Good Works, Better Practices, Great Homes
An interactive guide to operating AIDS housing

Section I: SERVICES

D. CASE MANAGEMENT & PROGRAM SERVICES

The essential purpose of an AIDS housing program is to improve a resident's quality of life by providing needed services in a stable living environment. It is useful, then to ask: how can we deliver services in such a way as to encourage resident stability? How can we keep residents housed for the long term? In other words, what circumstances lead to residents being discharged, voluntarily or involuntarily, and what can a program do to mitigate these?

As discussed in the Application and Intake sections, the services you provide should be suited to the clients' needs. But beyond that, keeping residents housed for the long term requires creating a certain kind of organizational culture. On one level, this culture is one in which residents' civil rights (their right to privacy, etc.) are respected. But in addition to that, the culture must be one in which staff and residents are involved in a process of engagement with each other. Engagement in this context has been defined as "repeated and consistent interaction over time, sustained through formal and informal interactions that build trust, develop comfort, and enhance and solidify relationships." Some factors that can help promote engagement include:

  • Creating an atmosphere of openness and dialogue: It can be quite difficult for clients to openly discuss deeply personal matters, particularly ones carrying a social stigma such as substance use and mental illness. Therefore, staff must set a tone of openness. This can be done in a variety of ways. First, when discussing services with new clients, staff has an opportunity to describe substance abuse, mental health, and money management services in a general way that demonstrates an accepting non-judgmental attitude. The staff might even describe a hypothetical client who relapses, and how the situation would be resolved. Second, the program may use group meetings, such as house meetings or support groups, to begin dialogue about hypothetical and potential conflict situations that may lead to discharge.
  • Ensure that the entire organization is supportive of the engagement philosophy: most AIDS housing programs have some sort of hierarchical structure. This means that any actions taken by direct service staff are subject to review by supervisors, and ultimately, by the organization's board of directors. Therefore, there should be active involvement from the board of directors all the way through the chain of command in the development of a philosophy that promotes engagement.
  • Develop a foundation of mutual respect within the housing program that ensures that each individual is given the right to act autonomously provided no other staff member's or resident's rights are infringed upon.
  • On a practical level, each program will need to do some self-assessment regarding client retention. If your program has been in operation for more than a year, it is helpful to assess how effectively you have been able to maintain your consumer base. If you discover you have become a revolving door of intake and discharge, consider why clients are being discharged. Ask your residents what they find to be the most challenging part of participating in your program. Plan with staff and residents alternative policies and procedures that enhance retention and decrease the number of discharges.

In order to provide effective case management services, staff will need to be competent in areas including:

  • HIV/AIDS treatment issues
  • Internal (Agency) practices particularly the grievance procedure
  • Public entitlements
  • Community resources
  • Substance use and abuse
  • Mental health and illness
  • The criminal justice system
  • Advance medical directives (http://www.cslib.org/attygenl/)
  • Personal care for the physically impaired
  • Tenant's rights/responsibilities
  • Landlord relations/housing law
  • Assessing and matching the client to the housing paradigm
  • Guardianship issues/Child protection and mandated reporting
  • Educational/vocational/recreational activities
  • Pastoral/spiritual care (HUD regulations re: proselytizing)

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