1.10 using rapid re-housing for survivors of domestic violence (billhardt)

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Slide 1 Presentation “The Problem” Chocolate Meets Peanut Butter: The DV Sector Meets the Calgary Homeless Foundation Project Goals and Outcomes Interagency Relationships Community Housing Team Workflow Forms What we Have Learned Where To?

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Page 1: 1.10 Using Rapid Re-Housing for Survivors of Domestic Violence (Billhardt)

Slide 1

Presentation “The Problem” Chocolate Meets Peanut Butter: The DV Sector Meets the

Calgary Homeless Foundation Project Goals and Outcomes Interagency Relationships Community Housing Team Workflow Forms What we Have Learned Where To?

Page 2: 1.10 Using Rapid Re-Housing for Survivors of Domestic Violence (Billhardt)

Slide 2

The Calgary Housing Company (CHC) [government operated subsidized

housing] advised the Calgary Shelter Directors Network [CSDN] (a committee

comprised of directors of Calgary emergency and transition shelters who work

together to address domestic violence issues in the Calgary community) that

women fleeing domestic violence (dv) demonstrated greater difficulty maintaining

shelter than the chronically homeless-rental arrears, late payment of rent, adding

tenants without informing the landlord, unsupervised children, poor relationships

with neighbors resulting in complaints from neighbors- poor tenancy habits

generally. The question to the SDN was “What are you going to do about this?”

The network did not choose to respond at that time but Discovery House (DH)

piloted the position of housing advocate (HA). The HA worked with women from

DH moving into subsidized housing to assess and help address any barriers to

maintaining housing. We discovered that many of our women required fairly

intensive housing support in the community around what really amounted to life

skills or building good tenancy habits in addition to addressing ongoing dv issues.

The service was successful but limited by our own resources. Serendipitously a

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year into the launch of this position the Calgary Homeless Foundation launched

their 10 year plan to end homelessness.

Slide 3

Rapid rehousing of homeless persons was one of the projects funded by the Calgary

Homeless Foundation (CHF). A program called Rapid Exit (RE) operated out of the

Community Urban Project Society (CUPS), a large well established and respected

homeless serving agency. RE had several teams focused on rapidly rehousing singles

and families in the community based on the housing first model. The rapid rehousing

teams consisted of Housing Locators (HL) who secured appropriate housing and liaised

with landlords around tenancy issues coupled with a small number of case managers

from various agencies who supported individuals and families once they were housed.

Less than a year into their rapid rehousing projects the CHF requested a meeting with

the CSDN and advised us that 48 % of the referrals for rapid rehousing into the

community came from emergency and second stage shelters for women and children

fleeing dv. They pitched the Housing First model to us and proposed the dv sector

partner with CUPS/RE to establish a housing first case management service for women

and children fleeing violence.

The CSDN came away with two concerns:

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1. How can this model safely house women and children fleeing dv in the community

[ also a significant concern for our Board of Directors]; and

2. How could we partner with the homeless serving community and preserve the integrity

of the issue of dv so that it did not “get lost” into the issue of homelessness vs. a

violence against women issue?

After much discussion the Network agreed that we would pilot the program and DH

would take the lead on behalf of the Network of seven shelters in Calgary preserving the

issue of dv and the overarching goal of shelters “To build the capacity of families to live

safely and independently in the community free of domestic violence.”

Our women and children needed housing and we knew they also needed the support to

sustain housing that shelters on their own could not afford to provide.

Slide 4 (See next page) Internal Project Goals and Outcomes

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Internal Project Goals and Outcomes

Goals Outcomes ResultsReduce the number of women & children who return to abusive relationships or homelessness due to lack of housing. 

Outcome 1a: 50 women and their children leaving emergency or transitional housing to access Rapid Exit will be provided with the appropriate case management and systems navigation support to stabilize their housing.

Over a course of 11 months the project served a total of 92 adult clients and 209 children.

Increase the capacity of abused women to live successfully, independently and violence free in the community.

Outcome 2a: Successful housing placements with no or limited tenancy problems.Outcome 2b: Number of women not returning to abusive relationships.Outcome 2c: Number of women demonstrating increased success in household financing including the number of women successfully accessing Income Support, existing Provincial and Municipal housing subsidies, and finding and holding paid employment.Outcome 2d: Number of women reporting enhanced life and personal development skills.

85% (n=78) of the clients have been housed in stable housing (including market or subsidized housing)

14% (n=11) were re-housed and additional 3 clients returned to their abuser.

36 clients (44%) experienced some type of tenancy problem 2 months after intake and 7% experienced such problems 6 months after intake.

Of 87 clients who required income support, 72 or 83% received such support.  Of 87 clients who required housing subsidies, 29 or 33% received such subsidies.

Reduce the dual impact of the trauma from domestic violence and from homelessness on women and children by creating stability in a new home environment.

Outcome 3a: Number of children remaining with mothers in stable home environment (ie, decreasing number of Child Intervention cases)Outcome 3b: Number of women indicating improved experiences of self-esteem, self-efficacy, personal safety, and recovery from trauma.

At intake, 17 (18%) of clients had active involvement with child welfare (CW).  Of these, 5 (29%) are now closed.

At intake, 26 children were in out of home placement (20 of these had CW involvement).  Of these, 3 (12%) have returned home.

See OQ – 45.2 Section Above

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Slide 5

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Slide 6

Our case management model is collaborative and ecological in nature focusing on client

strengths in the context of environment. Our goal is to build client capacity to sustain a

vibrant life including a home independently in the community and free of domestic

violence.

Program Manager: Responsible among other things for: hiring, supervision and training

of the Case Management Lead (CML), Case Manager (CM) and the Community Mental

Health Specialist (CMHS); development and maintenance of program and infrastructure

to support the program; creation and execution of a work plan for the program including

evaluation; stakeholder and community relations; performance management of staff,

reports to Director, Programs and Internal Operations

Case Management Lead: Responsible for accepting, screening and tracking referrals;

assigns cases to CM and CMHS based on client needs and case load management;

liaise with RE/CUPS around program/service issues, supervise day to day activities of

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CM and CMHS; comprehensive files reviews; coordination of client supports such as

rental subsidy program, bus tickets, grocery vouchers; reports to Program Manager

Case Manager: Responsible for systems navigation, advocacy, coordination and

communication between all service providers and the client. CM must balance service

provision and systems navigation with short term, medium term and long term strategies

to end homelessness. Seven Core Functions of CM: intake, assessment, planning,

referral and linking, advocacy and evaluation of case plan and transition including but

not limited to: obtaining rent subsidy, and other financing resources, secure immediate

basic needs, coordinate action plans of multiple community agencies, case reviews and

mediations between landlord and tenant. The CM must have experience and solid

understanding of domestic violence and homelessness. Report to Program Manager

Community Mental Health Specialist: Responsible for assessment and intervention

plan to assist client in the management of mental health issues and addictions. 72% of

clients have Axis 1 diagnosis of depression and anxiety; 59% have active addictions and

23% have concurrent disorders. CMHS initiate and track referrals into longer term and

specialized treatment options. Collaborate with community agencies to support clients in

the community.

*Housing Locator: Locate safe and affordable housing. Establish a relationship with the

landlord and put a letter of agreement in place between landlord and CUPS/RE [cover

damages to unit]. Completes move in inspection, lease signing with client [and case

manager] maintains regular communication with landlord and case manager, addresses

any tenancy concerns to CM, arrange moving assistance and tenant insurance and

security deposit and first months rent if necessary.

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Slide 7

Case Managers Forms At Intake: Intake, Release of Information, Participation Agreement,

Liability/Authorization-review Danger Assessment and Safety Plan completed by shelter,

Housing Information Sheet completed after intake and faxed to Rapid Exit within 24

hours, Temporary Subsidy Agreement if required.

Once Housed: Danger Assessment, Safety Plan, Child Safety Plan, Family Action

Plan-with 10 working days

Ongoing: 3,6,9,12 &18 month evaluation

Community Mental Health Specialist FormsAt Intake: Intake [mental health assessment] and Screening, Release of Information,

Counselling Consent,

*Q45: Q45 measures client’s life across 3 domains of functioning:

Symptom Distress: includes items that assess common intra-psychic problems such as

depression anxiety and substance use

Interpersonal Relations: includes items that assess satisfaction with, as well as problems

in interpersonal relations such as friendships, family and marriage

Social role: include items that assess the clients’ level of dissatisfaction, conflict, distress

and adequacy of functioning related to employment, family and leisure life.

flags suicidal and homicidal ideation

Q45 administered every 2 months. Clients demonstrated an improvement in all areas

over time. The areas of depression and anxiety remained the highest across time even

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with improvements in other areas. Indicates the importance of remaining engaged for at

least one year.

As Required: Substance Use Safety Plan and No Harm Contract,

*Working on the development of an acuity scale. Slide 8

New Option Created for Women With Children Fleeing DVThe Community Housing Team and Rapid Exit housed and supported 78 women and

209 children in 10 months. Discovery House second stage shelter houses on average 60

women and 100 children in a year. Fifty-two per cent (52%) of the rapidly rehoused

women were aboriginal and 26% were immigrants. Twelve women self-selected out of

the program at intake for fear that they could not be adequately protected in the

community. Of the women served 72% had Axis 1 diagnosis of depression and/or

anxiety and 59% had addictions with 26% having concurrent disorders. Housing

retention was 86%.

Discovery House as with all Calgary second stage shelters cannot and do not take into

residence women with unmanaged mental health conditions or addictions. Discovery

House primarily shelters immigrant and refugee women who due to multiple barriers,

including war trauma and higher safety concerns, stay longer in residence with the result

that limited shelter space becomes ever more limited.

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The needs of aboriginal women are better met in the community housing program. The

composition of aboriginal families changes consistently. It is common for mothers,

uncles, aunts, siblings, and children etc to move in and out of the family constellation.

Shelter living does not accommodate these kinship patterns. Aboriginal families have

significant adjustment challenges moving out of the communal reserve style of living to

the city which means they will go back and forth from the city to the reserve while they

adjust. Shelter living does not support this process.

Women from the Community Housing program with active mental health conditions

required 3-6 months time to respond to therapies and medication. This is a barrier to

transition and success in the community. CMHS are critical to ensuring the woman is

connected to mental health resources immediately and able to manage in the community

while awaiting longer term services. Getting in to see a psychiatrist or counselor can

take months. CMHS provides interim support and intervention while the client waits for

longer term resources. Both CM and CMHS work with the client to build/rehabilitate

community relationships with service providers who will continue to support the client

and their family long after we are gone.

The majority of women served would not have lasted one week in a traditional second

stage shelters and some were women who had been barred from emergency shelters.

They are the abused women who couch surf or live in homeless shelters because they

do not or cannot go into typical women’s shelters. Yet, they were successful at

remaining housed in the community with intensive wrap around service. The program

had an 85% retention rate.

Slide 9

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Within weeks we learned that CM and CMHS had to begin to work with our clients prior

to their being housed because there were so many complexities that were immediate

barriers to housing. Most of our clients come with a “cast of thousands”. Service

providers already in the client’s life come with their own agenda and action plans, often

times in conflict with each other. These same service providers are often not familiar with

the dynamics of homelessness and domestic violence. It is necessary to begin to

coordinate multiple service providers immediately and to obtain concrete benefits for the

client to begin the re housing process. Case examples:

a) Client A has all three children apprehended by Children’s Services due to

homelessness and domestic violence. The children would not be returned until she had

safe shelter for the family. Alberta Works [welfare] would only provide her with funding

for a single person preventing her from being able to secure affordable housing for her

and the children. The case manager liaised between the two agencies and was able to

persuade the welfare system to commence family funding immediately for the client to

expedite the return of the children. The case manager coordinated a large case

conference to ensure adequate support services were available for mother to address

addiction concerns that would also prevent the return of her children. The woman

remained housed; children are with her, addictions are under control.

b) Client B has no immigration status and is not eligible for any social assistance or

rental subsidy programs. Her English is limited to non-existent. She has a severely ill

new born that will require ongoing intensive medical treatment. Children’s services are

involved because her drug addicted abusive partner kidnapped the newborn. The client

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suffers from post partum depression. The CM and CMHS became involved immediately

arranging a case conference at DH with 8 service providers in attendance including

Children’s Services, the newborn’s doctor, community health, hospital social worker, a

settlement worker, a member of the client cultural community, her faith community and

the CM and CMHS.

A Settlement House was persuaded to house the woman and her newborn in an

apartment at their own expense while immigration issues continue to be resolved.

Necessities of life are provided, the newborns complex medical needs continue to be

addressed, the depression resolved, the immigration issues are nearing completion.

CHT remains involved.

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Slide 10

Only three women in the community housing program required rehousing for safety

reasons. Twelve women interviewed self-selected out of the program for safety reasons.

The Danger Assessment (Dr. Jacqueline Campbell, John Hopkins) scores for women in

the shelter and women in the community for the same period of time were on average

identical and in the highest category of danger. The Danger Assessment assesses the

lethality of the relationship verses global danger or risk of re-assault.

Applicants for community housing and second stage shelters are fairly homogenous in

that they come from a typology of coercive and controlling intimate partner violence.

Coercive controlling intimate partner violence is one of the strongest indicators of

lethality. Women in the community housing program appear to be able to keep

themselves safe with strategies and support provided by the case manager.

Safety planning is done within days of being housed with women and children. The

Calgary Police Service will flag the files of our community clients the result of which is

any 911 calls from their number and address become a priority response for the police

(POVI). Alarm systems will also be installed if necessary. Housing is often in secured

buildings. Women are at the greatest risk of being killed within the first year of

separation. The best indicator of the danger a women and her children are in comes

from the subjective belief of the women herself and in the face of a woman’s perception

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of fear and a low danger assessment score the women’s perception should be

determinative.

The differences in the hard costs between secure second stage sheltering and

community housing are still being measured. Discovery House is the most secure

women’s shelter in southern Alberta. Security costs us upwards of $150,000.00 per year.

Anecdotally, we are advised by our clients that it is empowering for them feel like they

can manage their lives in the community verses having to “hide out” in a shelter. For

women and children who must be in a shelter they report feeling safe from harm as one

of the best features of shelter living. Clearly having multiple options for these families is

critical.

Slide 11

Partnering with a homeless serving agency added a great deal of value to our

organization and the domestic violence sector generally. As a domestic violence serving

agency we were able to serve twice the number of families without building a new

facility. We were able to expand the options available to a new population of families

fleeing domestic violence. Information and skills from the homeless serving community is

value added to our knowledge and skill base the result being a more nuanced approach

to service delivery and a higher quality of service to our clients. We have learned there

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are more similarities than differences between victim of domestic violence and homeless

populations. We have shared best practices and resources that have saved us time and

resources i.e. Calgary Homeless Foundation used the Code of Ethics created by

Discovery House and in return shared research on case management best practices.

Three years ago the domestic violence sector resisted the concept of connecting to the

homeless community for fear the issue of domestic violence would be subsumed under

homelessness and women would not be safe served by the housing first model. The

homeless serving agencies and in particular the Calgary Homeless Foundation has been

particularly ethical and respectful of acknowledging the importance of keeping the issue

of domestic violence front and centre. The very act of the Homeless Foundation coming

to the shelters to lead a homeless project was the essence of ethical practice and

respect. Homeless serving agencies have embraced domestic violence best practices

and supported the focus on safety.

The domestic violence sector has greatly embraced rapid rehousing practices to the

point where many shelters now have their own rapid rehousing services. One of the

largest emergency shelters in Calgary presented an award to Discovery House and

Rapid Exit for innovative community programming that moves women and children out of

domestic violence.

Slide 12

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A total of 209 children were served by the Community Housing Rapid Exit teams.

82% of these children were under the age of 10, in crisis and with special needs

including ADD, ADHD, chronic medical conditions, most were developmentally

delayed and nearly all were behavioral. There is a distinct shortage of community

services for these children and the wait lists are long. Supporting these children

supports their mother and enhances the likelihood of her remaining in the

community. While Case Managers and Community Mental Health Specialists do

their best to meet the needs of these children the complexity of their needs

requires skilled child mental health specialists. We anticipate adding this role to

the team in future.

It is critical to support the children of homeless and at risk parents achieve their

milestones and avoid cross generational repetition of addiction, mental health

problems and family instability. Long term positive outcomes for families can be

achieved if these hard to access services are provided by the program either in

house or through community partnerships [child care services, school based

programs, medical and dental programs].

Slide 13

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Discovery House will continue to offer rapid rehousing services for women and

children who wish to move directly into the community. We will also continue to

offer transitional shelter for women who feel they need the support of a

residential setting. We have the luxury of having a program evaluator and

researcher on staff and are committed to learning more about the differences

between women and children who “do well” in both settings. We expect that

having a foot in both streams will inform our best practices.

We are in the process of integrating the neurosequential model of practice

[neurobiology and traumatology] into our work with our Community Housing

clients. Individuals chronically traumatized from an early age operate almost

entirely out of their primitive brain. The impacts include: highly sensitive stress

response system, [fight or flight] impulsivity, addictions, relationship impairments,

impaired recall and learning. See the work of Dr. Bruce Perry, Dr. Daniel Seigal,

Dr. Gabor Mate and the ACE Study [conversion of trauma into organic disease

across life span.]

Slide 14

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