Workshop 1.8 Transatlantic Practice Exchange: Lessons from ... · 2012 PIE for Homeless People Good...
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Workshop 1.8 Transatlantic Practice Exchange: Lessons from Across the Pond
Transcript of Workshop 1.8 Transatlantic Practice Exchange: Lessons from ... · 2012 PIE for Homeless People Good...
Workshop 1.8 Transatlantic Practice Exchange:
Lessons from Across the Pond
Historical Context & Policy Framework
1999 Devolution Settlement Devolved housing policy in England, Scotland, Wales &
Northern Ireland
The 1996 Housing Act Gave Local Authorities the statutory duty to find
accommodation for households deemed to be homeless, eligible for public funds, and in ‘priority need’
Homelessness Act of 2002 Extended those who qualify as having ‘priority need’ Requires Local Authorities to put strategies in place for
preventing homelessness
‘Priority Need’ = Households including:
A pregnant woman Dependent children Someone who is vulnerable due to: Old age Mental illness / physical disability Being homeless due to a natural disaster Being 16-17 years old Being under 21 after having been in Local Authority care between
ages 16-18 Being 21 or over and having left Local Authority care Having left the armed forces Having left prison Fleeing domestic violence
Affordable Housing Provision
There is significantly more affordable housing available in the UK than the US
Housing Benefit Decreases the amounts qualifying tenants pay for their rent Resembles the Section 8 Housing Choice Voucher program
Social Housing Resembles public housing Duties partly released with the 2011 Localism Act
Data
There is no common nation-wide database The voluntary sector primarily serves single adults,
with common groups being: Single men (aged 18-25) Young People (aged 16-24) Ex-offenders Minority Groups
Homelessness ‘Pathways’
Statutory Pathway 5 tests: eligibility; homelessness; priority need; intentional
homelessness; local connection
Voluntary Pathway (contracted by a Local Authority) Hostels Supported Housing Night Shelters Specialist Accommodation Projects
Voluntary Pathway (Independent) Outside Local Authority System Flexibility Disconnected from other support agencies
Aubrey Patino, LMSW Director of Tenant Programs
Frequent Users Systems Engagement
Supportive housing linked to coordinated primary and behavioral healthcare for homeless high utilizers of crisis health services. Key Components: 1. Cross Systems Partnership 2. Data driven strategy 3. Outreach based 4. Housing as healthcare/integration of housing
and healthcare 5. Evidence based practices
Making Every Adult Matter
Why MEAM Cambridge? Complex Needs/Chronically Excluded
Adults: • Touch multiple systems • History of complex trauma, often further
exacerbated by history of homelessness • Chronically homeless, “entrenched” • Complex behavioral and physical health
issues • Consequence of silo based interventions
with poor cross systems communication
Key Components
Outreach and Creative Engagement Focus on field work Not another silo/intervention Professionals meeting Governance structure - embedded in city
council 12-18 month intervention
MEAM Cambridgeshire Findings
Demonstrated cost savings of over 25% to the public sector showing a significant fall in crime and mental health costs, with other costs remaining broadly constant.
Case studies indicate significant quality of life improvements.
How does a cross systems model work in the landscape of their public sector?
Learning Objective
MEAM Approach
How did it begin? JSNA 1 “chaotic” individual MEAM seed money 4 years ago
Goal is to elevate professionals in community to do their jobs better,
increase transparency between providers, reduce the number of times providers are having the same conversation w/a client
“Let’s make the systems work before we overhaul them and create a new one because that’s really expensive and if we improve the systems for the clients we serve then we improve them for everyone.” Focus is not on impairment of individual, but on impairment of systems
failing to meet individual’s needs
Street Life Officers/Police
Street life officer team “Anti social behavior orders” Attend wrap around meeting
for CEA clients and are a part of community stakeholder group
Booking at jail – assessment, intervention, warm hand off to tx providers, nurse on site
"I went into it thinking about the human rights of those he was affecting (community members) and one provider said it's not just about the human rights of those in the community it's about his human rights too." Sgt. Kevin Misik
What housing options exist for this population?
Learning Objective
Emphasis on temporary solutions
Focus is on ending “rough sleeping” PIT only looks at those “bedding down” • 9 reported homeless in Cambridge (pop. 123,900) Temporary accommodations, “training flats” Housing First not widely implemented yet
Duty to “accommodate”
5 Tests: 1. Eligibility 2. Actually homeless 3. Priority need (indication of vulnerability) 4. Intentionality 5. Local connection
New Approach
City council securing private rentals w/housing benefit attached – business approach to landlord outreach work
Social Housing Housing first is a new concept, paradigm shift
How does primary care access and care coordination impact health?
Learning Objective
GP Access Surgery
Everyone in NHS has to be registered w/a GP Financially disincentivized from A&E admissions Shadowed 2 GP Access Surgeries – both targeted at
homeless/precariously housed 1 also served as opioid replacement therapy
prescriber Both offered DAAT/Mental Health tx in house Both housed outreach teams in house
Primary Care Observations
Focus on “wellness” not “illness” • “Acutely unwell” in lieu of SPMI or “chronically”
_________ Less interventionist Cultural expectation of the health and well being
the patient’s responsibility, not the provider’s “I would never practice in the US. I can’t be an ethical doctor there.”
Does the community have a working definition of harm reduction? What does DAAT look like? What harm minimization strategies are being employed?
Learning Objective
Drug and Alcohol Treatment
Drug and alcohol teams separate, treatment variance by drug of choice Wide spectrum of options, 12 step model not dominate “We offer a publicly funded addiction service that looks at the continuum of recovery.” History of treating a script as treatment, shift towards recovery/abstinence Class A vs. Class B drug tx outcome change Emphasis on education, harm minimization “Drug related death panel”
Huge emphasis on recovering at home, limited detox/res rehab options
Harm minimization
What role do experts by experience play in the model?
Learning Objective
Peer Support and Involvement
Service user forums – legally mandated and meaningful
Experts by experience
Cambridge Link Up
Jimmy’s – ½ are former service users
Recovery champions
Cultural Observations
Reliance on public sector Pragmatic approach to DAAT, reduced stigma (Ex: needle exchange in prisons) Significant emphasis on self determination Strategic in work (Ex: analysis of staff time in meetings) Bridge builders… Focus on health and safety (Ex: CPR example)
Similarities
Lack of sufficient affordable housing Funding short falls Magnet theory - “If you build it they will come” Pan handling incentivizes “antisocial behavior” Co-occurring d/o Reinventing the wheel (at least every 4 yrs.)
Differences
Professionals meeting Public health/police involvement Harm minimization, look at DAA related deaths Positive risk taking Less people sleeping out w/emphasis on “No 2nd
Night Out” Peer/service user feedback and involvement Police involvement
Next Steps
How can we more effectively achieve community ownership of our complex needs population with key decision makers at the table?
How can we effectively crosswalk a broader spectrum of DAAT and harm minimization strategies into the housing/homelessness sector?
Could their temporary accommodations serve as a model for safe haven or crisis respite programs in the US and how does their model translate to lower rates of street homelessness?
How can the housing/homelessness sector better involve other non traditional players (i.e. public health/police) ?
How do we continue to involve experts by experience and ensure funders support this work?
Contact Information
Aubrey Patino, LMSW Director of Tenant Programs
Avalon Housing 1327 Jones Drive
Ann Arbor, MI 48105 734-663-5858 ext 224
Hospital Discharge Practices for Homeless Patients
Adrienne Breidenstine Executive Director of the Journey Home
The Journey Home
Increase affordable housing
Increase access to comprehensive and affordable health care
Ensure that people have sufficient incomes and employment opportunities
Build the capacity of preventive and emergency services
Homelessness in Baltimore will be rare and brief
Learning Objectives
1. Explore the environmental factors and planning process used to develop hospital admission and discharge practices for homeless patients
2. Analyze hospital admission and discharge practice or homeless patients
3. Examine post-hospital care programs/models for people experiencing homelessness
4. Evaluate hospital and post-hospital program outcomes for discharged homeless patients
A Changing Environment
Health care reform through the Affordable Care Act (ACA) State option to expand Medicaid Medicaid service packages Discharge planning programs
Maryland is restructuring payment models to focus on health outcomes
Brighton, England
3rd largest homeless population in England Pathway Plus
“London by the sea”
Brighton Homeless Healthcare
Local Practices
Engage hospitals in design and development of coordinated intake and assessment
Identify long-term solutions for reducing unnecessary or avoidable hospitalizations for people experiencing homelessness
National Policy Recommendations
All states should fully expand Medicaid
Identify HHS funding for community supports, such as case management, care coordination, and peer supports
Identify consistent funding mechanism for Medical Respite care
Resources
Adrienne Breidenstine Executive Director of the Journey Home
Journey Home website: www.journeyhomebaltimore.org
Follow us on Twitter @TJHBaltimore
Elizabeth Eastlund, LCSW Rainbow Services
San Pedro, CA
Trauma Informed Services “Trauma-Informed Care is a strengths-based
framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and
emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and
empowerment.”
“Shelter from the Storm: Trauma-Informed Care in Homeless Services Settings” Hopper, et. al. 2010
PIE For Homeless People Good Practice Guide February 2012
1. Developing a psychological framework
2. The physical environment and social spaces
3. Staff Training and support
4. Managing relationships
5. Evaluation of outcomes
Timeline PIE TIS
Rooted in Therapeutic
communities
2012 initial funding from
Lambeth council to
incorporate PIE at the
Waterloo Project
2012 PIE for Homeless People
Good Practice Guide is
published
Rooted in expanding the
definition of PTSD &
addressing complex trauma
2001 – Harris and Fallot
publish Using Trauma Theory
to Design Service Systems
2005 – the National Center
on Trauma Informed Care is
created by SAMHSA
Learning objectives
I was interested in examining the significant relationship or differences between
Psychologically Informed Environments (PIE) and a Trauma Informed Services (TIS).
Learning Objectives What are the aspects of training and supervision
that are beneficial to shelter staff and result in
improved outcomes for survivors?
How are staff trained and supported in their
daily work with residents in a PIE system?
Learning Objectives How can we improve our services to engage
survivors with multiple challenges and long
histories or complex trauma?
Is there value in incorporating aspects of PIE
and TIS models to serve homeless survivors of
domestic violence?
London Burroughs
Enabling Assessment Services London
The Waterloo Project Collaboration between
Thames Reach and the National Health Trust funded by the Lambeth Council
18 beds – 6 women, 12 men; 2 year stay
Key Workers, Managers and Psychologists work to support residents with complex needs
Waterloo Project
Initial Outcomes for Waterloo Project
Similarities Promoting client choice
Organizational Change Process is challenging
Recognition of need to increase support to front line staff
Recognition that all aspects of an organization need training and support on understanding the model – from the executive level to volunteers
Similarities
Providing information, training and ongoing support to staff regarding the psychological
process of what may be happening with clients, just as increasing the understanding
the effects of previous traumatic experiences on present situations,
reduces staff frustration and increases empathy
Differences PIE TIS
Clear framework in adopting a PIE structure
Blend of operations and service staff on the front line
Implementation of Clinical Services in homeless shelters
Fluid & flexible framework in implementing TIS
Clear definition between role of residential & services staff
Clinical program in place at Rainbow Services and other DV specific shelters
Creating a culture of wellness
Creating a Culture of Wellness Regular Wellness Activities that provide staff the
opportunity to step away from their work and have fun together
Utilizing training, individual supervision to regularly discuss wellness, self-care, burnout, vicarious trauma…
Beginning meetings with grounding exercises
Moving forward Incorporating Reflective Practice
Provide information to staff about the theoretical
framework that supports our practice
Ongoing training and support for residential staff
Engaging with homeless service providers to create
and maintain good working relationships
Continue to build a culture of Wellness
Recommendations Homeless organizations can benefit from training
that increases the workers understanding of the
effects of trauma on a persons ability to care for
themselves and make positive decisions to reach
their full potential
Collaborations between private and public systems
may benefit those with the most complex needs
The COMPASSION REVOLUTION
RESOURCES FOR ADDITIONAL LEARNING ON TIS AND PIE
Harris & Fallot (2001) Using Trauma Theory to Design Service Systems
Herman, J. (1992) Trauma & Recovery The
aftermath of violence—from domestic abuse to political terror
Johnson, R. (2012) Complex Trauma and Its
Effects, Perspectives on creating an environment for recovery
RESOURCES FOR ADDITIONAL LEARNING ON TIS AND PIE The National Center on Trauma Informed Care:
www.samhsa.gov/nctic
Homeless Resource Center: www.homelessness.samhsa.gov
The National Center on Family Homelessness: www.familyhomelessness.org
ACE Study: www.acestudy.org
PIE Link—practice exchange for psychologically informed environments: www.pielink.ning.com
History of PIE in the UK: www.rjaconsultancy.org.uk
NO SECOND NIGHT OUT
ST. MUNGO’S BROADWAY LONDON, UNITED KINGDOM BY: DEANNA M. VILLANUEVA, M.A.
No Second Night Out Headquarters, City of London
Overview No Second Night Out started as a pilot program in April 2011 as a quick response to ‘rough sleeping,’ or street homelessness in London
The model was developed based on the belief that rough sleeping is urgent, harmful, dangerous and unacceptable
The primary objective is to get to people quickly and to get them to safety
The primary goal was that by the end of 2012, no one would live on the streets and anyone new would not spend a second night out
Definitions •Those who have not been contacted by outreach workers
previously and have not been entered into the database, CHAIN (Combined Homelessness and Information Network)
New rough sleepers:
•Those who have had a high number of contacts over three weeks or more with outreach workers
Living on the streets:
•Those who have irregular contacts with outreach workers Intermittent
rough sleepers:
Definitions taken from St. Mungo’s Broadway CHAIN Quarterly Report: Street to Home 1/14 – 3/14
Data: April 2013 – March 2014 London, UK Overall Rough Sleepers: • 6,508 people were seen rough sleeping by outreach workers
New Rough Sleepers: • 4,363 people (67% of total) were seen sleeping rough for the
first time
Returning Rough Sleepers: • 11% of those seen rough sleeping had returned to the
streets after a period of at least one year
Data taken from St. Mungo’s Broadway CHAIN Annual Report: Street to Home 13/14
Model Components Outreach teams go out to the streets at night to identify new rough sleepers
Once identified as a new rough sleeper, the outreach teams coordinate with the No Second Night Out hub that corresponds with their borough to make a referral
There are three hubs in the North (Islington), South (Lewisham) and the West (Hammersmith and Fulham)
South Hub Entrance, Lewisham
North Hub Exterior, Islington
West Hub Office, Hammersmith and Fulham
Model Components Continued The hubs work toward a 72-hour target to move the client from the hub
Within one hour of entering the hub, staff conduct an intake assessment and risk assessment
Staff work use intake information and verify it to establish a local connection, or residency
Once the local connection has been established, staff make a Single Service Offer to the client
Pathways out of the hubs Lo
ng-t
erm
ac
com
mod
atio
n
Private Rented Sector
Supported Housing
Shor
t-te
rm
acco
mm
odat
ion
Hostel/Bed and Breakfast
Detox/Clinic/Rehab
Reco
nnec
tion
to
Hom
e Ar
ea Friends and Family
Short and long-term accommodations
Applicability
Quick intervention
Central intake as a hub
Single Service Offer
Contact Information Deanna M. Villanueva, M.A. [email protected] www.deannavill.wordpress.com @deannavill See report for more detail For more data, visit broadwaylondon.org
YOUTH AND YOUNG ADULT HOMELESSNESS National Alliance to End Homelessness | 7/29/14 Megan Gibbard Homeless Youth & Young Adult Project Manager King County Committee to End Homelessness
Youth Homelessness in London: Learning Objectives • What are promising approaches in the United Kingdom in
the areas of • family reunification (Reconnect program) and • immediate night-one intervention (Nightstop program)
for homeless youth and young adults?
• How could these interventions be applied in the United States with homeless young people?
Host Agency:
Differences & Similarities: UK vs. US • London has effectively addressed youth homelessness.
• Housing Benefit offers a roof overhead. • Families are engaged. • “Independence” is defined differently for young people.
• Education and employment supports are tied to housing.
• Strong emphasis on agency coordination.
Differences & Similarities: UK vs. US • Similar concerns around resource cuts. • Neither country have an assessment tool that specifically refers young people to one type of housing or another.
• There is similar development in the US and UK in helping approach.
• We have similar challenges in coordinating entry to housing.
Practice Approaches The Nightstop Program provides emergency accommodation for 16 to 25 year old young people in the homes and spare rooms of approved volunteers. The Reconnect Program is a mediation service for homeless young people and their families. Where appropriate it will assist a young person to return home, or to remain at home pending a planned move in the future.
Nightstop: Youth & Hosts Young people: • 16 - 25 year olds who need emergency accommodation • No blanket bans on any “type” of young person • High needs YYA not well served
Hosts: • Recruited via word of mouth • Encouraged to not address YYA ongoing needs • Determine what days they’re available to host
Reconnect
Reconnect: Program Structure • Each family mediation program is completely flexible and
youth-driven in approach. • “My idea of a functional family is irrelevant. What does the family
want?”
• Success is redefined. • “At this point, the family broke down a long time ago, but we still
support the young person to take action.”
• It might not be called “family mediation”. • “I just don’t call it anything. I say ‘would you like to be able to call
your parent?’”
Reconnect: Barriers • Tension inherent when family reconnection is associated
in any way with housing • “Reconnection” step in the pathway can be another
gateway to housing access for youth • Tension between local authorities – safeguarding housing
resources – and Reconnect • Family-felt pressure around mediation – crisis or poverty
based • Measuring success
US Practice & Policy Implications
US Practice & Policy Implications (cont’d)
We must challenge deeply held assumptions about our existing homeless YYA system in the States:
1. We are simply not able to intervene immediately. 2. The scale of a system ensuring no young person
spends a second night out is out of our reach. 3. There will always be young people who sleep on our
streets.
US Practice & Policy Implications (cont’d) Factors that contributed to the change: 1. An absolutely deliverable plan used to lobby local
government. • Here are the people on the streets. • Here are the solutions and the cost.
2. A government that held the voluntary sector – and themselves – accountable.
• A massive investment to break the logjam of the formerly intractable youth homelessness issue.
• Government attention down to the person: “Michael so-and-so is on the streets tonight – what are you going to do about it?”
Are we willing to take risks for the most marginalized?
Megan Gibbard [email protected] 206-263-2974 (d)
