As rapid re-housing strategies spread throughout the homelessness system, a similar movement is occurring in the domestic violence system. This workshop will cover the nuances of rapid re-housing for survivors of domestic violence and the benefits for both the survivor and the provider. Speakers will present program examples and lessons learned.
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1.10 Using Rapid Re-Housing for Survivors of Domestic Violence
1. Slide 1
Rapidly Re-housing Women and
Children Fleeing Domestic
Violence
Discovery House Family Violence
Prevention Society Community
Housing Program
Presentation
• “The Problem”
• Chocolate Meets Peanut Butter: The DV Sector Meets the Calgary
Homeless Foundation
• Project Goals and Outcomes
• Interagency Relationships
• Community Housing Team Workflow
• Forms
• What we Have Learned
• Where To?
2. Slide 2
“The Problem”
• Women led families leaving domestic
violence are worse at sustaining their
housing than the chronically homeless.”
• Housing Advocate
The Calgary Housing Company (CHC) [government operated subsidized
housing] advised the Calgary Shelter Directors Network [CSDN] (a committee
comprised of directors of Calgary emergency and transition shelters who work
together to address domestic violence issues in the Calgary community) that
women fleeing domestic violence (dv) demonstrated greater difficulty maintaining
shelter than the chronically homeless-rental arrears, late payment of rent, adding
tenants without informing the landlord, unsupervised children, poor relationships
with neighbors resulting in complaints from neighbors- poor tenancy habits
generally. The question to the SDN was “What are you going to do about this?”
The network did not choose to respond at that time but Discovery House (DH)
piloted the position of housing advocate (HA). The HA worked with women from
DH moving into subsidized housing to assess and help address any barriers to
maintaining housing. We discovered that many of our women required fairly
intensive housing support in the community around what really amounted to life
skills or building good tenancy habits in addition to addressing ongoing dv issues.
The service was successful but limited by our own resources. Serendipitously a
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3. year into the launch of this position the Calgary Homeless Foundation launched
their 10 year plan to end homelessness.
Slide 3
Chocolate Meets
Peanut Butter:
DV Sector Meets the
Calgary Homeless Foundation
• Calgary’s 10 year plan to end
homelessness is launched
• 48% of all referrals for rapid housing came
from the domestic violence sector
• Sector concerns: safety and ensuring
domestic violence doesn’t get lost in
homelessness
Rapid rehousing of homeless persons was one of the projects funded by the Calgary
Homeless Foundation (CHF). A program called Rapid Exit (RE) operated out of the
Community Urban Project Society (CUPS), a large well established and respected
homeless serving agency. RE had several teams focused on rapidly rehousing singles
and families in the community based on the housing first model. The rapid rehousing
teams consisted of Housing Locators (HL) who secured appropriate housing and liaised
with landlords around tenancy issues coupled with a small number of case managers
from various agencies who supported individuals and families once they were housed.
Less than a year into their rapid rehousing projects the CHF requested a meeting with
the CSDN and advised us that 48 % of the referrals for rapid rehousing into the
community came from emergency and second stage shelters for women and children
fleeing dv. They pitched the Housing First model to us and proposed the dv sector
partner with CUPS/RE to establish a housing first case management service for women
and children fleeing violence.
The CSDN came away with two concerns:
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4. 1. How can this model safely house women and children fleeing dv in the community
[ also a significant concern for our Board of Directors]; and
2. How could we partner with the homeless serving community and preserve the integrity
of the issue of dv so that it did not “get lost” into the issue of homelessness vs. a
violence against women issue?
After much discussion the Network agreed that we would pilot the program and DH
would take the lead on behalf of the Network of seven shelters in Calgary preserving the
issue of dv and the overarching goal of shelters “To build the capacity of families to live
safely and independently in the community free of domestic violence.”
Our women and children needed housing and we knew they also needed the support to
sustain housing that shelters on their own could not afford to provide.
Slide 4 (See next page) Internal Project Goals and Outcomes
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5. Internal Project Goals and Outcomes
Goals Outcomes Results
Reduce the number Outcome 1a: 50 women and Over a course of 11 months the
of women & their children leaving project served a total of 92 adult
children who return emergency or transitional clients and 209 children.
to abusive housing to access Rapid Exit will
relationships or be provided with the
homelessness due appropriate case management
to lack of housing. and systems navigation support
to stabilize their housing.
Increase the Outcome 2a: Successful 85% (n=78) of the clients have
capacity of abused housing placements with no or been housed in stable housing
women to live limited tenancy problems. (including market or subsidized
successfully, Outcome 2b: Number of housing)
independently and women not returning to abusive 14% (n=11) were re-housed and
violence free in the relationships. additional 3 clients returned to
community. Outcome 2c: Number of their abuser.
women demonstrating 36 clients (44%) experienced
increased success in household some type of tenancy problem
financing including the number 2 months after intake and 7%
of women successfully experienced such problems 6
accessing Income Support, months after intake.
existing Provincial and Of 87 clients who required
Municipal housing subsidies, income support, 72 or 83%
and finding and holding paid received such support. Of 87
employment. clients who required housing
Outcome 2d: Number of subsidies, 29 or 33% received
women reporting enhanced life such subsidies.
and personal development
skills.
Reduce the dual Outcome 3a: Number of At intake, 17 (18%) of clients
impact of the children remaining with mothers had active involvement with
trauma from in stable home environment (ie, child welfare (CW). Of these, 5
domestic violence decreasing number of Child (29%) are now closed.
and from Intervention cases) At intake, 26 children were in
homelessness on Outcome 3b: Number of out of home placement (20 of
women and women indicating improved these had CW involvement).
children by creating experiences of self-esteem, self- Of these, 3 (12%) have returned
stability in a new efficacy, personal safety, and home.
home environment. recovery from trauma. See OQ – 45.2 Section Above
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6. Slide 5
Community Housing
Inter-Agency Relationships
Awo Taan
Healing Lodge
Calgary Women’s
Emergency Shelter
Calgary Urban Partnership Agreement Discovery House
Sheriff King Home
on behalf of
Project Society Women’s Shelter Brenda Strafford Centre
(CUPS) Director’s Network
M ary Dover House
Sonshine Centre
Collaboration
Rapid Community
Exit Housing
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7. Slide 6
Community Housing
Work Flow
Referral
Community
Intake
Family Housing Assessment
Fleeing Action Plan
Women’s
Domestic Case Management
Emergency Case Management Coordination
Violence Shelter Leader Leverage Services
of women’s shelter
and/or other agencies
Case Manager
& CUPS/Rapid Exit
Family
Mental Health Housing Location
Housed
Specialist *Housing Solution
*Crisis Intervention Screening, Intake Assessment Provision of Housing Resources Provision of Case
Management
*Local Implementation of 10 Year Plan to End Homelessness (7.11.05 NAEH Conference)
Our case management model is collaborative and ecological in nature focusing on client
strengths in the context of environment. Our goal is to build client capacity to sustain a
vibrant life including a home independently in the community and free of domestic
violence.
Program Manager: Responsible among other things for: hiring, supervision and training
of the Case Management Lead (CML), Case Manager (CM) and the Community Mental
Health Specialist (CMHS); development and maintenance of program and infrastructure
to support the program; creation and execution of a work plan for the program including
evaluation; stakeholder and community relations; performance management of staff,
reports to Director, Programs and Internal Operations
Case Management Lead: Responsible for accepting, screening and tracking referrals;
assigns cases to CM and CMHS based on client needs and case load management;
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8. liaise with RE/CUPS around program/service issues, supervise day to day activities of
CM and CMHS; comprehensive files reviews; coordination of client supports such as
rental subsidy program, bus tickets, grocery vouchers; reports to Program Manager
Case Manager: Responsible for systems navigation, advocacy, coordination and
communication between all service providers and the client. CM must balance service
provision and systems navigation with short term, medium term and long term strategies
to end homelessness. Seven Core Functions of CM: intake, assessment, planning,
referral and linking, advocacy and evaluation of case plan and transition including but
not limited to: obtaining rent subsidy, and other financing resources, secure immediate
basic needs, coordinate action plans of multiple community agencies, case reviews and
mediations between landlord and tenant. The CM must have experience and solid
understanding of domestic violence and homelessness. Report to Program Manager
Community Mental Health Specialist: Responsible for assessment and intervention
plan to assist client in the management of mental health issues and addictions. 72% of
clients have Axis 1 diagnosis of depression and anxiety; 59% have active addictions and
23% have concurrent disorders. CMHS initiate and track referrals into longer term and
specialized treatment options. Collaborate with community agencies to support clients in
the community.
*Housing Locator: Locate safe and affordable housing. Establish a relationship with the
landlord and put a letter of agreement in place between landlord and CUPS/RE [cover
damages to unit]. Completes move in inspection, lease signing with client [and case
manager] maintains regular communication with landlord and case manager, addresses
any tenancy concerns to CM, arrange moving assistance and tenant insurance and
security deposit and first months rent if necessary.
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9. Slide 7
Forms
Case Managers: Intake, Release of Information,
Participation Agreement, Liability, Danger
Assessment, Safety Plan for child and mother,
Housing Information Sheet, Temporary Subsidy
Agreement
Community Mental Health Specialist: assessment
and screening, counseling consent, Q45, no
harm contract, substance use safety plan
*3, 6, 9, 12 and 18 month evaluation
Case Managers Forms
At Intake: Intake, Release of Information, Participation Agreement,
Liability/Authorization-review Danger Assessment and Safety Plan completed by shelter,
Housing Information Sheet completed after intake and faxed to Rapid Exit within 24
hours, Temporary Subsidy Agreement if required.
Once Housed: Danger Assessment, Safety Plan, Child Safety Plan, Family Action
Plan-with 10 working days
Ongoing: 3,6,9,12 &18 month evaluation
Community Mental Health Specialist Forms
At Intake: Intake [mental health assessment] and Screening, Release of Information,
Counselling Consent,
*Q45: Q45 measures client’s life across 3 domains of functioning:
Symptom Distress: includes items that assess common intra-psychic problems such as
depression anxiety and substance use
Interpersonal Relations: includes items that assess satisfaction with, as well as problems
in interpersonal relations such as friendships, family and marriage
Social role: include items that assess the clients’ level of dissatisfaction, conflict, distress
and adequacy of functioning related to employment, family and leisure life.
flags suicidal and homicidal ideation
Q45 administered every 2 months. Clients demonstrated an improvement in all areas
over time. The areas of depression and anxiety remained the highest across time even
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10. with improvements in other areas. Indicates the importance of remaining engaged for at
least one year.
As Required: Substance Use Safety Plan and No Harm Contract,
*Working on the development of an acuity scale.
Slide 8
What We
Have Learned
• There is another option available to safely
help women and children out of domestic
violence
Greatest impact on women with
unmanaged or previously undiagnosed
mental health issues and addictions
Supports the cultural needs of aboriginal
clients
New Option Created for Women With Children Fleeing DV
The Community Housing Team and Rapid Exit housed and supported 78 women and
209 children in 10 months. Discovery House second stage shelter houses on average 60
women and 100 children in a year. Fifty-two per cent (52%) of the rapidly rehoused
women were aboriginal and 26% were immigrants. Twelve women self-selected out of
the program at intake for fear that they could not be adequately protected in the
community. Of the women served 72% had Axis 1 diagnosis of depression and/or
anxiety and 59% had addictions with 26% having concurrent disorders. Housing
retention was 86%.
Discovery House as with all Calgary second stage shelters cannot and do not take into
residence women with unmanaged mental health conditions or addictions. Discovery
House primarily shelters immigrant and refugee women who due to multiple barriers,
including war trauma and higher safety concerns, stay longer in residence with the result
that limited shelter space becomes ever more limited.
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11. The needs of aboriginal women are better met in the community housing program. The
composition of aboriginal families changes consistently. It is common for mothers,
uncles, aunts, siblings, and children etc to move in and out of the family constellation.
Shelter living does not accommodate these kinship patterns. Aboriginal families have
significant adjustment challenges moving out of the communal reserve style of living to
the city which means they will go back and forth from the city to the reserve while they
adjust. Shelter living does not support this process.
Women from the Community Housing program with active mental health conditions
required 3-6 months time to respond to therapies and medication. This is a barrier to
transition and success in the community. CMHS are critical to ensuring the woman is
connected to mental health resources immediately and able to manage in the community
while awaiting longer term services. Getting in to see a psychiatrist or counselor can
take months. CMHS provides interim support and intervention while the client waits for
longer term resources. Both CM and CMHS work with the client to build/rehabilitate
community relationships with service providers who will continue to support the client
and their family long after we are gone.
The majority of women served would not have lasted one week in a traditional second
stage shelters and some were women who had been barred from emergency shelters.
They are the abused women who couch surf or live in homeless shelters because they
do not or cannot go into typical women’s shelters. Yet, they were successful at
remaining housed in the community with intensive wrap around service. The program
had an 85% retention rate.
Slide 9
11
12. What We
Have Learned
• Depart from the model:
Case managers and mental health
specialist begin to work with the client prior
to housing
Within weeks we learned that CM and CMHS had to begin to work with our clients prior
to their being housed because there were so many complexities that were immediate
barriers to housing. Most of our clients come with a “cast of thousands”. Service
providers already in the client’s life come with their own agenda and action plans, often
times in conflict with each other. These same service providers are often not familiar with
the dynamics of homelessness and domestic violence. It is necessary to begin to
coordinate multiple service providers immediately and to obtain concrete benefits for the
client to begin the re housing process. Case examples:
a) Client A has all three children apprehended by Children’s Services due to
homelessness and domestic violence. The children would not be returned until she had
safe shelter for the family. Alberta Works [welfare] would only provide her with funding
for a single person preventing her from being able to secure affordable housing for her
and the children. The case manager liaised between the two agencies and was able to
persuade the welfare system to commence family funding immediately for the client to
expedite the return of the children. The case manager coordinated a large case
conference to ensure adequate support services were available for mother to address
addiction concerns that would also prevent the return of her children. The woman
remained housed; children are with her, addictions are under control.
b) Client B has no immigration status and is not eligible for any social assistance or
rental subsidy programs. Her English is limited to non-existent. She has a severely ill
new born that will require ongoing intensive medical treatment. Children’s services are
involved because her drug addicted abusive partner kidnapped the newborn. The client
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13. suffers from post partum depression. The CM and CMHS became involved immediately
arranging a case conference at DH with 8 service providers in attendance including
Children’s Services, the newborn’s doctor, community health, hospital social worker, a
settlement worker, a member of the client cultural community, her faith community and
the CM and CMHS.
A Settlement House was persuaded to house the woman and her newborn in an
apartment at their own expense while immigration issues continue to be resolved.
Necessities of life are provided, the newborns complex medical needs continue to be
addressed, the depression resolved, the immigration issues are nearing completion.
CHT remains involved.
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14. Slide 10
What We
Have Learned
• Women feel empowered by living in the
community
• Danger Assessment scores were high
• Strategies for keeping women safe
• Reduced costs of security to the
organization
Only three women in the community housing program required rehousing for safety
reasons. Twelve women interviewed self-selected out of the program for safety reasons.
The Danger Assessment (Dr. Jacqueline Campbell, John Hopkins) scores for women in
the shelter and women in the community for the same period of time were on average
identical and in the highest category of danger. The Danger Assessment assesses the
lethality of the relationship verses global danger or risk of re-assault.
Applicants for community housing and second stage shelters are fairly homogenous in
that they come from a typology of coercive and controlling intimate partner violence.
Coercive controlling intimate partner violence is one of the strongest indicators of
lethality. Women in the community housing program appear to be able to keep
themselves safe with strategies and support provided by the case manager.
Safety planning is done within days of being housed with women and children. The
Calgary Police Service will flag the files of our community clients the result of which is
any 911 calls from their number and address become a priority response for the police
(POVI). Alarm systems will also be installed if necessary. Housing is often in secured
buildings. Women are at the greatest risk of being killed within the first year of
separation. The best indicator of the danger a women and her children are in comes
from the subjective belief of the women herself and in the face of a woman’s perception
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15. of fear and a low danger assessment score the women’s perception should be
determinative.
The differences in the hard costs between secure second stage sheltering and
community housing are still being measured. Discovery House is the most secure
women’s shelter in southern Alberta. Security costs us upwards of $150,000.00 per year.
Anecdotally, we are advised by our clients that it is empowering for them feel like they
can manage their lives in the community verses having to “hide out” in a shelter. For
women and children who must be in a shelter they report feeling safe from harm as one
of the best features of shelter living. Clearly having multiple options for these families is
critical.
Slide 11
What We
Have Learned
• Sharing expertise gave us a bigger pie
• Twice the number of families served
• Added to expertise and resources
• Best practices shared
• The union of two large well respected
community serving communities
• Imitation is the highest form of flattery
Partnering with a homeless serving agency added a great deal of value to our
organization and the domestic violence sector generally. As a domestic violence serving
agency we were able to serve twice the number of families without building a new
facility. We were able to expand the options available to a new population of families
fleeing domestic violence. Information and skills from the homeless serving community is
value added to our knowledge and skill base the result being a more nuanced approach
to service delivery and a higher quality of service to our clients. We have learned there
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16. are more similarities than differences between victim of domestic violence and homeless
populations. We have shared best practices and resources that have saved us time and
resources i.e. Calgary Homeless Foundation used the Code of Ethics created by
Discovery House and in return shared research on case management best practices.
Three years ago the domestic violence sector resisted the concept of connecting to the
homeless community for fear the issue of domestic violence would be subsumed under
homelessness and women would not be safe served by the housing first model. The
homeless serving agencies and in particular the Calgary Homeless Foundation has been
particularly ethical and respectful of acknowledging the importance of keeping the issue
of domestic violence front and centre. The very act of the Homeless Foundation coming
to the shelters to lead a homeless project was the essence of ethical practice and
respect. Homeless serving agencies have embraced domestic violence best practices
and supported the focus on safety.
The domestic violence sector has greatly embraced rapid rehousing practices to the
point where many shelters now have their own rapid rehousing services. One of the
largest emergency shelters in Calgary presented an award to Discovery House and
Rapid Exit for innovative community programming that moves women and children out of
domestic violence.
Slide 12
What We
Have Learned
• Children’s services required
• 209 highly traumatized behavioral children
in crisis
• Scarcity of community services with long
wait lists
• Child mental health = long term positive
family outcomes
16
17. A total of 209 children were served by the Community Housing Rapid Exit teams.
82% of these children were under the age of 10, in crisis and with special needs
including ADD, ADHD, chronic medical conditions, most were developmentally
delayed and nearly all were behavioral. There is a distinct shortage of community
services for these children and the wait lists are long. Supporting these children
supports their mother and enhances the likelihood of her remaining in the
community. While Case Managers and Community Mental Health Specialists do
their best to meet the needs of these children the complexity of their needs
requires skilled child mental health specialists. We anticipate adding this role to
the team in future.
It is critical to support the children of homeless and at risk parents achieve their
milestones and avoid cross generational repetition of addiction, mental health
problems and family instability. Long term positive outcomes for families can be
achieved if these hard to access services are provided by the program either in
house or through community partnerships [child care services, school based
programs, medical and dental programs].
Slide 13
Where to?
• Keep a foot in both streams of service
• Learn form our experience
• Inform best practices in the homeless and
domestic violence sectors
• Neurosequential model of practice
17
18. Discovery House will continue to offer rapid rehousing services for women and
children who wish to move directly into the community. We will also continue to
offer transitional shelter for women who feel they need the support of a
residential setting. We have the luxury of having a program evaluator and
researcher on staff and are committed to learning more about the differences
between women and children who “do well” in both settings. We expect that
having a foot in both streams will inform our best practices.
We are in the process of integrating the neurosequential model of practice
[neurobiology and traumatology] into our work with our Community Housing
clients. Individuals chronically traumatized from an early age operate almost
entirely out of their primitive brain. The impacts include: highly sensitive stress
response system, [fight or flight] impulsivity, addictions, relationship impairments,
impaired recall and learning. See the work of Dr. Bruce Perry, Dr. Daniel Seigal,
Dr. Gabor Mate and the ACE Study [conversion of trauma into organic disease
across life span.]
Slide 14
If we can
be of assistance….
• Please contact:
Heather Morley, MA, Program Manager,
Community Housing, Discovery House,
casemanager3@discoveryhouse.ca
Michelle Murray, MSW, LL.B., Director,
Programs and Internal Ops, Discovery
House, clientservices@discoveryhouse.ca
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