# Presentation: 039162

## New Tools for Engagement: “Housing First – Work Fast”

**Ann V. Denton**
- Managing Director, Advocates for Human Potential
**Gary Shaheen**
- Managing Director, Advocates for Human Potential

## New Tools for Engagement:  "Housing First - Work Fast"

- 	People with disabilities, including people with mental illnesses or people with co-occurring disorders of mental illness and substance abuse, have high rates of poverty and have a high risk of homelessness.
- 	(GAO, 2000, p.16).

## New Tools for Engagement:  "Housing First - Work Fast"

**	****20%** of homeless people can be characterized as chronically homeless.
- 	Many of these individuals have serious mental illnesses, chronic substance abuse, or both.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Individuals on SSI have a higher than average risk of homelessness due to their poverty.
- 	Individuals who have serious mental illnesses/co-occurring disorders become homeless due to poverty.

## New Tools for Engagement:  "Housing First - Work Fast"

- The housing problems of people with mental illnesses are more about POVERTY than about mental illness.

## New Tools for Engagement:  "Housing First - Work Fast"

- People with serious mental illnesses/co-occurring disorders face significant, ongoing challenges to housing retention.
- The most significant challenge is ongoing poverty!

## New Tools for Engagement:  "Housing First - Work Fast"

- How do we break the cycle of homelessness and poverty?
- Housing and Jobs!!

## New Tools for Engagement:  "Housing First - Work Fast"

- The Housing First – Work Fast approach emphasizes real and meaningful community integration for people with significant psychiatric disabilities.
- Why is community integration so important?

## New Tools for Engagement:  "Housing First - Work Fast"

- What is the legal basis of community integration?
- The Olmstead Supreme Court decision of 1999 provided an interpretation of the Americans with Disabilities Act that strongly supports the community integration of people with disabilities.
- This includes housing and jobs!!!

## New Tools for Engagement:  "Housing First - Work Fast"

- What is the legal basis of community integration?
- The Americans with Disabilities Act of 1990 prohibits the unjustified segregation of qualified individuals through institutionalization.
- When people are institutionalized without clinical necessity, this is a form of disability-based discrimination.

## New Tools for Engagement:  "Housing First - Work Fast"

- What is the legal basis of community integration?
- ADA Provisions:
- Apply to States and public entities
- “No qualified individuals with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity or be subjected to discrimination by any such entity”  42 U.S.C. Section 12132

## New Tools for Engagement:  "Housing First - Work Fast"

- What is the legal basis of community integration?
- In 2001, President Bush issued Executive Order 13217, which confirmed federal policy to place qualified individuals in community settings whenever appropriate, and ordering federal agencies to implement swiftly the Olmstead decision.
- Every state has an Olmstead Implementation Committee.

## New Tools for Engagement:  "Housing First - Work Fast"

- What is the legal basis of community integration?
- Housing and work are two crucial indicators of community integration.  If people are segregated and isolated due to disability, the States or other public entities that support those practices are in violation of the ADA.
- So, Olmstead has significant implications for housing and employment policy.

## New Tools for Engagement:  "Housing First - Work Fast" .

- Housing is a basic right for all people
- Full community integration
- Client-driven
- Respect people’s ability to make an informed choice about what they want, the sequence they want it in, and for how long they want the service
- Use ACT team structure for services/supports

- Having a job is a basic right for all people
- Full community integration
- Client-driven
- Respect people’s ability to make an informed choice about what they want, the sequence they want it in, and for how long they want the service
- Use integrated services team structure for services/supports

##  New Tools for Engagement:  "Housing First - Work Fast"

- Permanent Supportive Housing is characterized by:
- Choice
- Housing as housing
- Integration
- Flexibility
- Individualization

## New Tools for Engagement:  "Housing First - Work Fast"

- 	*“**Housing First”* or *“Supported Housing”* approach is an emerging concept within the **Permanent Supportive Housing** umbrella.
- 	Provides individuals with on demand housing and a high degree of choice, integration, and community inclusion.
- 	Uses scattered sites, often with private market landlords.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Provides housing to persons with significant functional impairments, without requiring a demonstration of housing readiness,
- and...
- 	offering individuals housing *first,* is an engagement tool for seriously disenfranchised, significantly impaired group of people.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Offering housing *first*  to tenants with significant functional impairments and no demonstration of readiness results in...
- exiting homelessness.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Offering supports and services with the housing assistance means that people with significant functional impairments can—
- STAY in their homes.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	*Housing First* is an important tool to help communities end *chronic homelessness*
- because...
- 	chronically homeless individuals have multiple needs and the service delivery systems have been unsuccessful in meeting them.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	*Housing First* is – almost by definition –
- 	is for people who are not well served by programs that require:
-  sobriety
-  compliance with treatment regimens
-  spotless housing histories
-  other requirements

## New Tools for Engagement:  "Housing First - Work Fast"

- A key component of *Housing First* is **CHOICE**.
- Choice of their housing unit
- Choice of services and supports.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	An essential element of *Housing First* is **INTEGRATION** and community inclusion.
- 	Integration is a mix of populations in housing:  diversity in income and a mix of labeled and unlabeled people.
- 	Mixed incomes as a guiding principle comes from the affordable housing industry.
- 	True integration is completely scattered site housing.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Immediate **ACCESS** to housing is a crucial component of a *housing first* approach.  Housing becomes an engagement tool.
- 	Access to housing is not dependent on traditional predictors of readiness:
- Sobriety
- Med compliant
- Ability to shop or cook, etc.

## New Tools for Engagement:  "Housing First - Work Fast"

- HOUSING FIRST:
- Does not require participation in psychiatric treatment or sobriety as a condition for housing
- Provides people with apartments of their own, with ongoing support through ACT
- From outreach to directly into permanent independent scatter site apartments, rented from private landlords.
- Consumers have rights and responsibilities outlined in a standard lease.
- Stability in safe, affordable mainstream housing is the goal

- WORK FIRST
- Harm reduction approach (“Standing offer of work”)
- Work as a tool for engagement
- Low-demand jobs at minimum wage or above, with access to ongoing treatment, support services and case management
- Consumers meet standards of job quality and quantity, attendance and work behaviors
- Independent mainstream jobs at a living wage using employment EBP is the goal

## New Tools for Engagement:  "Housing First - Work Fast"

- What does it take to adopt a *housing first* approach?
- Identified need – Is your population underserved by current offerings?
- Rental assistance funds/financially assisted units
- Intensive services and supports
- Targeting services to people with significant functional impairments
- Effective outreach practices
- Staff training and support.

## New Tools for Engagement:  "Housing First - Work Fast"

- What does it take to adopt a *housing first* approach?
- 	Housing First requires some system changes to support the activity, including:
- Management and leadership buy-in
- Consensus about goals and methods
- Understanding, accepting, and managing risk
- Understand needs of multiple customers
- Updated Personnel policies, job descriptions, program policies/procedures/manuals
- New Partners
- Quality assurance

## Moving to Recovery:  Substance Abuse Issues

- 	People with co-occurring disorders (mental illness and substance abuse) can present a challenge to housing first implementation.
- 	Housing First approaches do not require sobriety as a pre-condition for housing.

## Moving to Recovery:  Substance Abuse Issues 

- 	A Different Approach:
- Addiction is an illness, not a moral failing or lack of character.
- An improvement in quality of life is a successful outcome.
- Being realistic with people about the risks of alcohol and drug use is essential.
- Choice is essential to understanding this service approach.  People are making choices.  You can help people make informed and competent decisions.
- Drawn from:  Lamp Community Model, 527 S. Crocker Street, Los Angeles, CA, 90013; www.lampcommunity.org

## Moving to Recovery:  Substance Abuse Issues

- 	Successful approaches for individuals with co-occurring disorders include:
- Integrated treatment plan and services teams
- Wet, Damp & Dry Housing
- Encouraging Abstinence
- Dual Recovery & Self Help Programs
- Supported or integrated employment

## Moving to Recovery:  Substance Abuse Issues

- For people with co-occurring disorders, the recognition that substance abuse is part of the clinical picture has implications for housing.
- 	The goal is improved quality of life, housing retention and community integration.

## New Tools for Engagement:  "Housing First - Work Fast"

- 	Outcomes of a Housing First approach:
- Successful for the chronically homeless and other seriously mentally ill groups.
- Improved community integration
- Improved housing retention
- High degree of choice, access, integration, flexibility and a separation of service and housing functions.
- No difference in rates of substance abuse among people with co-occurring disorders.

## New Tools for Engagement:  "Housing First - Work Fast"

- Outcomes of a Work Fast approach:
- Desire to increase hours of work, obtain a better job
- Develop an initial job goal
- Develop an initial support services plan
- Improve knowledge of job options, skills and credentials needed
- Practice job skills and aptitudes
- Make $$

## New Tools for Engagement:  "Housing First - Work Fast"

- Outcomes of the Housing First/Work Fast approach:
- Improved self-esteem and confidence
- Facilitated motivation to change
- Sense of personal stability
- Establish trust in self and others
- HOPE AND RECOVERY!!

## New Tools for Engagement:  "Housing First - Work Fast"

- 	It is up to each community to:
- 	assess housing and employment needs
-   assess and adjust service capacity
-   create community tolerance for various approaches
-   assess the needs of people who are chronically homeless

## New Tools for Engagement:  "Housing First - Work Fast"

- In summary,
- Housing is essential in ending homelessness and achieving community integration.
- Poverty is a significant barrier to community integration for people on SSI.
- Solutions must address poverty, and some form of financial housing assistance is essential.  Jobs and job training are essential to community integration.
- Long term solutions must make housing units affordable, offer jobs and job training, and make needed services and supports readily available.