Tips and tools for guiding people living with HIV toward stable housing

20 Pages·2017·0.31 MB·English

Finding Home:
Tips and tools for guiding people living with HIV
toward stable housing
Health Resources and Services Administration Special Projects of National Signifcance
Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations
ACKNOWLEDGMENTS
This toolkit was written, organized, and reviewed by the following individuals:
• Alexander de Groot, MPH, Center for Advancing Health Policy and Practice at Boston University
• Edi Ablavsky, MA, Center for Advancing Health Policy and Practice at Boston University
• James Apt, Boston Health Care for the Homeless Program
• Marena Sullivan, Center for Advancing Health Policy and Practice at Boston University
Webinar discussions regarding housing clients were coordinated and facilitated by the following individuals:
• Jane Fox, MPH, Center for Advancing Health Policy and Practice at Boston University
• James Apt, Boston Health Care for the Homeless Program
• Edi Ablavsky, MA, Center for Advancing Health Policy and Practice at Boston University
The content for this manual was provided by intervention staff, including peer navigators, social workers, and
patient navigators from the following grantees in the Health Resources & Services Administration Special
Projects of National Signifcance Initiative Building a Medical Home for Multiply Diagnosed HIV-Positive
Homeless Populations:
• N orth Carolina Rurally Engaging and Assisting Clients who are HIV-Positive and Homeless (NC-REACH)
Program at CommWell Health, Inc. in Dunn, North Carolina
• Project Hi-5 at Harris Health System in Houston, TX
• H omeless HIV Outreach and Mobile Engagement (HHOME) Program at San Francisco Department of Public
Health, in collaboration with the Asian & Pacifc Islander Wellness Center and the San Francisco Homeless
Outreach Team, in San Francisco, CA
• M ultnomah County HIV Health Services Center, in collaboration with the Cascade AIDS Project (CAP), in
Portland, OR
• City of Pasadena Public Health Department in Pasadena, CA
• T he Partnership for Access to Treatment and Housing (PATH Home) Program at the University of Florida
Center for HIV/AIDS Research, Education, and Service (UF CARES), in collaboration with River Region Human
Services and Ability Housing of Northeast Florida, in Jacksonville, FL
• The Health, Hope, and Recovery Program at Prism Health North Texas in Dallas, TX
• F amily Health Centers of San Diego (FHCSD), in collaboration with People Assisting the Homeless (PATH), in
San Diego, CA
• P roject Medical Home Engagement and Aligning Lifestyles and Transition from Homelessness (mHEALTH) at
Yale University School of Medicine AIDS Program, in collaboration with Liberty Community Services and the
Connecticut Department of Correction, in New Haven, CT
iF nding oH em : Tisp and tools for guiding ep olp e living with VIH toward stable housing 2
ACKNOWLEDGMENTS
Recommended Citation
Center for Advancing Health Policy and Practice at Boston University. (2017). Finding Home: Tips and tools for
guiding people living with HIV toward stable housing. Retrieved from http://www.cahpp.org/project/medheart/
housing-toolkit
Funding Statement
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S.
Department of Health and Human Services (HHS) under grant number U90HA24974 (Special Projects of
National Signifcance (SPNS) Initiative Building a Medical Home for Multiply Diagnosed HIV-positive Homeless
Populations, in the amount of $535,710) awarded to the Trustees of Boston University. No percentage of this
project was fnanced with non-governmental sources. This information or content and conclusions are those of
the authors and should not be construed as the offcial position or policy of, nor should any endorsements be
inferred by HRSA, HHS or the U.S. Government.
iF nding oH em : Tisp and tools for guiding ep olp e living with VIH toward stable housing 3
T ELBA FO TNOC TNE S
bA out the SNPS Initiative 5
Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations, 2012-2017 5
Introdutc ion 6
About this toolkit 6
Why this toolkit 6
How to use this toolkit 7
eG tting the rO ganiaz tion eR ady 8
Use the Housing First Model as a baseline for your organization’s housing approach 8
Anticipate needs and challenges your organization may face housing individuals 8
Form partnerships with housing and supportive service agencies 9
Stafng and training needs 10
Case example: Creating a medical home through the Building a Medical Home SPNS Initiative 10
aN vigating the Housing eS arhc eB— fore and uD ring 12
Step 1: Determine your clients’ housing readiness and goals 12
Step 2: Establish roles in the housing search for you and your clients 14
Step 3: Set realistic expectations with your clients 14
Step 4: Anticipate challenges 14
Step 5: Stay organized during the housing search 15
Step 6: Create a plan for helping your clients manage housing once it is attained 15
tS aiy ng Housed 16
Develop a support system 16
Develop housing skills 17
Support clients to stay healthy while housed 17
oC nlc usion and eR sourec s 19
Finding Home: Tips and tools for guiding people living with HIV toward stable housing 4
TUOBA TH E SNPS IIN TITA IVE
uB ilding a eM diac l Home for uM ltipl y iD agnosed HIVoP- sitive Homeless
oP pulations , 7102-2102

People who are experiencing homelessness are disproportionately afected by HIV, and those who are also living with
HIV are more likely to delay entering care, have poorer access to HIV care, and are less likely to adhere to antiret-
roviral therapy. In 2012, the Health Resources & Services Administration (HRSA), HIV/AIDS Bureau through its
Special Programs for National Signifcance (SPNS) Program* funded a national initiative with the goal of building
a medical home for a vastly underserved population: those who are experiencing homelessness or unstable housing,
living with HIV, and who face challenges of mental health or substance use disorders. Nine clinic and community-
based organizations and one multisite coordinating center were funded to implement and evaluate service delivery
models for this population. Te two main goals of the models were to 1) increase engagement and retention in HIV
care and treatment; and 2) improve housing stability. While each model was tailored to the environment in which it
existed and the needs of the specifc population served, the nine models all created a role of care coordinator/patient
navigator who worked with clients to access a networked system of services among HIV, housing, and behavioral
health care providers. To measure achievement of project goals, the nine programs are conducting a longitudinal
multisite evaluation study of the models.
Tis toolkit is a result of a series of conversations with staf from the nine sites and the coordinating center funded
under this initiative. It draws on the experiences and resources of frontline staf who worked to guide clients living
with HIV in their search for stable housing.
For more information about the initiative, visit http://cahpp.org/project/medheart/
*T e Special Projects of National Signifcance (SPNS) Program is charged with the development of innovative models of HIV treatment, in
order to quickly respond to emerging needs of clients served by Ryan White HIV/AIDS Programs. SPNS advances knowledge and skills in
the delivery of health and support services to underserved populations diagnosed with HIV. Trough demonstration projects such as the
initiative that gave rise to the Hi-5 Project, SPNS evaluates the design, implementation, utilization, cost, and health-related outcomes of
treatment models, while promoting dissemination and replication of successful interventions. Learn more at
https://hab.hrsa.gov/about-ryan-white-hivaids-program/part-f-special-projects-national-signifcance-spns-program
Finding Home: Tips and tools for guiding people living with HIV toward stable housing 5
INTRODUCTION
About this toolkit
people living with HIV (PLWH) who are homeless or
Tis toolkit is designed to provide resources to organiza- unstably housed. Nine HIV clinic and service organiza-
tions to increase access to stable/permanent housing for tions across the United States developed models of care
people who are experiencing homelessness or unstable to link individuals who are homeless and HIV-positive
housing, living with HIV, and who may have persistent with needed services and resources. Tese nine
mental illness and/or substance use disorders. It is organizations were:
primarily intended for Ryan White providers, medical
case managers, peers/community health workers, and • Prism Health North Texas, Dallas, TX
other “frontline staf” who provide direct services to the • F amily Health Centers of San Diego, Inc.,
aforementioned individuals. Te purpose of this housing San Diego, CA
toolkit is two-fold: • Harris Health System, Houston, TX
• M ultnomah County Health Department,
1. T o provide clinics with resources to help them develop, Portland, OR
implement, and maintain efective housing services for • C ity of Pasadena Public Health Department,
their chosen client population. Pasadena, CA
2. T o provide clinical staf working with clients who are • S an Francisco Department of Public Health,
experiencing homelessness or unstable housing with a San Francisco, CA
“one-stop shop” guide for resources and tools to assist • CommWell Health, Dunn, NC
in locating housing and developing essential household • University of Florida – UF Cares, Jacksonville, FL
skills. • Yale University, New Haven, CT
Te Medical Home HIV Evaluation and Resource
Why this toolkit
Team (Med-HEART), a collaborative efort between
Te need for this toolkit emerged from an initiative titled the Center for Advancing Health Policy and Practice
“Building a Medical Home for Multiply Diagnosed HIV- (CAHPP) at Boston University School of Public Health
Positive Homeless Populations.” Funded by the Health and the Boston Health Care for the Homeless Program,
Resources and Services Administration Special Projects of provided evaluation and technical assistance. More
National Signifcance, the goal of this fve-year initiative information about this initiative and the organizations
was to successfully integrate HIV care, housing services, involved can be found on the CAHPP website at
mental health services, and substance use treatment for http://cahpp.org/project/medheart/.
iF nding oH em : Tisp and tools for guiding ep olp e living with VIH toward stable housing 6
INTRODUCTION
lC ients who obtain supportive or stable housing have lc ients as well as the barriers the y enoc untered along
been shown to have improved 4DC oc unts , better the wa , y from preparing the organiaz tion to supporting
funtc ional health status , and a lower ris k of death , ey t lc ients to beoc me h“ ousing read ” , y through the housing
individuals grappling with homelessness , substanec uses ,earhc proec ss and , n� all , y to supporting lc ients as the y
and mental health issues – and consequently those who aduj st to and sustain stable housing . oW rik ng with the
serve them – confront multiple and signifcant barriers to eM dH- TRAE team , sta � from the nine partiic pating
n� ding and sustaining housin2,1 g. vO er several months , organiaz tions disuc ssed suec ssful strategies for housing
sta � from the nine partiic pating organiaz tions oc mpared their lc ients and what resourec s helped them prevent
notes on their housing advoac yc eo� rts on behalf of issues from arising or to oc nfront them when the y did
arise . i� s toolik t is a oc mpendium of their epx erienec s
and reoc mmendations drawn from those disuc ssions.
tiklot siht esu ot woH
i� s toolik t is organiez d along the maoj r steps in helping
lC ients who obtain supportive or
lc ients beoc me and remain housed: getting the organiaz -
stable housing have been shownt ion read y to support lc ients through the housing searhc
proec ss , navigating the housing searhc with the lc ients
to have improved 4DC oc unts ,
before and during the proec ss , and supporting lc ients
to sta y housed after the y have loac ted suitable stable
better funtc ional health status ,
housing p( lus some general resourec s to provide refer-
and a lower ris k of death , ey t enec and oc ntetx .) aE hc setc ion inlc udes resourec s the
sites found helpful at that stage in preparing and searhc -
individuals grappling with
ing for housing. You may go through the toolkit from
beginning to end to gain a good overview of helpful
homelessness , substanec use , and
strategies to support lc ients to beoc me housed . rO , oy u
mental health issues – and ac n sik p to the setc ion most relevant to oy ur immediate
needs . eR member: this guide is a wor k in progress ; as
oc nseuq entl y those who serve
new resourec s are developed and beoc me available , the y
will be added . uS ggestions for additional resourec s are
them – confront multiple and
weloc me . lP ease send oy ur oc mments and suggestions to
signiac� nt barriers to n� ding and ac
TEG TI GN TH E INAGRO TAZ I NO YDAER
Te frst step in the housing process is making sure your For specifc guidance on how to adopt a Housing First
organization has the capacity and structure to provide model at your organization, check out “Organizational
quality housing search assistance. Providing housing sup- Change: Adopting a Housing First Approach” from the
port to clients living with HIV in a way that is sustain- National Alliance to End Homelessness. A link to this
able and contributes to their well-being requires a team resource is available in the online Resources section of
approach. Terefore, it is important that your organiza- this toolkit.
tion uses a service delivery model that is collaborative
among clients, internal partners, and external partners,
nA tiic pate needs and hc allenges
and is also fexible enough to meet each client’s unique
housing goals. oy ur organiaz tion ma y faec
housing individuals
sU e the Housing First oM del as a
At the systems level, it is critical to understand the local
baseline for oy ur organiaz tions’ landscape when developing a housing search process
and setting client expectations. Factors that could play
housing approahc
a role in developing your housing model could include
One model for housing individuals commonly accepted local housing market conditions, transportation acces-
nationally is the “Housing First Model.”3 Housing First sibility, and fair housing and landlord-tenant laws. Tere
prioritizes fnding sustainable housing frst, regardless of are several questions you should consider to help you
the client’s existing or prior substance use, followed by anticipate needs and challenges your organization may
providing supportive services as needed. Tere are three face housing individuals:
critical elements to a Housing First model:
• W hat is the current HIV housing situation in your
1. A focus on helping individuals access and sustain area?
permanent rental housing as quickly as possible • How accessible is housing for people living with HIV?
• H ow do various organizations and programs (HIV
2. A variety of services delivered to promote housing and housing) in your area work together to meet the
sustainability and individual well-being needs of people living with HIV?
• W hat resources and programs in your area are
3. A standard lease agreement to housing, as opposed to available to help?
mandated therapy or other services • W hat barriers or challenges exist to working with
other agencies and providing services to people living
While your agency may choose to use a Housing First with HIV?
model when developing its housing program, it is impor- • W here are the gaps between resources available and
tant to note that every program that utilizes a Housing what a client needs to be successfully housed?
First model is unique. Your agency should anticipate the • W hat will the process of working with a client look
needs of the population it plans to work with and tailor like, from initial intake through support to retain
the program’s services to its clientele. housing?
• W hat staf will be involved to work with clients and
how will the various roles work together?
• W hat materials, tools, and trainings are needed to
3http://www.endhomelessness.org/pages/housing_frst make the process of housing clients efective?
Finding Home: Tips and tools for guiding people living with HIV toward stable housing 8
GETTING THE ORGANIZATION READY
Different housing challenges, different Building a formal relationship
housing approaches
“In Dallas, what started as an informal relation-
Staff in Jacksonville, Florida, where housing is ship developed into a formal working relationship.
generally adequate, employed a very different set The previous program director for one of the Dallas
of processes from staff in Portland, Oregon or San housing programs met regularly for coffee with our
Francisco, California, where a tight housing market director. That evolved into an MOU [memorandum
meant fewer options and possibly longer commutes of understanding] where they guarantee us a certain
to services or employment. Similarly, transportation number of slots and we provide case management
requirements both for the housing search and for and matching funds. That helps them meet their
clients once they were housed were addressed very grant requirements. We originally got 10 slots. By
differently when housing clients in rural North providing case management and matching funds,
Carolina compared to New Haven, Connecticut. we got that moved up to 25 slots. Their case man-
agers have more time to do other stuff, and we
manage our own clients. It helps them get their
slots flled with our clients, and that helps us.
Form partnerships with housing and -Staff from Prism Health North Texas
supportive service agencies
gnimro F rap spihsrent htiw lanretxe seicnega dna
sec ruose r liw pleh ruo y noitazinagro ediv o rp eht res seciv • hW ihc landlords might also benet� from the relationship ?
sti stneilc den taht ti yam ton eb elba ot .ediv o rp elihW desab-noisi M srepole ved yam den a rediv res o rp-eciv
rap spihsrent htiw seicnega yam rats t �o sa lamrofni -ale r pihsnoitale r ot ekam rieht gnidnuf snoitacilpa erom
,spihsnoit ereht yam emoc a emit nehw eht rap pihsrent .e vititepmoc semitemo S lanoitne vnoc sd roldnal ylpa
liw den ot emoceb .de zilamrof I n taht ,esac uo y liw rof cilbup gnidnuf dna yam eb ni a ralimis .noitautis
den ot tfard a mudnarome M fo gnidnatsredn U OM( ,)U A pihsnoitale r netirw otni eht gnidnuf lasopo rp si
a tnemucod taht seniltuo eht smret fo eht .rap pihsrent I n netfo ,tnenamrep dna eht gnisuoh/htlaeh noitcenoc
eht enilno eR sourec s noitces fo siht ,tiklot uo y nac dn� si re v y gnilaepa ot .srednuf
na elpmaxe fo OM ,s U eno mo rf hamontlu M ytnuoC
H htlae Drape tnemt dna eno mo rf eht ytiC fo anedasa P • hW o is most liek l y to maek deic sions about serviec
Drape tnemt fo cilbu P H.htlae provider relationships ?
si� nac eb etis-no repo rp yt ,sreganam lanoisefo rp
nehW gniredisnoc laitnetop rap srent ot ,hcao rpa pek repo rp yt tnemeganam ,seinapmoc ro repo rp yt .srenw o
ni dnim eht gniw olof :snoitseuq
• rA e m y reuq ests legal under national and loac l fair
• hW ihc landlords ac re about oy ur organiaz tional mission housing and landlord tenant laws ?
and target population ? I t si reisae rof sd roldnal ot krow htiw res eciv srediv o rp
ese� nac ra v y morf lanoitne vnoc sd roldnal taht tnaw ohw dnatsrednu eht swal dna snoitaluge r yeht evah ot
ot esu rieht repo rp yt ot ekam a ecne re�id ni rieht . w olof I s ’ t osla lufpleh rof res eciv srediv o rp ot w onk
ytinumoc ot esoht ohw evah dah secneirepxe ralimis eseht swal os taht yeht nac reteb etaco vda rof rieht
ot esoht decneirepxe yb eht elpoep ruo y noitazinagro .stneilc
res .se v
Finding Home: Tips and tools for guiding people living with HIV toward stable housing 9
GETTING THE ORGANIZATION READY
,eru romreht F ti si dednemoce r taht eniltno rf �ats
eviece r a muminim fo 04 sruoh fo gniniart no tcejbus
retam gniniart gnidulcni HI , V gnise rda ecnatsbus
re vetahW noitarobaloc uo y
esu dna latnem htlaeh ,segnelahc dna demrofni-amuart
,dliub ekam erus taht -emos ,e rac htiw rehse rfe r sgniniart no a raluge r .sisab T scipo
taht dluohs eb de re v oc ni eht gniniart :edulcni
s ’ gniht .netirw s ’ e re� a tol fo
• HIV knowledge
rev onrut ni ,seicnega dna fi uo y
• HIPAA and confdentiality
teg a dog noitarobaloc ,gniog • Home visits and workplace safety
• Community resources
uoy tnaw ot ekam erus taht • Trauma-informed care
• Motivational interviewing
ti nac eunitnoc ot tsixe ne ve
• Addressing substance use with clients
nehw enoemos snoitisnart rehtie • Mental health disorders
• Documenting staf work
nihtiw na ycnega ro ot rehtona • Self-care and boundaries
• Addressing intimate partner violence
. ycnega T gnikcar tahw er ’ uo y
• Local and national housing challenges
gniod dna yhw er ’ uo y gniod ti si
E elpmax gniniart slairetam nac eb dnuof ni eht enilno
. yek Resources noitces fo siht .tiklot
aC se eax mple: rC eating a mediac l
- �at S mo rf notsoB H htlae eraC
home through the Building a
rof eht H selemo margo r P
Medical Home SPNS Initiative
tS afn� g and training needs
A gnom eht enin setis taht rap detapicit ni eht
, ylani F ecno a gnisuoh ledom si nesohc dna a gnisuoh H-de M EART ,noitaula ve sehcao rpa ot gnik row htiw
margo rp si ,depole ved uo y liw den ot erih �ats dna stneilc ot dn� gnisuoh deira v eud ot srotcaf hcus sa eht
ediv o rp gniniart rof meht roirp ot eht s ’ margo rp -elpmi lacol gnisuoh ,tek ram nabru ro r laru ,gnites lacol dna
.noitatnem I t si lufpleh ot evah eniltno rf �ats ni ruo y etats swal dnuo ra ,gnisuoh dna elbalia va lacol sec ruose r
ledom ohw nac ediv o rp eno-no-eno gnisuoh ropus t ot dna rap gnirent .snoitazinagro E hca noitazinagro -maxe
rieht .stneilc O netf delac yb a yteira v fo ,seman -dulcni deni ’ stneilc sden dna detapicitna segnelahc ta hcae
gni erac , rotagivan rep , rotagivan krowten , rotagivan ro egats fo eht gnisuoh hc raes seco rp ot enimreted tahw
esac , reganam siht eniltno rf �ats nosrep liw eb laitnese ” maet “ dna seseco rp ot tup ni ecalp ot ropus t stneilc
ot gnidiv o rp eht ropus t elpoep gnicneirepxe -selemoh ot emoceb .desuoh e� tluse r saw enin gnisuoh ,sledom
sen dna gnivil htiw HI V yam den ot pleh teg .desuoh hcae detius ot eht sden fo eht stneilc ni taht noitacol
E selpmax fo boj snoitpircsed rof krowten srotagivan mo rf dna gniward no eht lacol sec ruose r elbalia va ot ropus t
eht H-de M EART tcejo rp nac eb dnuof ni eht enilno .meht
Resources noitces fo siht .tiklot
Finding Home: Tips and tools for guiding people living with HIV toward stable housing 10