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