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Housing First and Rapid Re-housing:

Principles & Practices

L a u r e n P a r e t i

l p a r e t i @ h o u s i n g i n n o v a t i o n s . u s

A n d r e a W h i t e

AW h i t e @ H o u s i n g I n n o v a t i o n s . u s

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Agenda

Implementing Housing First: Best Practices

in RRH

• Overview of Rapid Re-Housing Model in Arlington • Overview of Housing first• Implementing Housing First• Assessment & Service Planning• Case Studies• Closing• Resources• Upcoming

Webinars

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Rapid Rehousing• Designed to end homelessness using

the least amount of assistance necessary

• Not a solution to poverty - may provide a base to build from

• Connects people to housing & resources to assist them going forward

• Begins to address barriers to long-term housing retention

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Key Components of RRH

*NAEH

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• Designate staff to locate housing• Work with landlords• Teach tenancy and interviewing skills

Housing Location

• Assist with the costs of move-in• Rental assistance• Flexible to meet unique needs

Rent & Move-In Assistance

• Begin to address barriers to tenancy• Work with the tenants and landlords to

address any lease violations• Work with participant to develop a network

of care that will provide on-going support

Case Management

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Benefits of Program Structure• Establishes predictability for

participants and staff

• Avoids bias in decisions about who gets what & discrepancies across programs• Strengths-based – focuses on skills

building to develop resiliency and position households to succeed rather than on deficits• Predictability and strengths-focus are

key components of trauma-informed care.

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Policies & Procedures*CAS Operating Policies & Procedures 2/22/18

Practices

Disconnects are common.

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CAS Policies: RRH Admissions Committee

Convenes case conference:

• Prioritizes who gets RRH assistance

• Determines type of subsidy and length of assistance authorized

• Reviews strengths/barriers and recommends supports

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Bridge Subsidy• Bridge to longer-term subsidy – e.g., Housing Choice

Voucher, Permanent Supportive Housing, or Housing Grant

• Target Population: Severe housing barriers & wait-listed for another subsidy

• Tenant pays minimum 30% of income towards rent –40% strongly recommended if Housing Grant

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Graduated/Declining SubsidyTenant pays minimum 30% income towards rentSubsidy not to exceed:

•Months 1-3 – 100% of FMR•Months 4 to 6 - 80% of FMR•Months 7 to 9 - 60% of FMR•Months 10 to 18 - 40% of FMR

Exemption option to extend length/increase amount –authorized by RRH Admissions Committee

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Graduated/Declining Subsidy: Length of Assistance• Provides least assistance necessary

to prevent return to homelessness

• Short-term: Up to 3 months Rental Assistance (RA)

• Medium-term: Up to 6 months of RA

• Medium-Long-Term: Up to 9 months of RA

• Long-Term: 12-18 months of RA

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Housing First Principles and Requirements

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Housing FirstSystem and Practice Approach

Immediate Access to Housing with Supports Provided in Housing

Same expectations as any other renter in housing

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Housing First

Quick access to housing

while providing needed services

Housing is not

contingent on

compliance with services

Services are voluntary for tenants, but not staff –assertive

engagement

Services are wrapped around

individual and person is

assisted to meet lease obligations

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Housing First is not

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Housing onlyOr

Anything goes.

Landlord is responsible for enforcing the

lease.

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Fast access to housing: clear

path and participant

choice

Assertive Landlord/

Service coordination

Expectations are set by

community or lease-based standards

Services are available as

long as people need them

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Housing First Key Practices

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Housing First Supports

Implemented with success

for high acuity clients

• Access to high quality services and treatment resources (brokerage)

• Adequate staffing to visit people in their homes

• Support for staff to address clinical and system challenges

• Low demand approach with high expectations

• Supported by evidence-based practices

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Housing First Best PracticesAssertive engagement using motivational techniques

Comprehensive Assessment and Planning

Person Centered and Recovery Oriented

Based in the Community and in the Home

Links to Community Supports

Available 24/7 often through an on-call system

Focused on Housing and Work with Landlords

Contact as Needed – Individualized

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Implementing Housing First

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GroundworkTargeting: Low barrier approach –Everyone deserves housing

High expectations: Has the same rights and responsibilities as anyone else• No special rules for homeless people• Each person is expected to follow a

lease• Case Management is focused on every

person assuming full rights and responsibilities of tenancy

Engage: look for comfort and goals

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Education• Explain provider and participant roles and responsibilities• Educate each person about housing options• Choice is based on knowledge• Engage in an evaluative conversation: what would work

best for you• Assess and establish goals for housing

access and retention• Engagement based on seeing value in

services offered

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Tenant RightsRight to live in decent, safe, & sanitary housing, free from hazards, e.g., lead based paint

Right to have repairs in a timely manner

Right to reasonable notice in writing of any non-emergency inspection or entry into unit.

If landlord not maintaining apt., subsidy admin. can re-inspect & withhold payments until apt. meets standards.

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Obligations of Tenancy

Allow others quiet -

peaceful enjoyment

No criminal

activity in unit,

common area or grounds

Keep unit clean –

HQS

Proper waste

disposal

Only authorized occupants live in unit

Pay full rent to

landlord on time

Keep utilities current

and paid

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Service Participation Requirements.

“We just tell people they are required to participate in case management. We don’t actually enforce the rule.”What’s the downside of this approach?What other approaches might the team use to engage people in services?

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What things might be required?• Provide accurate

information for recertification - may be monthly

• Report changes in income or family composition

• Allow and be prepared for required inspection

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Assessment and Service Planning• Assessment and Service Planning

are essential

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Service Planning Process

Engagement

Assessment and Housing Barriers

Goal Development

Smart Goals

Motivational Techniques

Developing the Plan

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Engagement• Addressing simple needs develops trust and

establishes the structure of the relationship• Gives an opportunity for worker and tenant to talk

about what they bring to the table• Allows the participant to talk about their experiences• Sets the tone for future work

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Assessment• Assessment is a process not an event.• Allow the information to unfold over time.• As each person experiences challenges and progress

the assessment will deepen.• Assessments must be updated at a minimum before

each plan is developed.• Assessments are developed through observation,

conversation, consultation and worker skills.• Housing Barriers Assessment also lets people see

progress.

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Assessment Domains• Tenant Information•Housing and

Homelessness History and Information• Life Skills• Employment and

Education• Health • Behavioral Health,

Substance Use and Trauma

• Financial Resources and Obligations• Legal Involvement• Services Resources•Natural Supports• Interests and Hobbies• Strengths and Barriers

to Accessing resources• Summary

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Assess Housing and Homeless HistoryPast housing and Homeless experiences

Current housing goals

What they liked/didn’t like about previous housing

Barriers to access and sustainability

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Housing Needs and PreferencesLocation

Access to Transportation

Proximity to Significant Others

Proximity to Services

Unit Size and Housing Density

PetsIdeal v. Acceptable, Negotiable/Non-Negotiable

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Goal Based Strategies• Work from each person’s own experience and values.• Elicit and listen to the person and reflect back to clarify

and check understanding.• Goal setting is an individual process.• Empathize about goal setting and unmet goals.• Listen to resident’s perception of past successes and

struggles in reaching goals.• List and discuss strengths that may facilitate reaching

goals.• Connect goals to stable housing.• Goals and the process to reach goals builds motivation.

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Clarify What You Can Offer• Role of the worker•Housing Options and Expectations of Each• Rights in housing• Expectations of tenancy• Rent payment• Quiet enjoyment• Maintaining apartment

• Financial Realities

• Process and timelines

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SMART Goals

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•Specific•Measurable•Achievable•Realistic•Time-bound

•Who•What•Where•How•When

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Goal Setting Case StudiesUsing the assessment domains and the SMART goal format develop a goal for the following people:

• June and her three daughters went into RRH about 4 months ago. June got a job in a fast food restaurant and had been doing well. Covid derailed that .She and her children have been home. This has been difficult for everyone. June now has unemployment which is more than double what she made on her job. She does not want to go back to work and wants to apply for SSI for all her children and a permanent subsidy

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Goal Setting Case StudiesUsing the assessment domains and the SMART goal format develop a goal for the following people:Patricia has been in housing for 4 months. She has three children and had a job working in a convenience store. The children were in school. Her oldest child is having problems. She had lived with her grandmother most of her life, and this adjustment is hard. Patricia was called to the school. She lost her job. She tells you she needs to stay home with the children. She needs help getting money and a subsidy.

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Limit the areas of intervention

Focus on pressing needs that impact

Housing Access and Retention

Relate all interventions to long term goals

Be aware this may not be a linear process

Connect to sustainable resources

Focused Service Planning

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Microsoft Word 97 - 2004 Document

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Case study: PeteLarge Group DiscussionPete has been living in a shelter, and his sons stayed with his mother. There just wasn’t room for him. Their mother is in jail. Pete was helped to get housing for himself and the children. Pete works construction and did not get furloughed. However, he is having trouble looking after his sons and working. He has missed a lot of work and has been short on the rent. Sometimes his mother stays for a couple of days and takes care of all of them. He tells the worker he wants a girlfriend who can help him. This has not worked out well in the past. He is worried that even with the boys in school he will not be able to manage alone.

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Pete’s PerspectivePete tells the team he loves his children but cannot do it alone. He is worried about the cost of afterschool programs and upset that the school had called him frequently.He misses his friends and says he even missed the shelter.He might be able to make it with someone helping but there is not enough room for his Mom to move in and girlfriends aren’t looking for a job caring for two young children.He likes the case manager but feels meeting once a week is just one more thing.

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How might Pete’s perspective help you get to a plan?Focusing on the behavior interfering with housing: Pete is worried about rent and other costs associated with having a family.

Pete loves his kids and enjoys really being a dad, most of the time. He is proud to have put together a home.

Pete is really grateful to his mother for caring for the boys before the housing and sometimes after.

Pete would like a large enough apartment to househis whole family even his mother. He also knowsthat will be very expensive.

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MI Tool: Decisional Balance SheetSmall Group Exercise

Example: Pete having his mother live with them

Continuing on as Before Making a Change

What are some of the good things?

What are some of the not so good things?

What are some of the not so good things?

What are some of the good things?

Benefits Costs Costs Benefits• It is my house• I can raise my

children my way• I can have a

girlfriend over whenever I want

• I am losing time at work

• Mine is the only income

• I have to do a lot of chores when I come home

• It will be crowded

• Won’t have a way to relax

• She never likes my girlfriends

• I don’t want to rely on my mom

• Have more peace of mind

• Be able to go to work

• She is a great cook• She can cover some

expenses• I am lonely and like

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Changing ExpectationsMoving from crisis to planning

From immediate to 15 minutes from now

Critical thinking Use strategies and resources that work best for each tenant

Structure and purposeDeveloping structure and purpose to days

Developing new or changed life roles

From homeless person to tenant, family member, student, worker, advocate, artist, volunteer

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Questions?

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Closing Housing First makes it possible for participants to stabilize in their communities, eliminating barriers to housing access and providing support needed to maintain housing.Housing First is goal-oriented and client-driven.

Housing First has the same rules as all other rental housing using case management to assist each tenant to meet these expectations.It takes a village and depends on quality supports and assertive landlords.Choice is only real in the context of each person’s goals, knowledge, and consistent expectations.

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Resources

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Additional ReadingHousing First Manual: Tsemberis, Sam J. Housing First: The Pathways Model to End Homelessness for People with Mental Illness and Addiction. Dartmouth PRC-Hazelden. 2010CT BOS Housing First Principles: http://www.ctbos.org/wp-content/uploads/2017/04/CT-BOS-POLICIES-.pdf

Permanent Supportive Housing Toolkit:http://store.samhsa.gov/product/Permanent-Supportive-Housing-Evidence-Based-Practices-EBP-KIT/SMA10-4510

Developing the Support in Supportive Housing:http://www.csh.org/wp-content/uploads/2011/12/Tool_DevelopingSupport_Guide.pdf

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Additional Reading – cont. Housing First Checklist Interagency Council on Homelessness: http://usich.gov/resources/uploads/asset_library/Housing_First_Checklist_FINAL.pdf

Harm Reduction Coalition. Principles of Harm Reduction: http://www.harmreduction.org/about-us/principles-of-harm-reduction/

Pauly B, Reist D, Belle-Isle L, Schactman C (2012). Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy. Volume 4, Issue 4, Pages 284-290.

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Additional Reading - MIMiller, W.R. and Rollnick S. (2012). Motivational Interviewing: Helping People Change. 3rd Edition. New York: Guilford Press.Motivational Interviewing Website:

http://www.motivationalinterviewing.org/

Individual and Family Resource Guide for RRH

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Family Resouce Guide

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Upcoming Webinars7/13 10am - Helping Clients Adhere to COVID Transmission Prevention Protocols

7/22 10am – Using Shared Housing in RRH

More topics and dates to be announced soon!

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