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The Home Visit In a Housing First Model

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Bringing Housing First Principles to the Home Visit Graydon Andrus and Margaret King DESC, Seattle, WA – PowerPoint PPT presentation

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Title: The Home Visit In a Housing First Model


1
Bringing Housing First Principles to the Home
Visit
Graydon Andrus and Margaret King DESC, Seattle,
WA
2
Presentation Goals
  • Describe important aspects of the home visit from
    two service perspectives Clinical Case
    Management and Supportive Housing
  • Explore meaning of home and how to use it
    therapeutically
  • Provide clear examples of basic tenets of the
    home visit
  • Illustrate connection between housing first, harm
    reduction and home visit strategies
  • Relate strategies to goal attainment and Recovery

3
Housing First Principles
  • Move-in without preconditions
  • Robust support services/assertive engagement
  • Continued tenancy not dependent tenant
    participating in services
  • Housing units targeted to most disabled and
    vulnerable
  • Embrace harm reduction approach to addictions
    (and other issues)
  • Residents have leases and tenant protections
  • May be implemented as either a project-based or
    scattered site model

4

Home can be a room inside a house, a house
within a neighborhood, a neighborhood within a
city, and a city within a nation. At each level
the meaning of home gains in intensity and
deptha place of security within an world, a
familiar place within a strange world,a place of
autonomy and power. -Kimberly Dovey
5

We shape our dwellings and afterwards our
dwellings shape us. -Winston Churchill
6
If we close our eyes, take a deep breath, and
summon meaningful memories, we quickly notice
that they are tied to a specific place. -Sarah
Robinson

7
Homea place of security in an insecure world, a
familiar place in a strange world, a place of
autonomy and power.
Judy and Pam
8
Environmental Psychology
  • New image

9
Open and free, yet sheltering as a nest. -May
Sarton We depend on meaningful places

10
My mind is not so clear when my place is
messythats why I have a cleaner come in. -Mark

11
Why home visit?
12
Benefits of Home Visit
  • Helps build or restore clients experience of
    home as place of solace and power
  • Opportunity to leverage these benefits in service
    of other goals (including ADLs)
  • Opportunity to shift power dynamic a bit

13
Role of the clients home in the service
relationship
  • Represents new possibilities
  • Meeting in the home helps embed positive
    associations in it
  • A little fanfare goes a long way- encouragement
    and pride of place

14
Single Site Housing First
  • The neighborhood
  • The building environment
  • The unit
  • The staff and neighbors

15
Close but safely distant
  • Staff play multiple roles
  • Services are robust but voluntary
  • Tricky boundary balancing
  • Housing staff and outside program staff have
    complementary roles- but takes deliberate
    attention and refining to optimize

16
Co.nun.drum Noun a confusing and difficult
problem or question
  • Hoarding
  • Safety/harm reduction
  • Logistics of service partnering

17
Listen to the environment

18
Unit inspections
  • Predictable engagement opportunity, chance to
    assess ADLs and tailor services
  • Reinforces belief that residents deserve a safe,
    sanitary and friendly home
  • Asset management- required by outside funders

19
Hoarding
20
How much is too much?

21
Compassionate pragmatism tireless creativity
  • Weekly donation run
  • Side-by-side cleaning
  • Cleaning for the client
  • Incentives and rewards
  • Lease enforcement

22
Harm Reduction
  • Evidence of use in unit
  • Sustaining a clinical focus
  • Impact on neighbors
  • When to focus on lease enforcement

23
Purpose of Home Visit
  • Continuous engagement/relationship building
  • Provides continuity of support and treatment
  • Assess/address threats to housing retention
  • Purposeful and goal directed
  • Largely based on consumer stated goals
  • Health care needs?
  • Skill building (medication management, budgeting,
    housekeeping, social, employment related)

24
Clinical Case Management in Housing First
Context The Backdrop
  • Limited knowledge of person
  • Respect boundaries, life rhythms
  • Be ready for surprises
  • Multiple roles as case manager

25
The Backdrop
  • Continual development of relationship
  • Power dynamic shifts
  • Does it feel awkward? Talk about it.
  • Housing context single site/project based or
    scattered sites?

26
Home Visit to Assess The Person
  • How is the person today?
  • Their greeting
  • Clothing
  • State of Alertness
  • Mood
  • Changes from baseline?

27
Case Manager as Anthropologist
  • Be observant, not intrusive
  • Presence of dangerous objects/substances?
  • Risks to community within the building?
  • Neighborly relationships
  • Evidence of interests and pastimes something to
    build on.

28
Collaboration with Supportive Housing Staff
  • Broadens base of support
  • Increased continuity and coordination of care
  • Shared workload
  • Invest time to build a service plan with goals
    that are meaningful to client
  • Establish clear communication practices

29
Collaborating With a Landlord or Property Manager
  • Development of partnership with landlord
  • Educate to reduce stigma promote tolerance
  • Be available at critical times you are an asset
  • Visit client routinely and check in with landlord
    or resident manager
  • Work with tenant to reduce most concerning
    behaviors (drug related, aggression, property
    destruction)

30
Frequency of Visits
  • Variation over time
  • Variable influencing frequency
  • Non-linear process
  • Minimum visits
  • Alternating with office visits? No office
    visits?

31
Therapeutic Opportunities
  • Possibilities in every encounter
  • Brief and woven into the conversation
  • Client driven
  • Motivational Interviewing well suited to
    situation

32
Participant and Staff Safety
  • Does tenant feel safe in room with you?
  • Presence of dangerous objects?
  • History of violence/aggression? Bring a buddy?
  • Meet in common area of building?

33
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