Special Report: A Role Model for ASOs

Myriad needs addressed under one huge umbrella

Even legal services are provided

HIV/AIDS clients who seek help from Housing Works Inc. of New York City will find themselves enrolled in a holistic program that addresses personal and social needs, as well as their medical care.

Many clients are homeless, so helping them find permanent housing is one of the major services offered by the AIDS service organization (ASO), but Housing Works also guarantees full-time employment to people who complete the jobs training program. Additional assistance is available in the form of education training, relapse training, legal services, and case management, says Linney Smith, senior vice president for prevention and services.

"The case managers refer our clients to whatever service needs they have, including maybe detox, a primary care doctor, or to go to job training," she says. "We provide anything the family needs to be stabilized."

Here’s a nutshell look at the services offered by Housing Works:

  • Substance use.

"We’re a harm-reduction agency, so we don’t have drug treatment programs, but if someone requires or desires to be in a treatment program, we will make the referral," Smith points out.

Housing Works has a needle exchange program, treatment readiness, and has support groups and counseling for people trying to learn about harm reduction or how to take care of themselves while using substances, she continues.

A nutritionist and nutrition group help people plan meals and take care of their dietary health while taking antiretroviral medications, Smith adds.

About 120 people are enrolled in the harm reduction services, she says.

"Our daily usage is about 45-50 people," Smith notes. "Maybe one client will come in to the department for needle exchange and learn about cleaning and safe use, and then another may come in for the support group and harm reduction counseling."

The harm-reduction model is becoming more popular among ASOs with the realization that many HIV patients with substance use problems will not discontinue using illicit substances, she says.

"When I came to Housing Works 10 years ago, the harm-reduction model was not used," Smith recalls. "They thought it was imperative to have all clients drug-free, but they found out that many people became drug-free to access services and get in the door, and then there was a high rate of recidivism when they came in for treatment."

So the organization quickly changed to a harm-reduction model that accepts clients as they are and assists them to health care, shelter, clothing, etc. without requiring them to be clean and sober, Smith adds.

  • Job training.

Housing Works’ job training program is unique in a variety of ways.

For one, it guarantees full employment at a living wage with benefits for every person who successfully completes the job training program. While the guaranteed job is with Housing Works, many clients have moved on to other jobs, she notes.

"We have proven that our grads are successful members of society, re-entering the workplace and moving on to other agencies where they are working in bigger and better jobs," Smith says.

The job training program has two phases. The first is called the pre-vocational phase, and this includes a series of workshops that provide skills training to help clients become ready for a job, she explains.

"We teach teamwork, being responsible, and time management," Smith says. "They have to work in teams in the pre-vocational phase; they’re required to arrive on time."

Clients who repeatedly are late or absent without an excuse don’t graduate to the next phase.

"When someone is unable to come to class, they must call their instructor by 9 a.m.," she says. "Not being present in class that day is not an excuse for not completing an assignment."

This phase lasts 90 days and focuses on cooperation and team work, elements that are absolutely essential to future employment success, Smith adds.

"Trainees are given tasks they must complete as a team, and they end up making woven rugs where they have to work as a team to choose colors, patterns, and timing for who is responsible for what," Smith explains. "Each person has a responsibility and has to follow it through."

Next comes the 180-day life phase, during which clients are given a temporary job in a vocation they select. The six vocation choices are case management, information technology, retail, food services, administrative assistant, and residential aide, she says.

All of these temporary jobs are within Housing Works and are the first look clients have at the type of job they will have with the organization when they complete the program.

About 20% of the Housing Works’ more than 350 employees had been through the jobs training program, Smith notes.

"We believe in mobility, and people are promoted through the ranks," she says. "The program coordinator is a graduate of the program, and we have had people promoted to being a case manager who are graduates."

Mentors enhance training experience

While clients are enrolled in the job training program, they receive support in the form of a coach who works with the trainee, and a mentor who is just one step ahead of the trainee in job training experience, Smith says.

"We have elders who are graduates of the program and they make sure the program’s goals are carried out, and we have monthly meetings to hear any grievances they have," she explains. "Graduates of the program also are instructors in the program."

The job training and employment offered by Housing Works do not involve a pre-employment drug test, but the program is so rigorous that some substance users are unable to complete it successfully, Smith notes.

"We require 36 hours of work between the classroom homework assignments and the job training," she says. "So someone has to be really structured, prepared to take on that responsibility."

  • Housing.

Although plans are under way to expand the housing component, it currently involves two facilities, each of which have an AIDS adult day health care program, Smith says.

"Then we have a 12-room facility in East New York, which houses single men who are clean and sober in an Oxford-style housing, where men are responsible for the upkeep of the house and paying bills, etc.," she points out. "These are 12 men who are committed to the recovery process, and they can stay as long as they want."

There also is a 20-bed women’s transitional housing program where women, who recently were incarcerated, are expected to stay from one year to 18 months, and they are assisted in finding permanent housing, Smith says.

Another 12-15 bed, transitional housing program is for transgender clients, she adds.

  • Other services.

Housing Works provides services to deaf clients, including outreach and education.

"The coordinator is deaf, and we provide HIV/AIDS education and training to the deaf and to the hard-of-hearing population," Smith says. "It’s the only one of its kind in the city, and it’s very successful; we work with interpreters and sign language services."

The ASO has an advocacy and public policy program that provides policy analyses and recommendations, community organizing, lobbying, and statewide education and training activities.

Clients also have access to a legal services unit that provides on-site clinics to address civil legal needs, including client-landlord disputes and entitlement problems.

Clients who need criminal defense or family and immigration legal aid are referred to other attorneys. The department also represents HIV/AIDS people in class action litigation.

The legal department has the equivalent of 3.5 full-time employees, Smith says.

Housing Works provides street outreach in New York City’s underserved neighborhoods, targeting people who use substances and people of color. Operating through a contract with the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), the program’s goal is to increase HIV awareness among the target at-risk populations and link them with health services and HIV testing and counseling.

A Strengthening Families Program, which operates through a contract with SAMHSA, focuses on the prevention needs of homeless and formerly homeless African-American, Latina, and other racial/ethnic minority women and their children. Bilingual services are provided, and the program includes parenting, children’s, and family skills-training sessions, as well as links to the full continuum of health care and services.

Through the Intensive Community-Based Case Management Program, Housing Works assists thousands of HIV-infected people who are homeless with enrolling in Medicaid, receiving public assistance and housing placement, developing a treatment plan, and referral to resources both within and outside Housing Works.

"We have 20 case management teams that are comprised of a case manager, a case manager technician, and a community follow-up worker," Smith notes. "So they work within that team to help clients access services and to make referrals and to monitor clients."

The program now has more than 550 clients and at times has ranged up to 700 clients, she adds.