Stabilizing Homeless Families: Case Management Before

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• Stabilizing Homeless Families Case Management
  Before After The Move Into Permanent Housing
• Presented by
• Beyond Shelter
• 1200 Wilshire Blvd, Suite 600
• Los Angeles, CA 90017

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• Emergency shelters and transitional housing are
  simply stepping stones. If at the end of our
  interventions and our support, the homeless are
  still homeless or at risk of another episode of
  homelessness then what have we really
  accomplished?

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• Homelessness ends when an individual or family is
  stabilized in permanent, affordable housing,
  whatever that permanent housing type may be and
  whatever the support systems that must be in
  place to help them stay there.

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HUD CONTINUUM OF CARE MODEL
Outreach Intake Assessment
Traditional Housing, no services
Emergency Shelter
Transitional Housing
Supportive Housing
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ADDITIONAL HOUSING OPTIONS

• Service-Enriched Housing Private or nonprofit
  rental housing, with crisis intervention and
  services coordination ( often program
  activities) available to all residents,
  regardless of special needs.
• Permanent Housing with Home-Based Case Management
  Available through outside sources, either
  time-limited or long-term.

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COMPONENTS OF CASE MANAGEMENT

• Crisis Intervention and Stabilization
• Intake and Assessment
• Assistance Moving into Permanent Housing
• Home-Based Case Management(time-limited
  transitional or long-term)

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STEP 1 CRISIS INTERVENTION SHORT-TERM
STABILIZATION

• This phase usually includes emergency shelter
  services and short-term transitional housing
  geared to special needs, i.e. domestic violence,
  substance abuse treatment, etc.

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STEP 2 INTAKE, SCREENING, NEEDS
ASSESSMENTS

• The needs assessment results in an Action
  Plan, including short and long-term goals and
  objectives with concrete action steps.
• Can occur immediately or after stabilized in
  emergency shelter or other temporary housing.

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STEP 3 HOUSING SEARCH ASSISTANCE RELOCATION
TO PERMANENT, AFFORDABLE HOUSING

• Overcoming barriers to accessing affordable,
  rental housing.
• Assistance applying for housing assistance, rent
  subsidies, move-in funds, etc.
• Tenant education.
• Assistance conducting housing search,
  presentation to owners, negotiating.

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STEP 4 PROVISION OF HOME-BASED CASE
MANAGEMENT

• Intensive during the first 90 days.
• Intensifies during crises.
• Includes connecting people to community resources
  and services to meet their particular needs.
• May include longer-term case management for
  vulnerable and at-risk families and individuals.

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Case Management Before the Move into Permanent
Housing
   
   
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PRIMARY FUNCTIONS OF CASE MANAGEMENT

• Assessment
• Planning
• Linking
• Monitoring
• Advocacy

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• The primary functions of case management while
  families are homeless are to address their
  immediate shelter and social service needs and to
  ensure that they have access to all services and
  resources for which they are eligible.

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• While in a homeless state, families
• require crisis intervention and short-
• term case management. Once in permanent
• housing, families benefit from case
• management that helps them transition to
• stability. Services are intensive, but time-
• limited, depending upon need.

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Developing a Family Action Plan
   
   
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Individual Family Action Plan

• Developed before or after stabilization in
  emergency services
• Serves as the blueprint for short-term case
  management and transitional or long-term case
  management once the family moves into permanent
  housing

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General Questions

• What does the family need?
• What should the priorities be?
• How will they achieve these goals?
• What are the barriers they are confronting?
• How will they attain permanent housing?

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• How could their income situation be improved?
• What are the issues for the children?
• Are there mental health or recovery issues that
  should be addressed?

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Family Action Plan

• The objectives for the period from _______
• to ________ are
• __________________________________
• __________________________________
• __________________________________
• __________________________________
• _______________________________

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Specific Tasks/Responsibilities

• What we plan to do to meet these objectives/
• achieve goals
• ___________________________________
• ___________________________________
• ___________________________________
• ___________________________________

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Assistance Accessing Moving Into Permanent
Housing
   
   
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THE HOUSING PLAN

• The objective is to assist the family to obtain
  decent, affordable permanent housing in which
  they can stabilize and rebuild their lives. This
  requires a match between the housing unit and the
  familys needs. Suitable means decent housing in
  an environment which will be conducive to the
  familys stability in permanent housing.

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THE HOUSING SPECIALIST

• If possible, a Housing Specialist helps the
  family to identify and off-set (as much as
  possible) barriers to securing housing.
• The Housing Specialist also works with the client
  to identify appropriate, and reasonable, housing
  search goals. When no Housing Specialist is
  available, the case manager addresses these
  issues, working together with the family to
  resolve them.

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ACCESSING SECTION 8

• Recognizing the high cost of rental housing in
  most rental markets, it often becomes essential
  to develop working collaborations with local
  housing authorities in order to facilitate the
  move into permanent housing for families who are
  homeless.

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• Sometimes there are special set asides that can
  be developed (particularly for families and/or
  people with special needs). In some states,
  TANF-related subsidies can be utilized. It is
  vital to explore possibilities with housing
  authority administration and not to assume that
  it cannot be done.

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Examples of HOUSING ASSISTANCE

• Landlord/tenant education
• Advocacy for housing subsidies
• Transportation and coaching to meet potential
  property owners
• Referral to specific owners willing to rent to
  homeless families

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• Assistance in overcoming bad credit, no credit or
  eviction histories, etc.
• Assistance in obtaining move-in funds
• Follow up to ensure stable relationship with
  property owner.

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Case Management After the Move into Permanent
Housing
   
   
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Goal of Home-Based Case Management

• A major goal for formerly homeless families is to
  integrate stable living patterns into their daily
  lives.
• All benefit from assistance in developing a
  support network in the community responsive to
  their individual needs and available to be called
  in times of future crisis.

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• The primary functions of home-based case
  management are to assist families in making the
  transition from homelessness to stability in
  permanent housing and to link families to other
  community resources and services which they might
  need. A subgroup of homeless families will also
  benefit from assistance in the development of
  basic life skills.

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Provision of Home-Based Case Management

• Intensifies during crises.
• Includes connecting people to community resources
  and services to meet their particular needs.
• Should be intensive for some families during the
  first 90 days in permanent housing.

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• May include longer-term case management for
  vulnerable and at-risk families with special
  needs or long histories of homelessness.

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THE FIRST THREE MONTHS

• Experience has shown that formerly homeless
  families are most at risk for another episode of
  homelessness during the first 90 days in
  permanent housing.

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• Generally, the case manager provides the core
  level of services and refers families to
  mainstream programs for specialized services
  (i.e., substance abuse intervention, mental
  health services, family counseling, child care,
  etc.).

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• Some families require more intensive home visits
  that may include demonstrations of housekeeping
  skills, money-management and budgeting,
  development of grocery lists, assessments and
  referrals for parenting support, etc.

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• The majority of families, however, will simply
  need assistance in identifying resources in the
  community and periodic monitoring and support
  during the first few months in permanent housing,
  to insure a smooth transition.

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EXAMPLES OF SERVICES BY CASE MANAGERS

• Household management
• Money management
• Problem solving/survival skills
• Advocacy with CalWORKs, DCFS, GAIN, legal issues
• Resource referrals monitoring
• Crisis intervention

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Infant

Family

Enrichment

Child Care

Counseling

Recreation

Employment

Pre
-
School

Support
Programs

Job Readiness


Services


Health

Transportation

Care Nutrition



Services
Mental

Family
Health

Preservation/

Services

LINKING FORMERLY HOMELESS
Reunification



FAMILIES TO

Family



Planning


COMMUNITY SERVICES
Services for

Prenatal Care

Childrens

Special Needs

Family
Counseling and
Support/DV
Teen

Prevention

Services
Leadership
Development

Crisis

Intervention
Parole/
   
(personal or
Probation

Alcohol Drug
Grocery,
Elementary,
financial)

Prevention/

Laundromat,
Middle, High,
Treatment

bank, etc
   
Continuation
.

Schools

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Case Management Issues
   
   
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• Distrust.
• Listlessness.
• Manipulation.
• Failure to Follow Through Self-Sabotage.
• Poor Judgment Lack of Responsibility.
• Substance Abuse.

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• Family Violence.
• Child Maltreatment.
• Crisis Orientation.
• Denial.
• Refusal to participate.
• Anger.

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Steps to Effective Case Management
   
   
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• ENGAGEMENT The first and most important task of
  the case manager is to engage the client. During
  the phase when case management is likely to be a
  mandatory program component, developing trust and
  establishing a relationship (to both the case
  manager and the agency) is very important.

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• Access to the client and the ability to follow-up
  on the case plan, once they have moved into
  housing (and services are voluntary) depends upon
  this relationship. Initial engagement is even
  more important when you are establishing a
  relationship when the client is already in
  housing or in any voluntary setting.

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• ASSESSMENT Effective case management requires
  the ability to thoroughly and accurately assess
  your client. The ability to do this effectively
  depends upon the relationship between the client
  and case manager, since some issues are not
  easily or readily identifiable. These issues may
  only be known through disclosure.

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• SETTING PRIORITIES Once the basics have been
  addressed safety, food, shelter, and clothing,
  the client and case manager together must
  prioritize other issues needing to be addressed.
  NO matter what your sense of the priorities, if
  the client does not really believe the issue is a
  priority, he/she is not going to follow through
  with the plan.

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• DEVELOPING A REASONABLE PLAN It is important to
  divide the case plan into short- and long-term
  goals. Each goal is divided into several tasks,
  with clearly delineated responsibilities for the
  client and the worker. Every meeting these tasks
  are reviewed for follow-up and revised
  accordingly.

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• BUILDING ON CLIENT STRENGTHS Although the word
  empowerment is an overused phrase in social work
  today, the concept of helping people to help
  themselves is still a key principle in our
  profession. One of the best ways to do this is to
  assist clients in identifying strengths they
  already bring to the table which can help them
  to accomplish their goals.

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• MAINTAINING THE RELATIONSHIP All relationships
  require ongoing maintenance. Sometimes, as case
  managers we start to think the client needs us,
  and forget this basic premise. However,
  especially once a client is in housing, we also
  have a vested interest in maintaining the
  relationship to ensure family stability, and
  maintain our commitment to the clients, landlords
  and property managers.

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• IDENTIFYING RESOURCES All case management
  programs are only as strong as your service
  linkages. Next to maintaining a relationship with
  your clients, the relationships you have with
  specialized service providers substance abuse,
  mental health, D.V., youth programs are
  essential to effective case management.

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EXPECTED OUTCOMES

• Families Integrated into the Community,
• Striving towards Improved
• Social and Economic Well-Being

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OUTCOME EVALUATION

• Short-Term Outcomes For Families
• Movement from homelessness to temporary or
  permanent housing
• Decrease in psychological distress
• Decrease in substance use/abuse
• Participation in treatment, support, and training
  programs

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OUTCOME EVALUATION

• Short-Term Outcomes Children
• Regular school attendance
• Improved health assessment/care
• Reduction of behavioral/school problems

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OUTCOME EVALUATION

• Intermediate Outcomes Mothers
• Increased residential stability
• Continued improvement in psychological
  functioning and reduction in symptoms and
  symptoms of distress
• Continued reduction in substance use/abuse
• Improved life management skills, including
  job/vocational skills and goal setting
• Increase self-esteem and feelings of empowerment

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OUTCOME EVALUATION

• Intermediate Outcomes Children
• Continued reduction in behavioral and school
  problems
• Improved school performance and regular school
  attendance
• Regular health check-ups, inoculations,
  improved health status

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OUTCOME EVALUATION

• Long-term Outcomes
• Achieve residential stability
• Psychiatric stability
• Abstinence/continued reduction in substance
  use/abuse
• Competency in life management
• Employment or engagement in productive activity
• Stability as a family unit