contra costa county self-sufficiency matrix project case manager training october 29, 2007
TRANSCRIPT
Contra Costa County Self-Sufficiency
Matrix Project
Case Manager Training
October 29, 2007
What Is the Matrix?
• The Self-Sufficiency Matrix is a tool designed to be used by program staff to strengthen the quality of services provided.
• The Matrix is designed to give an overview at a point in time of the level of challenge each client is experiencing in areas in which the client is in crisis and the level of power the client may have in areas in which they are thriving.
Purpose of the Matrix
• The Matrix is designed to assist the Case Manager:
In identifying areas of concern that may be impediments to the client achieving stabilization; and
In developing the client’s individual service plan.
Purpose of the Matrix
• The Matrix is designed to assist the Agency:
In identifying repeated areas of concern that may prove to be obstructions to clients and assisting in the development of resources or techniques targeting these areas of concern;
In identifying case load capacity for each Case Manager at any point in time, thereby facilitating the assignment process of new clients;
In evaluating overall service provision; and In case conferencing.
Purpose of the Matrix
• The Matrix is designed to assist the Continuum of Care:
In collecting data; By becoming one of many tools used in evaluating programs;
In identifying providers’ best practices; In identifying technical assistance needs; In maximizing efficiency and effectiveness of programs; and
In identifying areas in the continuum that are lacking or insufficient.
Introduction to the Matrix
Introduction to the Matrix
• The Matrix is designed as a measurement tool, similar to a thermometer, to be used in assessing factors that influence the lives of clients.
• The tool is used best when gauging the stress or lack of stress in accessing resources or addressing challenges.
Introduction to the Matrix
• The Matrix allows you to take the “temperature” of your client on 20 different issues, called domains.
• Domains include: Housing Rental History Food Health Care Health Mental Health Substance Abuse Income Credit Employment Life Skills Legal Child Custody Childcare Mobility Community Involvement Adult Education Children’s Education Family Relations Identification
Introduction to the Matrix
• For each Domain, you will give the client a score of 1-5 with: 1 indicating the client is thriving in that area, 3 indicating the client is stabilized in that area and
5 indicating the client is in crisis in that area.
• If a Domain is Not Applicable to your client (e.g. childcare if the client does not have children) or you do not know and cannot find out your client’s status in that Domain, you would give the client a zero for that Domain.
Using of the Matrix
• The objective of using the Matrix is not to ‘rate’ our clients but to provide a professional subjective measurement of the level of crisis the client is experiencing or how the client is thriving at a specific point in time.
Using the Matrix
• The Matrix will not replace traditional activities but will be used in conjunction with current methods of assessment and evaluation.
• The Matrix cannot be inclusive of all particular issues or concerns that arise for any individual client.
• No one fits exactly into any particular classification.
Matrix as a Case Management Tool
• When you complete the Matrix with your client, it can be an easy visual way for you and your client to see which areas are causing the most stress in your client’s life.
Using the Matrix To Create an Individual
Service Plan• Having completed a Matrix, you and your client can create an Individual Service Plan that addresses all of your client’s needs.
Completing the Matrix
• A Matrix should be completed on the following clients:
For Interim Housing/ Emergency Shelters: every adult client
For Multi-Service Centers: every adult client who is receiving case management services
For Transitional and Permanent Housing: every adult client
• For households with more than one adult, a Matrix should be completed on every adult in the household.
Completing the Matrix
• The Matrix should be completed with the client present. If this is not possible, the case manager may decide to complete the matrix without the client present.
Matrix Completion Schedules
• For all programs, a Matrix should be completed on each client as soon as is reasonable but in any case, within 30 days of entry.
• In addition, a matrix should be completed: For Interim Housing/ Emergency Shelters: at exit
For Multi-Service Centers: at exit For Transitional Housing: every six months and at exit
For Permanent Housing: every twelve months and at exit
Matrix and Returning Clients
• For returning clients, the same Matrix should be used if the individual returns while the case file is still open at the agency. If the case file has been closed, a new Matrix should be completed.
Completed Matrix Documents
• The Matrix is a screen in the HMIS, and should be completed in the HMIS as will be discussed at a later training.
• It is acceptable to complete a “paper” Matrix and then transfer the answers into HMIS.
• The documents may be used to calculate the Case Manager’s case-load capacity and to chart the overall effectiveness of services by incorporating progress factors and final outcomes to assess program results.
The Matrix
The next section of the training is about the Matrix itself.
Filling Out the Matrix
• Looking at the Matrix….• If a domain doesn’t apply to your client, enter a zero.
• To find the current status average, add all 20 domains and divide that number by the number of domains that you scored from 1-5 (that is, the number of relevant domains).
• If you use the electronic version of the excel document, it will do the math automatically, you just need to enter how many domains were relevant to your client.
Matrix Categories
• There are two different types of domains in the Matrix: Resources and Issues.
• Resource domains apply to all clients and measurements are gauged according to their level of access to or possession of a particular item.
• Issue domains are not applicable to all clients. However, a client who does not have a connection to a particular issue is generally further removed from Crisis than someone who is dealing with one of these areas.
Resource Domains include:
HousingFoodHealth careIncome (earned or benefits)
EmploymentLife skills
ChildcareMobility Community involvementAdult EducationIdentification
Issue Domains include:
Health Mental health Substance abuseLegalChild custody
Overlapping Resources/ Issues
• Certain domains may overlap both resources and issues and can be evaluated from either or both perspectives.
• Example: Rental history may be a valuable resource to one client and involve complex challenges for another client.
Overlapping Resources/ Issues
• Example: A child’s education may be viewed as a resource in one case (the child now has a stable school, etc). A different client may have a child who requires assessments or is chronically missing school. These concerns for this client will increase the household stress and can impede progress in other areas.
Overlapping Resources/ Issues
•Categories that may overlap issue or resource perspectives include:
Rental HistoryCreditChildren’s EducationFamily Relations
Domain 1: Housing
• Crisis (5) = Homeless or At Risk • Thriving (1) = Paying market rate rent in unsubsidized permanent housing
• The placement in between 5 and 1 should consider multiple factors, including the impact of maintaining housing on the household budget.
Housing Examples
• Client in subsidized housing who is making the rent payment but is unable to handle any other basic needs (transportation, food, childcare, etc) without assistance is not as stabilized in their housing as someone who can handle these other concerns in their budget.
• Interim Housing/Emergency Shelter = no higher than “4”
• Clean & Sober and Transitional Housing = no higher than “3”
• Permanent Supportive Housing = no higher than “2”
Housing
Is the client homeless or at imminent risk of losing housing?
Is the client living in permanent unsubsidized housing without rent interfering with other basic needs?
Is the client living in Permanent Supportive or subsidized housing and paying 80% of market rate rent or 30% of income without critically impacting other basic needs?
2
Is the client living in Interim Housing or paying less than 50% of market rate rent?
Yes
Is the client living in Clean & Sober or Transitional Housing or paying 50% to 80% of market rate rent or 30% to 50% of the household’s income for rent?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 2: Rental History
• Crisis = Person has multiple evictions
• Thriving = Person is securely in permanent housing
• The ranges in between are to gauge how much the client’s rental history may impact their ability to secure permanent housing.
• A subjective approach can be used to move the rating through the scale.
Rental History Examples
• A person who had 2 evictions ten years ago but established acceptable rental history in between might be recognized as a “2” or a “3” dependent on the length of the positive rental history.
• A client who has positive rental history that is for less than 6 months might move down the scale where a client with 5 years (recently) of acceptable rental history might move up the scale because of longevity.
Rental History
Does the household have multiple evictions?
Has the household secured permanent housing?
Does the household have limited rental history?
2
Does the household have one eviction or no rental history?
Yes
Does the household have a poor rental history?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 3: Food
• Crisis = Client has no control over her food access
• Thriving = Client can purchase any food items she wishes without affecting her budget
Food Examples
• Households who are relying on Food Stamps have little actual control over their access to food and should not be rated above “4”.
• Households who are not on food stamps and rely on others to provide 30% or more of their food should also be considered no higher than category “4”.
Food Examples Cont’d
• Clients who are providing most of their food with a small amount of assistance (a few times each month) would generally be considered a “3”.
• Households that are providing all of their food without significantly impacting any other basic need would be considered a “2”.
Food Examples Cont’d
• Another factor to consider is whether the food a client is able to access is healthy or extremely basic.
• A family that has food to eat that is limited to two or three items (e.g. potatoes, cereal and beans) should not be considered past a “4” even when they are purchasing the food.
Food
Is the household without food or method to prepare it?
Can the household choose to purchase any food it desires?
Can the household provide its own food without assistance but must make choices about what to buy?
2
Is the household reliant on food stamps or consistent assistance for food or does the household eat limited types of food?
Yes
Does the household require a small amount of consistent assistance with food?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Impact
Domain 4: Health Care
• Crisis = Clients who have no insurance and need medical attention
• Thriving = Households where all members are covered and co-pays or other costs are not impacting the budget
Health Care Examples
• Households with MediCal or SCHIP should not be considered above a “3” since these are limited resources.
• All other situations should be considered reflecting on the difficulty or strength of the household’s specific situation.
• The current health of any particular family member could impact the amount of stress that a family is facing.
• The need for surgery or other expenses could impact the stress level of the household.
Health Care
Is the household without medical coverage and in immediate need of services?
Is the household covered by affordable, adequate health insurance and can it handle any out-of-pocket expenses?
Is the household covered by health insurance but has difficulty covering out-of-pocket expenses?
2
Are some members of the household without medical coverage or does the household have difficulty accessing services when needed?
Yes
Are some members of the household on MediCal or SCHIP?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 5: Health
• Crisis = Terminal or serious conditions
• Thriving = Households where all members are currently healthy
• There are households with family members who are disabled that may be considered Thriving because they have connected to all the support systems that they require and there is no impact on the day-to-day activities of the family unit.
Health
• This is an extremely fluid category and would not generally address the brief illnesses that all households experience such as colds or flu, but might address temporary conditions that will impact a family for several months.
• Each situation should be assessed by the Case Manager gauging the impact on the family’s stress level and ability to function in day-to-day activities.
Health
Is the household currently dealing with a terminal or severe chronic condition that impedes day-to-day life?
Is the household experiencing no health concerns or are all support systems needed to deal with a chronic or disabling condition in place?
Is the household implementing support systems to deal with acute short term conditions and enable the household to resume most normal activities?
2
Is the household dealing with a disabling or severe chronic condition that presents challenges to daily life, but has identified some support services and is resuming normal activities?
Yes
Is at least one household member suffering from a disabling or severe chronic conditionbut support systems are being implemented and the household is completing normal functions?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Impact
Domain 6: Mental Health
• Thriving = Clients who have been diagnosed with a severe mental health concern but have used a managed system of care to control their condition and are able to function without being impacted by their condition
• The rating for this category is based on observations of behavior that are impacting or not impacting a client’s ability to move forward.
• This category does not apply only to diagnosed individuals.
Mental Health
• This domain should not be used in any way to diagnose or assess any mental health issue.
• A client who does not have a diagnosis may exhibit behaviors that indicate they are impacted by even temporary mental health concerns. The factors that are being examined center around the amount of impact the apparent condition is having in their day-to-day activities and relationships.
Mental Health
Is the client a danger to self or others or experiencing severe difficulty in day-to-day lifedue to psychological problems?
Is the client experiencing good or superior functioning in a wide range of activities with rare or no symptoms?
Is the client experiencing minimal symptoms with only slight impairment in functioning?
2
Is the client experiencing recurrent mental health symptoms that affect behavior or persistent problems with functioning due to mental health symptoms?
Yes
Is the client experiencing mild, transient symptoms with onlymoderate difficulty in functioning due to mental health problems?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 7: Substance Abuse
• Crisis = Current abuse that has incapacitated the individual’s ability to function
• Thriving = Clients that have no history or have remained in control of their recovery
• The gauging of this category is predominately where the Case Manager identifies if the household is impacted by this issue.
Substance Abuse Examples
• A single mother who claims to have no history of use but exhibits behavior that indicates that she has addictive behavior issues might not be considered Thriving, but considered to fit a higher category of crisis.
• Other forms of addiction that may impact a household (gambling, shopping) to the point of disrupting normal functions should be rated in this category.
Substance Abuse
Is the client severely dependent on drugs or alcohol and may require institutional living or hospitalization?
Has the client exhibited any behaviors that might be associated with relapse mode?
2
Is the client dependent on drugs or alcohol with use resulting in avoidance or neglect of essential life activities?
Yes
Does client show evidence of persistent or recurrent social, occupational, emotional, or physical problems related to use?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Domain 8: Income- earned or benefits
• Crisis = Households with no income • Thriving = Households that have sufficient income to meet all of their needs and still save money
• Placement in other categories is dependent on how the income is serving to meet the household’s basic needs.
Income
Does the household without any income at all?
Does the household have sufficient, discretionary income and is the household able to save?
2
Is the income inadequate for the household to meet basic needs?
Yes
Can the household meet basic needs with a subsidy?
Yes
No
No Yes
Yes
No
3
4
5
1
No
Is the household without any income at all?
2
Is the household’s income inadequate for the household to meet basic needs?
Yes
Can the household meet basic needs with a subsidy?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Does the household have sufficient, discretionary income and is the household able to save?
Yes
Can the household meet basic needs, but not additional needs?
Domain 9: Credit
• Case Managers should assess this category by the degree of positive or negative impact credit and financial skills has on the client’s ability to move forward.
Credit
Does the household have damaged credit with existing debts that have not been addressed?
Is the household paying off debts on a regular basis and does it have sustainable income to continue until debts are paid but credit it not yet repaired?
2
Does the household have no credit or excessive debts that exceed annual income and/or engage in spontaneous or inappropriate spending?
Yes
Is the household starting the process of repairing its debt and/or engaging in appropriate spending?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Has the household repaired credit and established new credit, started a savings or credit account and is household income well-managed?
Yes
Domain 10: Employment
• Clients who are not seeking employment could be rated in this category or it could be skipped for them.
• Basic rating for this should be based on how stable the employment is and how effective it is in meeting the household’s needs.
Employment
• Factors that should be considered are: whether the client has no long term plans to ever seek employment; if the client is one of two adults in a household that has other income; or if the client is impacted by an inability to seek employment.
• Ratings should be assigned looking at the impact on the household’s ability to gain full control of their basic needs.
Employment
Does the client have a job?
Does the client have permanent job with adequate income and benefits?
2
Does the client have a full time job?
No
Does the client have a full-time job with adequate pay and benefits?
Yes
Yes
Yes No
No
No
3
4
5
1
Yes
Domain 11: Life Skills
• Gauging the areas between Crisis and Thriving in this Domain should incorporate how much the functioning of any individual or household is challenged by a lack of skills or empowered by a strong grasp of the tools they need to succeed.
• Some clients have incredible organizational skills and can maintain a structured and healthy household even in a shelter while others do not know where to start or how to manage basic activities.
Life Skills
Does the client have permanent job with adequate income and benefits?
2
Does the client have a full time job?
No
Does the client have a full-time job with adequate pay and benefits?
Yes
Yes
Yes No
No
No
3
4
5
1
Yes
Is the client unable to meet basic needs such as hygiene, food, and other activities of daily life?
Is the client able to provide beyond basic needs of daily living for self and family?
Is the client able to meet all basic needs of living without assistance, but not beyond?
2
Can the client meet a few but not all needs of daily living without assistance?
Yes
Can the client meet most but not all daily living needs without assistance?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 12: Legal
• Crisis = Clients with outstanding legal issues (dependent upon the severity of the issues)
• Thriving = Households that have no outstanding legal issues
• Factors that should be considered in gauging this category would be the severity of the legal issues (one ticket compared to thousands of dollars in tickets OR needing to file a restraining order vs. multiple felonies on a client’s record.)
Legal
Does the client have current outstanding tickets or warrants and/ or multiple felonies?
Has the client had no active criminal justice involvement for more than 12 months and/or no felony history?
Has the client successfully completed probation or parole within the past 12 months with no new charges filed?
2
Does the client have current charges, trial pending, and/or noncompliance with probation/parole?
Yes
Is the client on probation or parole but fully compliant?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Impact
Domain 15: Mobility
• The range between Crisis and Thriving should be determined by factoring in accessibility, reliability, legal compliance (insurance, licenses, registrations) and the impact to the client’s budget.
• Clients who rely only on public transportation should not be considered above a “4” since the control they have over their mobility is limited.
Mobility
Is he client without access to transportation, public or private?
Does the client have access to readily available and affordable transportation with adequate care insurance?
Does the client only generally have access to transportation to meet basic travel needs?
2
Does the client only have access to public transportation or unreliable, unpredictable or unaffordable transportation (e.g. no car insurance, no drivers’ license)?
Yes
Does the client only have access to limited and/or inconvenient transportation and/or is the client licensed but minimally insured?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 16: Community Involvement
• This category predominately is a gauge of the socialization skills and current social function of the client.
• The range from Crisis to Thriving is determined by: how connected the client is to others, impediments to the client becoming more connected, and the scope of the client’s connection.
Community Involvement Examples
• A client who is actively involved in the recovery community but withdrawn in their interaction in the other community aspects of their life (neighborhood, school, faith organizations, workplace, etc.) would not be rated as thriving.
• Mono-community involvement could be an indication of a different type of isolation and does not necessarily demonstrate knowledge of how to connect and interact with others.
• Generally individuals with the skills to develop and maintain community relationships will have a variety of connections to groups that fall in their circle of community.
Community Involvement
Is the client in crisis or survival mode?
Is the client actively involved in the community, including multiple groups?
Does the client have some community involvement but have barriers to full involvement?
2
Is the client socially isolated?
Yes
Does the client lack knowledge about ways to become involved in the community?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 17: Adult Education
• The rating for this category is generally as defined in the Matrix.
• Crisis = Anyone who does not have a GED/ diploma and is experiencing literacy problems
• Thriving = Not necessarily determined by the type of education/training the client has but how vocationally prepared the client is due to such education/training.
Adult Education Examples
• A client with a Masters Degree in a limited or highly competitive profession may be far less prepared to access employment than an individual who completed a training to acquire a Class A Drivers License.
• The education/training resource should be examined for the accessibility to a living wage occupation that it provides.
Adult Education
Has the client completed education/training needed to become employable?
No
Does the client have a high school diploma or GED?
Does the client have the education/literacy skills to function effectively in society?
Is literacy a serious barrier to employment?
No
No
Yes
2
3
45
1
Yes
Yes
Yes
No
Impact
Domain 19: Family Relations
• This category is designed to evaluate the support relationships that are or are not in place for a client.
• The term family should be used as the client might identify the term.
• Family members are individuals who provide primary support to the client and are very connected to the client.
• This domain is generally not an evaluation of recent or current relationships but of relationships that are likely to be in place ten years from now.
Family Relations
Is the client lacking in necessary support from family and friends or is abuse or neglect occurring?
Does client have a healthy, expanding support network with a stable household with consistently open communication?
Is the client receiving strong support from family and/or friends, but client is not expanding support network or household communication is not always open?
2
Is the client’s family and friends supportive but lacking the ability or resources to help or do family members not relate well to each other?
Yes
Is the client receiving some support from family and friends and/or are family members seeking to change negative behavior and learn to communicate and support?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 20: Identification
• Crisis= Client has no identification documents at all
• Thriving= Client has all relevant identification documents
Identification
Is the client without any form of identification?
Does the client have all identification documents s/he needs?
Does the client have only one reliable identification document?
2
Does the client only have limited forms of identification and/or is the client unable to access benefits or housing with current identification?
Yes
Is the client without reliable identification but has secured the documents necessary to apply for identification documents?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Impact
Child-Related Fields
• A few categories that are not completed for all clients are: Child Custody, Children’s Education and Childcare.
• These areas are to be completed only for adults in households with custodial care of minor children.
• Exceptions: The single parent who does not have custodial care of their child but is impacted by any or all of these three areas because they have a vested interest and devote a substantial amount of their focus to concerns that surround their children.
Domain 13: Child Custody
• This category only applies to clients with children who are connected to their children.
• A client who has children but has not seen their children and is not necessarily interested in pursuing a reconnection would not be rated in this category.
• Any parent who is connected or interested in being connected should be rated in this area.
Child Custody
• Crisis = Parents who have lost custodial care or visitation
• Thriving = Parents that have never lost custody or have completed a CFS involvement
• The gauging of this category is based upon the stress level of the situation and the level of focus it is impacting in a client’s life.
Child Custody
Does the client not have custodial care of one or more minor children due to legal processes?
Does the client have no CFS involvement or has the client completed CFSS reunification process?
Has the client completed a legal case or is in the last month of CFS involvement with custodial care projected as outcome?
2
Is the client facing current pending legal actions to remove custodial care of one or more children?
Yes
Is the client currently CFS involved or involved in legal action that jeopardizes continued custodial care?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 14: Childcare
• This category only applies to clients with custodial care of minor children who required supervision.
• Crisis = No childcare • Thriving = Ability to select and pay for any childcare of choice
• Factors to consider between crisis and thriving are primarily the financial concerns and the variety of accessible childcare available.
Childcare
Is the client unable to access needed childcare?
Is the client able to select quality childcare of choice without financial assistance?
Is the client able to access limited chocies of reliable, affordable, unsubsidized childcare?
2
Does the client only have access to unreliable, unaffordable, or inadequate childcare?
Yes
Does the client only have access to limited, affordable, subsidized childcare?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Domain 18: Children’s Education
• This category only applies to clients with children who are connected to their children.
• Parents who are connected to their children but do not have custodial care may or may not be impacted by this category dependent on the scope of their involvement.
Children’s Education
Are any of the household’s eligible children not enrolled in school?
Are all eligible children passing all classes with the parent(s) involved at school?
Are all of the household’s children enrolled and attending with parent participation, but with only marginal grades?
2
Are any of the household’s eligible children enrolled but not attending classes?
Yes
Are all of the household’s children enrolled in school but one or more child is only occasionally attending classes?
No
No
No Yes
Yes
Yes
3
4
5
1
No
Yes
Data Entry into HMIS
• This will be addressed in a training next Spring.
Questions
• If you have questions about the matrix and its use in Contra Costa County, please contract Piper Ehlen at HomeBase at 415-788-7961 ext 304 or [email protected].
• If you have questions about using the Matrix with HMIS, please contact Kimberly Baello, HMIS Systems Administrator, Contra Costa Health Services at 510-220-9406 or [email protected].