February 11, 2010 Kristina Hals and Marie Herb Technical Assistance Collaborative, Inc.
<ul><li>“ A system of moral principles” </li></ul><ul><li>“ That branch of philosophy dealing with  values relating to hum...
<ul><li>“ The  skill ,  competence , or  standards  expected of a member of a profession.” </li></ul>Source: dictionary.com
<ul><li>“ When an  individual or organization involved in  multiple interests , one of which could possibly corrupt the mo...
<ul><li>Fundamental to our work </li></ul><ul><li>Not just  what  we do to help but  how  we do it </li></ul><ul><li>Most ...
<ul><li>“ Agree or Disagree?  Providing case management in supportive housing for people who are homeless  sometimes gives...
<ul><li>“ Agree or Disagree?  Providing case management in supportive housing for people who are homeless  sometimes bring...
<ul><li>Recognize the inherent P and E challenges in our field </li></ul><ul><li>Caution  ourselves about conflicts of int...
<ul><li>Identifying Ethics & Professionalism Challenges  </li></ul><ul><li>Improving Case  Management Professional Practic...
<ul><li>Identifying Ethics/Professionalism Challenges  </li></ul>
<ul><li>Sources of the Challenge </li></ul><ul><li>Examples of the Quandaries </li></ul><ul><li>Discussion </li></ul>
<ul><li>Identifying Ethics/Professionalism Challenges  </li></ul>
<ul><li>Each PSH has a signature approach  </li></ul><ul><li>The field of PSH has evolved </li></ul><ul><li>Best practices...
<ul><li>Staff are primarily paraprofessionals – on the job training </li></ul><ul><li>Staff are typically mobile and indep...
<ul><li>Challenge of retaining staff when salaries are low </li></ul><ul><li>Clinical staff (nurses, psych) = first cut fr...
<ul><li>Common Tenant Characteristics  </li></ul><ul><li>Under stress – economic, emotional, health issues  (100%) </li></...
<ul><li>Demanding jobs  </li></ul><ul><li>Stress - encountering life and death situations </li></ul><ul><li>Feelings of he...
<ul><li>Hard to find middle ground between hoping residents stay clean and sober and regulating it  (89%) </li></ul><ul><l...
<ul><li>Small towns </li></ul><ul><li>Landlords have histories with staff and tenants </li></ul><ul><li>Lack of highly pro...
<ul><li>Identifying Ethics/Professionalism Challenges  </li></ul>
<ul><li>Confused perceptions held by tenants of role of staff  (100%) </li></ul><ul><li>Residents’ misinterpretations of a...
<ul><li>Ensuring confidentiality with property management  (78%) </li></ul><ul><li>Property management played against case...
<ul><li>Guide for Peer to Peer Discussion of Identifying Challenges </li></ul><ul><li>As a group, review slides 21 and 22 ...
<ul><li>Improving Case Management Professional Practice </li></ul>
<ul><li>Elevating Supervision Quality </li></ul><ul><li>Promoting Best Practice/Principles in Case Management </li></ul><u...
<ul><li>Improving Professional Practice </li></ul>
<ul><li>PSH housing is demanding work </li></ul><ul><li>Paraprofessionals carry out much of the CM work  </li></ul><ul><li...
<ul><li>Norms of the Field </li></ul><ul><li>One supervisor per six staff  </li></ul><ul><li>Clinical skills, degrees, cer...
<ul><li>Categories  </li></ul><ul><li>Support </li></ul><ul><li>Education </li></ul><ul><li>Accountability </li></ul>Sourc...
<ul><li>Tips </li></ul><ul><li>Meet weekly with staff  </li></ul><ul><li>Use individual and group modalities </li></ul><ul...
<ul><li>Tips </li></ul><ul><li>Train and orient new staff thoroughly </li></ul><ul><li>Use case conferences as teachable m...
<ul><li>CM Performance Review </li></ul><ul><ul><li>Effectiveness with tenants </li></ul></ul><ul><ul><li>Effectiveness wi...
<ul><li>Improving Professional Practice </li></ul>
<ul><li>Features </li></ul><ul><li>Work with housing retention itself as primary objective </li></ul><ul><li>Think of “Hou...
<ul><li>Features </li></ul><ul><li>Case Managers give tenants freedom in choice making  </li></ul><ul><li>Tenants allowed ...
<ul><li>Reasons  </li></ul><ul><li>Can be interpreted as voluntary services </li></ul><ul><li>Research demonstrates  bette...
<ul><li>Tips </li></ul><ul><li>Put aside personal judgments and biases </li></ul><ul><li>Respect residents’ different valu...
<ul><li>CM Skills </li></ul><ul><li>How to help set goals resident wants </li></ul><ul><li>How to partner rather that dire...
<ul><li>What the Theory Teaches Us </li></ul><ul><li>Contemplation – Preparation  – Action - Maintenance </li></ul><ul><li...
<ul><li>Elements of the Approach </li></ul><ul><li>Build trust over time </li></ul><ul><li>Know the person </li></ul><ul><...
<ul><li>The Basics </li></ul><ul><li>Know the need for boundaries in helping professions </li></ul><ul><li>Develop  Transf...
<ul><li>Improving Professional Practice </li></ul>
<ul><li>Tips </li></ul><ul><li>Have new CM staff shadow experienced staff </li></ul><ul><li>Offer weekly case conferences ...
<ul><li>Case management overview </li></ul><ul><li>Basic counseling skills  </li></ul><ul><li>Cognitive behavioral strateg...
<ul><li>Recommended Topics </li></ul><ul><li>Overview of psychiatric disorders </li></ul><ul><li>Psychosis </li></ul><ul><...
<ul><li>To Know </li></ul><ul><li>Expectations for behavior (bad stuff stemming from SA) </li></ul><ul><li>Focusing on beh...
<ul><li>Guide for Peer to Peer Discussion of Professional Practice </li></ul><ul><li>As a group, review the topics of Segm...
<ul><li>Bettering Organizational Planning and Structure  </li></ul>
<ul><li>Dividing CM from Property Management </li></ul><ul><li>Establishing Staff Roles and Structure </li></ul><ul><li>Es...
<ul><li>Bettering Organizational Planning and Structure  </li></ul>
<ul><li>Reasons </li></ul><ul><li>Two different roles performed by different people </li></ul><ul><li>Residents should see...
<ul><li>Tips </li></ul><ul><li>Define role distinctions in Job Descriptions </li></ul><ul><li>Practice confidentiality in ...
<ul><li>Bettering Organizational Planning and Structure  </li></ul>
<ul><li>Tips </li></ul><ul><li>Ratio of CM to residents = 1:10 to 1:25  </li></ul><ul><li>Use General Case Managers for fo...
<ul><li>Options </li></ul><ul><li>Supervisor/ Director </li></ul><ul><li>Case Managers  </li></ul><ul><li>ACT team (assert...
<ul><li>Tips </li></ul><ul><li>Frequency of  CM contacts – 1-2 contacts/week </li></ul><ul><li>More frequent contacts to n...
<ul><li>Skills Needed </li></ul><ul><li>Showing empathy  </li></ul><ul><li>Being trustworthy  </li></ul><ul><li>Being resp...
<ul><li>Bettering Organizational Planning and Structure  </li></ul>
<ul><li>Reasons </li></ul><ul><li>Counteracts power imbalances of the PSH model </li></ul><ul><li>Skill building for resid...
<ul><li>Techniques </li></ul><ul><li>Resident Advisory Board </li></ul><ul><li>Resident Peer Mentors (may be paid/certifie...
<ul><li>Events </li></ul><ul><li>Community meetings </li></ul><ul><li>Social events –outings, holiday parties etc. </li></...
<ul><li>Guide for Peer to Peer Discussion of  </li></ul><ul><li>Organizational Planning & Structure </li></ul><ul><li>As a...
<ul><li>Using National Standards and Tools </li></ul>
<ul><li>Improving Policies and Procedures </li></ul><ul><li>Properly Protecting Confidentiality </li></ul><ul><li>Practici...
<ul><li>Using Standards and Tools </li></ul>
<ul><li>Tips </li></ul><ul><li>Create a Policies and Procedures Manual </li></ul><ul><li>Train new staff in Policies and P...
<ul><ul><li>Eligibility determination procedures </li></ul></ul><ul><ul><li>Tenant selection process </li></ul></ul><ul><u...
<ul><li>Using Standards and Tools </li></ul>
<ul><li>Rules to Develop </li></ul><ul><li>To whom CM can share information about residants </li></ul><ul><li>What can and...
<ul><li>Standards  </li></ul><ul><li>Never left in public space or view </li></ul><ul><li>Maintained in secured location o...
<ul><li>Contents </li></ul><ul><ul><li>Tenant’s full name, signature, date </li></ul></ul><ul><ul><li>Entity to whom discl...
<ul><li>Using Standards and Tools </li></ul>
<ul><li>Standards </li></ul><ul><li>Fulfills all funders’ requirements </li></ul><ul><li>Use social work voice – nonbiased...
<ul><li>Income Verification </li></ul><ul><li>Homelessness Status Documentation </li></ul><ul><li>Intake Documentation </l...
<ul><li>Using Standards and Tools </li></ul>
<ul><li>Definition </li></ul><ul><li>A person is considered homeless only when he/she resides in one of the three places d...
<ul><li>Caveats </li></ul><ul><li>If a person is in one of the three categories listed above, but most recently spent less...
<ul><li>Recommendations </li></ul><ul><li>All persons that may be eligible can apply </li></ul><ul><li>Clear, written tena...
<ul><li>Recommendations </li></ul><ul><li>Denials limited to: </li></ul><ul><li>Does not fit eligibility as defined by the...
<ul><li>Recommendations for Notice </li></ul><ul><li>Explains the reason applicant is denied </li></ul><ul><li>Includes co...
<ul><li>Develop fair practice for waiting lists </li></ul><ul><ul><li>Chronological </li></ul></ul><ul><ul><li>Lottery at ...
<ul><li>Guidelines </li></ul><ul><li>Illegal to ask about nature/severity of a disability during tenant selection.  </li><...
<ul><li>Guide for Peer to Peer Discussion of Professional Practice </li></ul><ul><li>Review the topics related to Standard...
<ul><li>AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston...
<ul><li>HUD Homeless Resource Exchange website:  www.hud.hre.gov </li></ul><ul><li>Corporation for Supportive Housing webs...
<ul><li>1. Do Voluntary  Case Management Services Work? </li></ul><ul><li>Final Report on the Education of the Closer to H...
<ul><li>Annual End Homelessness Conference: July every year.  www.endhomelessness.org </li></ul><ul><li>Annual End Family ...
<ul><li>Center for Urban and Community Services, New York, NY </li></ul><ul><li>  </li></ul><ul><li>Technical Assistance C...
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Training Curriculum: Ethics in Case Management Practice

  1. 1. February 11, 2010 Kristina Hals and Marie Herb Technical Assistance Collaborative, Inc.
  2. 2. <ul><li>“ A system of moral principles” </li></ul><ul><li>“ That branch of philosophy dealing with values relating to human conduct ” </li></ul>Source: dictionary.com
  3. 3. <ul><li>“ The skill , competence , or standards expected of a member of a profession.” </li></ul>Source: dictionary.com
  4. 4. <ul><li>“ When an individual or organization involved in multiple interests , one of which could possibly corrupt the motivation for an act in the other.” </li></ul>Source: dictionary.com
  5. 5. <ul><li>Fundamental to our work </li></ul><ul><li>Not just what we do to help but how we do it </li></ul><ul><li>Most of our residents have histories with injustices </li></ul><ul><ul><li>Inequality </li></ul></ul><ul><ul><li>Discrimination </li></ul></ul><ul><ul><li>Lack of opportunity </li></ul></ul><ul><li>Protect us against conflict of interest </li></ul>
  6. 6. <ul><li>“ Agree or Disagree? Providing case management in supportive housing for people who are homeless sometimes gives rise to ethical dilemmas ?” </li></ul><ul><li>90% Agree </li></ul>
  7. 7. <ul><li>“ Agree or Disagree? Providing case management in supportive housing for people who are homeless sometimes brings up questions as to how case managers can act professionally in every situation ?” </li></ul><ul><li>90% Agree </li></ul>
  8. 8. <ul><li>Recognize the inherent P and E challenges in our field </li></ul><ul><li>Caution ourselves about conflicts of interest in our field </li></ul><ul><li>Learn national best practices and standards in our field </li></ul><ul><li>Understand how to foster a culture of P and E in PSH </li></ul><ul><li>Share our collective expertise on the topic </li></ul><ul><li>Know where to find national guidance about our field </li></ul>
  9. 9. <ul><li>Identifying Ethics & Professionalism Challenges </li></ul><ul><li>Improving Case Management Professional Practice </li></ul><ul><li>Bettering Case Management Planning and Structure * </li></ul><ul><li>Using National Standards and Tools </li></ul>* Most popular in the Pre-work Survey Monkey
  10. 10. <ul><li>Identifying Ethics/Professionalism Challenges </li></ul>
  11. 11. <ul><li>Sources of the Challenge </li></ul><ul><li>Examples of the Quandaries </li></ul><ul><li>Discussion </li></ul>
  12. 12. <ul><li>Identifying Ethics/Professionalism Challenges </li></ul>
  13. 13. <ul><li>Each PSH has a signature approach </li></ul><ul><li>The field of PSH has evolved </li></ul><ul><li>Best practices and principles are unevenly applied </li></ul><ul><li>Research is not widely shared </li></ul><ul><li>National training does not reach most PSH </li></ul><ul><li>PSH work is demanding and stressful </li></ul>
  14. 14. <ul><li>Staff are primarily paraprofessionals – on the job training </li></ul><ul><li>Staff are typically mobile and independent </li></ul><ul><li>Supervision varies and is limited by staff mobility </li></ul><ul><li>Staff operating “from their wits” </li></ul>
  15. 15. <ul><li>Challenge of retaining staff when salaries are low </li></ul><ul><li>Clinical staff (nurses, psych) = first cut from budgets </li></ul>
  16. 16. <ul><li>Common Tenant Characteristics </li></ul><ul><li>Under stress – economic, emotional, health issues (100%) </li></ul><ul><li>Have poor problem solving skills –prone to conflict (100%) </li></ul><ul><li>At-risk – can feel like life and death (89%) </li></ul><ul><li>Have symptoms impacting cognition/personality (89%) </li></ul><ul><li>Undiagnosed or inconsistently treated mental illness (78%) </li></ul><ul><li>Have symptoms producing confusing behaviors (78%) </li></ul><ul><li>Have serious illness HIV/AID, prematurely aged (67%) </li></ul>
  17. 17. <ul><li>Demanding jobs </li></ul><ul><li>Stress - encountering life and death situations </li></ul><ul><li>Feelings of helplessness, burn out, frustration </li></ul>
  18. 18. <ul><li>Hard to find middle ground between hoping residents stay clean and sober and regulating it (89%) </li></ul><ul><li>The fine line between “housing” and “program” (78%) </li></ul><ul><li>The vaguery as to whether services are voluntary or required (56%) </li></ul>
  19. 19. <ul><li>Small towns </li></ul><ul><li>Landlords have histories with staff and tenants </li></ul><ul><li>Lack of highly professional property owners/ managers </li></ul><ul><li>Staff time expended on travel </li></ul><ul><li>Wide geographic catchment area = staff spread out </li></ul><ul><li>Smaller organization = informality to CM practice </li></ul>
  20. 20. <ul><li>Identifying Ethics/Professionalism Challenges </li></ul>
  21. 21. <ul><li>Confused perceptions held by tenants of role of staff (100%) </li></ul><ul><li>Residents’ misinterpretations of aspects of the program (100%) </li></ul><ul><li>Inconsistent philosophical practice from one staff to next (78%) </li></ul><ul><li>Residents not making enough personal choices (68%) </li></ul><ul><li>Overstepping by staff stemming from unclear boundaries (68%) </li></ul><ul><li>Conflicts with tenants that become “personal” (56%) </li></ul><ul><li>Misunderstandings stemming from cultural differences (56%) </li></ul><ul><li>Staff have difficulty holding back in helping relationship (45%) </li></ul>
  22. 22. <ul><li>Ensuring confidentiality with property management (78%) </li></ul><ul><li>Property management played against case management (78%) </li></ul><ul><li>Knowing all arrangements with community partners are proper and do not create conflict of interest (68%) </li></ul><ul><li>Following directives of the funder (45%) </li></ul><ul><li>Avoiding public relations problems stemming from staff communications (34%) </li></ul><ul><li>Making sure record keeping meets standards (23%) </li></ul>
  23. 23. <ul><li>Guide for Peer to Peer Discussion of Identifying Challenges </li></ul><ul><li>As a group, review slides 21 and 22 together. </li></ul><ul><li>Answer these questions: </li></ul><ul><li>Which difficulties listed in the slides have we experienced most? </li></ul><ul><li>What are specific real examples of the kinds of difficulties listed on the slides? </li></ul><ul><li>Which of these problems pose the greatest risk to our work? </li></ul><ul><li>Which of these problems do we need new tools to solve? </li></ul>
  24. 24. <ul><li>Improving Case Management Professional Practice </li></ul>
  25. 25. <ul><li>Elevating Supervision Quality </li></ul><ul><li>Promoting Best Practice/Principles in Case Management </li></ul><ul><li>Improving Staff Training </li></ul>
  26. 26. <ul><li>Improving Professional Practice </li></ul>
  27. 27. <ul><li>PSH housing is demanding work </li></ul><ul><li>Paraprofessionals carry out much of the CM work </li></ul><ul><li>Many staff have no academic/professional preparation </li></ul><ul><li>Staff negotiate their supportive/advocacy role with each new tenant </li></ul><ul><li>Staff makes judgment calls all day long. </li></ul><ul><li>Complex diagnosis are common in tenants: </li></ul><ul><ul><li>Substance abuse </li></ul></ul><ul><ul><li>HIV </li></ul></ul><ul><ul><li>Mental illness </li></ul></ul><ul><ul><li>Cognitive impairments </li></ul></ul><ul><ul><li>Head injury </li></ul></ul><ul><ul><li>Co-occurring diagnosis </li></ul></ul><ul><ul><li>Trauma </li></ul></ul>Reasons:
  28. 28. <ul><li>Norms of the Field </li></ul><ul><li>One supervisor per six staff </li></ul><ul><li>Clinical skills, degrees, certifications desired </li></ul><ul><li>Management experience desired </li></ul><ul><li>Strong supervision in helping professions background </li></ul>
  29. 29. <ul><li>Categories </li></ul><ul><li>Support </li></ul><ul><li>Education </li></ul><ul><li>Accountability </li></ul>Source: Corporation for Supportive Housing, Toolkit for Developing and Operating Supportive Housing, New York,
  30. 30. <ul><li>Tips </li></ul><ul><li>Meet weekly with staff </li></ul><ul><li>Use individual and group modalities </li></ul><ul><li>Provide clinical insight and the big picture </li></ul><ul><li>Coach staff to be effective with tenants </li></ul><ul><li>Support staff in sustaining morale, managing stress </li></ul><ul><li>Offer concrete resource information </li></ul><ul><li>Keep open door policy for staff </li></ul><ul><li>Be available and highly accessible to staff </li></ul>Source: Kaduchin, A., Supervision in Social Work, Columbia University Press, 2002
  31. 31. <ul><li>Tips </li></ul><ul><li>Train and orient new staff thoroughly </li></ul><ul><li>Use case conferences as teachable moments </li></ul><ul><li>Conduct scheduled trainings on special topics </li></ul><ul><li>Offer in-service trainings by outside specialists </li></ul><ul><li>Teach principles and best practices of PSH </li></ul>
  32. 32. <ul><li>CM Performance Review </li></ul><ul><ul><li>Effectiveness with tenants </li></ul></ul><ul><ul><li>Effectiveness with colleagues on the team </li></ul></ul><ul><ul><li>Job satisfaction and self-care </li></ul></ul><ul><ul><li>Meeting of the program goals </li></ul></ul>Source: CUCS, New York, NY www.cucus.org
  33. 33. <ul><li>Improving Professional Practice </li></ul>
  34. 34. <ul><li>Features </li></ul><ul><li>Work with housing retention itself as primary objective </li></ul><ul><li>Think of “Housing as Healthcare” </li></ul><ul><li>Know that more complex cases do not correlate with poorer housing outcomes </li></ul><ul><ul><ul><li>Coming from street </li></ul></ul></ul><ul><ul><ul><li>Coming from incarceration </li></ul></ul></ul><ul><ul><ul><li>Co-occurring diagnosis </li></ul></ul></ul><ul><li>Engage the most mentally ill or most complex </li></ul>Sources: Burt and Anderson, Program Experiences in Housing Homeless People with Serious Mental Illness
  35. 35. <ul><li>Features </li></ul><ul><li>Case Managers give tenants freedom in choice making </li></ul><ul><li>Tenants allowed to make bad choices </li></ul><ul><li>Choices considered the path to self-direction and learning, recovery </li></ul><ul><li>Derived from national Mental Health consumer movement </li></ul>Source: Barrow, Soto, and Cordova; Final Report on the Evaluation of the Closer to Home Initiative
  36. 36. <ul><li>Reasons </li></ul><ul><li>Can be interpreted as voluntary services </li></ul><ul><li>Research demonstrates better outcomes </li></ul><ul><li>Frees CM staff of burden of service compliance </li></ul><ul><li>Residents participate at higher rates </li></ul><ul><li>Assures you are serving those most in need </li></ul><ul><li>Gets your program out of the “gray area” </li></ul><ul><li>Normalizes housing arrangements </li></ul>Source: Barrow, Soto, and Cordova; Final Report on the Evaluation of the Closer to Home Initiative
  37. 37. <ul><li>Tips </li></ul><ul><li>Put aside personal judgments and biases </li></ul><ul><li>Respect residents’ different value systems than those of staff </li></ul><ul><li>Use “nonjudgmental” as compass to guides CM work </li></ul><ul><li>The practice of cultural competence </li></ul>Sources: CSH and CUCS, Case Management Services Curriculum; Supportive Housing Series; U.S. Department of HUD Sponsored
  38. 38. <ul><li>CM Skills </li></ul><ul><li>How to help set goals resident wants </li></ul><ul><li>How to partner rather that direct the resident </li></ul><ul><li>How to help define small steps leading to larger goal </li></ul><ul><li>How to see the progress in failures </li></ul>Source: CSH and CUCS, Case Management Services Curriculum; Supportive Housing Series; U.S. Department of HUD Sponsored
  39. 39. <ul><li>What the Theory Teaches Us </li></ul><ul><li>Contemplation – Preparation – Action - Maintenance </li></ul><ul><li>Early period = great loss and sense of vulnerability </li></ul><ul><li>Many feel constantly at risk to relapse - AA for decades </li></ul><ul><li>What helps in PSH </li></ul><ul><ul><li>Altering daily routines </li></ul></ul><ul><ul><li>Finding new social groups </li></ul></ul><ul><ul><li>New activities </li></ul></ul>Sources: Encyclopedia of Homelessness
  40. 40. <ul><li>Elements of the Approach </li></ul><ul><li>Build trust over time </li></ul><ul><li>Know the person </li></ul><ul><li>Assist in cognitive restructuring </li></ul><ul><li>Teach visualization </li></ul><ul><li>Provide support </li></ul><ul><li>Establish an agreement </li></ul>Sources: CSH and CUCS, Case Management Services Curriculum; Supportive Housing Series; U.S. Department of HUD Sponsored
  41. 41. <ul><li>The Basics </li></ul><ul><li>Know the need for boundaries in helping professions </li></ul><ul><li>Develop Transference Awareness </li></ul><ul><li>Set guidelines for boundaries between staff – residents </li></ul><ul><li>Discuss impropriety of overstepping relationship </li></ul><ul><li>Maintain focus on resident </li></ul><ul><li>Limit CM staff from sharing personal information </li></ul><ul><li>LUNCH BREAK </li></ul>
  42. 42. <ul><li>Improving Professional Practice </li></ul>
  43. 43. <ul><li>Tips </li></ul><ul><li>Have new CM staff shadow experienced staff </li></ul><ul><li>Offer weekly case conferences – peer to peer learning </li></ul><ul><li>Have CM learn some skills and practices on the job </li></ul>
  44. 44. <ul><li>Case management overview </li></ul><ul><li>Basic counseling skills </li></ul><ul><li>Cognitive behavioral strategies </li></ul><ul><li>Cultural competence </li></ul><ul><li>Motivational interviewing </li></ul><ul><li>Reducing job-related stress </li></ul><ul><li>Stages of Change model of recovery </li></ul><ul><li>Trauma and its aftermath </li></ul><ul><li>Conflict resolution </li></ul><ul><li>From incarceration to community </li></ul><ul><li>Helping tenants develop skills for independent living </li></ul><ul><li>Understanding chronically homeless people </li></ul><ul><li>Creating a culture of moving on </li></ul><ul><li>The 1st year in supportive housing </li></ul>Recommended Topics Source: Center for Urban Community Services, PSH training series topics; www.cucs.org
  45. 45. <ul><li>Recommended Topics </li></ul><ul><li>Overview of psychiatric disorders </li></ul><ul><li>Psychosis </li></ul><ul><li>Understanding Borderline Personality Disorder </li></ul><ul><li>Psych Crisis and Suicide Prevention </li></ul><ul><li>Mental Health Treatments </li></ul><ul><li>Dual diagnosis </li></ul><ul><li>Recovery Process </li></ul><ul><li>Recovery </li></ul>
  46. 46. <ul><li>To Know </li></ul><ul><li>Expectations for behavior (bad stuff stemming from SA) </li></ul><ul><li>Focusing on behavior (noise, visitors that violate lease etc.) </li></ul><ul><li>Relapse (time of opportunity – engage, identify trigger) </li></ul><ul><li>Rule Violations (help understand mistake, plan future) </li></ul><ul><li>Address Drug Dealing (monitor – brings on other crimes) </li></ul><ul><li>Stages of Change Principles (Protroshaka, DiClemente, Norcrosse) </li></ul>Sources: CSH, Substance Use Services and Supportive Housing
  47. 47. <ul><li>Guide for Peer to Peer Discussion of Professional Practice </li></ul><ul><li>As a group, review the topics of Segment Two (slides 26-46): </li></ul><ul><li>Elevating Supervision Quality </li></ul><ul><li>Promoting Best Practice Case Management </li></ul><ul><li>Improving Staff Training </li></ul><ul><li>Answer these questions: </li></ul><ul><li>In which of the segment topics does my organization excel? </li></ul><ul><li>In which of these areas do we most need growth or improvement? </li></ul><ul><li>What are the needed first steps to foster needed growth in these areas ? </li></ul>
  48. 48. <ul><li>Bettering Organizational Planning and Structure </li></ul>
  49. 49. <ul><li>Dividing CM from Property Management </li></ul><ul><li>Establishing Staff Roles and Structure </li></ul><ul><li>Establishing Resident Involvement and Community </li></ul>
  50. 50. <ul><li>Bettering Organizational Planning and Structure </li></ul>
  51. 51. <ul><li>Reasons </li></ul><ul><li>Two different roles performed by different people </li></ul><ul><li>Residents should see the roles as separate and distinct </li></ul>
  52. 52. <ul><li>Tips </li></ul><ul><li>Define role distinctions in Job Descriptions </li></ul><ul><li>Practice confidentiality in communications </li></ul><ul><li>Schedule cross-trainings between parties </li></ul><ul><li>Use Releases of Information between the parties </li></ul><ul><li>Use Communications Logs </li></ul><ul><li>Have method for Incident Review </li></ul>
  53. 53. <ul><li>Bettering Organizational Planning and Structure </li></ul>
  54. 54. <ul><li>Tips </li></ul><ul><li>Ratio of CM to residents = 1:10 to 1:25 </li></ul><ul><li>Use General Case Managers for foundation </li></ul><ul><li>Include Specialist Case Managers as compliments </li></ul><ul><ul><li>Public Benefits Specialist </li></ul></ul><ul><ul><li>Employment Specialist </li></ul></ul>
  55. 55. <ul><li>Options </li></ul><ul><li>Supervisor/ Director </li></ul><ul><li>Case Managers </li></ul><ul><li>ACT team (assertive community treatment) </li></ul><ul><li>Peer specialist </li></ul><ul><li>Substance Abuse Counselor </li></ul><ul><li>Resident Aides </li></ul><ul><li>ADL (Act of Daily Living) Specialists </li></ul><ul><li>HIV Specialists </li></ul><ul><li>Benefits Specialists </li></ul>
  56. 56. <ul><li>Tips </li></ul><ul><li>Frequency of CM contacts – 1-2 contacts/week </li></ul><ul><li>More frequent contacts to newer residents </li></ul><ul><li>More frequent contacts for at risk residents </li></ul><ul><li>By 3rd month, plan gradual reduction in service </li></ul><ul><li>Anticipate spikes in need for services </li></ul><ul><li>Plan for residents “stepping down” from services </li></ul>
  57. 57. <ul><li>Skills Needed </li></ul><ul><li>Showing empathy </li></ul><ul><li>Being trustworthy </li></ul><ul><li>Being respectful </li></ul><ul><li>Demonstrating flexibility </li></ul><ul><li>Active listening </li></ul><ul><li>Effective communication </li></ul>Source: CUCS, New York, NY; www.cucus.org
  58. 58. <ul><li>Bettering Organizational Planning and Structure </li></ul>
  59. 59. <ul><li>Reasons </li></ul><ul><li>Counteracts power imbalances of the PSH model </li></ul><ul><li>Skill building for residents </li></ul><ul><li>Reframes residents as contributors not takers </li></ul>
  60. 60. <ul><li>Techniques </li></ul><ul><li>Resident Advisory Board </li></ul><ul><li>Resident Peer Mentors (may be paid/certified) </li></ul><ul><li>Resident as Employees </li></ul><ul><li>Speakers’ Bureau of Residents as public relations </li></ul>Source: Corporation for Supportive Housing, Toolkit for Developing and Operating Supportive Housing, New York
  61. 61. <ul><li>Events </li></ul><ul><li>Community meetings </li></ul><ul><li>Social events –outings, holiday parties etc. </li></ul><ul><li>Staff-tenant team building activities </li></ul><ul><li>Coffee hours, entertainment, guest speakers </li></ul>
  62. 62. <ul><li>Guide for Peer to Peer Discussion of </li></ul><ul><li>Organizational Planning & Structure </li></ul><ul><li>As a group, review the topics of Segment Three (slides 49-61): </li></ul><ul><li>Dividing CM from Property Management </li></ul><ul><li>Establishing Staff Roles and Structure </li></ul><ul><li>Establishing Resident Involvement and Community </li></ul><ul><li>Answer these questions: </li></ul><ul><li>In which of the segment topics does my organization excel? </li></ul><ul><li>In which of these areas do we most need growth or improvement? </li></ul><ul><li>What are the needed first steps to foster needed growth in these areas ? </li></ul>
  63. 63. <ul><li>Using National Standards and Tools </li></ul>
  64. 64. <ul><li>Improving Policies and Procedures </li></ul><ul><li>Properly Protecting Confidentiality </li></ul><ul><li>Practicing Needed Record Keeping </li></ul><ul><li>Ensuring Propriety in Resident Admissions </li></ul>
  65. 65. <ul><li>Using Standards and Tools </li></ul>
  66. 66. <ul><li>Tips </li></ul><ul><li>Create a Policies and Procedures Manual </li></ul><ul><li>Train new staff in Policies and Procedures </li></ul><ul><li>Update manual regularly </li></ul>
  67. 67. <ul><ul><li>Eligibility determination procedures </li></ul></ul><ul><ul><li>Tenant selection process </li></ul></ul><ul><ul><li>Intake and lease-up procedures </li></ul></ul><ul><ul><li>Supervision procedures </li></ul></ul><ul><ul><li>Case management procedures </li></ul></ul><ul><ul><li>Record keeping procedures </li></ul></ul><ul><ul><li>Confidentiality procedures </li></ul></ul><ul><ul><li>Emergency procedures </li></ul></ul><ul><ul><li>Grievance procedures </li></ul></ul><ul><ul><li>Incident procedure </li></ul></ul><ul><ul><li>Staff impropriety procedures </li></ul></ul><ul><ul><li>Property management functions and procedures </li></ul></ul><ul><ul><li>HUD funding compliance information </li></ul></ul>Contents Source: AIDS Housing Corporation, The Program Director’s Workbook: Tools for Implementing Supportive Housing
  68. 68. <ul><li>Using Standards and Tools </li></ul>
  69. 69. <ul><li>Rules to Develop </li></ul><ul><li>To whom CM can share information about residants </li></ul><ul><li>What can and cannot be shared outside PSH program </li></ul><ul><li>Role of the Release of Information </li></ul><ul><li>Confidentiality standards in resident groups </li></ul><ul><li>Protocol for a breach of confidentiality </li></ul>
  70. 70. <ul><li>Standards </li></ul><ul><li>Never left in public space or view </li></ul><ul><li>Maintained in secured location or record system </li></ul><ul><li>Reviewed in privacy </li></ul><ul><li>Not transmitted electronically without protections </li></ul>
  71. 71. <ul><li>Contents </li></ul><ul><ul><li>Tenant’s full name, signature, date </li></ul></ul><ul><ul><li>Entity to whom disclosure is authorized </li></ul></ul><ul><ul><li>Type of information being disclosed </li></ul></ul><ul><ul><li>Time period during which release is effective </li></ul></ul><ul><ul><li>Statement of voluntary nature of release </li></ul></ul><ul><ul><li>Statement that release can be revoked anytime </li></ul></ul><ul><ul><li>Staff signature and date </li></ul></ul>Source: AIDS Housing Corporation, The Program Director’s Workbook: Tools for Implementing Supportive Housing
  72. 72. <ul><li>Using Standards and Tools </li></ul>
  73. 73. <ul><li>Standards </li></ul><ul><li>Fulfills all funders’ requirements </li></ul><ul><li>Use social work voice – nonbiased reporting style </li></ul><ul><li>Includes verifications of eligibility and case progress record </li></ul><ul><li>Clinical mental health records maintained separately by licensed provider </li></ul><ul><li>Objective language - accounts of fact and behavior </li></ul><ul><li>Use of a universal language common to all entries </li></ul>Source: AIDS Housing Corporation, Achieving Excellence
  74. 74. <ul><li>Income Verification </li></ul><ul><li>Homelessness Status Documentation </li></ul><ul><li>Intake Documentation </li></ul><ul><li>Individualized Service Plan </li></ul><ul><li>Emergency Contacts </li></ul><ul><li>Individualized Crisis Plan </li></ul><ul><li>Provider Contacts </li></ul><ul><li>Signed Release of Information Forms </li></ul><ul><li>Signed Grievance Procedure </li></ul><ul><li>Signed Residents’ Rights </li></ul>Contents Source: AIDS Housing Corporation, Achieving Excellence
  75. 75. <ul><li>Using Standards and Tools </li></ul>
  76. 76. <ul><li>Definition </li></ul><ul><li>A person is considered homeless only when he/she resides in one of the three places described below. For new and renewal Permanent Housing projects, persons assisted must be homeless and come from: </li></ul><ul><li>Living in a place not meant for human habitation, such as cars, parks, sidewalks, and abandoned buildings; </li></ul><ul><li>An emergency shelter; or </li></ul><ul><li>Transitional housing for persons and who originally came from streets or shelter. </li></ul>Source: HUD HRE website. Frequently Asked Questions, November, 2009.
  77. 77. <ul><li>Caveats </li></ul><ul><li>If a person is in one of the three categories listed above, but most recently spent less than 90* days in a jail or institution, he/she continues to qualify as coming from one of these categories. (2009 NOFA) </li></ul><ul><li>In addition to coming from the above three categories, projects providing Transitional Housing, Safe Havens, or Supportive Services Only may also serve populations experiencing the following circumstances: </li></ul><ul><li>Eviction within a week from a private dwelling unit and no subsequent residence has been identified and the person lacks the resources and support networks needed to obtain housing; or </li></ul><ul><li>Discharge within a week from an institution in which the person has been a tenant for 30 or more consecutive days and no subsequent residence has been identified and he/she lacks the resources and support networks needed to obtain housing. </li></ul>Note: For Permanent Housing projects renewed after 2005, the stricter screening criteria applies to units as they become vacant.
  78. 78. <ul><li>Recommendations </li></ul><ul><li>All persons that may be eligible can apply </li></ul><ul><li>Clear, written tenant selection criteria </li></ul><ul><li>Selection distinct different step from intake </li></ul><ul><li>Tenant Selection limited to: </li></ul><ul><li>Fits eligibility as defined by funding source </li></ul><ul><li>Is able to comply with the lease agreement and obligations as tenant </li></ul>Source: AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston
  79. 79. <ul><li>Recommendations </li></ul><ul><li>Denials limited to: </li></ul><ul><li>Does not fit eligibility as defined by the funder </li></ul><ul><li>Not suitable for upholding the lease agreement </li></ul><ul><li>Scrutiny to ability to uphold the lease applied consistently </li></ul><ul><li>If you run CORI, do so on all applicants </li></ul><ul><li>If you check references, do so on all applicants </li></ul>Source: AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston
  80. 80. <ul><li>Recommendations for Notice </li></ul><ul><li>Explains the reason applicant is denied </li></ul><ul><li>Includes contact name and phone for an appeal </li></ul><ul><li>Contains a contact information for local Fair Housing </li></ul><ul><li>Contains HUD Fair Housing Discrimination Line </li></ul><ul><li>Conveys that Reasonable Accommodations are offered </li></ul>Source: AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston
  81. 81. <ul><li>Develop fair practice for waiting lists </li></ul><ul><ul><li>Chronological </li></ul></ul><ul><ul><li>Lottery at periodic intervals </li></ul></ul><ul><li>Avoid sobriety as a requirement for admissions </li></ul><ul><li>Have tenant selection method reviewed by housing law attorney </li></ul><ul><li>Know that in assessing ability to uphold a lease, may request </li></ul><ul><li>Previous landlords </li></ul><ul><li>Credit companies </li></ul><ul><li>Employers </li></ul><ul><li>Probation officers </li></ul><ul><li>Social workers </li></ul><ul><li>Past residential programs (if and when there is question of ability to uphold lease) </li></ul>Source: AIDS Housing Corporation, The Program Director’s Workbook: Tools for Implementing Supportive Housing Recommendations
  82. 82. <ul><li>Guidelines </li></ul><ul><li>Illegal to ask about nature/severity of a disability during tenant selection. </li></ul><ul><li>Illegal to make decisions about eligibility based on the nature/severity of a disability. </li></ul><ul><li>The Reasonable Accommodation law applies </li></ul><ul><li>Local and national fair housing laws apply </li></ul>Source: AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston
  83. 83. <ul><li>Guide for Peer to Peer Discussion of Professional Practice </li></ul><ul><li>Review the topics related to Standards and Tools (slides 66-83): </li></ul><ul><li>Improving Policies and Procedures </li></ul><ul><li>Properly Protecting Confidentiality </li></ul><ul><li>Practicing Needed Record Keeping </li></ul><ul><li>Ensuring Propriety in Tenant Admissions </li></ul><ul><li>Answer these questions: </li></ul><ul><li>In which of the segment topics does my organization excel? </li></ul><ul><li>In which of these areas do we most need growth or improvement? </li></ul><ul><li>What are the needed first steps to foster needed growth in these areas ? </li></ul>
  84. 84.
  85. 85. <ul><li>AIDS Housing Corporation, Achieving Excellence: Standards of Care and Best Practices in Supportive Housing, Boston, www.aidshousing.org </li></ul><ul><li>AIDS Housing Corporation, The Program Director’s Workbook: Tools for Implementing Supportive Housing, www.aidshousing.org </li></ul><ul><li>Corporation for Supportive Housing, Toolkit for Developing and Operating Supportive Housing, New York, www.csh.org/publications </li></ul><ul><li>Corporation for Supportive Housing, Developing the Supportive Services Program. New York, www.csh.org/publications </li></ul><ul><li>CUCS, Supportive Housing Workbook for Mental Health Program Leaders, New York, www.cucs.org </li></ul><ul><li>National Center for Family Homelessness; What about You? A Workbook for Those who Work with Others, Newton, MA, www.familyhomelessness.org </li></ul>
  86. 86. <ul><li>HUD Homeless Resource Exchange website: www.hud.hre.gov </li></ul><ul><li>Corporation for Supportive Housing website: www.csh.org/publications </li></ul><ul><li>CUCS, New York website: www.cucs.org   </li></ul><ul><li>AIDS Housing Corporation website: www.ahc.org </li></ul><ul><li>National Center for Family Homelessness: www.familyhomelessness.org </li></ul><ul><li>Building Changes: www.buildingchanges.org </li></ul>
  87. 87. <ul><li>1. Do Voluntary Case Management Services Work? </li></ul><ul><li>Final Report on the Education of the Closer to Home Initiative </li></ul><ul><li>Program Experiences in Housing Homeless People with Serious Mental Illness </li></ul><ul><li>California’s Supportive Housing Initiative Act Program Evaluation Report </li></ul><ul><li>2. How can we Case Managers help SA PSH residents who are not complying with treatment?: </li></ul><ul><li>Substance Use Services and Supportive Housing </li></ul><ul><li>Developing the Support in Supportive Housing </li></ul><ul><li>3. How do we separate Case Management from Property Management roles? </li></ul><ul><li>Coordination of Property Management and Supportive Services in Permanent Supportive Housing </li></ul>
  88. 88. <ul><li>Annual End Homelessness Conference: July every year. www.endhomelessness.org </li></ul><ul><li>Annual End Family Homelessness Conference: March www.endhomelessness.org </li></ul>
  89. 89. <ul><li>Center for Urban and Community Services, New York, NY </li></ul><ul><li>  </li></ul><ul><li>Technical Assistance Collaborative, Boston, MA </li></ul><ul><li>National Center for Family Homelessness, Newton, MA </li></ul><ul><li>Corporation for Supportive Housing, New York, NY </li></ul>
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