Engagement Strategies: Service Delivery in Supportive Housing

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Engagement StrategiesService Delivery in
Supportive Housing

• Joyce Grangent
• Senior Program Manager
• Corporation for Supportive Housing www.csh.org

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Every tenant brings a history, a culture, a set
of expectations and behavior that can be shaped
by such things as

• Criminal histories
• Long-term homelessness
• Development disabilities
• Histories of trauma
• Issues specific to women with children
• Much more!

• Cultural, ethnic, and racial differences
• Gender and sexuality issues
• Mental Health History
• HIV/AIDS
• Other medical issues
• Domestic violence

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What else tenants bring

• Housing history
• Family history
• Spiritual life
• Survival skills
• Social networks and support systems
• Tolerance level for structures and rules
• Behavioral history
• Expectations and Preferences

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A Clash of Agendas

• The Professional Support Person
• Duties and responsibilities
• Product oriented
• Caring (We hope!)

• The Homeless Person
• Multitude of losses
• Depth of mostly negative feelings
• Unique and uniquely acquired strengths

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Resolving the Clash

• Dont create more losses
• Understand the feelings
• Uncover and build on strengths
• Using strategies and techniques
• Harm Reduction
• Stages of Change
• Motivational Interviewing
• Reflective Listening

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Engagement Strategies

• Engagement sets the stage for formal case
  management and treatment sessions where in-depth
  assessments, counseling, and referrals can occur
  on an individualized basis.

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Goals of Engagement

• Care for immediate needs
• Develop a trusting relationship
• Provide services and resources
• Connect to mainstream services and social
  networks to maximize independence
• Helping people stay housed

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Effective Engagement

• Create the proper physical environment
• Respect, accept and support people
• Develop active listening skills
• Let the tenants goals drive the services offered
• Help people make informed choices
• Be consistent with repeated, predictable patterns
  of interaction
• Engagement should be non-threatening

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Effective Engagement

• Effective engagement for people with mental
  health issues
• Effective engagement for people with substance
  use issues

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Engagement is a Process

• Where we introduce tenant to services
  relationship
• Explain our role
• Find common ground to build on
• Engagement is not an event
• Does not happen overnight
• Varies from tenant to tenant

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Creative Engagement Strategies

• For Open
• Friendly
• Listen
• Maintain eye contact
• Keep conversation light
• Respond to humor

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Creative Engagement

• For Closed
• Intrusive
• Talk to much
• Too opinionated
• Lecture
• Analytical
• Demanding

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Engagement for People With Mental Illness

• Enhanced When
• Worker develops shared reality with tenant
• Interaction is consistent
• Worker allows tenant to exercise control in the
  interaction
• Worker communicates his/her role clearly

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Whose Goal Is It

• Orient new tenants
• Provide coordination among service providers
• Develop buddy systems
• Provide individual case management

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Opportunities to Achieve Goals

• Develop case management plan
• Help with skill building
• Coordination of mental, physical and substance
  abuse services
• Assistance with medications and/or doctor
  appointments

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Developing Trusting Relationships

• Professional Relations
• Goal is maintain housing
• Information is confidential
• We must set limits

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In a Personal Relationship

• Different goals with different people
• We can gossip to friends
• We dont have to set limits

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Enhancing Motivation for Change
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Building Motivation for Change

• Build Trust Be consistent, trustworthy and
  honest
• Get to know the person
• Learn to recognize and Identify Emotions/Physical
  sensations of anxiety
• Define the helping relationship

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Working With Ambivalence and Resistance

• Reactance Theory helps to predict how people
  respond to the perceived loss of valued freedom
• Reactance Theory states that it is natural for
  people to try to maximize control and choice

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Why Tenants May Be Resistant

• Afraid staff will tell them what to do
• Dont want to be controlled or lose the right to
  make choices
• We view resistance as negative and part of
  tenants illness
• Tenant is trying to maintain their
  independence/freedom

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When Working with tenants Who Is Resistant

• Avoid telling tenant what to do, instead present
  options
• Explore both sides of an issue, one-sided focus
  increases reactance
• Address one problem at a time-partner with tenant
  to set priorities and timelines for addressing
  them
• Work with tenant where they are along spectrum of
  change

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What if this is not working?

• Steps to consider before terminating your clients
• Discuss with Colleagues and Supervisor
• Talk to clients about consequences/alternatives
• Is there a way to negotiate the dispute?
• Remember this is the only way for our folks to
  get
• permanent housing

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Roadblocks to Listening

• Directing- Do it this way
• Warning- Creates fear or submission
• Making suggestions-Tenant is not competent or
  judgment is not trusted
• Persuade with logic- you need to stop drinking,
  or you may damage your liver
• Shaming-Do you really want others to see you like
  this

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Motivational Interviewing

• Motivational Interviewing - is a way to get
  tenants to recognize and do something about
  problems
• Useful with tenants who - are reluctant to change
  and ambivalent about ability to change
• Intended to help resolve ambivalence and get
  tenant moving on path to change
• Staff acts as change agent

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Five Basic Principals To Motivational Interviewing
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Express Empathy

• Accurate Empathy
• Not identifying with tenant instead seeks to
  understand what the tenant is saying without
  being judgmental, criticizing or blaming .
• Acceptance lowers defenses and make tenant more
  open
• Trying to make tenant change creates resistance
  and refusal

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Develop Discrepancy

• Listening patiently can help tenant see the
  discrepancy between their present behavior and
  goals
• Gaining insight into discrepancy can help gain
  motivation to change (must remember what is said)
• It should be the tenant who begins to fell safe
  enough to voice concern

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Avoid Argumentation

• Avoid expert trap
• Arguing leads to negativity
• Destroys alliance
• Increases defensiveness.

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Roll With Resistance

• Resistance is not bad.
• Its normal and we should expect it
• Go with it and dont get into power struggle
• It gives insight to guide our work

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Support Self-Efficacy

• Hope, optimism and self esteem are needed for
  change
• Plant seed of believability
• Reframe failures
• Lets figure out what didnt work

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Life takes on meaning when you become motivated,
set goals, and charge after them in an
unstoppable manner.

• Les Brown

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CSH Tools and Resources
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CSH Resources

• CSH website www.csh.org
• Institute website www.csh.org/IL/institute
• CSH Publications www.csh.org/publications
• Not a Solo Act
• Developing the Support in Supportive Hsg
• Toolkit for Developing and Operating Supportive
  Housing www.csh.org/toolkit2