Successfully Housing Successfully Housing People with Substance People with Substance Use Issues Use Issues

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The research, development, and publication of this curriculum was funded by the Housing Opportunities for Persons with AIDS (HOPWA) National Technical Assistance Program in partnership with the U.S. Department of Housing and Urban Development’s Office of HIV/AIDS Housing. The substance and findings of the work are dedicated to the public. The author and publisher are solely responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not necessarily reflect the views of the Government.

Prepared by Clegg & Associates, Inc. (Seattle, WA)Prepared by Clegg & Associates, Inc. (Seattle, WA)

Under contract with AIDS Housing of Washington, in Under contract with AIDS Housing of Washington, in partnership with the Corporation for Supportive Housingpartnership with the Corporation for Supportive Housing

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Training SessionsTraining Sessions

I.I. Understanding the Understanding the Issues Your Tenants FaceIssues Your Tenants Face

II.II. The Housing ContextThe Housing Context

IV.IV. Separating the Personal Separating the Personal from the Professionalfrom the Professional

III.III. The Effective Tool KitThe Effective Tool Kit

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Session 1Session 1Understanding the IssuesUnderstanding the IssuesYour Tenants FaceYour Tenants Face

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Three Classes of DrugsThree Classes of Drugs

Stimulants (“Uppers”)Stimulants (“Uppers”)

Depressants (“Downers”)Depressants (“Downers”)

Psychedelics/Psychedelics/HallucinogensHallucinogens

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““Uppers”Uppers”

Cocaine / “crack”Cocaine / “crack”

AmphetaminesAmphetamines

Over-the-counter Over-the-counter stimulantsstimulants

NicotineNicotine

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Physical Effects of “Uppers”Physical Effects of “Uppers”

Constricted blood vesselsConstricted blood vessels

Increased heart rateIncreased heart rate

Increased blood pressureIncreased blood pressure

Increased respirationIncreased respiration

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Behavioral Effects of “Uppers”Behavioral Effects of “Uppers”

ConfidenceConfidence

AlertnessAlertness

EuphoriaEuphoria

IrritabilityIrritability

RestlessnessRestlessness

ParanoiaParanoia

AggressivenessAggressiveness

AnxietyAnxiety

ViolenceViolence

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““Downers”Downers”

Opiates/opioidsOpiates/opioids

Sedative hypnoticsSedative hypnotics

AlcoholAlcohol

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Physical Effects of “Downers”Physical Effects of “Downers”

Slowed respirationSlowed respiration

Depressed heart rateDepressed heart rate

Decreased coordinationDecreased coordination

SleepinessSleepiness

Pain messagesPain messagesblockedblocked

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Behavioral Effects of “Downers”Behavioral Effects of “Downers”

Diminished anxietyDiminished anxiety

Inability to concentrateInability to concentrate

EuphoriaEuphoria

SluggishnessSluggishness

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Psychedelics/HallucinogensPsychedelics/Hallucinogens

LSDLSD

MarijuanaMarijuana

PCPPCP

EcstasyEcstasy

MushroomsMushrooms

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Physical Effects of Physical Effects of Psychedelics and HallucinogensPsychedelics and Hallucinogens

Increased heart rate, blood Increased heart rate, blood pressure, pressure, and body temperatureand body temperature

DizzinessDizziness

Dilated pupilsDilated pupils

SweatingSweating

Visual distortionVisual distortion

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Behavioral Effects of Behavioral Effects of Psychedelics and HallucinogensPsychedelics and Hallucinogens

Impaired reasoningImpaired reasoning

Slow reaction timeSlow reaction time

Extremes of euphoria Extremes of euphoria and panic/paranoiaand panic/paranoia

Delusions of persecutionDelusions of persecution

Feelings of grandeurFeelings of grandeur

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Recognizing Behaviors – Recognizing Behaviors – Substance Use vs. Substance Use vs. Mental Health IssuesMental Health Issues

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The Cycle of UseThe Cycle of Use

No use of legal or illegal drugsNo use of legal or illegal drugsAbstinenceAbstinence

Curiosity and Curiosity and willingness to actwillingness to act

ExperimentationExperimentation

Periodic use with no Periodic use with no established patternestablished pattern

Social/RecreationalSocial/Recreational

Established patternEstablished patternof useof use

HabitualHabitual

Continued use regardless Continued use regardless of negative consequencesof negative consequences

Heavy Use/Drug AbuseHeavy Use/Drug Abuse

Compulsive behaviorCompulsive behavior

Chaotic Use/AddictionChaotic Use/Addiction

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Symptoms of WithdrawalSymptoms of Withdrawal

SeizuresSeizures

SweatingSweating

Goose bumpsGoose bumps

VomitingVomiting

DiarrheaDiarrhea

TremorsTremors

Lack of energyLack of energy

DepressionDepression

FlashbacksFlashbacks

Heavy cravingsHeavy cravings

Erratic mood swingsErratic mood swings

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No awarenessNo awarenessPrecontemplationPrecontemplation

Aware andAware andconsidering changeconsidering change

ContemplationContemplation

Thinking about takingThinking about takingsteps towards changesteps towards change

PreparationPreparation

Continuing Continuing the change processthe change process

MaintenanceMaintenance(including relapse)(including relapse)

Stages of ChangeStages of Change

Modifying behavior to Modifying behavior to overcome problemovercome problem

ActionAction

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Relapse – A Natural StageRelapse – A Natural Stagein a Recovery Processin a Recovery Process

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Signs of RelapseSigns of Relapse

ArguingArguing ForgetfulnessForgetfulness Stress symptomsStress symptoms Returning to old habitsReturning to old habits Lack of self careLack of self care Moodiness or depressionMoodiness or depression BoredomBoredom EuphoriaEuphoria

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Relapse TriggersRelapse Triggers

Lack of or loss of a Lack of or loss of a support networksupport network

Troubled Troubled relationshipsrelationships

Social pressureSocial pressure Negative life eventsNegative life events Positive life eventsPositive life events

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TenantsTenants

Every tenant brings a history, Every tenant brings a history, a culture, and a set of a culture, and a set of expectations andexpectations andbehaviorsbehaviors

PersonalityPersonality

Social historySocial history

Mental healthMental health Physical healthPhysical health

Housing experienceHousing experience

Ethnic/racial identityEthnic/racial identity

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Drug and Alcohol Use Drug and Alcohol Use Creates Its Own CommunityCreates Its Own Community

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The Goal – The Goal – Keeping Tenants HousedKeeping Tenants Housed

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Session 2Session 2The Housing ContextThe Housing Context

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Applicable Federal Applicable Federal Laws and RegulationsLaws and Regulations

Equal Protection ClauseEqual Protection Clause Fair Housing ActFair Housing Act Americans with Americans with

Disabilities ActDisabilities Act Rehabilitation Act of 1973Rehabilitation Act of 1973 Age Discrimination ActAge Discrimination Act HUD regulations HUD regulations

(including “One Strike”)(including “One Strike”) Confidentiality lawsConfidentiality laws

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Other Rules andOther Rules andRegulations to ConsiderRegulations to Consider

Agency rules, Agency rules, policies, and policies, and proceduresprocedures

Local housing Local housing authority regulationsauthority regulations

State and local State and local landlord-tenant lawlandlord-tenant law

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Your Role in ComplianceYour Role in Compliance

Complying with the Complying with the Fair Housing ActFair Housing Act

Ensuring reasonable Ensuring reasonable accommodationaccommodation

Maintaining tenant confidentialityMaintaining tenant confidentiality

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Resources - HousingResources - Housing

Emergency sheltersEmergency shelters

Transitional housingTransitional housing

Residential treatment Residential treatment programsprograms

Permanent housingPermanent housing

Population-Population-specific housingspecific housing

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Resources – Internal TeamResources – Internal Team

Maintenance staffMaintenance staff HIV/AIDS specialistsHIV/AIDS specialists Chemical dependency specialistsChemical dependency specialists Mental health specialistsMental health specialists Case managersCase managers Property managersProperty managers LandlordsLandlords Resource coordinatorsResource coordinators Peer-to-peer workersPeer-to-peer workers SupervisorsSupervisors

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Resources – Service ProvidersResources – Service Providers

Mental health Mental health providers/hospitalsproviders/hospitals

Health care servicesHealth care services Public benefitsPublic benefits Substance use Substance use

treatment programstreatment programs Child care/Child care/

foster carefoster care Adult day careAdult day care Money management Money management

servicesservices

Employment-related Employment-related servicesservices

Educational servicesEducational services TransportationTransportation Domestic violence Domestic violence

agenciesagencies Legal servicesLegal services Criminal justice systemCriminal justice system Food banks/Food banks/

meal providersmeal providers

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Other ResourcesOther Resources

FamilyFamily FriendsFriends Faith-based organizationsFaith-based organizations NeighborsNeighbors LibraryLibrary InternetInternet

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Qualities of an Effective TeamQualities of an Effective Team

Clearly defined goalsClearly defined goals Clearly defined rolesClearly defined roles Relevant skillsRelevant skills Clear communicationClear communication Personal accountabilityPersonal accountability Unity of approachUnity of approach Trust of tenants Trust of tenants

and co-workersand co-workers Commitment to learningCommitment to learning LeadershipLeadership

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Keep the Lines of Keep the Lines of Communication OpenCommunication Open

Community service Community service providersproviders

Off-site property Off-site property management management staff and landlordsstaff and landlords

On-site service staff and On-site service staff and property property management staffmanagement staff

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Session 3Session 3The Effective Tool KitThe Effective Tool Kit

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Goals of EngagementGoals of Engagement

Care for Care for immediate needsimmediate needs

Development of trustDevelopment of trust

Provision of servicesProvision of services

Connection to social networksConnection to social networks

Increased housing stabilityIncreased housing stability

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Engagement StrategiesEngagement Strategies

Set the stageSet the stage Initiate your Initiate your

engagement strategyengagement strategy Sustain the Sustain the

relationshiprelationship Maintain momentumMaintain momentum

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Tips on EngagementTips on Engagement

Pace yourselfPace yourself

Listen, observe, Listen, observe, and communicateand communicate

Maintain realistic Maintain realistic expectationsexpectations

Use a non-judgmental Use a non-judgmental approachapproach

Emphasize strengths Emphasize strengths vs. weaknessesvs. weaknesses

Focus on behaviorsFocus on behaviors

Be consistent Be consistent and reliableand reliable

Negotiate and Negotiate and compromisecompromise

Stay “up” when the Stay “up” when the tenant is “down”tenant is “down”

Celebrate the Celebrate the smallest successessmallest successes

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Employment as anEmployment as anEngagement StrategyEngagement Strategy

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Motivational Interviewing –Motivational Interviewing –An Engagement ToolAn Engagement Tool

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Five Principles of Five Principles of Motivational InterviewingMotivational Interviewing

Express empathyExpress empathy

Distinguish goals from Distinguish goals from current behaviorcurrent behavior

Avoid arguingAvoid arguing

Roll with resistanceRoll with resistance

Embrace optimismEmbrace optimism

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The Role of CommunityThe Role of Community

Creates a Creates a vested interestvested interest

Fosters self Fosters self awarenessawareness

Develops self-esteemDevelops self-esteem Builds skillsBuilds skills

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Building CommunityBuilding Community

Welcome and orient new Welcome and orient new tenantstenants

Encourage, support, and Encourage, support, and reinforce reinforce community normscommunity norms

Offer group activitiesOffer group activities Develop leadership Develop leadership

qualities and peer supportqualities and peer support

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Understanding AssessmentUnderstanding Assessment

Identify drug-Identify drug-and non-drug-related and non-drug-related risk behaviorsrisk behaviors

Prioritize service needsPrioritize service needs

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The Purpose of AssessmentThe Purpose of Assessment

Determine what you Determine what you need to know need to know to help the tenantto help the tenantstay housedstay housed

Identify what you need Identify what you need to know to protect the to know to protect the stability of your other stability of your other tenantstenants

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Identify Stress PointsIdentify Stress Points

Economic/financial Economic/financial issuesissues

Health-related Health-related concernsconcerns

Loss of Loss of community/familycommunity/family

Parenting pressuresParenting pressures

Psychological Psychological stressorsstressors

History of violenceHistory of violence

Spiritual voidsSpiritual voids

Lack of food or Lack of food or other basic needsother basic needs

Physical mobilityPhysical mobility

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Key Issues in AssessmentKey Issues in Assessment

Ability to meet Ability to meet basic needsbasic needs

Environmental and Environmental and behavioral triggersbehavioral triggers

Predatory Predatory behaviorsbehaviors

InterestsInterests StabilityStability

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Key Approaches in AssessmentKey Approaches in Assessment

Be clear and calmBe clear and calmabout your purposeabout your purpose

Don’t fear being too Don’t fear being too intrusiveintrusive

Avoid yes/no questionsAvoid yes/no questions Avoid being manipulatedAvoid being manipulated Be consistentBe consistent Ask about past Ask about past

behaviorsbehaviors

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Service Planning FundamentalsService Planning Fundamentals

Involve the tenantInvolve the tenant

Be realisticBe realistic

Develop Develop achievable goalsachievable goals

Have a “Plan B”Have a “Plan B”

Don’t generalizeDon’t generalize

Be creative and Be creative and willing to experimentwilling to experiment

Network, network, Network, network, networknetwork

Avoid “splitting”/Avoid “splitting”/triangulationtriangulation

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Health and Safety ChecksHealth and Safety Checks

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Conflict ResolutionConflict Resolution

Ask questions and listenAsk questions and listen

Define the problemDefine the problem

Brainstorm solutionsBrainstorm solutions

Evaluate optionsEvaluate options

Use behavioral contractsUse behavioral contracts

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Handling Crisis SituationsHandling Crisis Situations

Calm the tenantCalm the tenant Listen carefullyListen carefully Maintain personal safetyMaintain personal safety DebriefDebrief Receive trainingReceive training Keep emergency Keep emergency

numbers at handnumbers at hand

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Working with TenantsWorking with Tenantsat Risk of Evictionat Risk of Eviction

Mobilize your resourcesMobilize your resources Step up the intensityStep up the intensity Develop a behavioral Develop a behavioral

plan with the tenantplan with the tenant Communicate withCommunicate with

the tenantthe tenant

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Eviction as a RealityEviction as a Reality

Understand local Understand local landlord-tenant lawslandlord-tenant laws

Follow legal proceduresFollow legal procedures

Document behaviorsDocument behaviors

Be prepared to go to courtBe prepared to go to court

Learn to let goLearn to let go

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Session 4Session 4Separating the PersonalSeparating the Personalfrom the Professionalfrom the Professional

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Professionalism Means:Professionalism Means:

Self awarenessSelf awareness Understanding your roleUnderstanding your role Reliability and consistencyReliability and consistency Knowledge of resourcesKnowledge of resources Commitment to learningCommitment to learning TeamworkTeamwork Understanding cultural Understanding cultural

competencycompetency

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Boundaries – Rules for MaintainingBoundaries – Rules for Maintaininga Professional Relationshipa Professional Relationship

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Warning Signs of Boundary BlurWarning Signs of Boundary Blur

Seeking out tenant Seeking out tenant outside workoutside work

Anticipating appointmentsAnticipating appointments

Disclosing considerable Disclosing considerable detail about yourselfdetail about yourself

Taking responsibility for Taking responsibility for the tenant’s successthe tenant’s success

Accepting giftsAccepting gifts

Tolerating aggressive Tolerating aggressive behaviorbehavior

Diverging from formal Diverging from formal policies policies and proceduresand procedures

Doing favors forDoing favors fora tenanta tenant

Linking your Linking your advancement to advancement to tenant’s successtenant’s success

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Formal Policies vs.Formal Policies vs.Informal PracticeInformal Practice

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Appropriate Boundary CrossingAppropriate Boundary Crossing

Action directly relates Action directly relates to housing or clinical needsto housing or clinical needs

Professional literature Professional literature supports your actionsupports your action

Risk-benefit analysis Risk-benefit analysis supports your decisionsupports your decision

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Tips for Self CareTips for Self Care

Clarify expectationsClarify expectations Have realistic Have realistic

expectationsexpectations Keep a sense of Keep a sense of

humorhumor Celebrate small Celebrate small

successessuccesses Roll with the Roll with the

punchespunches Set limitsSet limits Recognize strengthsRecognize strengths

Learn to let goLearn to let go Don’t get caught up Don’t get caught up

in sense of urgencyin sense of urgency Don’t be a rescuerDon’t be a rescuer Don’t try to be a drug Don’t try to be a drug

treatment experttreatment expert Don’t take it Don’t take it

personally personally Don’t try to go Don’t try to go

it aloneit alone