2.7 A Review of Addiction and Substance Abuse Programs

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2.7 A Review of Addiction and Substance Abuse Programs

  1. 1. A Review of Addiction and Substance Abuse Supportive Housing Programs 7/12/2010 National Conference on Ending Homelessness Presented by: Cullen Ryan, MA Executive Director Community Housing of Maine
  2. 2. CHOM’s Mission <ul><li>To acquire, develop, own, and maintain quality housing which is affordable for people with low-to moderate-incomes, including people who are homeless and/or have special needs; </li></ul><ul><li>To foster and support additional housing opportunities for people with low-to moderate-incomes, people who are homeless, and people with special needs, through public education and policy development </li></ul>
  3. 3. Characteristics of populations served by CHOM: <ul><li>People who are homeless </li></ul><ul><li>People with low or very low incomes </li></ul><ul><li>People experiencing mental illness </li></ul><ul><li>People with developmental or intellectual disabilities </li></ul><ul><li>People with physical disabilities </li></ul><ul><li>Refugees </li></ul><ul><li>People recovering from addiction </li></ul><ul><li>People living with HIV/AIDS </li></ul><ul><li>People who have been victims of domestic violence </li></ul><ul><li>Homeless Veterans </li></ul><ul><li>People who can’t afford to live near their work </li></ul>
  4. 4. Some Examples of CHOM’s Housing Programs for people in recovery <ul><li>Howe Street – Transitional Housing program for adults who are homeless and dually diagnosed (mental illness and substance abuse). </li></ul><ul><li>Nye Street – Transitional/Permanent Housing program for adults who are homeless and dually diagnosed (mental illness and substance abuse). </li></ul><ul><li>The Landing Zone – Transitional/Permanent Housing program for adults who are homeless Veterans with in recovery from substance abuse/chemical dependency. </li></ul>
  5. 5. Howe Street: Transitional Housing program for adults who are homeless and dually diagnosed <ul><li>Two year transitional housing with focus on sobriety and addiction recovery. Individual apartments. </li></ul><ul><li>All tenants are dually diagnosed with mental illness and substance abuse/chemical dependency. </li></ul><ul><li>Support is offered within the apartments, and at offsite social service agency within a short walk. </li></ul><ul><li>Connections to broader community support including AA, etc., are a significant part of the strategy. </li></ul>
  6. 6. Nye Street: Transitional/Permanent Housing program for adults who are homeless and dually diagnosed <ul><li>Two year transitional housing with focus on sobriety and addiction recovery. SRO/congregate living. </li></ul><ul><li>All tenants are dually diagnosed with mental illness and substance abuse/chemical dependency. </li></ul><ul><li>Support is offered within the apartments, and at offsite social service agency within a short walk. </li></ul><ul><li>Group support is required part of the housing. </li></ul><ul><li>Connections to broader community support including AA, etc., are a part of the strategy </li></ul><ul><li>20% of the units are permanent allowing longer time period of support and role modeling for transitional residents. </li></ul>
  7. 7. Nye Street: Recidivism Rates <ul><li>National Average for substance abuse recovery: </li></ul><ul><ul><ul><li>People who work with a program (AA, substance abuse counseling, etc.) and stay sober: 24% </li></ul></ul></ul><ul><ul><ul><li>People who use no support and stay sober: 2% </li></ul></ul></ul><ul><li>People who live/work in the Nye Street program and stay sober: 60% </li></ul><ul><li>Harvard Medical Center 200(7)? seminar </li></ul>
  8. 8. The Landing Zone: Permanent Housing program for homeless Veterans with disabilities <ul><li>Permanent supportive housing with primary focus on sobriety and addiction recovery. SRO/congregate model. </li></ul><ul><li>Generally tenants are dually diagnosed with mental illness and substance abuse/chemical dependency. </li></ul><ul><li>Support is offered within the apartments, and at offsite VA Medical Center, within a 30 minute drive. </li></ul><ul><li>Connections to broader community support including AA, etc., are a significant part of the strategy. </li></ul>
  9. 9. The Landing Zone: Permanent Housing program for homeless Veterans with disabilities <ul><li>Group/self support is provided within as mandatory part of the housing. </li></ul><ul><li>This program loosely follows the Oxford House Model, where decisions are made by the cohabitants about how to run the house, address relapse issues, etc. </li></ul><ul><li>Support is offered within the building, and at offsite VA Medical Center, within a 30 minute drive. </li></ul><ul><li>Connections to broader community support including AA, etc., are a part of the strategy. </li></ul>
  10. 10. The Landing Zone: Permanent Housing program for homeless Veterans with disabilities <ul><li>Residents have “voted people off the island” following relapse when behaviors destroyed trust, and allowed people to return when detox/recovery was sought earnestly. </li></ul><ul><li>Code of Silence: Biggest problem has been overcoming tendency towards closed enmeshed environment where relapse has been kept secret (initially). Homeless Vets tend to want to solve things themselves individually or as a group. Confronting relapse is frequently seen as betraying confidence. </li></ul><ul><li>Steady group support from external sources is necessary to overcome closed system issues. </li></ul><ul><li>Pursuit of further education and gainful employment has been a secondary gain. </li></ul>
  11. 11. Some Examples of CHOM’s Housing Programs for people in recovery: Observations <ul><li>Group support is pivotal to success. It is enhanced by natural support formed by sharing a building or household, and commonalities rooted in recovery. </li></ul><ul><li>Connections to the broader community, including AA/NA, etc., is consistent with success. </li></ul><ul><li>The longer the stable transition, the more likely permanent stability is achieved. It takes significant time to overcome patterns like substance abuse, and replace them with healthy patterns of utilizing support, being honest and direct, and maintaining sobriety. </li></ul><ul><li>We can help engineer success. </li></ul>
  12. 12. Engineering success: CHOM’s four way “collaborative lean” <ul><li>Designed to create strong, interdependent partnerships with tenants, service providers, and maintenance providers. </li></ul><ul><li>Designed to foster empowerment. </li></ul>
  13. 13. Maintenance Providers : Agree to respond swiftly to maintenance problems and treat tenants with respect to reinforce their sense of empowerment in their home. Tenant : Agrees to take care of the apartment to prevent costly repairs, and alert property managers when maintenance issues arise. Service Providers : Agree to help the tenants apply for housing subsidies, obtain services and supports which can help achieve stability, and help find new tenants when vacancies occur . CHOM : Agrees to develop and maintain good quality units that tenants want to live in, to help the tenants develop a sense of “home”, while at the same time remaining strong financially.
  14. 14. CHOM incentive plan: CHOM pays tenants $500 with no strings attached if the tenant: <ul><li>Stays working with the service provider. </li></ul><ul><li>Sees through securing a rental subsidy and pays his/her share of the rent (30% of income). </li></ul><ul><li>Leaves the apartment in essentially the same condition as found during move in, normal wear and tear excepted. </li></ul>
  15. 15. CHOM’s incentive plan continued <ul><li>Tenant can use the $500 towards college or adult education classes, an automobile, a new security deposit at a more expensive apartment, or anything desired. </li></ul><ul><li>We use the opportunity to explain this program as a means to develop trust and rapport with each tenant so that the tenant begins to see us as an ally, and so the tenant feels invited and welcome to communicate with us. Through communication we can offer flexibility and assistance to them in achieving success. </li></ul><ul><li>We insist that we want them to have everything work properly in their apartment, asking them to call if they experience anything less than excellence in service from our maintenance providers. </li></ul><ul><li>We explain that we know sometimes things come up that can cause problems with paying their rent and that we will work flexibility around payments if they communicate with us. We know that becoming behind on rent can trigger shame and predictions of failure, and that many of our tenants would avoid us and wait for the inevitable – that we would ask them to leave. By predicting this and developing a strategy at the onset, we have been able to be extremely successful at overcoming these hurdles, and engineering success. </li></ul>
  16. 16. CHOM’s incentive plan continued <ul><li>Why do we do this? </li></ul><ul><li>It better fits our mission to support clients with future success than to repair walls. </li></ul><ul><li>We believe that the services are what allow success; the housing allows the services to be delivered efficiently and effectively. If the tenant quits services, we can predict success. We want to encourage the tenant to work with the service provider. </li></ul><ul><li>We know there can be a manifest pattern of negative self-esteem where a tenant who begins to fall behind in rent (which is not unusual), can give up on his/her own success, closing down communication and awaiting eviction and failure. We want that to change decidedly; we want the tenant to feel empowered to assertively communicate right at that juncture when she/he may be about to fall behind on rent. We are happy to work with the tenant to overcome that crisis so that she/he can be back on track quickly and achieve success. Through assertive communication, needs can be met . </li></ul>
  17. 17. CHOM’s internal role as property manager <ul><li>Quality housing, mutual respect, and open communication: </li></ul><ul><ul><li>CHOM ensures that the apartment is in exceptional condition before the tenant moves in. By providing tenants with high quality housing they are more likely to take care of the apartment, report maintenance issues, and pay the rent on time each month. </li></ul></ul><ul><ul><li>CHOM staff take time to introduce ourselves and get to know each tenant on a personal level during the lease signing. CHOM wants the tenant to feel empowered and comfortable communicating in regards to rent payments and maintenance needs. </li></ul></ul><ul><ul><li>CHOM seeks to be responsive to tenant needs to demonstrate that they deserve to have everything in proper working order in their home. Through this, CHOM shows it is dedicated to a standard of high quality homes for all tenants. </li></ul></ul><ul><ul><li>CHOM offers to supply paint and/or gardening materials, etc. for the tenant if they want to personalize their apartment and help them feel empowered in their home. </li></ul></ul>
  18. 18. CHOM’s internal role as property manager <ul><li>Rent and security deposits: </li></ul><ul><ul><li>CHOM monitors rent payments weekly to ensure that tenants are not falling behind. </li></ul></ul><ul><ul><li>CHOM provides flexibility and sets up individualized payment plans as needed so that tenants do not feel overwhelmed if they fall behind on their rent. This flexibility and open communication helps keep people in their housing and provides them with a positive landlord reference for future housing. </li></ul></ul><ul><ul><li>CHOM holds tenants accountable to their payment plan to ensure stable housing and expectations as the landlord. </li></ul></ul><ul><ul><li>CHOM encourages direct deposit for rent payments and offers a $50 incentive for those who establish this. </li></ul></ul><ul><ul><li>CHOM does not require a full security deposit at move in, and typically sets up a payment plan towards this. Even if it is $20/month, we have found a security deposit creates an incentive to care for the apartment as well as a benefit to the tenant upon move-out. </li></ul></ul>
  19. 19. Results from the “collaborative lean” <ul><li>There has been a dramatic reduction in the frequency and cost of damages to units as tenants take more responsibility for maintaining their units and feel empowered to contact the maintenance providers as needed. </li></ul><ul><li>There has been a reduction in tenant turnover as tenants have stabilized in CHOM’s transitional housing. </li></ul><ul><li>Subsidies have been acquired more quickly as a result of the sense of urgency instilled in our service providers. </li></ul><ul><li>There has been an increase in the percentage of tenant rent and security deposits collected. </li></ul><ul><li>Tenants in transitional housing have been transitioning out of their housing and programs after 2 full years with a $500 bonus, a full security deposit refund, and into permanent housing. </li></ul>
  20. 20. CHOM Housing Programs VS. Independent Apartments <ul><li>Support every day </li></ul><ul><li>Reminders of what keeps people healthy and responsible. </li></ul><ul><li>Apartments can be isolating unless interconnected with services and sobriety community. </li></ul>
  21. 21. An Analysis of CHOM’s Supportive Housing Andrew Totman – August 2009 <ul><li>Project Overview: </li></ul><ul><li>Thirty three interviews were conducted with residents at Community Housing of Maine (CHOM) properties across the state. </li></ul><ul><li>Twenty two of these interviews were conducted face-to-face while eleven were done over the phone. </li></ul><ul><li>The interviewer asked a series of six questions probing the residents’ feelings about the quality of their housing, personal stability, access to new opportunities, and goals and plans for the future. </li></ul><ul><li>The interviewer intentionally targeted a wide range of CHOM’s supportive housing projects in an attempt to gather information from as many different vulnerable populations as possible. </li></ul><ul><li>Populations included in the study are homeless refugees, adults with mental illness and substance abuse treatment needs, homeless veterans, and victims of domestic violence. </li></ul>
  22. 22. Homeless Adults with Mental Illness and substance abuse treatment needs: Results <ul><li>Proud of housing 89% </li></ul><ul><li>Feel part of community 100% </li></ul><ul><li>Increase in stability 97% </li></ul><ul><li>Access to new opportunities 83% </li></ul>
  23. 23. Homeless Veterans: Results <ul><li>Proud of housing 100% </li></ul><ul><li>Feel part of community 83% </li></ul><ul><li>Increase in stability 100% </li></ul><ul><li>Access to new opportunities 83% </li></ul>
  24. 24. Summary of Results <ul><li>Data and stories gathered from the project indicate that supportive housing has had a transformative effect on the lives of an overwhelming majority of CHOM’s residents. </li></ul><ul><li>The quality of CHOM’s supportive housing is reflected in the fact that thirty out of the thirty three residents indicated that they were proud of their housing. </li></ul><ul><li>In addition, thirty two out of the thirty three residents interviewed stated that their housing had added stability to their lives. </li></ul><ul><li>Twenty four of the thirty three residents reported that they felt like they were part of a community at their supportive housing property. </li></ul><ul><li>Finally, twenty eight of the thirty three residents noted that they had gained access to new opportunities as a result of having supportive housing. </li></ul>
  25. 25. Conclusions <ul><li>People who experience homelessness have numerous issues underlying their homelessness. Poverty is a common denominator. Housing success depends on stability, relationships, and support with those issues. Success with sobriety appears to be very similar. </li></ul><ul><li>It is the support that allows people success in housing; it is the housing that allows that support to be delivered efficiently and effectively. </li></ul><ul><li>Negative self-esteem and isolation frequently accompany homelessness. Everything we do can positively affect self-esteem, and promote successful communication and productive relationships; these are the antidotes. </li></ul><ul><li>People who have not been successful in housing often require us meeting them where they are at, and adjusting along the way. Flexibility is key, but it must be rooted in relationship to be effective. </li></ul>
  26. 26. Cullen Ryan Executive Director 309 Cumberland Ave Suite #203 Portland, ME 04101 www.chomhousing.org (office) 207-879-0347 (fax) 207-879-0348 [email_address]

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