IMPLEMENTING HOUSING FIRST. Practical Strategies and Tools for Service Providers

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Edmund Clarke
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1 IMPLEMENTING HOUSING FIRST Practical Strategies and Tools for Service Providers

2 Why Housing First? Because......housing is a basic Human Right! and...housing or other survival services should never be a reward for treatment compliance.

3 The Seven Guiding Principles 1. Move people into housing directly from streets and shelters without preconditions of treatment acceptance or compliance. 2. The provider is obligated to bring robust supports to the person. These are predicated on assertive engagement, not coercion. 3. Continued tenancy is not dependent on participation in services. 4. Units are targeted to most vulnerable homeless members of the community. 5. Harm reduction approach must be embraced, and recovery at any stage must be supported. 6. Tenants must have leases and protections under the law. 7. Can be implemented in either project-based or scattered site models (and really any setting)!

4 1. Acceptance without precondition Strategy: Eliminate those Barriers! Do you have screening or rule out criteria? Burdensome application fees? Require treatment for program acceptance? Think about why these barriers are in place. What can you do to eliminate them?

5 2. Bring the services to the people Case management or support services on-site Meals and transportation assistance Accessible building designs Strategy: Make partnerships to fill service gaps! Community events or groups on site Medical outreach

6 3. Tenancy is not dependent on service enrollment Are people forced to leave if they don't want mental health treatment? Substance use disorder treatment, won't tend to medical concerns? If so, why? Strategy: Tailor services to the needs of the person. Outreach and engage, don't coerce. Train staff on Motivational Interviewing!

7 4. Offers targeted to most vulnerable Many service providers support people with a wide array of service needs. Are you serving the most vulnerable? What can you do to be inclusive of all, especially those who are most at risk without assistance? Strategies to Try: -Eliminate practices that require a high degree of organization (checking in at specific times, waiting in line, anything that requires first come first served). -Target outreach to those who may not be able to ask for assistance (go to hospitals, streets, jails, shelters or day centers).

8 5. Harm Reduction instead of abstinence only Embrace and support all stages of recovery Tailor your approaches to each individual, wherever they are in their recovery as they define it Remember Harm Reduction isn't Harm Acceptance Provide the tools people need to be safe:partner with programs that can offer this support if you can't (ex. PHRA, needle exchange, etc.)

9 6. Tenants Rights and Protections ly For Housing Providers: Think about how scary it would be to not have the stability of a lease or mortgage... make sure your tenants aren't second-class citizens, they should have all the same protections as any other tenant in your city. Do what you can to minimize the rules and work through instances of lease violations on a case-by-case basis. For other Service Providers: Think about how the services you offer provide a sense of support, safety and security. Do whatever you can to maintain that sense of safety for the people you're serving. Work through instances of rule breaking on a case-bycase basis, and eliminate unnecessary rules.

10 7. Applicable in any housing type For any setting you can: -Advocate for elimination of barriers -Bring services to the people -Target the most vulnerable -Offer tenant rights and protections

11 Applying Housing First Broadly Offer any services without preconditions Individualized, tailored care Target the most vulnerable Harm Reduction orientation

12 Problem Solving Exercise In small groups: Think of some common criticisms you've heard about Housing First, or concerns you may have about implementing within your organization. Be prepared to report out to the group.

13 Were these on your mind? Social Behaviors: isolation, cooperation, communication, hygiene Substance Use: safety, dealing, drug traffic/trade, intoxication Violence: threats, fights, assaults, staff safety Apartment Conditions: cleanliness, hoarding, damages, pests

14 The actual positive impacts of Housing First Meet Cheena

15 FINAL INSIGHTS OR QUESTIONS?

16 LUNCH BREAK!

17 Harm Reduction The model defined What it is What it isn't Direct v. Indirect Overcoming Challenges

18 Harm Reduction is... A set of non-judgmental strategies and approaches which aim to provide and/or enhance skills, knowledge, resources and support that people need to live safer, healthier lives. -Streetworks, 1997

19 The Harm Reduction Approach Focus is on person-directed goals Rooted in unconditional positive regard for the person Values social justice (e.g., housing is a human right)

20 Applying Harm Reduction to all aspects of life Health Finances Mental Health Weight Loss Intimate& Social Relationships Substance Use

21 Harm Reduction Examples in Everyday Life Automobile Use/Abuse: Wearing seat belts Infant car seats Legal alcohol limits for driving Emissions standards Sports: Helmets Penalties Fines

22 Harm Reduction isn't... Passive Anything goes Don't ask, don't tell Enabling A hook to get people into treatment A direct path to abstinence

23 The "enabling" hypothesis (misconception)

24 SIP-2R scores (alcohol problems) In Actuality: Decrease in Alcohol Problems Time (in months) χ 2 (5, N = 94) = 18.93, p=.002 Time: β=.-.10, SE=.04, p=.01 HF exposure (mos): β=.-.26, SE=.10, p=.01

25 Mean number of drinks In Actuality: Decreases in Quantity Over Time Participants drank 8% less during peak occasion with each 3-month time period Typical quantity Peak quantity Time (in months) Typical: χ 2 (5, N = 95) = 25.21, p <.001 Time: IRR=.93, SE=.02, p=.002 HF exposure (mos): IRR=.97, SE=.01, p=.01 Peak: χ 2 (5, N = 95) = 35.48, p <.001 Time: IRR=.92, SE=.02, p<.001 HF exposure (mos): IRR=.97, SE=.01, p=.03

26 BREAK TIME!

27 Direct Harm Reduction Approaches Practices that require participant buy-in

28 Needle Exchange Alcohol Monitoring Methadone or substitution therapy Use reduction Condoms Screens or rubber tubing on crack pipes Getting off bus two stops early and walking Switching timing Paying rent before buying substances Changing use patterns Groups or treatment w/harm Reduction focus

29 Indirect Harm Reduction Approaches Practices that do not require buy-in from participant

30 Medication distribution Case management Education around safer practices Wrap around services Protective payeeships Outreach and engagement Welfare checks (scheduled) MH Court or Drug Court Coordination of primary care Unit inspections/chore services Narcan/naloxone onsite

31 Additional Suggestions for Reducing Risk Changing social patterns of use Switching to marijuana instead of harder drugs Cigarette monitoring Beer/Alcohol monitoring Drinking beer instead of liquor, or light beer instead of regular beer

32 Common Concerns we hear from Staff Approach leads to stress, leads to desire for more rules or structure Continued concerns about "endorsing" substance use How to balance unconditional positive regard vs. acceptance of behaviors Fear of doing the wrong thing

33 Case Study: Tammy 43 years old, spunky, friendly, well known to staff Has dx of schizophrenia, borderline PD, HIV+, addiction to crack/alcohol Engages in sex work to afford drugs Brings predatory people into apartment building Is frequently assaulted on street, at times in building Often refuses to seek medical care

34 What to do? Focus interventions on harm reduction Negotiate visitor agreement Develop safety protocol for when visitors are in the building Have medical staff outreach her on the street or in the building Have condoms readily available to her Outreach and engage, build rapport Other ideas?

35 Small Group Work: In groups of 4-5 talk about positive aspects or concerns you still have regarding Harm Reduction. As a group we'll brainstorm solutions to different problems. Take about 2 minutes per person.

36 WRAPPING UP: WHAT WILL BE NEEDED TO IMPLEMENT A NEW HARM REDUCTION APPROACH WHERE YOU WORK? TOOLS, BUY-IN, POLICY CHANGES... What would you like to commit to today, and what would be helpful in terms of support?

Harm Reduction: Blending Principles and Practice

Harm Reduction: Blending Principles and Practice Presenters Intro Christina Clayton, LICSW, CDP (she/her) Ash Warren, LICSW (he/him) Lisa Grillo, CDP (she/her) Harm Reduction Topics Intro Viewpoints Strategies