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Responding to APS Cases Involving Adults Experiencing Homelessness

We create experiences that transform the heart, mind, and practice.

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About the Academy

The Academy is a project of San Diego State School of Social Work. Serving over 20,000 health and human services professionals annually, the Academy’s mission is to provide exceptional workforce development and learning experiences for the transformation of individuals, organizations and communities.

OUR PROGRAMS

San Diego State University

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About the Academy & APSWI

  • Adult Protective Services Workforce Innovations (APSWI)
  • Training program of the Academy for Professional Excellence, a project of the San Diego State University School of Social Work.
  • APSWI provides innovative workforce development to APS professionals and their partners.

OUR PROGRAMS

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Housekeeping

  • Video Camera
    • Option to hide “self view”
  • Mute, unmute
  • Chat box
  • Reactions:
    • Thumbs up, clap, raise hand, heart emoji, etc.
  • If you must step away

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  • Potential technical glitches

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Welcome

Chat box:

  • On a scale from 1-10, how confident are you in your ability to assess the immediate needs of someone who is experiencing homelessness?

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OR

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  • How many months or years have you been working with individuals experiencing homelessness?

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Today’s Goal and Learning Objectives

Workshop #2 of a series: How to Effectively Work with Older Adults Experiencing Homelessness

  • Workshop #1: Examining the Layers (foundational, knowledge)
  • Our goal today: understand the complexity of these cases, explore the reality you may experience, and work through potential challenges.

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Learning objectives:

  • Summarize the unique traits, challenges and needs experienced by people who are at risk of or are experiencing homelessness
  • Identify effective methods and plan for challenges when conducting outreach and engagement
  • Apply practical techniques when completing the initial assessment with individuals experiencing homelessness
  • Develop their own personal plan to encourage self-care and build resiliency as an APS professional

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Possible Shift in Current Practice

Today may challenge current practice and provide moments to “shift”.

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Housing First:

  • Passed in CA in 2016
  • Based on Maslow’s hierarchy of needs
  • Keep in mind when addressing initial protective issue

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Various takeaways from today’s workshop, not all will apply to every APS program.

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Our Why

“To value someone who is otherwise devalued, to believe someone who is otherwise disbelieved, to stand by someone who is otherwise alone, may be a powerful means to help them ‘find the world’ again.” (Henderson and Pochin, 2001)

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Think about clients or types of cases you’ve had that “touched” you more than others. Why was this the case?

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  • Moral Responsibility
  • Professional Responsibility
  • Social Responsibility

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Living Unhoused: A Choice?

  • Is it the outcome of failed systems, discrimination, and/or accessibility?
  • Do people have unmet mental, physical and/or cognitive health needs?

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  • Housing First- meeting people’s most basic needs

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Considerations

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  • High vulnerability to victimization
  • Often mistrustful of service providers and reluctant to engage
  • Hard to reach and experience deep social exclusion
  • Experience self-neglect that leads to homelessness
  • No affordable options for stable housing
  • Unrealistic care plans
  • Stereotyping and stigma
  • Continued stress of life on streets
  • Less resilient as they grow older

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What are some of your concerns when working with this population?

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Think back to Workshop #1, what are some factors in someone’s life that may contribute to them becoming less resilient?

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Length of Homelessness

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*All share inherent trauma of experiencing homelessness

IMMINENT:

  • Financial abuse (self or others)
  • Eviction
  • Self-neglect (ADL’s)

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NEWLY HOMELESS (transitional):

  • Result of structural economic constraints
  • Impact of social situations
  • Left against medical advice

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CHRONIC:

  • Complex and chronic health needs/risks
  • Lack of support from family/friends
  • Often refuse help
  • Serious and persistent mental illness and/or drug use

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Safety Strategies Prior to Meeting

Chat box: Share ways in which you practice safety while visiting people you interview

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Handout #1: Tip Sheet

  • Teams
    • Pairs
    • Develop a contingency plan before leaving the office.
    • “Code word” (e.g. “Where’s Charlotte?”)
    • Conduct regular gear up/debrief

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  • Strategies
    • Keep others informed
    • Plan for safer locations
    • Approachable or not?
    • PPE
    • People who are sleeping, peeking/touching tents

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Safety Strategies While Engaged

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  • Introductions and appearance
  • Don’t interrupt sales of drugs or sex.
    • If you suspect that a client is under the influence, consider rescheduling and visiting on a different day.
    • Do not accept or hold any type of controlled substance.
  • Refrain from petting dogs/animals that may belong to your client or “community”.
  • In an emergency, call, or have another person call 911.
  • LISTEN TO YOUR GUT/INTUITION

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Safety Strategies Upon Completion

Consultation

    • Providers can gain insight and share experiences, successes and areas of improvement
    • Regular case conferencing
      • Weekly team meetings
      • Multidisciplinary Teams: may include agency partners, such as housing representatives and mental health providers

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Training

    • Agency-wide safety trainings (i.e., Non-violent Crisis Intervention)
    • Regular review of individual and team safety protocols

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Meet Iris

Handout #2: Iris Case Study

  • Iris, late sixties, has been homeless for five years.
  • Referred to APS by the County Homeless O&E Team.
  • Iris typically stays alone near the park benches, but often visits the local Senior Center.
  • She has a prepaid cell phone and one bag of personal belongings.
  • O&E reporting self-neglect: Iris has diabetes and a large wound on her left foot, but she has not sought medical treatment in several months.
  • Reports that Iris is friendly but may have some untreated mental health issues.
  • She receives a monthly disability check and is a MediCal/Medicare recipient.

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Safety and Outreach:

What are some things you would want to do to prepare or think about before meeting Iris?

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Principles of Outreach

Contact individuals in non-traditional settings who might otherwise be ignored or underserved.

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Principles:

  • “Inreach” – ‘walking’ with the client
  • Creating a human connection
  • Building trust
  • Developing a sense of community
  • Dignity and respect
  • Honesty
  • Versatility
    • Providers as ambassadors, navigators and bridge builders

(NHCHC, 2013 & 2014)

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Outreach Strategies

Handout #3: Tip Sheet

  • Initial approach
  • Time of day
  • Gatekeepers
  • “Three homes”
  • Respond, don’t react
  • Be culturally responsive
  • Trauma-informed Care
  • Contact information and anticipated follow up
  • Repeat visits
  • Hygiene kits, water, incontinence products

(NHCHC, 2013)

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Outreach Challenges

Knowing some of the challenges ahead of time will help prepare you and possibly allow time to think of solutions.

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  • Differences in perspectives among team members and agencies
  • Unmanaged mental illness, especially when a client lacks insight to their symptoms
  • Lack of client readiness and trust
  • Limited resources within the community (phones, transportation, translation services, housing options, etc.)
  • Staff burnout and turnover

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(NHCHC, 2014) � 

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Developing Your Personal Outreach Style

My Own Motto Activity

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1. Individually: Reflect on your own style when engaging with clients, alleged perpetrator and collaterals.

    • What is at the core of your work and how you interact with people?
    • Write/type it down in your participant manual

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2. Breakout Room Activity:

    • Share and note similarities and differences.
    • Allow each person to share.

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Engagement and Assessment Strategies/Techniques

Handout #4: Tip Sheet

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  • Get to know the client’s personal narrative
  • Have a consistent presence
  • Follow up and follow through
  • Let the client lead
  • Encourage client to set goals
  • Work towards small steps (SMART)
  • Move at the client’s pace
  • Pay attention to health literacy

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We must continuously balance the client’s freedom of choice with the severity of conditions and limitations of your role.

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Psychoeducation

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What it might look like when working with people experiencing homelessness:

  • Information and education about illness (mental health and/or substance use, medical issues), including options for treatment
  • Coping skills, recognizing triggers, relapse prevention, medication management
  • Behavioral interventions (sleep hygiene, nutrition, etc.)

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Considerations when sharing information:

  • Build off client strengths and resiliency
  • Interactive, structured and comprehensible
  • Allow time for clients to ask questions
  • Include caregivers/family in the discussions if possible

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(Motlova et al., 2017)

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Engagement Case Study

Handout #5: Iris Case Study Continued

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What skills and attitudes would you use/have with Iris depending on the phase of engagement/where you are in the case?

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Possible answers:

    • Introduce self and purpose; demonstrate empathy and respect; reflect the client’s feelings and message; ask open-ended questions, allow the client to tell their story; consider providing emergency items
    • Complete biopsychosocial assessment and safety evaluation
    • Identify client strengths/coping skills, limitations, goals
    • Offer concrete assistance based on client’s needs and preferences and available/appropriate community resources
    • Service coordination with local clinics, housing agencies, etc.

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Tasks

Complete assessment (biopsychosocial)

    • Assess need for emergency treatment, self-neglect, physical condition
    • Support system
    • Shelter options
      • Housing First Model

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Assist with completing forms

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Explore and introduce linkage with outside providers

    • May include warm handoff
    • Does the client have an established relationship with another agency?

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Addressing Peoples’ Health Concerns

Chat box: What do you know about person-centered practice?

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Person-centered practice:

  • Partnership where all involved have the role of advocate
  • Reduce barriers to care through the sharing of responsibilities

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Chat box: What do you know about Trauma-informed Care (TIC),

including any specific principles?

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TIC Principles:

  • Safety
  • Choice
  • Collaboration
  • Trustworthiness
  • Empowerment

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Recovery Model

Chat box: What do you know about the Recovery Model?

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Principles:

  • Self-direction
  • Individualized and person-centered
  • Empowerment
  • Holistic
  • Nonlinear
  • Strength-based
  • Peer support
  • Respect
  • Responsibility
  • Hope

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Interventions:

  • Harm Reduction
  • Motivational Interviewing

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Applying Recovery Model to Sub Populations

Severe and persistent mental illness:

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  • Give the client control (decision making)
  • Provide calm, consistent support
  • Involve staff from mental health agencies that may be familiar with the client

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Cognitive impairments:

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  • Set realistic goals based on client limitations
  • Consider putting information in writing
    • Use of binder, calendar, signs, etc.
  • Ask questions to assess ability to manage ADLs
  • Make referrals to agencies specializing in Neurocognitive Disorders

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Recovery Model and Iris

Handout #5: Iris Case Study Continued

Using the Recovery Model, what are some short and/or long-term goals for Iris?

*Remember the goal making process is collaborative

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Possible Answers:

  • Short term:
    • Safety assessment (self neglect?)
    • Assess/address need for medical/mental health intervention
    • Basic needs (food, hygiene kits)
    • Explore interest in housing (shelter or permanent)
  • Long term:
    • Create collaborative action plan (SMART goals) to address Iris’ needs
    • Coordinate housing placement if Iris is interested in permanent housing
    • Connecting Iris with agencies in community (e.g., help completing application to IHSS)

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Vicarious Trauma, Compassion Fatigue & Burnout

This work requires patience, positive regard and persistence. Feelings of anxiety, guilt, frustration, reluctance, fear and exhaustion are common.

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Vicarious Trauma: The process of change that happens because you care and feel committed or responsible to help.

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Compassion Fatigue: The physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period or time.

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Burnout: Characterized by physical, emotional and mental exhaustion caused by long-term involvement in emotionally demanding or stressful work.

*Cumulative effect…doesn’t happen over night.

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Mitigating Burnout and Compassion Fatigue

Understand it:

  • Personal and professional risk factors

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Be Aware of it:

  • Signs and symptoms

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Address it:

  • Develop a Personal Action Plan
    • ProQol (past 30 days) (?s 3, 6, 12, 16, 18, 20, 22, 24, 27, 30)
    • Balance: Vicarious Resiliency- recently, what is:
      • Something you did at work that you are proud of?
      • A work related kudos, praise or thank you that you’ve received (no matter how small)
      • Something you were a part of that felt successful (no matter how small)
    • Self-care and Connection

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Workshop Review

Think back to Iris…

  • How could you tailor your conversation with Iris to meet her specific needs based on today’s content?
  • What if APS could only meet with her once but considered the Housing First Model within that one interaction?

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Safety and Outreach

  • Develop personal outreach style

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Engagement and Assessment

  • Psychoeducation

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Considerations & Interventions when working with sub-populations

  • Recovery Model

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Your self-care

  • Develop a personal action plan

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Takeaways and Evaluations

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Chat Box: Share one thing you learned today that you will use in your practice when meeting with those experiencing homelessness.

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Please complete the evaluations

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Thank you!

We envision a world where �the quality of life for individuals, organizations, and communities �is transformed into a healthier place.

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Thank You!