6.7 Intensive Service Interventions for People with Disabilities

Intensive Service Interventions for People with Disabilities: Helping Families Stabilize & Thrive 2011 National Conference on Ending Family Homelessness Devra Edelman Director of Programs Hamilton Family Center February 11, 2011 [email_address]

Overview:
Who are Intensive Service Interventions for?
Targeting services
Where are Intensive Service Interventions Provided
Program Types
How are Intensive Service Interventions Provided?
Core Philosophies
What are Intensive Service Intervention models?
Promising Practices
Intensive Service Interventions for People with Disabilities: Helping Families Stabilize & Thrive

Circumstances:
History of Homelessness
Housing History
Credit / Debt History
Immigration Status
Young Head of Household
Current or Past Involvement in Child Welfare
Past Institutional Care
Recent Traumatic Life Event
Challenges:
Mental Health Issues
Substance Abuse Issues
Physical Disabilities
Chronic Health Issues (including HIV/AIDS)
Intensive Service Interventions for People with Disabilities: Helping Families Stabilize & Thrive WHO are Intensive Service Interventions For?

Family Needs identified through in-depth application and assessment process, including:
Service provider referrals,
Family interviews,
and the use of an assessment tool, such as HFC’s Housing Assessment Matrix (HAM).
Housing Options / “Fit” May be:
Market Rate Housing
Short-term Rental Assistance
Medium-term Rental Assistance
Affordable Housing
Deeply Subsidized Housing
Transitional Housing Program
Permanent Supportive Housing
Assessment Indicators include:
Income level
History of Homelessness
Housing options
Lease History
History of Evictions
Age of Primary Caregiver
Mental Health History
Substance Use
Criminal Justice Barriers
Temporary Financial Strain
Recent Trauma
Child Welfare History
Education Level
Work Experience
Work Inhibiting Disabilities
Income Plans
Family Composition
Transportation Barriers
Child Care Barriers
Income Sources
Intensive Service Interventions for People with Disabilities: Helping Families Stabilize & Thrive Assessing Needs / Program Fit

Assessment & Targeting Transitional Housing or Permanent Supportive Housing?
TRANSITIONAL HOUSING:
Possible indicators for TH can include:
History of homelessness: Episodic
Lease History: Primary caregiver has never held a lease in his/her name
Need for outpatient mental health services in past 12 months;
Recently completed substance abuse program and/or self-identified substance abuse; need for outpatient recovery / maintenance
Age of primary caregiver: Young head of household , 18-24 w/children or pregnant
Household member has experienced issues related to domestic/intimate partner violence in past 12 months
Child Welfare: Household has involvement w/child welfare in past 12 months
Household has children currently separated from family by CPS, reunification is planned; or family has reunified in last six months
Education Level: No adults in household have a high school diploma or equivalent
Criminal Background : An adult in the household has been arrested or convicted of a felony
One or more adults in the household cannot work 30 or more hours /week because of childcare needs ;
PERMANENT SUPPORTIVE HOUSING:
Possible indicators for PSH can include:
History of homelessness, meets definition of chronic homelessness
History of evictions : two or more evictions on their record or an eviction from a previous permanent supportive housing placement
Mental health services: Inpatient treatment within past 12 months
Substance abuse services: Inpatient, intensive outpatient, or detox treatment within last 12 months or untreated substance abuse
Work experience : No adults have worked 30 or more hours a week in the past three years
Work inhibiting disabilities : Inhibits client from working 20+ hours per week
Criminal Background : An adult in the household has been convicted of a felony
Other possible considerations can include recent DV, recent involvement w/CPS
Network of support

Housing Assessment Matrix (HAM) Tool: Strategically targeting resources to maximize opportunities for homeless families Housing Assessment Matrix: http://hamiltonfamilycenter.org/ latest-news/promising-practices/

Intensive Service Intervention Components
“Therapeutic” Housing:
Direct therapy services
Therapeutic Consultation for Staff
Wrap-Around / Collaborative Services
Linkages among Housing, Services and Supports
Parent-Child Interaction / Family Focus
Children’s Programming / Enrichment
Intensive Case Management
Safe Environment (Physical & Emotional)
Individualized Family Action Plan
Choice within Structure

Core Philosophies for Providing Intensive Service Interventions Housing First Harm Reduction Trauma-Informed Services

Housing is a basic human need and right
Families are more responsive to intervention and social service support once in permanent and stable housing
Everyone is valuable and capable of being a valuable resident and community member
Outreach should be targeted to reach the most vulnerable
Residents, property managers, and service providers should work together to integrate services into housing
Client focused services
Move homeless families into permanent, affordable housing
Rapidly
Time-limited, home-based support services
Housing First

Shelter Services
Short-term Crisis Intervention and stabilization
Linkages and referrals
Advocacy
Assessment and Service Plan: short and long term goals and objectives
Employment Services
Money Management
Housing First
Housing Services
Targeted Housing Assessment
Linkages and referrals to housing resources
Spending Plan and budget
Move-in assistance
Home-based Support Services
Eviction Prevention

Trauma Informed Services
To be a “trauma-informed” provider is to root your care in an understanding of the impact of trauma and the specific needs of trauma survivors.
Avoid causing additional harm to those we serve / re-traumatizing clients.
Help clients on their path to recovery.
Becoming trauma-informed means adopting a holistic view of care and recognizing the connections between housing, employment, mental and physical health, substance abuse, and trauma histories.
Providing trauma-informed care means working with community partners in housing, education, child welfare, early intervention, and mental health.

Trauma-Informed Services
Trauma-informed
Problems/Symptoms are inter-related responses to or coping mechanisms to deal with trauma.
Shares power/Decreases Hierarchy. Homeless families are active experts and partners with service providers.
Primary goals are defined by homeless families and focus on recovery, self-efficacy, and healing.
Proactive – preventing further crisis and avoiding re-traumatization.
Understands providing choice, autonomy and control is central to healing.
Traditional Approaches
Problems/Symptoms are discrete and separate.
Hierarchical.
People providing shelter and services are the experts.
Primary goals are defined by service providers and focus on symptom reduction.
Reactive – services and symptoms are crisis driven and focused on minimizing liability.
Sees clients as broken, vulnerable and needing protection from themselves.
Adapted from L.Prescott via K. Guarino

Harm Reduction
Focus on reducing the personal and societal harm created by substance use.
Policies based upon on behaviors rather than substance use
Goal to foster and encouraging lasting therapeutic change
Non-judgmental, non-coercive provision of services and resources
Meet people “where they are at”
Motivate change in a collaborative, empathic environment.

Promising Practices: Early Childhood Mental Health Initiative / Therapeutic Alliance for Children
Objective:
To provide onsite, accessible, culturally competent mental health consultation to homeless and formerly homeless families and their young children, as well as to the staff providing services. Includes a mix of direct treatment and consultation services that meet the needs of children, parents, and program staff.
Services include:
Mental health support and education for parents
Onsite individual and group mental health treatment for children and their parents
Child Developmental Screening (ASQ and ASQ-SE)
Training, case consultation, and emotional support for program staff
Program consultation
Outreach and referral

Mental Health Initiative Improves Homeless Children’s Emotional Well-Being ** p < .05 * P <= .06 The DPH Child Care Screening Tool, used as an outcome measure supports the decrease in Internalizing problems (Withdrawn and Emotional Reactivity), and also suggests changes in the Externalizing problem of Attention Deficit-related problems.

Program staff feel more confident working with clients How would you rate your skills dealing with [children/ parents] with mental health problems? Highly skilled Not skilled at all Before consultant After consultant Before consultant After consultant Both changes represent statistically significant gains

Partnership with the Court System
Collaboration with Dependency Drug Court and Behavioral Health Court prioritizes child welfare / substance abuse and behavioral health / criminal justice referrals
Up to 10 DDC and 5 BHC referred families accepted in the program at any given time.
Other referrals continue to be accepted
Emergency Shelters
Domestic Violence Programs
Treatment Programs, etc.
From 2008 through 2010, 80% of the families who entered the program had histories of child welfare involvement, substance use, mental health or other specialized needs (39 out of 49).
28 of these families had CPS involvement, 17 of whom were referrals from DDC (16) or BHC (1).
Promising Practices: Family Transitional Housing - Collaborative Justice Partnership

Promising Practices: Family Transitional Housing - Collaborative Justice Partnership
DDC / BHC Key Service Components
Increased Judicial Supervision
Integrated team provides support and wraparound services
Intensive Case Management
Supportive, but Structured Environment
Accessible, appropriate treatment services
Relapse Support
Coordinated Responses to Family Needs
Substance Abuse Treatment
Behavioral Health Services
Parenting Support
Housing

Promising Practices: Transitional Housing – Collaborative Justice Partnership ATTORNEY’S AND COUNSEL Policy Counsel – City Attorney Parent’s Attorney TREATMENT PROVIDERS Outpatient Services INTENSIVE SUPPORT SERVICES Homeless Prenatal Program Team Manager Case Manager CHILD AND FAMILY SERVICES Protective Services Worker COLLABORATIVE JUSTICE COURT: Commissioner Coordinator Court-Appointed Social Worker TRANSITIONAL HOUSING PROGRAM Case Manager / Housing Liaison Therapist Children’s Programming Developmental Screening Parent Education

Contact: Devra M. Edelman Director of Programs Hamilton Family Center 415-409-2100 x122 [email_address] www.hamiltonfamilycenter.org

6.7 Intensive Service Interventions for People with Disabilities

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