Working with Active Users: approaches

GPD WEBINAR

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AGENDA Intro to the session Overview Techniques Assessment Intervention Negotiation Case Study Discussion

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GOALSExplore strategies that extend to previously hard to engage substance using VeteransReduce risk and optimize outcomes for Veterans who use and/or abuse substancesAssist Veterans access housingConnect motivational interviewing/harm reduction techniques to recovery processDiscuss practices to support recovery within the context of transitional housing

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Substance Abuse DiagnosisRecurrent use resulting in failure to fulfill major role obligation at work, home or school

Recurrent use in physically hazardous situations

Recurrent substance related legal problems

Continued use despite persistent or recurrent social or interpersonal problems caused or exacerbated by substance

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WHY PEOPLE USESelf medicate symptomsTo socializeWorks for themBiological vulnerabilityLearned behaviorTo get a break from problemsIsolationFeels goodDecreases inhibitionsEstimate 10% of the population has SA problem but 1% is homeless

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Housing Risks Associated with Use

Rent ArrearsUnable to Maintain UnitNoise ViolationsGuests and Occupancy ViolationsProblems with bills –lights, foodArguments with neighborsIllegal drugs in unitBorrowing money

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Goals for GPD Programs The purpose is to promote the development and provision of supportive housing and/or supportive services with the goal of helping homeless Veterans achieve residential stability, increase their skill levels and/or income, and obtain greater self-determination.

The performance metric is at 65% for Veterans discharged from GPD to permanent housing

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Regs regarding Substances

Grant and Pre Diem 38 CFR Part 61.80 section 14 Residents must be provided a clean and sober environment that is free from illicit drug use or from alcohol use that: could threaten the health and/or safety of the residents or staff; hinders the peaceful enjoyment of the premises; or jeopardizes completion of the grantee’s project goals and objectives

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Why Veterans access GPD

Discussions with GPD Liaisons: What are the identified gaps in service in helping homeless Veterans move towards housing?

How do the VA Homeless Programs see GPD as a resource? Is GPD being used to provide a safe environment until VASH or other Subsidized/ unsubsidized Housing is available?

Is the GPD program seen as resource to address substance use issues? Why would a Veteran be referred to GPD as opposed to VASH or other housing programs?

What resources does your program need to assist Veterans with the transition to housing?

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Case Examples Peter Smith has been referred to GPD. Peter has been homeless for over a year. He has been denied benefits multiple times and has expressed a desire to work. He has been unemployed for over 5 years. He had been employed as a roofer but drinking and falling got in the way. He says he wants to be sober but he has had multiple relapses since he has been in the program.

1. Is Peter appropriate for your GPD program?

2. What are Peter’s barriers to accessing and maintaining housing?

3. How will these barriers be addressed

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Peter1. Can Peter be accommodated in the program with multiple

relapses?

2. Income is a barrier to housing

Peter has not been housed for a year but what worked for him in the past? Could Peter be considered for a subsidized program such as S+C or VASH

3. Are there resources to assist with benefits and employment, tenancy skills, treatment and support around SA?

TechniquesAssessment

Stages of ChangeIntervention

Motivational InterviewingNegotiation

Harm Reduction Strategies

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STAGES OF CHANGEPre ContemplationContemplationPreparationActionMaintenanceRelapse

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VALUE OF STAGES OF CHANGE

Stages of Change was based on research with self-changersIntervention can begin before the action phaseNormal for people to try to change several timesRelapse is often part of the processInterventions can be designed to match Veteran’s stageResistance is often the result of not understanding where a person is atInstead of sobriety, the focus in on raising awareness and increasing motivation to change SoC handout

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Motivation for Change Look at Veteran’s goals and behaviors to discuss importance of components

Ask for examples and elaboration Link tenancy barriers to identified behaviors Look at competencies based on history and other successful changes

Look at barriers to the goals◦ Assess barriers using stages of change◦ Establish how negotiable some barriers are: guests, upkeep, rent◦ Looks at importance to person of the behaviors associated with

barriers: such as drinking with friends in the house

Motivation for Change Ensure a common understanding Develop several paths to desired change Weigh cost / benefits of components of each Look back for competencies to build confidence Look forward for hope and inspiration Lay the foundation for future planning Accept behavior may not fully change but outcome can be different

Working toward RecoveryChanging behavior is a long processIn order to achieve long lasting change the Veteran has to be fully engagedReducing/ stopping use can assist Veterans to attain their goalsDiscussion of Recovery can be involved in all aspects of careOnce decision is made to access treatment it must be readily availableThis requires coordination with all levels of care and

support within the VAMC and community

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Harm Reduction: Negotiating Change

Harm Reduction is a perspective and a set of practical strategies to reduce the negative consequences of drug use, incorporating a spectrum of strategies from safer use to abstinence.

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MOST SUBSTANCE USERS ARE NOT READY TO CHANGE

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01020304050607080

Active Users

Ready 20%Not Ready 80%

HARM REDUCTION Offers Services to Active Users Works on needs and goals identified by Veteran Could have recovery as a means to the goal Raises awareness of risk and strategies to reduce harm

Abstinence may be possible, but accepts alternatives that reduce risk associated with use

Prioritizes risks that may cause serious harm Sees recovery as a non-linear process Offers user friendly services Low barriers, informal atmosphere, extended hours, location

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HARM REDUCTION: examples

Harm Reduction can be applied to many behaviors that have negative consequences

Examples include: Sleeping medication is someone is responding to voices all night and will not consider anti psychotics

Changing shifts if someone is not able to wake up early for whatever reason

Coming to an AA meeting when a person is using or have just had a slip

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Enabling? Harm reduction connects use to harm Goal focused: Reduces resistance Begins the stages of changeHarm reduction requires person to look at behaviorHR requires an evaluation of priorities Treatment is always one of the options Uses the same rules as everyone else This is the beginning of the conversation

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Program Design What are the stated goals of your program?

◦ Does this reflect the goals of the Veterans referred to your program?

◦ Does this reflect the priorities of the VA Homeless Programs?

How does 38 CFR Part 61.80 section 14 affect the program structure?◦ Are Veterans required to be sober when they come in?◦ How is relapse and/or use handled?◦ How does the program facilitate the transition to housing

◦ What resources do you have access to◦ What are the gaps

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Program Design Clearly defined goals: making the program a choice What is the population the program serves?

◦ Will you serve active users, Veterans with psychiatric symptoms, Veterans with medical problems?

Structure to move towards goals: what are the paths to the goals.◦ Breaking down housing options with paths and timeframes

Availability of services: service agreements and/or staff competencies clearly stated:◦ Example: benefits advocacy, access to employment services, access

to legal assistance, financial management skills, tenancy skills, medical/psychiatric assistance, substance abuse treatment resources

Looking at outcomes: does this meet GPD and Program outcomes

Wrap up and DiscussionFollow up:

Andrea White

awhite@housinginnovations.us

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