Residential Services

Introduction –

Residential Services –

Referal Procedures –

What Happens When My Client Gets Housing? –

What Happens After The Placement? –

Questions

Introduction

Housing Problems

One of the challenges facing the residents of Boston is the availability

of affordable housing. The housing economics in the city affects the availability

of housing for our clients. Massachusetts Mental Health Center had 459 rehabilitative

residential slots. There were 277 people on our residential waiting list;

forty-six people left those beds. With the number of beds remaining fixed,

clients must leave residential services before we can take another person

off the waiting list.

What Is DMH Housing?

Over the past twenty years, housing for the mentally ill has gone through

many changes. Today, DMH provides rehabilitative residential programs and

not permanent housing. Group homes, supported housing services, and shared

apartment programs are temporary living arrangements. People may remain

in the program while they learn skills. When they obtain the skills necessary

to live in the community, they move on to independent housing.

Before a

client is admitted to a rehabilitative residential program, staff must identify

a service goal. Annually, staff assesses progress and identifies a rehabilitation

goal. When clients can no longer benefit from rehabilitative services, they

must move on. With DMH housing, it usually means the client must move. However,

Massachusetts Mental Health Center has some placements that allow the client

to stay in their apartment while we remove the services.

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Residential Services

Housing Assistance

This service, which started in September 1999, is Massachusetts Mental

Health Center’s response to the affordable housing shortage in the

Boston area. A Residential Services staff person helps clients find rental

subsidies, apply for housing vouchers, and find apartments.

While individual help is limited, some clients can benefit from other

formats. The Residential Services Resource room is located in room S

300. Staff and clients can use the various resources, such as, a current

list of available apartments, descriptions of housing search services,

information on rental subsidies, et cetera, to help them with their search.

For those who cannot find housing on their own, clients may receive individual

Housing Assistance. Residential Service staff will help clients obtain

a rental assistance voucher. Through established relationships with the

Boston Housing Authority, Brookline Housing Authority and the Metro Boston

Housing Partnership, staff determine the available vouchers, assist the

client through the application process, and secure a voucher. Clients

then participate in the weekly Housing Search Support group. Here, they

share their frustrations with the search process. Staff teaches housing

search strategies, including filling out applications, negotiating with

property owners, etc. A full-time housing search specialist scours the

housing market looking for available housing. Then accompanies clients

to view the apartment. When an apartment is identified, the Residential

Service staff secures the apartment with a deposit, and completes the

paperwork to start the subsidy. Staff may help the client get furniture,

obtain discount fuel, electricity, and telephone services. Finally, a

client receives the keys to an apartment.

Housing obtained through the Housing Assistance Service is permanent housing

for people who are able to live alone or with family or roommates. They

may get their support through Continuing Care, Community Rehabilitation

Support, or other programs. However, Residential Services will respond to

problems with property owners and try to get the clients connected with

other DMH services if they are experiencing problems.

Rehabilitive Residential Programs

A rehabilitative residential program provides the training and support

for clients to learn to live independently in the community. Rehabilitative

Residential Programs provide the support and training that a client needs

to learn the skills and gain the confidence necessary to live independently.

Rehabilitative Residential Programs are not permanent housing; they are

learning environments. Once the person has learned the requisite skills,

the supports are removed or reduced. In many programs, this means the

client must move. In some Supported Housing Service settings, the supports

can be reduced and the housing becomes permanent.

Massachusetts Mental Health Center divides the Rehabilitative Residential

Programs into two groups: Specialized Rehabilitative Programs, Rehabilitative

Residential Network.

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Referal Procedures

Completing A Referral For Residential Services

Determine If The Client Is DMH Eligible

Each client referred for residential services must be a DMH client eligible

for DMH continuing care services. If the person is not a DMH client, they

must go through the Eligibility Determination Process. We cannot accept

referrals until the client is eligible for DMH continuing care services.

The Referral Process

While most referrals to Residential Services begin with the Housing Referral

Meeting, the referral can have a number of starting points (See flow chart

next page). The DMH shelters, DMH inpatient units, and others may seek

placements for clients in their care. However, to participate in planning

for residential services, and assure a client’s place on the Housing

Waiting List, clinicians, case managers, CRS workers and others should

follow the referral process outlined here:

1. Massachusetts Mental Health Center Residential Services holds a referral

   meeting on alternate Friday mornings. The person making a referral gives

   a short presentation. Meeting participants discuss the possible programs

   and services that may meet the client’s needs. Staff submits the

   DMH Metro Boston Referral Form at this time.

2. Representatives from various departments meet and assign clients to

   program openings at the weekly Placement Meeting. They may create openings

   by “promoting” or “graduating” other clients in

   residential programs. The Placement Meeting produces and distributes a

   Proposed Placement Plan.

3. After reviewing the Proposed Placement Plan, the clinician or case

   managers working with a client meet with the Placement Team to discuss

   the plan, answer questions, and solve problems at the weekly housing meeting.

   Residential Services staff work with the clinical team to move the client

   into the identified placement.

As the clients’ rehabilitation progresses, they move to settings that

are more independent; eventually they leave residential services.

Completing the DMH Metro Boston Referral Form

Fill out the DMH Metro Boston Referral Form. Pay particular attention to the

second page. The Capacity for Self-Care and Residential Referrals sections

give the residential staff an introduction to the services that your client

may need.

Scheduling a Presentation at the Residential Placement Meeting

Residential Services holds a placement meeting on every other Friday in room S304 at

Massachusetts Mental Health Center. The person referring clients for residential

placement gives a short presentation to Residential Services and provider staff.

Those present discuss the possible programs and services that may meet the client’s

needs. You must turn in the DMH Metro Boston Referral Form at this time.

There is no referral until you submit the form.

To schedule a time at this meeting, you can call (617) 626-9589.

There is a book in room S105, which contains the schedule for this meeting.

If you schedule a time and are unable to make it, be sure to cancel, others

are waiting for a time to present.

Keep the Information Current and Accurate

After your presentation and you turn in the required paperwork, the Placement

Team will review the referral. The team will develop a Placement Plan or place

your client on the Waiting List.

Inaccurate or out of date information may cause your client to miss a housing

opportunity. It is your responsibility to keep the information accurate.

You must contact residential services with any information that may effect the

status of your client. Send updates to: Robert Foster, Director of Residential

Services.

The Residential Services Waiting List

How Long Is The Wait?

There is no way to predict the length of the wait. Priority Status and Target

Program effects the lengths of time. People who were placed in the past

year, who had a Homeless priority status, waited an average of thirteen

months for a program.

Removed From The Waiting List

We remove clients, who are not available for placement, from the Waiting

List. This often happens when a client looses contact with the clinician

or case manager. Residential staff will try to locate a client through

the contacts listed on the referral form. However, if we cannot locate

your clients, we will remove them from the waiting list.

We also remove clients who may not be ready for placement. Usually, this

is the result of a client’s stay in an inpatient unit, incarceration,

admission to a detoxification unit, or participation in another residential

program. Once a client becomes available for placement, you may return them

to the Waiting List by completing an updated referral form.

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What Happens When My Client Gets Housing?

Placement In A Rehabilitive Residential Program

The Proposed Placement Plan

The Placement Team monitors the flow of referrals, openings and progress

of clients in residential services. The team develops Placement Plans

to move clients through the residential rehabilitative process. On a weekly

basis, the Placement Plan Update contains the Proposed Placement Plans.

Team Leaders, Case Management, Day Hospital, Fenwood Inn and others receive

the Placement Plan Update. You should find out who receives this list

in your department and check with them at the beginning of each week.

We convene the Housing Meeting every Friday at 10:20 AM to discuss the week’s

Proposed Placement Plans. Staff should attend the meeting, discuss the

plans, and address any questions or concerns. This is also the time to

raise any concerns about the transition. Our goal is to complete the process

quickly. If your client will need an extended transition, you should discuss

the matter at the meeting. The plans are approved at this meeting and placement

begins.

The Determination Of Need

Before someone moves into a rehabilitative residential program, a licensed

practitioner must determine whether the provision of rehabilitative residential

services is clinically appropriate. The licensed practitioner must base

this determination on a review of the existing assessments and performing

whatever further evaluation deemed necessary to formulate an opinion.

After a proposed placement plan receives approval, you should complete

a Determination of Need or find a licensed clinician that can do so. The

licensed practitioner will review the available assessments. Assessments

will include: a review of the client’s mental health status, social

and environmental supports, health, client preference, ADLs, appropriate

diagnostic and screening tests, legal status, vocational skills and employment

history, education and training, preferred language, criminal justice

history, and resource availability.

The licensed practitioner will then determine if rehabilitative residential

services are clinically appropriate. They will record their findings in

the Determination of Need for Rehabilitative Residential Services section

on a Department of Mental Health Determination of Need/Authorization for

Residential Services form. Then the licensed practitioner will submit the

form to the Director of Residential Services.

Contact By Residential Program Or Service Provider

Once the plan is approved, the staff at the residential program will contact

you. They will inform you of the availability of the opening and work

with you to begin the transition process.

The program staff will ask you for additional information. This, and any

further paperwork, confirms the client’s eligibility and begins the

process of admission. Please complete the Determination of Need and all

other paperwork and requests for information quickly. If the information

is not complete, your client cannot be admitted to the program.

Admission Process

After completing the necessary paperwork, clients will begin a series

of interviews and visits to the program. The program staff will set up this

schedule with your client. We strive for a short transition process. Our

goal is to complete the move within three to fourteen days. If there is

a clinical need to move more slowly in the transition of your client, you

should explain the problems at the Housing Meeting during the discussion

of the Proposed Placement Plan.

Choices

While your clients consider a program, they will not receive any other

offers. Therefore, it is important that your clients reject a program as

soon as it is clear that they will not accept the program.

Penalties For Rejecting A Program

Residential Services does not have penalties for a client who rejects

an offer. They retain their position on the waiting list. If they reject

a program, they will receive notice of another opening when it occurs. We

consider client preference. If the client states a reason for their rejection,

that information may effect their target program and their next referral.

How Can I Be Helpful?

During The Initial Decision

Help your client process their feelings, weigh the advantages and disadvantages,

and make the plans necessary to complete the move. Go with them to the house

or apartment for their first visit. Ask the staff about the program. Ask

your client about their impressions after the visit. People who make an

informed decision to move into a program have a greater success rate.

During The Transition

Transitions take about two weeks. Take the opportunity to begin working

closely with the staff at the program. Inform them of issues for your client.

If questions arise, take the time to get them answered by the program staff.

After The Move

It is often helpful to ask a residential staff person to give updates on

the progress of a resident. This becomes essential when the client has trouble.

The residential staff may also request meetings to discuss problems.

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What Happens After The Placement?

What Must I Do While My Client Is In A Residential Program?

Maintain Contact With the Residential Staff

While a client is in a residential program, the client will have a particular

staff person as their primary contact. You should find out who are your

client’s primary contact person and the director of the program. Maintain

contact with the program through these people. Send them copies of the Individual

Service Plan or Treatment Plan. Ask them to send you a copy of the Program

Specific Treatment Plan. Be sure to inform them of any significant changes

in the client’s treatment. By maintaining open communication, we

can coordinate services and help you client move toward their rehabilitation

goals.

Determination Of Need

A Determination of Need and Authorization for Placement expires after

one year. A rehabilitative residential program must receive a new DON

to continue the placement. A licensed practitioner must determine whether

the continuation of rehabilitative residential services is clinically

appropriate. The licensed practitioner must base this determination on

a review of the assessments and performing whatever further evaluation

deemed necessary to formulate their opinion.

When you begin the annual review of a client’s services, you should

identify a licensed practitioner who will determine whether there is a

need for rehabilitative residential services.

The licensed practitioner will review the available assessments. Assessments

will include a review of the client’s mental health status, social

and environmental supports, health, client preference, ADLs, appropriate

diagnostic and screening tests, legal status, vocational skills and employment

history, education and training, preferred language, criminal justice

history, and resource availability.

The licensed practitioner will then determine if rehabilitative residential

services are clinically appropriate. They will record their findings in

the Determination of Need for Rehabilitative Residential Services section

on a Department of Mental Health Determination of Need/Authorization for

Residential Services form. Then submit the form to the Director of Residential

Services.

What If The Placement Does Not Work Out?

Sometimes, it becomes clear that the program is not what the client requires.

If this happens, we will work with you and your client to find an alternative.

Work with the residential program staff and inform Residential Services.

You may also schedule a Rehabilitation Coordination Case Conference.

Rehabilitation Coordination Case Conference

There is a Rehabilitation Coordination Case Conference every Monday. This

meeting is an opportunity for an entire treatment team to come together,

discuss problems, identify possible solutions, and coordinate intervention

efforts. Clinicians, Case Managers, Residential Services Staff, Residential

Staff, or Shelter Staff, who want to discuss problems with a client in

a rehabilitative residential program, or Parker Street West Shelter, should

schedule an appointment.

The meeting is in room S117, on Mondays at 11:30 AM to 12:30 PM. Anyone

on the client’s team may schedule a block of time at the meeting.

The meeting has blocks of 15 minutes. You may schedule as many blocks

that you think you need.

You will find the schedule in room S105. You may call (617) 626-9589. You,

as the person who schedules the meeting, must invite the other members of

the clinical team.

What Happens If The Placement Is Successful?

Housing Assistance

Clients placed in housing through this program are in permanent housing.

Annually, Residential Services staff will contact the property owner, the

client, or the subsidy provider to assure the pro cess of signing a new

lease goes smoothly.

Rehabilitive Residential Programs

Residents of Rehabilitative Residential Programs, who have progressed

in their rehabilitation, must move on. Some settings will require the

client move to a new location. Other settings may allow the client to

remain, and the rehabilitative services will be reduced or removed. The

Clinician, Case Manager, or Residential Program staff may propose that

the client move to a more independent setting. Staff working with a client,

may meet at a Rehabilitation Coordination Case Conference to discuss

and coordinate a change in service. This meeting may also include the

client, the client’s family, or Legally Authorized Representative.

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Questions

Robert Foster, Director Of Residential Services

Phone: 617 626-9469

[email protected]

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