contribute to her new home. Because Mary wasn’t yet receiving SSI, she doesn’t have anything to contribute. •Jeff reassures her that just like his agency was able to cover her housing application cost, they could now help her to pay for the security deposit, some household items and essential furniture, and her first month coverage and set up fees for her electricity, phone and water bills. •Jeff forgets to mention that there is a limit to the amount that Housing Deposits can cover, Mary begins to dream about the furniture, including multiple beds, so her grandbabies can live with her. Applying EBP’s: Housing Deposits Ensure tenants have a lease and all the rights and responsibilities of tenancy Transparency & collaboration Keep person informed about what can and cannot be covered. Brainstorm a budget to support other purchase goals. Talk honestly about what is in the lease and strategies for having guests and reducing risk of lease violations Listen to what makes a place a home-what values are you hearing in Mary’s dreams? Housing First Care Harm Reduction Motivational Meeting #6: Tenancy sustaining planning •A few days after move-in, Jeff visits Mary in her new place. •They work together to update her individualized housing support plan now that she is in housing. •Jeff gives Mary the space and time to really think about what she needs to stay stably housed. •Her plan includes steps to help with the goal of moving back to her preferred neighborhood. •They haven’t talked much about substance use. Jeff tells Mary that she should never bring drugs or alcohol into the building. Applying EBP’s: Tenancy sustaining planning Plan is person-centered and emphasizes an individual’s choice in services and supports Maintain a holistic view of person Instill hope and establish future-oriented goals Allow person to drive goal planning and decision making Plan is realistic about a person’s decision to potentially engage in risky behavior and seeks to minimize harm. Allow for extra time to establish relationship and gain trust Housing First Care Harm Reduction Motivational Meeting #7: Education and collaborative support •Jeff and Mary decide to use this meeting to review the lease again and some materials that Jeff has on tenant rights and responsibilities. •Mary told Jeff that the landlord knocked on her door the other day and asked to check on the air conditioning unit. She wasn’t sure what to do. It wasn’t a good time, but she was nervous, so she let her in and stayed in the bedroom while she was there. •Jeff reviewed Mary’s rights as a tenant and helped her develop strategies for engaging with the landlord in the future. Jeff reminded Mary that she is usually open and friendly with others, and she shouldn’t be afraid to be herself around the landlord. Mary told him that she had been taught growing up to be more respectful to authority figures. Jeff said not to worry about that. •After the meeting, and with Mary’s permission, Jeff called the landlord and reminded her that he was available to help address any issues in the future. Applying EBP’s: Education and collaborative support Prioritize individual/family’s housing stability over property management’s needs Account for individual’s cultural background in education and coaching Use the opportunity to help person understand and take responsibility for their actions. Affirm the individual and build on strengths to enhance skill development and elicitation of change.​ Housing First Care Harm Reduction Motivational Meeting #8: Eviction prevention •Jeff made an unplanned visit to Mary after getting a call from the landlord about a noise complaint. The landlord had been to Mary’s unit and seen that she was sleeping in a tent in her bedroom. She had also missed a rent payment. •Mary explained that she had her friends from the encampment stay overnight the night before. She had been very anxious and having them around made her feel safer. Jeff empathized with that, and they thought of a few strategies to keep the noise down in the future. •Jeff also told her that she needed to take the tent down and start sleeping in her bed. Mary didn’t see how the tent bothered anyone else. •As for the rent payment, she had just forgotten! Jeff helped her get set up with a bank that could do automatic bill pay for rent in the future. Applying EBP’s: Eviction prevention Connect people with supports needed to move forward Recognize how traumatic stress can impact behaviors Use interventions specific to cultural backgrounds Focus on impact to housing, not specific behaviors Use reflective listening and empathy to build rapport. Housing First Care Harm Reduction Motivational Meeting #9: Maintaining stable housing •Mary had been living in her new unit for 11 months now and was doing well-she missed rent once and was on a repayment plan. Her neighbor two doors down had been helping her with some household chores and cooking in exchange for watching her kids occasionally. •She now had SSI and other benefits in addition to her rental assistance, so she was more financially stable. •Mary wasn’t home for the past two times Jeff tried to visit. She grew frustrated when Jeff called and told her she forgot about their plan to meet. Mary told Jeff that he didn’t need to visit her anymore and that she had things figured out. Mary told Jeff to give her space. •Jeff offered to step back saying he wouldn’t call her for the next week, but asked if he could check in with her in a month to work on her annual housing recertification together. Applying EBP’s: Maintaining stable housing Services are voluntary: there will be times when individuals don’t want to engage in services. You can make amendments to a service plan or recommend that someone move on from services- however you should continue to offer services until they officially end. Safety measures are in place Provider responses are consistent, predictable and respectful. Knowing that there will be a range of needs among your clients, and for individual clients over time, build in space to increase/decrease services as needed. What value is motivating Mary’s request? How could Jeff listening to what is most important to Mary help him to offer relevant services?​ Housing First Care Harm Reduction Motivational