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
April Morrison
Fred Morton
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.