Connecticut Supportive Housing Quality Initiative

Excerpts from:

Working in Supportive Housing:

An Orientation forNew Case Managers

2017

Alice MinervinoDMHAS

Fred MortonDMHAS

April MorrisonCSH New England

TopicsHistory of Supportive Housing in CT

Housing First & Supportive Housing

Overview of DMHAS

Overview of SHQI

CANs

DDaP & HMIS

TCMs

Target dates

Connecting the Assessment/Acuity, Service Plan, and Progress

Notes

Progress Note guidelines

Objectives

Obtain an overall understanding of:

The history of supportive housing CT

Housing First & Supportive Housing

CTs Coordinated Access Network

DDaP, HMIS, and Targeted Case Management

Become familiar with the operations of:

DMHAS and the SHQI

Receive documentation guidance on:

Target dates

The Assessment/Acuity Index

Service Plans

Progress Notes

Supportive Housing in CT

Valley Park - Torrington

My Sister’s Place - Hartford

Geller Commons – New Haven

Liberty Commons - Middletown

Supportive

Housing

Quality

Initiative

(SHQI)

A collaboration

between CSH

and the

Connecticut

Department of

Mental Health

and Addiction

Services

(DMHAS)

Supportive Housing in CT1995 Supportive Housing Demonstration Program 281 units

2000 Supportive Housing PILOTS Initiative 700 units

2005–present Next Steps Supportive Housing Initiative 771 units

Additionally, the State of Connecticut has created 80 units of

supportive housing targeted specifically frequent users of jail and

shelter through the Frequent Users Services Engagement (FUSE)

Program. FUSE units are currently located in 5 communities

throughout CT (Hartford, New Haven, Bridgeport, Waterbury and

Southeastern CT)

CURENTLY REVIEWED UNDER THE SHQI

• 47 SH programs in CT who’s services are funded by DMHAS

• LC (1996) & MSP – first in demonstration program

• VP in second round Next Step

• Geller Commons – newest – leased up in 2016; 23 units = 16

affordable, 7 youth aging out of foster, 10 chronic

Housing First

pathwaystohousing.orgThe basic definition

Housing First is a proven method of ending all types of homelessness and

is the most effective approach to ending chronic homelessness. Housing

First offers individuals and families experiencing homelessness immediate

access to permanent affordable or supportive housing. Without clinical

prerequisites like completion of a course of treatment or evidence of

sobriety and with a low-threshold for entry, Housing First yields higher

housing retention rates, lower returns to homelessness, and significant

reductions in the use of crisis service and institutions. - USICH

Housing First Principles

#1 Homelessness is first and foremost a housing problem and

should be treated as such.

#2 Housing is a right to which all are entitled.

#3 Return people who are experiencing homelessness or at

imminent risk of homelessness to stable, permanent

housing as quickly as possible and connect them to

resources that sustain housing.

#4 Issues that may have contributed to a household’s

homelessness can be best addressed once they are

housed

Housing First

• Maximize tenant choice

• Accept tenant choice without judgment

• Accept that risk is part of the human experience

• Staff understands the clinical and legal limits to choice

and intervenes as necessary when someone presents

a danger to self or others

• Help tenants understand the legal obligations of

tenancy

• Provide meaningful opportunities for tenant input and

involvement

Housing First

We are responsible for the intervention

not the outcome.

Services are voluntary for tenants but mandatory for providers

Supportive Housing

Basic definition:

Supportive housing is an innovative and proven

solution to some of communities' toughest problems.

It combines affordable housing with services that

help people who face the most complex challenges

to live with stability, autonomy and dignity.

Supportive Housing

Supportive Housing

Case Managers are friendly but not FRIENDS – BOUNDARIES

Use supervision for talking about boundaries & other questions and situations

where direction is needed

Case Managers have to take care of themselves to be effective with tenants –

careful to watch for burn out

Supportive Housing

Supportive Housing

Case Managers should promote and encourage tenant independence,

using every opportunity possible as a teaching moment. Try to anticipate a

fall. Help them get a bike & learn how to ride. Be there when they fall &

offer support. The hope is that eventually they'll ride on their own & maybe

try new things.

DMHAS

DMHAS Region 4

DMHAS Region 2

DMHAS Region 3

DMHAS Region 5

DMHAS Regions

Supportive Housing Quality InitiativeOverview

Reviews

Assessment/Acuity Index

Forms & Documents

DMHAS Supportive Housing Training Catalog

Learning Collaborative

Supportive Housing Community

ReviewsPurpose of reviews, frequency, and process

Reviews allow for:

• Agency self-evaluation

• Assessment of policies, procedures & practices

• Improvement towards alignment with DMHAS standards and

guidelines

Reviews consist of:

• A request for information approx. 1 month before the review

• Separate interviews/focus group with case managers, supervisors,

and tenants

• Chart reviews looking back 1 year prior to the review date

• Discussion between CSH & the agency reviewed re: preliminary

findings

• Recommendations for improvement or corrective action

• In-person debriefing on review feedback

• Final report sent to the agency & DMHAS

Assessment and Acuity Index

http://www.csh.org/CT-QI

Service PlanningConnection to service

plan goals

Tenant choice

Evidence in notes

Assessment/Acuity Index

Service Planning

Caseload distribution

Level of contact

Moving On

Forms, Documents & Training

Sample forms for providers

Review & Guidance documents

http://www.csh.org/CT-QI

DMHAS Supportive Housing Training Catalog

Peer Learning Collaborative

Community

The catalog, trainings, and review process have

created community of resource among providers

CANs

Northeast

CAN

Southeast

CAN

Middlesex

Meriden

Wallingford

CAN

Greater

Hartford

CANWaterbury/Litchfield

CAN

Central

CAN

Fairfield

County

CAN

Greater New Haven

CAN

8

CANs

Identification and Entry

• People in housing crisis should dial 2-1-1, and select

option 3, followed by option 1

• People can call any hour of any day to schedule a

coordinated entry assessment

In calendar year 2016, there were more than 91,000

housing related service requests to 211.

The top three were:

shelter (61,860),

rental assistance (12,637), and

low-cost housing (11,137).

CANsCAN Assessment• CANs assess housing needs with a focus on identifying special

populations like Chronic, Veterans, Families, Youth, etc.

• People not diverted are enrolled in the CAN system and entered into HMIS

• People who can self-resolve their homelessness are reported to do

so within 14 days. As such, CANs typically wait 2 weeks before

administering the VI-SPDAT

CANs

CAN Matching Process• Video of CAN match meeting (Fairfield County)

DDaP & HMIS

Services Subsidy (primarily)

For questions about HMIS, please contact

Nutmeg Consulting or CCEH

DDaP: DMHAS’ Service Reporting System

Intake Assessment (Admission)

Periodic Assessment Update (Every 6 Months – at least)

Discharge

Service Data Reporting – importance of Real Service Times

DDaP Direct Entry vs Agency Electronic Health Record (HER)

Data can be entered directly into DDaP

Some Agencies use a standard EHR or HMIS to enter data. Data is then fed

into the DMHAS data warehouse through an upload.

TCMs…assessment, planning, linkage, support and advocacy activities delivered by a case manager

to assist and enable tenants to gain access to

http://www.ct.gov/dmhas/lib/dmhas/publications/TCMtraining.pdf

DEFINITION: The Medicaid State Plan Amendment (SPA) defines TCM services as: “services

furnished to assist individuals eligible under the State Plan in gaining access to needed

medical, social, educational, and other services.”

• No Medicaid? – No TCM

The Medicaid Provider Manual defines case management services as “the continuum of

assessment, planning, linkage, support and advocacy activities systematically carried out by

an individual case manager that are available to assist and enable an individual to gain

access to needed medical, clinical, social, educational or other services.”

Target dates

• First contact (progress note) – within 10 days of program admission

• All progress notes – within 1 week of service delivery

• Assessment/Acuity Index (AAI) – within 30 days of move-in

• Service plan – within 60 days of move-in and always AFTER A/AI

• Tenant guide – reviewed and signed at time of admission and annually

• Release Of Information – at least annually, or at agency-defined intervals

• Assessment of the health, safety, and maintenance of the unit by the Case

Manager – at 6-month intervals

• Deferred elements from the Acuity Index portion of the Assessment discussed

– before the next service plan written (every 6-months at least)

• Documentation of discharge planning – as soon as discharge is underway

• Provision of the discharge grievance process to a tenant being discharged - as

soon as discharge is underway

• Contact or attempts at contact with a discharged tenant post discharge – 1x

per month for three months at approximately 30 day intervals

Progress Note GuidelinesComponents only - for true format go to http://www.csh.org/CT-QI

Note #

Date of

Note

Date of

Service

Duration

of Contact

Location/Type

of Contact

Staff Entering

Note

Service Plan Goal(s)

Addressed

1

2

3

4

• Documentation is essential to providing the best quality of work for our participants

• These are components pulled from the sample Progress Note DMHAS has

approved (on CSH website) – all 6 components must be present

• Allows 4 notes to be entered on one form

• Signature or electronic signature of person entering note AND date must be present

• Entered within one week of service delivery (service delivery vs. note

written/entered)

• If it’s not written down, it didn’t happen!

Progress Note Guidelines

Content

• Goal related - objective vs. subjective; Document progress towards

goals/objectives in service plan – 2x month for each goal

• List frequency of contact or attempts at contact - Document 2 contacts

per month with at least 1 being face to face; Document unsuccessful

attempts; Continued outreach and re-engagement with varied methods

• Document critical issues & interventions

• Show an awareness of tenant issues

• Advocacy

• Responsive to tenant choice or preference

• Obtaining/maintaining benefits

• Critical Incidents or incidents of child abuse or neglect

• Moving On conversations

• If it’s not written down, it didn’t happen!

Connecting the Assessment/Acuity Index, Service Plan, and Progress Notes

Assessment/Acuity Index

• Identifies housing status and history, medical and behavioral health status and history, legal

involvement, finances, employment, etc.

• Identifies needs in areas that affect housing stability and could be used as service plan

goals

• Shows tenant choice in goal selection (Active/Deferred)

SERVICE PLAN

• Develop framework from AAI

• Shows tenant choice in goal selection (Active/Deferred 0s & 1s - tenant’s own words)

• Identifies detailed strategies toward goal completion

PROGRESS NOTES

• Describe execution of activities listed as objectives or interventions in the service plan

• Should describe the effectiveness of objectives or interventions

• Should be reviewed to inform alterations or changes to the next service plan

© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH.

Please Join Us!

Alice Minervino

alice.minervino@ct.gov

April Morrison

april.morrison@csh.org

Fred Morton

fred.morton@ct.gov

Supportive Housing Acronyms

1

ACRONYM AGENCY TYPE

BRS Bureau of Rehabilitation Services STATE of Connecticut

CLRP Connecticut Legal Rights Project STATE of Connecticut

CSSD Court Support Services Division STATE of Connecticut

DCF Department of Children and Families STATE of Connecticut

DDS Department of Developmental Services STATE of Connecticut

DMHAS Department of Mental Health and Addiction Services STATE of Connecticut

DMHAS YAS Department of Mental Health and Addiction Services Young Adult Services STATE of Connecticut

DOC Department of Corrections STATE of Connecticut

DOH Department of Housing STATE of Connecticut

DPH Department of Public Health STATE of Connecticut

DSS Department of Social Services STATE of Connecticut

HUD Department of Housing and Urban Development FEDERAL

SSA Social Security Administration FEDERAL

ACRONYM AGENCY TYPE

ACT Aids Connecticut PRIVATE Non-profit

CCEH Connecticut Coalition to End Homelessness PRIVATE Non-profit

CSH Corporation for Supportive Housing PRIVATE Non-profit

HI Housing Innovations Consultant

LMHA Local Mental Health Authority LOCAL/STATE

PSC Partnership for Strong Communities PRIVATE Non-profit

ACRONYM PROGRAM TYPE

BHH Behavioral Health Home LOCAL/STATE

BOS Balance of State STATE of Connecticut

CAN Coordinated Access Network STATE of Connecticut

CCT Community Care Team LOCAL/STATE

CoC Continuum of Care (HUD required) STATE/FEDERAL

PSH [Permanent] Supportive Housing STATE/FEDERAL

RAP Rental Assistance Program STATE of Connecticut

RRH Rapid Rehousing STATE of Connecticut

SAGA State Administered General Assistance STATE of Connecticut

SSI Supplemental Security Income FEDERAL

SSDI Social Security Disability Insurance FEDERAL

SNAP Supplemental Nutrition Assistance Program FEDERAL

TCM Targeted Case Management STATE of Connecticut

ACRONYM SYSTEM TYPE

EQMI EQMI - Evaluation, Quality Management and Improvement [Division] STATE of Connecticut

DDaP DMHAS Data Performance STATE of Connecticut

HMIS Homeless Management Information System STATE/NATIONAL

Supportive Housing Acronyms

2

ACRONYM PHILOSOPHY

EB or EBP Evidence-based or Evidence-based practice

HF Housing First

HR Harm Reduction

MI Motivational Interviewing

ACRONYM OR ABBREVIATED NAME FACILITY

Capitol Region Capitol Region Mental Health Center

CMHC Connecticut Mental Health Center

CVH Connecticut Valley Hospital

ES Emergency Shelter

RVS River Valley Services

SWCMHS Southwestern CT Mental Health System

Western Western CT Mental Health Network

ACRONYM FORM/TOOL

BNL By Name List (used by CAN)

VI-SPDAT Vulnerability Index-Service Prioritization Decision Assistance Tool (used by CAN)

Supportive Housing Acronyms

3

What Is the Difference Between Social Security Disability (SSDI) and SSI?

Both SSI and SSDI disability programs offer cash benefits for disabled individuals, but the financial eligibility requirements are very different.

By Beth Laurence, J.D.

The main difference between Social Security Disability (SSD, or SSDI) and Supplemental Security Income (SSI) is the fact that SSD is available to workers who have accumulated a sufficient number of work credits, while SSI disability benefits are available to low-income individuals who have either never worked or who haven't earned enough work credits to qualify for SSD.

While many people don't distinguish between SSI (Supplemental Security Income) and SSDI (Social Security Disability Insurance), they are two completely different governmental programs. While both programs are overseen and managed by the Social Security Administration, and medical eligibility for disability is determined in the same manner for both programs, there are distinct differences between the two.

What Is SSI?

Supplemental Security Income is a program that is strictly need-based, according to income and assets, and is funded by general fund taxes (not from the Social Security trust fund). SSI is called a "means-tested program," meaning it has nothing to do with work history, but strictly with financial need. To meet the SSI income requirements, you must have less than $2,000 in assets (or $3,000 for a couple) and a very limited income.

Disabled people who are eligible under the income requirements for SSI are also able to receive Medicaid in the state they reside in. Most people who qualify for SSI will also qualify for food stamps, and the amount an eligible person will receive is dependent on where they live and the amount of regular, monthly income they have. SSI benefits will begin on the first of the month when you first submit your application.

What Is SSDI?

Social Security Disability Insurance is funded through payroll taxes. SSDI recipients are considered "insured" because they have worked for a certain number of years and have made contributions to the Social Security trust fund in the form of FICA Social Security taxes. SSDI candidates must be younger than 65 and have earned a certain number of "work credits." (To learn more, see our article on SSDI and work credits.) After receiving SSDI for two years, a disabled person will become eligible for Medicare.

Under SSDI, a disabled person's spouse and children dependents are eligible to receive partial dependent benefits, called auxiliary benefits. However, only adults over the age of 18 can receive the SSDI disability benefit.

There is a five-month waiting period for benefits, meaning that the SSA won't pay you benefits for the first five months after you become disabled. The amount of the monthly benefit after the waiting period is over depends on your earnings record, much like the Social Security retirement benefit.