Mark Graham, LCSWDirector, Housing First ACT ServicesPathways To Housing, New York City

Housing First started in 1992 by Dr Sam Tsemberisin response to the growing homeless crisis in NYC.

Housing Without Strings / Target those considered “not housing ready”

Providing a stable living environment enables recovery.

Relationships with Landlords were developed and private apartments secured.

Housing First Case Managers put in place to offer support services

Establishment of HF ACT teams. The partnership of these two models allowed for the most seriously mentally ill homeless people to be housed.

Currently 600 + consumers housed throughout PTH programs in NYC

Pathways To Housing

NYC

Administration

Supportive Housing

Resource

Center

HF With ACT

Service

Housing First

ACT Teams

Multi-Disciplinary

Teams

Psychiatric Treatment

and Housing Case

Management

Apartment Programs

Service Coordinator

Serious mental illness

Medication management

Family relationship problems

Drug and alcohol use/abuse

Money management

Daily living skills

Advocacy and Empowerment

Maintain good working relationship with landlords.

Comply with the standards set by HUD and other funders.

Ensure the safety of all in the community including the consumer.

Ensure consumers pay required rent contribution to comply with funding regulations.

Comply with NYC Housing Law.

Complaints from other tenantsConsumers who are compulsive hoardersDrug traffic in and out of buildingKeeping a pet in violation of leaseConsumers with poor personal hygieneConsumers observed in poor mental healthDamage to property

Service

Coordinator

Landlord

Consumer

Agency

John has lived in a PTH apartment for 4 years without incident.

Team visit discovered he now has three dogs. John reports that he is minding them for his son

who is in prison.Pets are a violation of John’s lease.Three months later Landlord contacts agency

requesting dogs are moved immediately. John repeatedly refuses.

Role Confusion - Advocate/ Therapist vs. Enforcer

Ethical dilemmas

Sense of being de-skilled

Affect on morale

Increased rate of staff turnover

Assist staff to recognize how housing problems can be a symptom of a clinical issue.

Provide training on targeted clinical interventions that can be used to resolve a housing problem.

Housing Department takes on a more active role with the individual consumer.

Utilize the Use And Occupancy Agreement.

Use the Housing Inspection process to empower consumer.

Weekly Clinical Housing Decisions Meeting

Monthly Clinical Risk Management Meeting

Senior Management

Entire Housing Department

Consumer invited to attend

Team member escorts consumer

Team’s role remains supportive

Corrective Action Plan Devised

Senior Management

Psychiatrist

Clinical Staff

Clinical Recommendations Proposed

Role Clarification

Increased Morale

Reduction in staff turnover