Bringing Housing First Principles to the Home

Visit

Graydon Andrus and Margaret KingDESC, Seattle, WA

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

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

“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 depth…a place of security within an world, a familiar place within a strange world,…a place of autonomy and power.”

-Kimberly Dovey

“We shape our dwellings and afterwards our dwellings shape us.”

-Winston Churchill

“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

“Home…a place of security in an insecure world, a familiar place in a strange world, a place of autonomy and power.”

Judy and Pam

Environmental Psychology

New image

“Open and free, yet sheltering as a nest.” -May Sarton

We depend on meaningful places

“My mind is not so clear when my place is messy…that’s why I have a cleaner

come in.” -Mark

Why home visit?

Benefits of Home Visit

Helps build or restore client’s 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

Role of the client’s home in the service relationship

Represents new possibilitiesMeeting in the home helps embed

positive associations in itA little fanfare goes a long way-

encouragement and pride of place

Single Site Housing First

The neighborhoodThe building environmentThe unitThe staff and neighbors

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

Co.nun.drum: Noun: a confusing and difficult problem or question

Hoarding

Safety/harm reduction

Logistics of service partnering

Listen to the environment

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

Hoarding

How much is too much?

Compassionate pragmatism: tireless creativity

Weekly donation runSide-by-side cleaningCleaning for the clientIncentives and rewardsLease enforcement

Harm Reduction

Evidence of use in unit

Sustaining a clinical focus

Impact on neighbors

When to focus on lease enforcement

Purpose of Home VisitContinuous engagement/relationship buildingProvides continuity of support and treatmentAssess/address threats to housing retentionPurposeful and goal directedLargely based on consumer stated goalsHealth care needs?Skill building (medication management,

budgeting, housekeeping, social, employment related)

Clinical Case Management in Housing First Context: The Backdrop

Limited knowledge of person

Respect boundaries, liferhythms

Be ready for surprises

Multiple roles as case manager

The BackdropContinual development of relationship

Power dynamic shifts

Does it feel awkward? Talk about it.

Housing context: single site/project based or scattered sites?

Home Visit to Assess The Person

How is the person today? Their greetingClothingState of Alertness MoodChanges from baseline?

Case Manager as AnthropologistBe observant, not intrusivePresence of dangerous

objects/substances?Risks to community within the building?Neighborly relationshipsEvidence of interests and pastimes –

something to build on.

Collaboration with Supportive Housing Staff

Broadens base of supportIncreased continuity and coordination

of careShared workloadInvest time to build a service plan with

goals that are meaningful to clientEstablish clear communication practices

Collaborating With a Landlord or Property Manager

Development of partnership with landlordEducate to reduce stigma & promote toleranceBe available at critical times – you are an assetVisit client routinely and check in with landlord

or resident managerWork with tenant to reduce most concerning

behaviors (drug related, aggression, property destruction)

Frequency of Visits Variation over time

Variable influencing frequency

Non-linear process

Minimum visits

Alternating with office visits? No office visits?

Therapeutic Opportunities

Possibilities in every encounter

Brief and woven into the conversation

Client driven

Motivational Interviewing well suited to situation

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?

Participant and Staff Safety