There’s a common trope among social service providers—don’t work harder than the client. While this makes practical sense, as programs aim to increase participant independence, it isn’t the appropriate approach in the Housing First Model. Housing First programs are designed to support the most vulnerable, and oftentimes disengaged, members of our communities. The participants that Housing First caters to are often reluctant to engage due to histories of trauma, symptoms of mental illness, or negative experiences trying to access care.
To overcome the barriers to engagement, case managers in Housing First programs will work harder than their clients at times. A case manager may end up making numerous unsuccessful attempts to engage someone—scheduling a home visit, making follow-up calls, leaving notes, or trying to find the participant in the community. These outreach and engagement efforts are time consuming and require the case manager to be persistent and patient. Housing First values the autonomy of a client and recognizes that a case manager cannot decide whether or not someone will make changes or force them to do so. However, case managers can increase the likelihood of engagement and change by consistently attempting to reach the client in a respectful, compassionate manner.
Many Housing First programs ask that clients have regular, meaningful engagement with a case manager. This can range from weekly meetings, to one or two engagements per month, to a meeting every three months. This minimum level of engagement gives the program an opportunity to confirm the client is still occupying their apartment and check in to see if any additional supports are desired. Housing First workers should strive to express concern and offer support without making the participant feel like the program is trying to catch them doing something wrong or that they’re expected to fail.
...case managers in Housing First programs will work harder than their clients at times.
Previously, we’ve talked about reduced service requirements as a critical ingredient of Housing First programs. This presents a dilemma for Housing First programs. How can we require that someone have contact with a case manager and not require them to participate in services? Programs are torn between providing support and encouraging self-determination. Housing First programs around the country navigate these issues by balancing competing concerns in different ways. For instance, there are some programs that prioritize housing maintenance above all else and choose to mandate that clients have a representative payee so that their rent is always paid and their housing is never lost due to nonpayment. Other programs place greater emphasis on the Housing First principle of valuing the client’s perspective so that a client chooses whether or not they want a rep payee. This has been framed in the mental health recovery model as “the dignity of risk.” Providing a greater degree of autonomy and independence is noble, but also comes with the risk that the participant may fall behind in rent. If that happens, it’s the case manager’s job to communicate with the landlord and increase engagement attempts to identify the participant’s barriers to paying rent.
People also shouldn’t be penalized for getting better. Sometimes, Housing First participants will engage less often because they are doing really well. They may be busy with employment, volunteering, spending time with family, or life in general. In these cases, engagement with Housing First staff may be as minimal as a phone check-in every couple months. Between a brief check-in and a lack of complaints from a landlord or property manager, the case manager can be assured that someone is doing well enough in housing that they do not need additional support.
This demonstrates the need for “moving on” or “bridge” programs. This approach helps people transition out of Housing First programs, which provide ongoing case management using a permanent supportive housing model, but keeps them connected with ongoing housing subsidies (e.g. housing choice vouchers) by partnering with local housing authorities. When clients no longer need ongoing support, our communities should be able to link them with less intensive programs that still assist with paying the rent. This can also open the door for someone else to enter the supportive housing spot they leave behind.
Adaptations can happen with an evidence-based practice while still staying true to the model. Ultimately, agencies must make individualized choices about how to operate their Housing First programs. To determine the appropriate level of engagement, programs should consider factors like the amount of staff time available, the level of need of participants, and the Housing First principles that they want to prioritize. Housing First programs should be prepared to be flexible with clients and understand that it’s difficult to come up with a one-size-fits-all approach to any program. Although requirements to engage on a monthly basis seem like a violation of reduced service requirements, they provide an opportunity to engage with participants and ensure they have access to community supports that can help them retain housing placement. With or without a requirement, it's up to the case manager to commit to reaching out regularly and attempting to stay connected with their participants.
We’ve taken a break from blogging the past month to work on our annual conference, Harm Reduction in the House. The conference focuses on how harm reduction can be applied to improve the delivery of housing and other social services. There are a number of nuanced issues that come up for participants in programs using the Housing First Model. This year, conference attendees were able to hone in on areas to use harm reduction including safer substance use practices, sexual health promotion with tools like PrEP, and engagement strategies that promote positive changes like the SODAS Method. The conference hosted several hundred presenters and attendees from around the Midwest including Illinois, Indiana, Wisconsin, Michigan, and Ohio. In this post, we look at some of the reaction and takeaways from the conference.
The theme of this year’s conference was “Growing from Our Roots.” Harm reduction is getting into the mainstream. In recent years, a broader range of programs and providers around the world have embraced harm reduction. Growing from Our Roots is a reminder that harm reduction work began with drug users and people actually engaged in risky behaviors. Their community, respect, and self-determination drive the principles of the harm reduction philosophy in service delivery. They are experts in their own lives and must be included in the work and accompanying advocacy efforts. Daniel Raymond, policy director at the Harm Reduction Coalition, attended the conference and offers additional thoughts on this topic and more in “Holding space for the unredeemed: harm reduction and justice.”
One of the popular sessions at the conference was the “Irreverent: Harm Reduction Youth Work and Radical Ministry” workshop. Rabbi Menachem Cohen and Pastor Alli Baker led a group discussion including youth who are LGBTQ and have experienced homelessness. The conversation explored the experience of homelessness from a young person’s perspective and what providers can do to create safe, welcoming environments. When workers listen nonjudgmentally and remain flexible, they have the power to support youth in getting off the streets and remaining housed. Rev. Kathryn Ray is a member of Clergy for a New Drug Policy and offered her thoughts on this workshop after attending the conference in “Rule Breaking and Radical Love.” She discusses the way that harm reduction can open doors for people and says, “Harm reduction work is gospel work.”
We have to acknowledge that we could not put on this conference without the help of our amazing volunteers. Thanks to everyone who pitched in! Among other duties, we had volunteers live-tweeting the conference. Below are some of the highlights from the day. For a full list of tweets, check out #HousingisHR on Twitter.