5.9 Housing the Most Vulnerable Families. Living in Communities: The Power of Housing and Time- Limited Case Management Support

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1 5.9 Housing the Most Vulnerable Families Living in Communities: The Power of Housing and Time- Limited Case Management Support Martha Kenton, Director of Management Services CUCS Institute February 20, 2015 The Universe of Housing Options? Rapid Rehousing Permanent Supportive Housing WHAT ABOUT THE FAMILIES IN THE MIDDLE? 2 1

2 Home To Stay: Foundation-Funded Pilot Project Launched in 2010 Is a partnership between Robin Hood Foundation NYC Department of Homeless Services Center for Urban Community Services Jericho Project and Women in Need Targets chronically and episodically homeless families who return to shelter from subsidized and unsubsidized housing Provides support services targeting families while in shelter and providing individualized, strengths-based case management Uses the evidence-based practices Critical Time Intervention and Motivational Interviewing 3 Home to Stay Pilot Case Management Model & Program Goals Program Model: Services informed by the Critical Time Intervention model goal of moving into permanent housing caseloads of 10 to 15 clients per worker connecting to appropriate community resources attaining housing stability within 9 months of securing housing individualized service plans developed collaboratively with family Program Goals 1.Remain stably housed and do not return to the city s shelter system 2.Connect to community-based resources aimed at maintaining housing stability: physical health, mental health, substance abuse, employment, education, community and social support, legal 3.Increase income to 200% of rent and/or obtain housing subsidy, if eligible and available 4.Exit from service program within 9 months of moving into permanent housing 4 2

3 Home to Stay Pilot Program Results In general, Home to Stay program outcomes are better than standard service outcomes True even when controlling for timeframe and for presence of rental subsidy. Recent shelter Home to Stay entrants had significantly better outcomes than recent shelter entrants receiving standard services. However, older-entry families did not see any statistical difference with housing vouchers and Home to Stay case management. Return to shelter rate is less than 20%. Those families who do return to shelter remain housed for an average of 414 days before re-entry. Levitt, A; Mitchell, K; Pareti,L; Degenova, J; Heller, A; Hannigan, A; Gholston, J; Randomized Trial of Intensive Housing Placement and Community Transition Services for Episodic and Recidivist Homeless Families; American Journal of Public Health; 2013, Vol 103, No. S2 5 Living in Communities - From Pilot to Permanent What s Different? 1.LINC is a city-funded housing voucher managed in a partnership between three separate New York City agencies. Department of Homeless Services (DHS) Housing Preservation and Development (HPD) Human Resources Administration (HRA) 2.Recertification is required to maintain the subsidy 3.Case management services are initiated in shelter or after a family is housed. 4.The 9-month CTI timeline is the same as in Home to Stay, but the length of each phase may change based on the time required for a family to move out of shelter. 6 3

4 Living in Communities - From Pilot to Permanent What makes LINC unique? Home to Stay research pilot became an evidence-based practice for targeting resources to families; now that practice will be broadly applied. Program evaluation was a central element of the pilot design; now integral to program implementation Unique opportunity to transition a foundation-funded pilot into a fully funded city program. Demonstrates creative use of housing dollars for an unmet need by City and State governments 7 Thank You. Living in Communities: The Power of Housing and Time-Limited Case Management Support Presented by: Martha Kenton, MSW MUP martha.kenton@cucs.org The CUCS Institute 198 East 121 st Street New York, NY

5 CTI APPROACH CTI is focused on: strengthening community linkages limiting areas of focus to 2-3 areas essential to making the transition successful gradually transferring care from CTI Worker to community alternative to traditional approach of building skills, by linking the person to community supports that can do so 9 RECENT RESEARCH & APPLICATION OF CTI: CTI Task Shifting (CTI-TS) Study: Galea & Susser, A multicountry pilot in Rio de Janeiro in Brazil, Santiago in Chile, and Buenos Aires in Argentina includes both mental health & peer support workers to improve quality of life and reduce unmet needs. CTI-Hoarding Disorder Study: Rodriguez, Aim of study to test whether the adapted CTI-HD reduces the risk of homelessness for people with hoarding disorder who have been threatened with eviction. CTI Netherlands Shelter Study: Wolf, Two randomized trials - 1. assessed effectiveness of CTI in improving housing and other outcomes in people from nine adult homeless shelters. 2. The Women s Shelter Sector Trial assessed the effectiveness of CTI in improving quality of life in women from eight domestic violence shelters. 10 5

6 RECENT RESEARCH & APPLICATION OF CTI: CTI for Severely Mentally Ill Released Prisoners, Trial at three prisons in Manchester, Leeds and Brixton to test the effectiveness of CTI in improving engagement with services and reducing re-offending. CTI for Men with Mental Illness Leaving Prison PI, Tested effectiveness of CTI in preventing re-offending and improving community integration. CTI-Intensive Housing Support Program, Carmody, Australia - first time that an agency s electronic medical records were used for generating fidelity ratings. CTI-Brazil, 2010, Test feasibility of implementing adapted CTI for Brazilian context [problems of violence, drug use & unemployment in Rio s favelas are concrete obstacles to continuity of mental health care]. 11 MOTIVATIONAL INTERVIEWING RESOURCES Burke, W. W., Lake, D. G., & Paine, J. W. (2009). Organization change, a comprehensive reader. Jossey-Bass. Chadwick, P., Birchwood, M.J., Trower, P. (1996) Cognitive therapy for delusions, voices and paranoia. Wiley Covey, S. (2013) The 7 habits of highly effective people. Simon & Schuster. DiClemente, J. O. (1991). From preparation to action: Getting started. SAMHSA. Festinger, L. (1997). A theory of cognitive dissonance. The American Journal of Psychology, 110(1), Gordon, T. (2003). Teacher effectiveness training. First Revised Edition. New York: Three Rivers Press. 12 6

7 MOTIVATIONAL INTERVIEWING RESOURCES Hetterna, J., Steele, J., Miller, W.R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, Lundahl, B., Burke, B. (2009) The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses, Journal of Clinical Psychology: In Session, Vol. 65(11), Miller, W.R., Rollnick, S. (2012). Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing). Guilford Press. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing, preparing people for change. The Guilford Press 13 MOTIVATIONAL INTERVIEWING RESOURCES Miller, W.R. (1999). Toward a theory of motivational interviewing. Motivational Interviewing Newsletter: Updates, Education and training, 6(3), 2-4. Rogers, C. R. (1951). Client-centered therapy. Boston, MA: Houghton- Mifflin. Rogers, C. (2003) Client-centered therapy: its current practice, implications and theory, Robinson Publishing. Sobell, L., & Sobell, M. (2008) Motivational interviewing strategies and techniques: Rationales and examples 14 7