The TYP held a public conversation on Wednesday, April 28, 2010 at the Cansler YMCA about case management in permanent supportive housing. Bill Lyons, the City of Knoxville’s Senior Director of Policy & Communication, acted as moderator. Ginny Weatherstone, CEO of Volunteer Ministry Center, and several members of VMC’s staff along with a resident of the Jackson Apartments, a PSH apartment building owned by VMC, presented led the discussion about case management in PSH as practiced by VMC. The meeting was well attended, and the conversation was very good.
I’ve transcribed my notes from the conversation below with very few minor edits for clarity.
[These are my notes. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post.]
Attendees included all City Councilpersons except one who was recovering from a medical procedure. Two Knox County Commissioners were present.
Bill Lyons, Senior Director of the City’s Policy & Communications Department, acted as moderator. He defined this meeting’s topic as being focused on case management in permanent supportive housing (PSH), and said that this meeting will be the first of a series to fully explain and dialog about the components and strategies connected with our community’s efforts to end chronic homelessness. The format of this meeting was one hour. The first half hour was mostly used for presentation, the second half hour was for conversation with attendees.
Ginny Weatherstone, CEO of Volunteer Ministry Center (VMC) presented. VMC views case management as the road from homelessness into housing. case management is a very big topic. Other agencies do case management, and there are many ways to do it. Tonight we will skim the surface, and our discussion will be focused on how we do case management at VMC.
We believe in the effectiveness of the case management we do. It works. Case management for us is facilitated coordination of services at a community level. Case managers connect their clients with the resources they need to take control of their lives, and are focused on the goals of the individual client. Case management is about empowering them to meet their goals. Case management is a way for you to go from one place to another place that you could not have gone on your own.
Homelessness is characterized by chaos, noise, uncertainty, lack of safety, lack of privacy, proximity to illicit substances, lack of trust, no autonomy, little responsibility and very little accountability. This is the environment within which a homeless person must work to regain control of his or her life, and to gain the stability necessary to live a good life in the community. For some people, it is impossible to cope with the challenges of life on the street, and with the challenge of trying to get off the streets.
Housing changes this environment completely. Life in one’s own apartment is characterized by safety, security of person and possessions, calm, privacy, autonomy, high levels of responsibility and accountability because residents pay rent and must abide by the terms of a lease agreement. All of can be very positive, but can also be extremely difficult for a person who has been homeless for a long time. Not all of them can get there without help.
Case management is about building and maintaining relationship, and this happens in steps.
- It begins with an individual’s expression of the desire to leave homelessness.
- An individual assessment is performed and the person is matched with a case management. At VMC, the end goal is always housing and becoming a part of the community.
- Secure the documents that are necessary for gaining access to housing. This can involve many different kinds of agencies and can be very daunting. case managers help their clients navigate the bureaucracies involved.
- Apply for housing. In our community, there’s not a huge supply of appropriate housing. There’s usually a wait, and that lag time is productively used. It lets the case management client relationship build.
- Once housing is obtained, case managers help clients get the stuff they need and help them move in and get established.
- Case managers help clients to find and get to all of the services they need to help them meet their individual recovery goals and stay successfully housed.
- Case managers facilitate basic skills development. These can be related to many different things, such as skills related to successful employment, managing money, healthy diet, etc.
- Case managers engage in advocacy on behalf of their clients.
- Case managers visit clients often in the client’s apartment. This is a critical component of the ongoing assessment. It lets the case management know immediately if the client is experiencing any kind of issues that might affect his or her ability to remain successfully housed on the path to recovery.
- Case managers help clients find people who will help them feel good, have fun, and do things that are interesting and fulfilling. We’re really talking about helping them find and make friends with people who are different from their old associates.
Case management delivery is cost efficient when clients live close together. Sometimes the first case manager engaged by a client will make a “handoff” of that client to another case manager who is attached to the residence.
Case managers also plan and conduct activities that foster a sense of community. This helps residents decide that their housing is something that they really want to keep, to decide that “I want this to be my life and it’s worth working to maintain it.”
Two case managers, Megan Lappas and Matt Nance, and one of their clients, James Johnson, comprised a panel.
Challenges: Megan Lappas: One of the biggest challenges faced by case managers is that there is not enough housing. it is hard to instill hope when move-in is far away. Navigating bureaucracies is hard enough for case managers—imagine how challenging that is for a person who lives in the chaos of the streets. Matt Nance: The case manager’s fight is the fight against the tide of the chaos of the streets.
Megan Lappas: Our presence helps to keep people calm at Jackson Apartments, but so does the sense of community among the residents. Matt Nance: Community is a strong reinforcer of cohesion. “Don’t do bad things here because that will mess up what we’ve all built and are doing here.”
James Johnson: We depend on case managers for good advice. They’re not too authoritative. They’re kind of like family members. You can trust them. My apartment at Jackson Apartments is a blessing. I don’t know what I would do or where I’d be without it.
Dr. Lyons established ground rules for the second half. No reason for anyone to exceed 3 minutes with their comments/questions. Stay on the topic for this evening. Other than that, there are very few rules.
Della Volpe: Will the family atmosphere translate to 57 units? Matt Nance: It’s like a dorm experience in college. Lots of small interactions create the sense of community. That doesn’t happen necessarily because of big events.
Joe Minichiello: Does federal money restrict zero tolerance policies? Ginny Weatherstone: Good case managers know what is in a lease. Most leases address disruptive behavior, not alcohol consumption per se. If a case manager suspects that a person is going to be a disruptive presence because of issues related to any addiction, then that person will not be placed in that housing. Not all homeless people are addicts, though, and not all are alcoholics. It is very important to note this. Only about half the residents at Jackson Apartments, for example, are mentally ill. Members of this population are all disabled, but they are also very diverse.
Dan Smith: Where does the sustaining funding for case management come from? Bill Lyons: It doesn’t all get secured at once or from one source. Ginny Weatherstone: We get grants from the City and the County for case management funding. Plus, VMC has embraced this as what we do. We fundraise. We’re increasing our pursuit of grants. We do much else to raise money for this work. Also, we will not provide ALL of the case management for everyone in PSH. Helen Ross McNabb, for example, does a great deal of excellent case management in the community, and they seek funding in many of the same ways we do. It’s just what you have to do.
Ginny Weatherstone: We know that what we do will save the community money, but that the effect of that savings will be cumulative and will not be immediately apparent. We will see it down the road when the jail doesn’t have to build another pod, for instance. You’re not going to immediately notice a savings to the community when just one person is housed, though.
Whitney Stanley: Are there separate approaches to case management and separate restrictions for people who are chronically homeless as opposed to those who are just down on their luck? Ginny Weatherstone: The latter would not be housed in a PSH development. Are there tighter restrictions on people in PSH? A better way to think of it is that there is a lot more supervision.
Is disability income used to pay for treatment? Ginny Weatherstone: Yes, part of the treatment.
Is this housing really permanent, or is it more transitional? Ginny Weatherstone: It is whatever the resident needs it to be. One of our folks at Jackson has been there for 15 years and will probably be with us for the rest of his life. Others have moved out much faster. It all depends on their needs.
How diverse is the chronically homeless population? Ginny Weatherstone: Very. They are disabled, but their disability is not always caused by addiction and it’s not always caused by mental illness. I mentioned before that only about half of the residents at Jackson have mental illness. We have some residents whose disability is simply the result of a physical impairment. Some are very young and some are elderly.
Nancy Mott: I have a concern about our progress moving forward. The old way was very expensive and it was less effective. I have brought some resources to help people understand this and would like to hand them out. They address myths about Ten-Year Plans, statistics on savings. You cannot treat addiction in people who are living on the streets.
Ron Peabody: Can disability recipients work? Ginny Weatherstone and Matt Nance: They can work, which scales back the disability payments for which they’re eligible.
Joe Minichiello: I’d like to ask James if I may where he is from and why he is here. James Johnson: I’m originally from Florida. I came here looking for work, and after I got here, I couldn’t find work and found myself homeless.
How are case managers trained? What kind of turnover do they experience? How stressful is the work environment? Megan Lappas: We have very low turnover at VMC. Our training occurs on a constant basis. The stress is pretty high, but the work is very rewarding.
Is two hours per week per client a sufficient amount of time for case management delivery? Megan Lappas: Different clients have different needs. I might have a client that I need to see on a daily basis, and I might have others who become self-sufficient enough that I might check in with them once a month. They’re very diverse in their needs and that affects the intensity of engagement. Matt Nance: We also maximize our efficiencies. For instance, I might wait until I’ve got a group of 4 or 5 clients who need to go to the Social Security office, and then get a van and take them all there at one time. We look for ways to do that kind of thing whenever we can.
Commissioner Brown: How do you make sure that meds are being taken? Megan Lappas: Some clients are responsible enough to take them on their own. Some get PACT (Programs of Assertive Community Treatment) supervision, which is for people who need more intensive mental healthcare. Sometimes the solution is as simple, and effective, as getting them an alarm watch to remind them of when they should take their medication. Matt Nance: The home visits we do let us check very closely on how this is going. We can see if a bottle of medication is being consumed at an appropriate rate. We can check on the condition of their apartment. All of those things will tell us if we have an issue that we need to deal with. Ginny Weatherstone: Also, not all PSH residents are mentally ill. There is also a very high incidence of diabetes, hypertension, and we have to watch those things too.
The last question related to cost, and I didn’t really get much on paper about it. I think someone asked how we “arrived at a figure of $7M.” Someone else asked why Minvilla was not bid, I believe. The answer to the latter is that Minvilla’s construction contract was bid twice. (The contractor is making excellent progress on Minvilla, btw.)
Bill Lyons wrapped up our time by pointing out that the pro forma for Flenniken was presented at a recent City Council meeting, and it shows that no local tax dollars are in its funding mix, which is made up of private dollars invested via purchase of tax credits, grants, and federal dollars already appropriated for like purposes, allocated by the City and the County. He thanked everyone for taking the time to come out, and for the good dialog.
The next public conversation will be held at the Cansler YMCA from 6-7pm on Wednesday, May 19. The topic will be cost of PSH. We’ll follow the same basic format. First half hour presentation, second half conversation about the subject.