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
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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

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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

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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
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We shape our dwellings and afterwards our
dwellings shape us. -Winston Churchill
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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

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

• New image

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

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

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Why home visit?
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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

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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

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Single Site Housing First

• The neighborhood
• The building environment
• The unit
• The staff and neighbors

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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

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

• Hoarding
• Safety/harm reduction
• Logistics of service partnering

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Listen to the environment

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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

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Hoarding
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How much is too much?

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Compassionate pragmatism tireless creativity

• Weekly donation run
• Side-by-side cleaning
• Cleaning for the client
• Incentives and rewards
• Lease enforcement

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Harm Reduction

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

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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)

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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

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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?

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Home Visit to Assess The Person

• How is the person today?
• Their greeting
• Clothing
• State of Alertness
• Mood
• Changes from baseline?

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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.

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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

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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)

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Frequency of Visits

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

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Therapeutic Opportunities

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

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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?

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