1.10 Using Rapid Re-Housing for Survivors of Domestic Violence (Billhardt)
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1.10 Using Rapid Re-Housing for Survivors of Domestic Violence (Billhardt)

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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 ...

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 (Billhardt) 1.10 Using Rapid Re-Housing for Survivors of Domestic Violence (Billhardt) Document Transcript

    • 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?
    • 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 2
    • 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: 3
    • 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 4
    • 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 5
    • 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 6
    • 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; 7
    • 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. 8
    • 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 9
    • 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. 10
    • 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
    • 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 12
    • 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. 13
    • 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 14
    • 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 15
    • 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
    • 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
    • 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 18