Housing First: A Realistic View of the Importance of Case Management
What is Housing a First? Why should I (or my agency follow it)? Where is proof that Housing First works? But, Michael...it's really hard to implement? Why should we change?
I genuinely hope that you take the time to read this blog if you've found yourself or your agency asking any of the above noted questions.
Housing First is a very simple philosophy that is based on the idea that all humans deserve to have a safe place to call home. However, Housing First goes a little further in that it acknowledges that it is near damn impossible to gain stability while living outdoors, or even in shelters.
Housing First encourages Outreach and Stabilization staff, homeless providers, and local, state, and federal housing agencies to house individuals without merit or current ability to pay, capacity to be sober, disability acuity, or even just housing those individuals who you would classify as an easy housing case, i.e., those with a very low acuity (yes... I said it).
I know there are many homeless providers who deny the importance of Housing First. I’ve heard several housing providers all across the state that do not feel that housing case management is necessary or required to be ongoing after a Client enters housing. Just hear me out.
How can we as homeless providers expect or assume that an individual who has been living beneath a bridge for the last 8 years will be fine being dropped into an apartment and told, “Welcome Home" without any follow up or ongoing case management? Do any of your handbooks or Code of Ethics alert you that the best thing to do after housing someone is to, “Drop them and run”?
Housing First does articulate that we, as homeless providers, should eliminate all barriers leading to housing. But paired with that very important philosophy, is also ongoing and intensive case management to work through crisis' (if they occur), obtaining mainstream benefits, getting hooked up with employment (yes, someone who has been homeless can, and often do, work), accessing SSI/SSDI income, completing a SOAR application, or setting up a personalized housing plan with relevant goals and objectives. By being present during every step of the way, we're able as Stabilization Case Managers to assist the Client(s) in becoming stabilized and self-reliant.
Case Management after someone enters housing begins day one. It is important that a Case Manager meet with the Client several times that first week to begin developing mutual expectations and to begin setting up goals and objectives (that are agreed on by both the Case Manager AND the Client). Common themes for housing Case Management are: money management, access to addiction services, income services, employment, legal assistance, medical and psychiatric services, access to mainstream benefits and many others.
The most important part of Case Management is being present and there (in their home) as a support. You would be shocked by how past negative behaviors sometimes disappear and you see more goal directed behaviors after someone enters housing. Case Management is not enabling bad behaviors it simply breaks down the many barriers a Client experiences into bite size pieces and the Case Manager is present as a support while those barriers are eradicated.
Case Management leads to housing stabilization. We cannot assume that by providing an apartment or place to live, that an individual will be stabilized. It doesn't work that way at all. Case Management is hard work but I personally cannot think of a more worthwhile career than assisting those individuals who previously experienced homelessness obtain and remain in permanent housing.
If we do not pair Housing First with Case Management we're doing a grave injustice to our Clients. Housing with no ongoing case Management leads to negative outcomes (those individuals regaining their homeless status). By following up and being an encouragement (and sometimes the bad guy/girl), we are seeing wonderful results in WV homeless services.
There will always be excuses not to do the right thing because it is hard, but I am telling you do the hard thing because it is right. I can guarantee you that all of the energy, sweat, and even tears will be worth it when:
the Client finally tells you that she wants to put down the bottle after 25 years of excessive drinking;
you assist a Client who was diagnosed with cancer access Hospice care and passes away respectfully in his own apartment;
• you aide a Client who has been living under the same bridge for the last 10+ years access housing and health care;
• you help a Client access employment after being told that “he’ll never make anything of himself”;
• you assist a Client set up their apartment and put curtains up after living for 2+ years under a bridge;
• you help a Client find purpose in their life again;
• and ultimately, you see that housing and case management saved their life.
Housing First paired with Case Management will positively impact lives and lead to more positive housing outcomes, I guarantee it if you actively case manage.
There is a lot of work to do... so let us begin.
See you on the streets,