Acknowledgments
The Kentucky Interagency Council on Homelessness (KICH) Services Subcommittee gratefully
acknowledges the efforts of Kentucky Housing Corporation, the Kentucky Domestic Violence
Association, the Kentucky Department of Veterans Affairs, the Kentucky Division of Behavioral Health,
the Boulware Mission, the Central Kentucky Housing and Homeless Initiative, Hazard-Perry County
Community Ministries, the Kentucky Communities Economic Opportunity Council, Welcome House of
Northern Kentucky, Phoenix Health Center, Louisville Legal Aid Society, Family and Children’s Place
and the Homeless and Housing Coalition of Kentucky.
The Council also recognizes, with appreciation, the case managers, case management supervisors,
and homeless services organizations for their work and their commitment to quality case management
services for Kentuckians who are homeless.
Special thanks to the following persons who assisted in the compilation and writing of this case
management guide.
Lee Alcott
Thomas Beatty
Jeff Been
Melissa Benton
Claudia Blaylock
Deloris Cornelius
Helen Deines
Kelly Dycus
Wade Jordahl
Richard McClain
Patrick McKiernan
Jessica Moorman
Keli Reynolds
Jennifer Smith
Karan Vertrees
Jennifer Weeber
Beth Workman
Linda Young
Kentucky Interagency Council on Homelessness
2013
ii
By Executive Order
2007-751 of the Commonwealth of Kentucky, the Kentucky Interagency Council on Homelessness
(KICH) is composed of representation from state government, nonprofit, and advocacy agencies to
collaborate and perform the following functions and duties:




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Serve as the single statewide homelessness planning and policy development resource for the
Commonwealth of Kentucky.
Review, recommend changes, and update Kentucky’s Ten-Year Plan to End Homelessness.
Monitor and oversee implementation of Kentucky’s Ten-Year Plan to End Homelessness to
ensure that accountability and results are consistent with the plan.
Serve as a state clearinghouse for information on services and housing options for the
homeless.
Conduct other activities as appropriate.
Mission
The KICH mission is to coordinate and influence policy across Kentucky to end homelessness.
Background
KICH was initially established after representatives from Kentucky Housing Corporation (KHC)
participated in a Homeless Policy Academy in 2002, sponsored by the U.S. Department of Health and
Human Services and the U.S. Department of Housing and Urban Development (HUD). Kentucky was
one of eight states invited to participate in the first of these intensive policy-building forums, designed
to develop action plans for improving access to mainstream services for people experiencing
homelessness.
Established Goals





Commit state's leadership to forge partnerships
among state agencies that allow communities to
achieve local solutions to end homelessness.
Develop and implement continued planning
strategies.
Develop a comprehensive, public education
program to familiarize all stakeholders and the
general public on issues related to
homelessness.
Access and commit the resources necessary to
develop new units of supportive housing.
Create evaluation and tracking systems to
measure outcomes and guide future planning.
The 2010 K-Count (Point-InTime Count) of Kentucky’s
homeless during one designated
24-hour period found more than
6,600 homeless individuals. In
addition, over 9,800 persons
were precariously housed. Due
to the transient nature of
homelessness, there were likely
thousands more at that
designated time who were not
counted.
Strategies



Create interagency collaboration.
Maximize targeted efforts to influence and improve systemic efficiency, policy development
and service delivery.
Establish policies throughout the state to resolve the causes of homelessness rather than
treating the symptoms of homelessness.
iii
Ten-Year Plan to End Homelessness
In response to a national call to end homelessness, KICH and KHC developed Kentucky’s Ten-Year
Plan to End Homelessness in 2005. The plan proposed a new approach to proactively fight
homelessness by treating the causes instead of providing services after an individual or family
becomes homeless. The plan was compiled with public input from 12 community forums held across
the state.
Regional Strategies
In 2007, homeless and housing services leaders throughout the state came together to kick off a yearlong planning process intended to develop local strategies for implementing Kentucky’s Ten-Year
Plan to End Homelessness. Each region focused its energies on the five central issue areas that
have been defined as “core concerns” in the plan, which are housing, services, prevention, data
development, and building public support and political will. While six regional plans identified dozens
of specific strategic recommendations to address local priorities, the following key themes and
objectives were apparent across regional boundaries.


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Increase access to safe and affordable housing units for homeless families, individuals, and
youth.
Increase funding for and access to comprehensive supportive services that help assure
housing stability and encourage self-sufficiency.
Increase funding for prevention services to reduce the numbers of persons falling into
homelessness.
Increase scope and quality of data collection through the statewide Homeless Management
Information System to document both evolving progress and continuing need.
Develop and carry out a coordinated statewide public education and outreach campaign that
establishes the foundation for building public support.
KICH has an ongoing commitment to this initiative and offers support to six Balance of State
Continuum of Care regions, as well as Lexington and Louisville, to continue the work to end
homelessness in their communities. These regional recommendations were used to develop a
statewide action plan.
KICH remains committed to engaging the state’s leadership to forge partnerships among state
agencies that enable all Kentucky communities to achieve local solutions to ending homelessness.
For more information, visit the Kentucky Homeless Web site at www.kyhomeless.org or contact the
Specialized Housing Resources Department within KHC toll-free in Kentucky at (800) 633-8896 or
(502) 564-7630; TTY 711.
Partnerships – Planning Strategies – Education – Resources – Data
Solutions to End Homelessness
iv
Kentucky Homeless Services
Case Management Training Manual
Contents
Introduction.......................................................................................................................................... 1
UNIT 1: Homelessness ....................................................................................................................... 2
UNIT 2: Case Management ................................................................................................................ 8
UNIT 3: Assessment and Goal Setting.............................................................................................. 11
SECTION 1: Assessment .............................................................................................................. 12
SECTION 2: Service Planning and Goal Setting............................................................................ 14
UNIT 4: Housing ............................................................................................................................... 19
UNIT 5: Entitlements and other Government Resources .................................................................. 25
UNIT 6: Income and Money Management ........................................................................................ 39
UNIT 7: Health Care ......................................................................................................................... 44
SECTION 1: Homelessness and Health: What’s the Connection? ................................................ 45
SECTION 2: Special Problems and Barriers .................................................................................. 46
SECTION 3: Accessing Services ................................................................................................... 46
UNIT 8: Legal Services ..................................................................................................................... 48
UNIT 9: Safety .................................................................................................................................. 54
SECTION 1:
SECTION 2:
SECTION 3:
SECTION 4:
SECTION 5:
Why do People Become Aggressive? ....................................................................... 55
Prevention/Preparation ............................................................................................. 55
Assessment .............................................................................................................. 57
De-escalation/Intervention ........................................................................................ 60
Post Crisis/Return to Equilibrium ............................................................................... 61
UNIT 10: Mental Illness .................................................................................................................... 63
SECTION 1:
SECTION 2:
SECTION 3:
SECTION 4:
Definitions: Who are Persons with a Mental Illness? ................................................ 64
Types of Mental Illnesses.......................................................................................... 65
Medication and Medication Management .................................................................. 67
Emergency Services ................................................................................................. 70
UNIT 11: Substance Abuse .............................................................................................................. 73
UNIT 12: Domestic Violence ............................................................................................................. 80
UNIT 13: Veterans ............................................................................................................................ 83
Introduction
Case management is an art form. It’s about relationships and knowing your community and its
resources. It’s about having compassion and a strong sense of justice, knowing how to be a private
investigator. It’s being creative; redefining success and understanding the role of failure. It’s a
balancing act; understanding where you end and another person begins. It’s being professional;
documenting everything. It’s exciting. It’s about understanding psychology, sociology, social work,
medicine, communication, and more. It’s hard. It’s planting a seed.
Case management is a collaborative process of assessment, planning, facilitation, monitoring, and
advocacy for options and services to meet an individual's specific needs. Case managers are the
professionals that make things happen.
This case management course is not all that you need to know in order to be a good case manager.
In fact, it is just a start. This course will introduce you to some of the basic concepts of case
management and areas of knowledge needed to work with people who are homeless. In many ways,
this is meant to be a springboard into a lifetime of learning and honing skills in order to provide the
most effective services that you can.
Two of the most important things you can do as a case manager are (1) build relationships and (2)
ask questions. This course will not necessarily teach you how to do either one of those things.
However, it hopefully will point you in the right direction in building relationships and figuring out the
questions you need to ask to build your skills and help your clientele.
1
UNIT 1: Homelessness
Description:
This unit presents a general overview of homelessness, the causes of homelessness, and some of
the special populations affected by homelessness.
Objectives:
1. At the conclusion of this unit, trainees will be able to:
2. Identify what is meant by “homelessness.”
3. Identify what is meant by “a home.”
4. Describe the causes of homelessness.
5. Identify special populations affected by homelessness.
2
Defining the Problem


It is estimated that between 2.3 million and 3.5 million people in America experience
homelessness each year. Approximately 39 percent of these individuals are children, living
primarily in family units.1
Other sub-populations of homeless persons include runaway youth (outside of families),
victims of domestic violence, migrant workers, and persons with mental illness or substance
abuse disorders.
What is meant by “homelessness”?


HUD, in its major homeless program (Continuum of Care), defines a homeless person as “an
individual who lacks a fixed, regular, and adequate nighttime residence, and an individual who
has a primary nighttime residence that is either (i) a supervised temporary living shelter, (ii) an
institution that provides temporary residence for individuals intended to be institutionalized, or
(iii) a place not designed for or ordinarily used as a regular sleeping accommodation for
human beings.” For a more detailed definition of homelessness, please see HUD's
Homelessness Resource Exchange at http://www.hudhre.info/index.cfm.
U.S. Department of Health and Human Services, U.S. Department of Education, and other
government entities use different definitions. Even HUD uses slightly differing definitions for
its other programs, such as Emergency Solutions Grant.
What is a home?

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




It is secure. We know where we are going to sleep tonight; we know that "home" is going to
be there when we get there.
It is safe. Although no safety is perfect, we have a way to lock our place, to control who
comes in when we are there and when we aren't. We can leave our belongings at home and
have a reasonable expectation of finding these safe when we get back.
We are sheltered from the weather, and we can safely warm ourselves.
We have a way to store and prepare food.
A space that is considered our own.
We have hot and cold running water, a toilet, and a shower/bathtub to wash ourselves.
We can come and go at our own choice.
It is located in a place near enough to the work needed to maintain ourselves in this home.
Causes of Homelessness

There are two broad trends occurring in the United States that have significantly contributed to
the rise of homelessness over the past 25 years.
 A growing shortage of affordable rental housing
 Stagnation of wages and an increase in poverty.2
Contributing Factors to Homelessness
It should be noted that two substantially different perspectives generally prevail when examining the
contributing factors of homelessness. One perspective sees homelessness primarily as a problem of
individual failure or dysfunction. From this perspective, individuals are substantially responsible for
their homelessness, for any number of reasons (lack of skills, substance abuse, mental illness, etc.).
The second perspective generally recognizes that individual factors contribute to one‘s risk of falling
into homelessness but tends to place greater emphasis on systemic factors that significantly increase
the likelihood that some people will fall into homelessness. From this perspective, homelessness is
1
Urban Institute, The. A New Look at Homelessness in America. February 2000. Accessed at http://www.urban.org/url.cfm?ID=900366,
November 2006.
2
National Coalition for the Homeless. Who is Homeless? June 2006.
3
seen more as a social problem than solely as an individual problem. As one would expect, the former
perspective generally offers individual solutions to homelessness and the latter suggests solutions
stressing the need for greater social change and community involvement. The following discussion
on the causes of homelessness presents explanations from both perspectives that are commonly
discussed in the literature on homelessness.
1. Poverty and a lack of adequate, affordable housing: There are two broad trends occurring
in the United States that have significantly contributed to the rise in homelessness over the
past two or three decades: a growing shortage of affordable rental housing and a
simultaneous stagnation of wages and increases in poverty.3
Shortages of Affordable Housing - HUD defines “worst case needs” households as “unassisted
renters with very-low incomes (below 50 percent of area median income) who pay more than
half of their income for housing or live in severely substandard housing.” In a 2003 report,
HUD found that “a substantial proportion of households with worst case needs experience
these problems despite being fully employed. Of families with children that have worst case
housing needs, 41 percent have earnings consistent with full-time, year-long work at low
wages.”4
Surprisingly, the federal government’s response to this nearly three-decade long decline in
affordable housing has been a steady reduction in the national commitment to allocating
federal dollars toward affordable housing. Federal investments in affordable housing have
been drastically reduced since 1980. HUD’s budget has plummeted from $104.5 billion in
1980 (in 2005 dollars) to only $19.2 billion in 2005. Not surprisingly, these cutbacks in our
national commitment to affordable housing have been mirrored by increasing numbers of
homeless persons and families in the United States.
However, it should also be noted that total federal outlays for housing have not declined during
this same period. In fact, these have actually increased. Primarily because of the homeowner
deductions allowed under federal tax law, the emphasis of federal housing policy over this
period has increasingly shifted to benefit middle and upper income property owners, as
indicated by the following chart.
3
4
National Coalition for the Homeless. Who is Homeless? June 2006
U.S. Department of Housing and Urban Development. Affordable Housing Needs: A Report to Congress on the Significant Need for
Housing. 2003.
4
Declining or Stagnating Real Incomes - Amidst increasing housing costs that are consistently
outstripping the general rate of inflation, most Americans have faced decades of declines or
stagnation in their real wages. In 2004, 37 million people, comprising almost 13 percent of the
U.S. population, lived in poverty. Rising housing costs, in addition to stagnant incomes and
lower safety-net benefits, are factors in the rising number of Americans living in poverty. The
bottom half of wage earners has seen its income stagnate or decline in the last 20 years, while
the top 5 percent of households has seen its income double. The minimum wage has steadily
lost purchasing power since its inception as legislative increases have substantially lagged
inflation. Wage inequality has dramatically grown in the last twenty years as a result of a
variety of changes in the economy and in public policies that shape the economy. The
disparity between the incomes of those at the top and those at the bottom is at its greatest
point since the decade of the “roaring 20s” that preceded the Great Depression. Nearly half of
American households are deeper in debt, insecure about their jobs or downsized into the
temporary workforce, and contemplating a future retirement that is significantly diminished with
little or no economic security.5
In addition, reductions in public assistance programs, including the 1996 repeal of the Aid to
Families with Dependent Children (AFDC) program, have made it more difficult for single
mothers to rise out of poverty. Temporary Assistance to Needy Families (TANF), the program
designed to replace AFDC, provides families with only a fraction of the income received under
the previous program. In Kentucky, the maximum monthly TANF benefit for a family of three is
$262. Bad credit, no credit and poor or non-existent property owner references are barriers to
housing for families. In Minnesota, a study of over 3,100 homeless individuals and families
found that 22 percent had credit problems and 11 percent had an eviction or other rental
problems on their record. Another 9 percent had no local rental history.
2. Mental illness and/or substance abuse: Recent studies estimate that 40 percent of
chronically homeless individuals have substance abuse disorders, 25 percent have a physical
disability, and 20 percent have serious mental illness. While individuals with mental illness or
addiction disorders often have the ability to maintain housing, their vulnerability to
homelessness is increased. “Individuals whose mental illnesses or co-occurring substanceuse disorders are untreated may disturb their neighbors, be a threat to themselves or others,
miss rent or utility payments, or neglect their housekeeping, and be evicted.” In addition,
hospitalization or incarceration may cause these individuals to lose their housing when they
are unable to pay their rent.
Persons with co-occurring disorders have been found to deny their mental illness and their
addiction problems and to refuse treatment and medication. Once they become homeless,
these individuals “have more problems, need more help or are unable to benefit from services,
and are more likely to remain homeless than other groups of people.” If these individuals do
decide to seek treatment, a severe shortage of beds in treatment programs, short lengths of
stay in programs, and lack of adequate discharge planning increase the likelihood that they will
return to the streets.
3. Individuals “age out” into homelessness: It is estimated that between 5 and 8 percent of
unattached youth experience homelessness. This represents 1 million to 1.6 million youth
each year. Unaccompanied minors are at a higher risk for anxiety disorders, depression, posttraumatic stress disorder and suicide, as well as physical and sexual assault or abuse, and
physical illness including sexually transmitted disease. Prostitution and drug use and abuse
5
National Coalition for the Homeless. Who is Homeless? June 2006.
5
are also more likely in this population that in permanently housed youth. Twenty to twenty-five
thousand youth ages 16 and older “age out” of the system each year, moving from foster care
to legal emancipation. Approximately 25 percent of former foster youth were homeless at
least one night within four years after exiting foster care.
A survey of almost 400 homeless parents in New York City found that 20 percent lived in
foster care as children; 70 percent experienced sexual, physical, or emotional abuse as
children; 20 percent have one or more children in foster care; and 35 percent have an open
case for child abuse or neglect with New York’s child protective service agency. The study
also found that, “when compared to the overall homeless population, these parents are 30
percent more likely to have a history of substance abuse, 50 percent more likely to have a
history of domestic violence, and more than twice as likely to have a history of mental illness.”
Youth are also vulnerable to homelessness due to insufficient work and rental histories and
lack of a support network to help them transition into self-sufficiency. Youth “may lack
financial resources due to low-income jobs and insufficient time to amass savings. Moreover,
while most young people move out of their home with the full support of their parents – who
assist with signing contracts, budgeting, advising, and often financial support – for those who
have lost their parents, are estranged from their family, have grown up in foster care, or have
been incarcerated, a supportive network and opportunities to access these resources and
acquire life skills are not readily available.
4. Women and children fleeing domestic violence experience episodic homelessness: A
2002 report by the U.S. Conference of Mayors found that 44 percent of the cities surveyed
identified domestic violence as the primary cause of homelessness. Just three years later, in
2005, 50 percent of the 24 cities surveyed by the U.S. Conference of Mayors identified
domestic violence as a primary cause of homelessness. In fact, it has been found that 92
percent of homeless women have experienced severe physical and/or sexual assault at some
point in their lives. Victims of domestic violence often leave their abuser multiple times before
leaving permanently. Therefore, they often experience multiple episodes of homelessness
before reaching self-sufficiency. An inability to find or maintain permanent housing frequently
causes victims to return to their abuser.
5. Individuals are released from incarceration into homelessness: According to a study
conducted by the Center for Law and Social Policy, 12 percent of African-American men, 4
percent of Hispanic men, and 1.6 percent of white men in their twenties and early thirties are in
prison or jail. More than 650,000 people are released from state prisons in the United States
each year and an additional 9 million are released from jails. These individuals are at high risk
of becoming homeless due to educational, employment, and other barriers. Less than onethird of men and half of women in state prisons have completed high school, and 60 percent of
employers reported they probably would not hire an applicant with a criminal record. Inability
to become employed upon release contributes to the likelihood of homelessness. Forty-nine
percent of homeless adults have spent five or more days in jail during their lifetime, and 18
percent have been incarcerated in state or federal prison systems.
A study of 50,000 individuals released from New York State Prisons who returned to New York
City in the mid-1990s revealed that the risk of re-incarceration increased 23 percent among
those who had stayed in a homeless shelter before being incarcerated and 17 percent among
those who stayed in a shelter after their release. In contrast, studies have shown that those
individuals released from incarceration who become engaged in a supportive housing program
have drastically reduced involvement with the criminal justice system. Jail incarceration rates
6
among this population were reduced by up to 30 percent and prison incarceration rates were
reduced up to 57 percent.
A significant number of Veterans are homeless: The U.S. Department of Veterans Affairs (VA)
estimates that 200,000 Veterans are homeless on any given night and 400,000 experience
homelessness over the course of a year. Ninety-six percent of homeless Veterans are male and the
majority are single. Forty-five percent suffer from mental illness and more than 70 percent suffer from
addiction disorders. The National Coalition for Homeless Veterans notes that “in addition to the
complex set of factors affecting all homelessness…a large number of displaced and at-risk Veterans
live with lingering effects of Post-Traumatic Stress Disorder and substance abuse, compounded by a
lack of family and social support networks.”
Learning Activities and Next Steps
 Find out where all of the homeless shelters in your area are, how to contact them, and what
their admission criteria are.
 Review the K-Count, count of homeless individuals and families in Kentucky, on KHC’s Web
site under Specialized Housing, K-Count.
7
UNIT 2: Case Management
Description:
This unit will review the major activities of the case management process.
Objectives:
1. Describe the four major activities in the case management process.
2. Understand the importance of the client/case manager relationship.
8
Major Activities of the Case Management Process
Case management services can be thought of in terms of the following four major activities:
coordination, advocacy, linking, and monitoring.
Coordinating with and for the individual
 Develop a long-term supportive relationship.
 Maintain regular contact from several times a day to once a month, depending upon needs.
 Maintain contact with eligible individuals no matter where they reside (street, shelter, jail,
transitional housing, etc.) through outreach, taking the initiative to stay in touch.
 Provide case management services on a continuous basis, depending on needs.
 Discuss and develop a comprehensive service plan for and with each individual based upon a
needs assessment.
Advocating for rights
 Work with individuals to advocate for service improvements when services are judged unfair,
inadequate, or non-existent.
 Bring examples of unmet needs and possible solutions for meeting such needs to the attention
of decision-makers for their consideration for possible action.
 Encourage and assist individuals to join any advocacy groups in their area or form groups
where none exists.
Linking to services
 Become knowledgeable about the community support and resources available (public and
private treatment providers, advocacy and self-help groups, low-income housing resources,
employment and training programs, financial benefits, etc.,) Maintain regular contact with
these groups to aid access.
 Work with individuals to:
 access appropriate programs within local resources
 obtain all benefits for which they are eligible
 obtain a satisfactory living situation
 secure employment training and/or work opportunities and assist them in meeting
employment goals
 obtain needed health care services as well as regularly scheduled physical examinations
 Assist in developing a range of social supports (self-help groups, families, peers, etc.).
Monitoring
 Follow-up and evaluate, with the individual, to ensure that services are meeting their needs.
 Evaluate services on an on-going basis to assess if the individual can reach the goals of their
service plan.
Case Manager–Client Relationship
A primary factor in being a successful case manager is the working relationship. A good case
management relationship is based upon trust, mutual respect, and a willingness to work together to
attain agreed-upon objectives. The primary target for change is not the individual, but the
environment. The case manager does not attempt to change the person’s beliefs, values, or
emotions, but works with the individual to improve living conditions. In doing this, the case manager
can help the person increase his/her skills and expand the individual’s horizons. A strong partnership
for advocacy, when it is conscientiously pursued over the long term, can change people as well as
9
their environment. The case management relationship, like any other, thrives on consistency,
regularity of contact, openness, honesty, and the careful building of trust.
The case manager’s ability to engage and connect with the consumer is very critical in developing the
relationship. Developing and establishing trusting relationships is an ongoing process and requires a
variety of skills. One of the most powerful ways to foster trust is to have genuine respect for
individuals by allowing them to make their decisions, establish their own goals, and set their pace.
Case managers must develop a belief in the potential for growth. Your attitude about homelessness,
the reasons people are homeless, and the possibility of change are communicated to the person
seeking help. You are attempting to form a partnership with the individual; be aware that your actions
will influence the development of this partnership. You are a vital participant in the change process
and must convey a positive, open perspective if you are to have any impact.
Case managers must be timely, reliable, dependable, and authentic in all their interactions. Different
individuals may want to have different degrees of personal connections with their case managers.
Some may find frequent contacts intrusive; others may need daily support.
Critical elements of engagement:
 Start slow; do not push the person to make decisions.
 Do not assume the individual will know what case management services are or that they will
desire this type of service. The best way to describe what case management is all about is by
doing.
 It is essential to initiate a follow-up contact after the first contact.
 If contact is lost, reinitiate contact and set a time when you can both get together.
 Use the strengths assessment as a tool to build a partnership with the individual.
 Finally, be willing to talk openly and honestly about any concerns the individual may have.
The process of change is slow and will not always progress as you would like. You ultimately are the
key; be patient and communicate your willingness to struggle with the individual as they attempt to
adjust. Remember, establishing relationships takes time.
Transportation
While providing case management services, you will frequently have individuals in your (or the
agency’s) vehicle. Some points to keep in mind are:
 If you are able to drive personal vehicles for case management, check with your agency and
your own personal insurance company to ensure proper coverage.
 Know and follow your agency policies about transporting individuals. Discuss these policies
with your supervisor.
 Do not transport individuals alone whom you believe are a safety concern.
Learning Activities & Next Steps
 Assess some of your biases and beliefs about people who are homeless. How will these help
you to establish relationships and work with people? How will these hinder your ability to
establish relationships and work with people? What work do you need to do to improve your
ability to establish relationships and work with people?
 Set up a lunch date with a person who has been working as a case manager with people
experiencing homelessness. What tips can that person offer you? What tools and
methodologies for working with people has that person found to be successful? What else can
you learn from an experienced case manager?
10
UNIT 3: Assessment and Goal Setting
Description:
This unit describes the assessment phase of the case management process focusing on how to
assess strengths, needs, and priorities. This unit also addresses service planning and goal setting,
monitoring, advocacy, and closure. The long- and short-term goals are based on the information
obtained in the assessment and prioritized on the needs list. The service plan provides useful longterm and short-term goals and related actions steps that can be used to support recovery.
Objectives:
At the conclusion of this unit, participants will be able to:
1. Understand how to develop an assessment.
2. Understand how to develop a service plan.
3. List the four global purposes of monitoring.
4. Complete an assessment and service plan.
11
SECTION 1: Assessment
The assessment process, identification, and prioritization of needs should be a cooperative and
collaborative process in partnership with the individual with which you are working. Unique individual
characteristics, values, desires, and needs must be taken into consideration. Remember that each
step of the model represents a building block for change and the enhancement of growth for the
persons that you serve.
In order to determine what services are needed, an evaluation is necessary. This evaluation is called
a needs/strengths assessment. Once this assessment is made, a service plan is developed which
outlines long-term goals and the smaller steps that must be taken to achieve those goals.
The assessment is intended to provide a framework for addressing needs and a list of strengths and
resources to address those needs. The degree to which the individual is committed or motivated to
work with the case manager corresponds directly to the degree to which they are involved in
assessing or planning from the beginning.
What is an Assessment?
A tool to obtain and represent the ongoing strengths and needs of the individual and that person’s
situation and circumstances including:
1. Behaviors indicating danger to self/others
2. Activities of daily living
3. Interpersonal/social relationships
4. Mental health and substance abuse services
5. Vocational
6. Treatment participation
7. Medication adherence
8. Benefits/financial resources
9. Crisis incidents
10. Housing
11. Medical/health needs
12. Educational
13. Legal issues
14. Transportation
The following questions may help guide the assessment process:
1. What kind of experience has the person had up to this time?
2. What is going on now?
3. Where would the person like to be?
4. What resources can he/she use to make the desired changes?
5. What talents or experience can be used to meet the desired goals?
6. What steps does he/she need to take to make the changes?
7. What is the most important at this time?
The assessment is an ongoing working document and is to be updated when the person’s status is
altered, goals change, or new resources are acquired. This assessment should be reviewed at least
every 90 days.
Developing an Assessment
There are certain areas in an assessment. These will include reviewing and documenting the need
for community resources/services. The assessment should build upon the assets, strengths, and
capacities of individuals to maintain a sense of identity, dignity, and self-esteem. The procedure
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should be natural and flexible.
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Start where the person is. An adult-to-adult relationship accentuates and models effective
communication.
Focus on strengths.
Select a comfortable environment to conduct the assessment.
All of the areas should be addressed and prioritized, as per the person’s ability to participate.
Ask open-ended questions.
Involve family members and other significant social resources and natural supports in the
process with the person’s release of information.
Introduction and Exploration
In this initial phase, the case manager will:
 Introduce himself/herself.
 Explain the case management process and the goals of this service.
 Begin to evaluate the current level of engagement. It should be kept in mind that willingness
to participate in case management services is closely associated with individual choice.
Persons may be temporarily satisfied with their lives and circumstances, and not want to work
on more progressive goals and objectives.
 Explore the person’s community and unique situation with respect to present and future needs,
past experiences, interests, aspirations, and current or previously used skills and resources.
Empowerment and Acceptance
The individual is the "expert” about his or her own unique strengths, interests, and aspirations. Case
managers can positively influence willingness by fostering hope and belief in the person receiving
services. Services and assessments should incorporate self-help approaches and should be provided
in a manner that allows individuals to retain the greatest possible control over their own lives. As
much as possible, individuals set their own goals, decide what services they will receive, and are
active participants in the assessment, service plan development, and services provided.
This principle recognizes the recovery process. Active listening, reflection, and verbal support are
critical to the acceptance and empowerment. In this process, the case manager may respond to the
information presented by reflecting what the person said and drawing out strengths. The individual is
encouraged to explore their situation to identify their own personal strengths. For example, “You said
you'd like to live in an apartment; tell me what kinds of things you do when you are on your own."
The Assessment Discussion
The case manager responds to the person by moving in whatever sequence is natural throughout the
discussion. It could begin with living arrangements and then move to finances. There is no
prescribed sequence. Responses are used to determine their level of need in the needs assessment.
It is important to collect and record details regarding responses. This information can then be
incorporated into the assessment.
Since an assessment is ongoing, the case manager may stop the process at any point in order to:
 Respond to restlessness or unwillingness to continue.
 Start the prioritization of needs to move into the development of a service plan.
 Set a continuation date/time to gather further information prior to developing a service plan.
Prioritizing Needs
After completing the assessment, the individual and case manager must identify the priority areas for
goal setting. These are first based on critical survival needs (food, shelter, clothing, and medical care)
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and then less critical needs. Once the needs have been prioritized, the individual and case manager
are ready to develop a service plan to accomplish one or more of the goals.
Elements of a Case Management Strengths Assessment Form
Basic Information Section
Identifying information: marital status, education status, sources of monthly income, monthly
expenses, insurance coverage, and legal status.
Assessment
Information from the assessment sets the basis for subsequent steps such as establishing goals and
hope. The assessment provides questions to assist the individual in looking at their current situation,
their past and where they want to be in the future.
Categories of the assessment form may include:
Current Status: “What’s going on now?”
Resources include community and individual strengths, such as, Supplemental Security Income (SSI),
Social Security Disability Insurance (SSDI), who lives with the person, medication, taking care of a
pet, belonging to a support group, etc. Frequency of activities or resources used and type of use are
important.
Personal Goals: “Where I’d like to be?”
If the goal appears unrealistic, the first steps toward attainment usually are not. For example, if the
aspiration is to be employed, marketable work skills and experience are logical steps toward
attainment of that goal.
Resources Internal/External: “What have I used?” “What can I use?”
Resources define areas of strengths to which the individual has access, but which are not currently
being used; such as work skills used in the past, membership in a club even though there is no
attendance, old friends who have not been seen for some time, ability to cook even though the person
is not now cooking, activities enjoyed in the past even though they do not seem of interest at the
present time, etc.
Needs: “What steps do I take to get there?”
Initial needs for community living and the development of potential are assessed and noted. This is
not intended to be a formal goal statement or resource acquisition plan. Readily identifiable needs to
attaining resources are noted. Examples of needs that may be noted in this section are: housing,
food, transportation, an appointment for therapy, or medication.
SECTION 2: Service Planning and Goal Setting
The Service Plan: Development and Implementation
Once a needs assessment is complete and needs have been prioritized, the identified goals are
recorded in a service plan.
What is a Service Plan?
A service plan is a set of action steps designed to achieve one or more of the goals stated during the
needs assessment.
It is a plan that contains:
 Long-term goals
 Short-term goals or action steps
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Parameters of service delivery
Review date
Just as the needs assessment is completely based on the individual, so is the service plan.
Consequently, there are guidelines for completing the plan but the design and emphasis of the plan is
based on the individual.
The Role of the Case Manager in Designing a Service Plan
The role of the case manager is to:
 Assist the individual in prioritizing his/her needs.
 Establish a goal statement(s) from his/her needs assessment.
 Identify the necessary action steps to accomplish the goal(s).
 Design a plan that will support progress.
Each goal must be broken down into a set of action steps. These steps are listed along with who is
responsible and how and when the step will be accomplished. The art of designing a personal plan is
to develop action steps that are small enough and a plan of support large enough, so that
disappointments and failures are minimized.
Checklist for writing quality action steps:
 Positively stated
 Realistic and achievable
 Measurable and observable
 Specific, not global
 Person centered, not case manager oriented
 Initial action step that is immediate with a high probability of success
 Sequential order and serves to accomplish a short-term goal
 Small enough to not overwhelm, but large enough to set a direction and set a challenge
 Restate strengths identified in the assessment in the goal(s)
Once the needs assessment has resulted in a specific, time-limited service plan, the process of
implementing the plan begins. Remember that nobody's life can be traced by a straight line! Expect
that the plan will need to be changed and revised from time-to-time.
Implementing the Service Plan
The next step is implementation. Now the case manager and the individual will utilize resources and
services in the community to meet the goals on the service plan. The case manager will offer both
practical support and encouragement throughout this process.
Offering Support
The most frequently expressed concern of new case managers is the perceived lack of progress. The
"revolving door syndrome,” often addressed in literature and expressed in the field, describes
individuals who cycle through various institutions–shelters, psychiatric hospitals, jails, and prisons. It
must be emphasized that case managers can only do so much. The ultimate attainment of the
individual’s goals rests with the individual, but the case manager and an active case management
system are key players in eliminating obstacles to progress. Growth and movement are supported by:
Celebrating Small Steps: Each time an action step is completed a celebration is in order. The
celebration may be as simple as acknowledging the success with direct eye contact and a
verbal, "Good job, you did it!"
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Asking How You Can Help: Helping attain goals requires just the right amount and kind of
assistance. Sometimes helping can be unhelpful if it conveys a message of incompetence or
unworthiness. The case manager's job is to help in a way that strengthens the individual and
the relationship.
Staying in Touch: Depending upon the resources of each program, the individual may be able
to make contact with a member of the program staff 24 hours a day. Of course, the case
manager is not on duty 24 hours a day. However, staying in touch often means following the
individual both into and out of crises, changing situations, and hospitalizations. Active outreach
is a cornerstone of case management.
Go With the Flow: A case manager must support changes in individual choice even it involves
more time and energy in paperwork. Completing the small action steps, celebrating
successes, building community supporters, rehearsing a problem solving process, and having
someone they trust to help them survive in the community are the real goals. "'Going with the
flow" requires not only patience but also a clear understanding of case management and a
true commitment to serving homeless individuals.
New Goals
After achievement of goals, determine new goals and follow the same steps toward achievement.
This step does not require further elaboration except to note that as the individual and case manager
move on to new sets of goals it is important for the case manager to continue to monitor the status of
the linkages that have already been established. The ongoing performance should be reviewed
periodically by the case manager to direct immediate attention to any problems or barriers that may
begin to appear.
Tracking and Evaluation
It is important that the case manager continuously track the status of all goals and evaluate if the
desired goals were achieved and that no new problems have arisen because of the goal attainment
process. Often, when individuals move to a different status because of the accomplishment of one
goal, problems with adjustment to this status can occur. For example, if a consumer has secured
housing, the stress and circumstances (new expectations) need to be monitored for potential
difficulties that may be created in the person’s life.
Monitoring
Case management is a fluid activity; case managers are community bound, not office based. To
monitor service delivery, the case manager must actively watch, listen, and interact with both the
individual and all the service providers. Monitoring involves being with the individual in his/her natural
surroundings, as well as the service environments. Therefore, the case manager might be at one of
many locations–the street, shelter, any office of a service provider, or a housing program, to name a
few. Case managers often receive the most current and reliable information if they make first-hand
observations. Also, to be effective, case managers must develop solid working relationships with both
individuals and service providers.
Monitoring serves four global purposes (Moxley, 1989):
1. Ensure service coordination: At its best, it reviews programs and services not only for
accountability but also to see if everyone is addressing the same purposes stated in the
service plan. Otherwise, the individual may be exposed to discontinuous and/or conflicting
interventions.
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2. Determine achievement of the goals/objectives in the consumer’s service plan: Through
monitoring, the case manager can determine whether goals are being achieved, whether they
are being met according to the plan’s projected timeline(s), whether goals continue to fit the
needs of the individual, or whether there is a failure to achieve stated goals.
3. Determines service and support outcomes: Ongoing observations can trigger reconsideration
of the plan and its recommended interventions when the service plan is not accomplishing its
desired effects.
4. Identify the emergence of new needs: Monitoring enables the case manager to stay in touch
with the individual. Monitoring provides consistent help to the individual in identifying problems,
modifying plans, ensuring the individual has resources to complete goals, and tracking
emerging needs.
When the case manager is monitoring progress towards meeting the service plan goals, he or she will
be attempting to answer these questions.
1.
2.
3.
4.
5.
6.
Is the individual getting the services established by the service plan?
Are the services provided in a way that the individual can benefit from them?
Are the services provided meeting the objectives of the service plan?
Are the services provided in a manner that is beneficial or usable?
Are the plan’s objectives appropriate to current needs, skills, and abilities?
Will meeting the plan’s objectives give the individual the ability to live successfully in the
community?
7. Are additional services or interventions needed for continued progress?
The questions point to the effectiveness of the services and the appropriateness of the service plan.
The answers to the questions will lead to the next action. If the current service plan is not helping, a
revised assessment and service plan may be in order.
Advocating
In the role of an advocate, the case manager attempts to bring about solutions to problems impeding
the individual’s progress or infringing on his/her rights. The case manager also teaches the individual
to be a strong self-advocate.
Additionally, the case manager develops a network of community collaborators for advocacy.
Community collaborators are resourceful, caring, and responsible individuals committed to the growth
and development of the individual. Often, these collaborators are family members, friends, neighbors,
and community agency personnel. By meeting regularly with the individual and with collaborators,
barriers to progress can be identified and steps can be taken.
Advocacy takes place at different levels of the service system. For example, the case manager may
go with the individual to reapply or submit an appeal for financial assistance or a case manager may
approach a public housing authority about developing low-income housing in rural areas. Advocacy is
important. Through the process of case management, positive and long-term improvements can be
made.
Closure
Termination of case management can occur when the individual no longer wants to receive case
management services or when the case has been successfully completed. In order to determine if a
particular case is ready for closure, the following points need to be assessed.
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Has the individual acquired the needed resources and skills? Are any other resources or skills
needed to maintain the individual in the community?
How long a period of stability has the individual experienced in the community? In assessing
this question, it is essential to review (through case records) the cyclical nature of the
individual’s history. Individuals may experience distress around specific dates, stressors, or
issues in their life.
Have you monitored the individual’s use of resources to ensure that the relationships between
the individual and resources are secure and stable? How are problems resolved, and have
any new problems arisen?
Have sufficient community supports been established to maintain the individual/resource
relationship? This could include using the family, neighbors, and friends to provide support
and a telephone number of someone who can provide “on-call” assistance in times of crisis.
Has the individual learned how to acquire resources to meet his/her goals? It may also
include teaching how to set personal goals, break them into smaller steps, generate alternative
resources, and how to approach the resource controllers.
Case managers must keep these five criteria clearly in mind while they plan and implement case
closure. In a sense, the process of closure begins when a case is first received. The ending of a
personalized relationship is difficult. Take time to process the closure issues that do arise.
Remember that this can be an emotional time for both the case manager and individual; use
supervision (University of Kansas, 1985).
Learning Activities & Next Steps
 Does your agency have an assessment form already in place? Get a copy of it and study it.
Think about how you can use that tool to best assess a person’s situation. Then, get a
colleague, friend, family member, or other willing guinea pig to role play with you by serving as
a client while you conduct the assessment.
 Does your agency have a service plan form? If so, get a copy of it and study it. Think about
how you can best use that tool (or just a blank piece of paper) to create a service plan with a
client. Then, get a colleague, friend, family member, or other willing guinea pig to role play with
you by serving as a client with whom you create a service plan.
 Review the service plan you just created. Is it realistic based on your assessment? Looking at
it with a critical eye, are the goals really yours or your “client’s”? How will you be able to
determine if the service plan is working? What can you do if it’s not working?
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UNIT 4: Housing
Description:
This unit presents an overview of the continuum of housing options and housing programs through the
U.S. Department of Housing and Urban Development and the Kentucky Housing Corporation. It also
presents an overview on how to access other housing resources in one’s community.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Identify the continuum of housing options that exist to meet the specific needs of individuals
and families at a given time.
2. Identify the methods of housing assistance.
3. Identify housing programs specific to homelessness.
4. Identify methods for accessing private-market housing.
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Housing Programs
The affordability standard for housing is considered to be 30 percent of household income. That
means that a person/household should pay no more than 30 percent of the monthly income for rent
and utilities. Since many of the persons you will be assisting receive SSI or are employed in low-wage
jobs, finding affordable housing can be difficult.
A continuum of housing exists to meet the specific needs of individuals and families at a given time.
The continuum includes:
 Prevention (LIHEAP, various rental and utility assistance programs in your area)
 Emergency Shelter (Domestic violence and homeless shelters)
 Transitional (HOME TBRA)
 Permanent (Shelter+Care)
 Supportive Housing Programs
 Project-Based Rental Assistance (Housing authorities in each county and other developments
in each area)
 Tenant-Based Rental Assistance (Section 8 or Housing Choice Voucher Program administered by the local Housing Authority or Kentucky Housing Corporation)
The Homeless Resource Guide on KHC’s Web site under Specialized Housing, Resources, provides
the resources available in each Continuum of Care across the state.
HUD determines fair-market rent for each county in each state. Nowhere in the United State are there
any counties in which a person on SSI can afford fair-market rent.
Two methods of housing assistance make up the difference.
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Project-Based Rental Assistance
Tenant-Based Rental Assistance
Persons must meet income eligibility and should check other requirements/qualifications, such as the
ability to get the utilities turned on in their name, a felony conviction, rental history, etc.
Needed documents include: birth certificate, photo ID, Social Security card, and police report.
Project-Based Rental Assistance
These include the local housing authorities in each county, and other subsidized, low-income housing
developments. A person living in one of these housing units will pay approximately 30 percent of their
monthly income for rent. (There are adjustments for what income is counted and for allowable
deductions.) Funding for the subsidy for these housing units comes from HUD and the U.S.
Department of Agriculture Rural Development (USDA-RD). This assistance is available as long as the
person remains in the rental unit. In other words, the assistance goes with the apartment, not with the
person. If the person moves out of the unit, this assistance is lost. If a person wants to move out of
one of these units, they can request to be transferred to Tenant-Based Rental Assistance.
For more information on this program and a list of local Housing Authorities and Subsidized
Apartments, visit the HUD or USDA-RD Web sites.
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Section 811 Supportive Housing for Persons with Disabilities.
HUD also provides funding through this program to nonprofit organizations to develop rental housing
with the availability of supportive services for persons with disabilities. The tenant will again pay
approximately 30 percent of their monthly income for rent, and supportive services are available but
are not required as a condition of occupancy. The purpose of this program is to allow persons with a
disability to live as independently as possible in the community.
Tenant-Based Rental Assistance
This assistance is similar to the Project-Based Rental Assistance in that the tenant will pay
approximately 30 percent of monthly income for rent. The difference is that this assistance goes with
the tenant not the apartment.
A person receiving this assistance will locate a property owner within the community that will accept
this assistance. The unit must then pass a Housing Quality Standard inspection. If, after one year, a
person wants to move to another rental unit, that person can take the assistance with them to the new
unit within program guidelines.
This assistance is more commonly known as Section 8 or the Housing Choice Voucher Program and
is administered in some areas by the local housing authority. In 87 Kentucky counties, it is
administered by KHC.
More information on this program is available on the HUD Web site.
KHC also administers other rental programs that may be of assistance.
HOME TBRA
These funds may be used to help pay the cost of monthly rent, utilities, and security deposits. It is
similar to the Housing Choice Voucher Program in that the tenant pays approximately 30 percent of
their income; however, this assistance is temporary. It is hoped that the tenant can then be
transitioned to the Housing Choice Voucher Program. Your regional board for Mental Health or
Individuals with an Intellectual Disability (Regional MHID Boards) may have access to this assistance;
other nonprofits, local governments, and private developers can apply for this program.
Homeless Assistance
KHC also administers other programs through the HUD Continuum of Care process that may be of
assistance.
Shelter+Care links rental assistance to supportive services for hard-to-serve homeless persons with
disabilities and their families.
Supportive Housing Program promotes the development of supportive housing and supportive
services for homeless persons and includes the development or expansion of permanent housing
facilities for homeless, disabled persons.
More information on homeless assistance programs available through KHC is available on KHC’s
Web site under Specialized Housing.
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Accessing Private Market Rentals
Security and Utility Deposits
Once housing is located, most property owners/managers will require a security deposit before the
tenant moves in, and utility companies may require a utility deposit.
There are often resources to assist a person in obtaining these funds. There are limited programs
through the Department of Community Based Services (DCBS) for people receiving Kentucky
Transitional Assistance Program (K-TAP) benefits and who are engaged with the Department of
Protection and Permanency. In both of these cases, the person should contact DCBS. There are
also limited programs available through local community mental health centers, particularly if the
person is involved in case management, therapeutic rehabilitation, or their children are involved in the
IMPACT program. In all of these cases, the person should contact their case manager. Other
assistance for security and utility deposits may be found at community action programs, local
nonprofits, and churches.
Security Deposits
A typical security deposit is the amount of one month’s rent. If no resources exist for security deposit
assistance, it may be possible to work out a payment plan with the property owner to pay the security
deposit in smaller chunks over the course of several months. If this route is taken, make certain that
the plan created is one that is realistic for the tenant.
When a person moves out of their unit, the security deposit should be refunded. The property
owner/manager can legally keep some of the deposit to cover rental arrears, fines and fees, and
damages beyond normal wear and tear that are caused to the unit. For this reason, it is important to
do a walk-through inspection of the unit with the property owner/manager prior to moving into the unit
and once again when the person moves out of the unit. The inspection should note items that are not
in good condition, marks on surfaces, and other damages. If a property owner keeps part or all of the
security deposit, make certain to get an itemized list of what is being kept and why. If a security
deposit is not returned and the person does not agree with the money not being return, the person
can contact legal services (see this section) for assistance.
Utility Deposits
A deposit will be charged for each utility the person is responsible for paying. The deposit may be a
set charge or may depend on the person’s payment history with the utility company. When the person
moves out the unit, the deposit may be returned to the person. The utility company can legally keep
all or part of the deposit to cover utility arrears and fees. The person may also be able to simply
transfer the deposit to their next unit.
Fair Housing
The Fair Housing Act, as amended, prohibits discrimination in the buying, selling, renting, insuring,
and financing of housing to persons based on race, religion, color, national origin, sex, familial status,
and disability. It expands the real estate market by making all housing and property available to all
persons. It protects an individual’s basic right to choose where they live.
It is unlawful for a real estate operator, broker, or sales agent to:
 Refuse to sell, rent, lease, or exchange real property for discriminatory reasons.
 Refuse to receive or transmit good faith offer to purchase or rent.
 Deny any services or facilities relating to real property transactions.
 Represent that real property is not available for inspection, sale, or rental when it is.
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Retain a listing with the understanding that the seller plans to discriminate in the terms or
conditions of a sale or rental.
It is unlawful to coerce, intimidate, threaten, or interfere with any person in the exercise or enjoyment
of any housing rights. It is unlawful for a financial institution to:
 Discriminate in the granting, rates, terms, conditions, or services of financial assistance in real
estate transactions.

Discriminate in making or purchasing of loans.
It is unlawful for a real estate operator or a financial institution to:
 Engage in the tactics and practices of panic-selling, to represent that the racial composition of
a neighborhood is going to change or that property values will lower, or make similar false and
misleading statements.
It is unlawful for an insurance agent to:
 Discriminate in term, conditions, or privileges of insurance against hazards to a housing
accommodation.
It is unlawful for a multiple listing service/real estate organization to:
 Deny access or restrict membership or participation for discriminatory reasons
All real property (houses, apartments, trailer lots, etc.,) rented or sold, whether by or through a real
estate broker, sales agent or operator, or directly by the owner is covered under the Fair Housing
Law.
Exemptions include:
 The rental of an owner-occupied duplex or one room in a private home, the sale of property
without help from a real estate dealer and without public advertising, and rental of churchowned housing to the extent of giving preference to those of that religion.
Refusal to rent on the basis of sex if:
 A single-sex dormitory, the landlord chooses not to rent to unmarried couples, or the landlord
rents fewer than ten units or to fewer than ten persons in an owner-occupied facility, it can be
demonstrated that gender-based exclusions are necessary for reasons of personal modesty or
privacy.
Refusal to rent on the basis of familial status if:
 Housing is intended for or occupied by occupants 62 years of age or older or 80 percent of all
units in a facility have occupants 55 year of age or older and special services for older persons
are provided.
Who must obey the Fair Housing Law?
 Real estate operators, brokers, and agents.
 Savings and loan associations, mortgage lenders, banks, or other financial institutions.
 Apartment house agents.
 Rental agents.
 Builders, contractors, and developers.
 Owners of building lots.
 Advertising media.
 Homeowners advertising and selling their own home.
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Multiple listing services/real estate related organizations.
Insurers and agents.
Enforcement of the Fair Housing Law in Kentucky is done by the Kentucky Commission on Human
Rights. The KCHR:
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Receives complaints which must be filed within one year of the alleged discrimination.
Investigates the complaints and determines whether discrimination has occurred.
Attempts to eliminate discriminatory acts through conference, persuasion, and conciliation.
Enters into conciliation agreements which are enforceable in court.
Holds public hearings on complaints where discrimination has occurred if conciliation attempts
fail.
Issues court-enforceable cease-and-desist and affirmative action orders.
Awards damages for embarrassment and humiliation when appropriate.
Assesses civil penalties when appropriate.
To file a complaint, contact KCHR at 332 West Broadway, Suite 700, Louisville, Kentucky 40202 or
(800) 292-5566.
Eviction
Please refer to the Legal Services section of this manual to learn about evictions.
Learning Activities and Next Steps:
 Find out if you have a local fair housing board and how it operates.
 Find out who provides rental housing assistance in your community and about the application
process; introduce yourself to the staff.
 Find out property owners with whom your agency already works.
 Learn the best places to locate private-market rental housing.
 Find out who offers assistance with security and utility deposits in your community.
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UNIT 5: Entitlements and other Government Resources
Description:
This unit describes entitlement and other government resources that are available to low-income
individuals and families, including those who are experiencing homelessness. It outlines what these
resources provide, how they can be accessed, and if there are considerations within the program for
persons experiencing homelessness. These are all mainstream resources for individuals and families
experiencing homelessness to meet their basic needs.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Understand what entitlements and other government resources are available to assist
individuals and families experiencing homelessness to meet their basic needs.
2. Understand how to assist individuals and families experiencing homelessness in accessing
these resources.
3. Understand the importance of accessing these resources.
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Child Care Assistance Program
The Child Care Assistance Program (CCAP) provides access to quality childcare that allows lowincome parents to work, attend education and training programs, and/or to participate in the K-TAP.
The program also improves the quality of childcare and promotes coordination among early childhood
development and afterschool programs.
CCAP is administered by the Division of Child Care within the Department of Community Based
Services in the Cabinet for Health and Family Services and is funded by through the Child Care and
Development Block Grant Act that is passed to the states by the Administration for Children and
Families within the U.S. Department of Health and Human Services.
The Division of Child Care provides vouchers to eligible families who then select their own childcare
provider. The childcare provider the family selects must be licensed, certified and registered. The
childcare providers must meet basic health and safety requirements, including prevention and control
of infectious diseases, building and physical safety, and health and safety training of staff.
The Division of Child Care contracts with Child Care Resource and Referral Agencies throughout the
state to administer the program. Families in need of childcare assistance must meet with staff from
their local CCR&R and complete an application to determine eligibility. Families can be connected to
their local CCR&R through their local DCBS office, through their childcare provider, by going online to
Kentucky Partnership for Early Childhood Services or by calling (877) 316-3552.
Child Care Resource and Referral Agencies
 Provide information about local child care providers.
 Provide information to help families recognize the quality child care option that is best suited
for them.
 Direct families to the appropriate sources for child care assistance and support.
 Offer several ways to obtain information concerning the health, safety and well-being of
children in person, by phone, by mail and through the Web site.
Choosing the Right Caregiver
Choosing the right caregiver is one of the most important decisions that a family can make. In your
role as a case manager, you can help families to make good choices about their caregiver. You can
have information on the caregivers in your community that are eligible providers through the CCAP
and provide information on choosing a caregiver. The following is information that families may find
useful in choosing a caregiver. Encourage families to get as much information as they can and to talk
to friends, family members and parents with children in childcare and get their opinions.
When choosing a caregiver, encourage families to visit several facilities/providers and compare:
 Watch staff and children interaction.
 See what activities are available.
 Ask questions and make sure their questions are answered to their satisfaction. (You can help
the family figure out what questions they may have.)
 Current license or certificate and any current deficiencies should be posted.
 Things to think about when choosing a provider:

child's age

child's personality

locations of the facility compared to your home and workplace

hours of the center and fees
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Once a family has chosen a caregiver, encourage them to:
 Drop in unannounced at various times of the day to see what the conditions are. If they see
anything that makes them uneasy, encourage them to talk to the caregiver or the director
about it and to keep going back to check.
 Watch for recurring bumps or bruises or changes in their child's behavior.
 Talk to other parents when they pick up their child. Compare notes.
 Trust their instincts and look for another childcare facility, if necessary.
STARS for KIDS NOW
STARS for KIDS NOW, Kentucky's voluntary quality rating system for licensed childcare centers and
certified family childcare homes, uses a scale of 1 through 4 STARS to identify levels of quality. All
STAR levels surpass the minimum licensing requirements that all programs must meet. Early care
and education programs work to meet standards associated with quality care that result in positive
outcomes for young children. Programs are assessed in the following areas: staff/child ratios, group
size, curriculum, parent involvement, training/education of staff, regulatory compliance, and personnel
practices.
STARS for KIDS NOW provides parents with a tool to help identify levels of quality when seeking a
childcare setting outside of their home. Childcare centers and family childcare homes participating in
STARS for KIDS NOW demonstrate a commitment toward providing quality care and education.
Parents can use the rating system to gain an understanding of the factors that contribute to quality
care and education, and can choose a child care setting that best matches their family's needs.
Supplemental Nutrition Assistance Program (SNAP)
SNAP (formerly called food stamps) helps people with little or no income buy food for healthy meals at
participating stores. Food benefits increase a household's food buying power when added to the
household's money. It is administered through the Division of Family Support in the DCBS Cabinet for
Health and Family Services. For assistance with SNAP benefits, call (502) 564-7050.
Who is eligible for food benefits?
Any household meeting basic income and other requirements may be able to receive food benefits.
A household is any person, family or group of people who live and buy and eat food together. Adult
children older than 21 who live with their parents may qualify for their own food benefit accounts if
they purchase and prepare food separately from their parents. Adult siblings living together, but not
with their parents, who purchase and prepare meals separately may also have separate food benefit
accounts.
The following people must be included in one household account, regardless of whether they
purchase and prepare meals separately:
 A spouse of any household member.
 Parents living with their natural, adopted, or stepchildren who are age 21 or younger.
 Children younger than 18 who are dependents of an adult household member.
What are the basic eligibility requirements?
Citizenship
Only United States citizens and some legal foreign residents of the United States may receive food
benefits.
Work Registration
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Anyone in a household who is 16 to 60 years old and can work must register for, look for and accept
work. There are some exceptions to this requirement.
Resources
A household may have no more than $2,000 in cash and bank account assets. If a member of the
household is 60 or older, the household may have no more than $3,000 in resources. Some
resources not used to calculate household assets include the dwelling, its contents and personal
belongings. Vehicles also are excluded.
Income
The amount of money a household can receive and still receive food benefits depends on household
size. Money from wages or other payments to any household member is counted as income.
A household may qualify for deductions from the household's income such as rent, utilities, legally
obligated child support paid to someone outside the household, and babysitting expenses. If the
household includes older or disabled members, they may be able to deduct medical costs.
Proof of income and expenses must be provided to receive deductions. Such proof can be provided
with pay stubs, Social Security letters, rent and utility receipts, or savings account statements. The
amount of benefits the household will receive is based on household size and income after
deductions.
How does a household apply for food benefits?
The head of the household, or an authorized representative, must be interviewed by a SNAP
caseworker in the Family Support Office in the county where the household lives. Benefits begin the
date the household’s application is received.
The household may name someone to be their authorized representative to act on their household's
behalf in completing the interview for food benefits and to use their benefits to purchase food for their
household if they are unable to do so.
If the household needs help right away, they may be able to get their food benefits within a few days
after applying.
If the head of the household is 60 years or older and disabled or if the household lives more than 30
miles from the local office and they cannot get to the food benefit office, the household should call the
local office to make other arrangements for an interview.
If the head of household must miss work to apply, s/he should call ahead and make an appointment.
This will help reduce the time the person must miss from work.
How does the household know if it is approved for food benefits?
After filing an application, the household will receive a notice within 30 days telling them whether or
not the household has been approved for food benefits.
If the household is approved, they will receive a letter telling them the amount of benefits they will
receive and advising them when they will have to be interviewed again to continue receiving benefits.
How are food benefits used?
The household's food benefits will be deposited into a food benefit account each month. The
household will receive an Electronic Benefit Transfer (EBT) card and a Personal Identification Number
(PIN) in the mail to use to access their food benefit account.
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The head of the household should sign the back of the EBT card right away. Food benefits can be
used just like money to purchase almost any food item, except ready-to-eat hot foods. Food benefits
may also be used to buy seeds and plants to grow fruits and vegetables. The following items cannot
be purchased with food benefits: tobacco, alcohol, pet food, soap and other household products,
medicines, and other non-food items.
What are the rights of a food stamp participant?
 The household may begin the process of applying for food benefits the same day they visit the
food benefit office by completing a short form.
 The household will be notified within 30 days of applying for food benefits if their application is
approved or denied.
 The household may receive food benefits within a few days if they qualify and have little or no
money, or if they meet certain income requirements.
 If the household disagrees with any action taken in their case, they are entitled to a fair
hearing. At this hearing, the household will have a chance to tell an impartial hearing officer
why they disagree with any action in their case. If it is found that an error has been made in
the household's case, they will receive any benefits denied as a result of the error.
 By federal law, sales tax may not be charged on food purchased with food benefits. If the
household purchases food with a combination of food benefits and cash, sales tax may only
be charged for taxable items paid with cash.
For more information about the Food Benefits Program, call the food benefit office in the county where
the household lives or call the Ombudsman toll free at (800) 372-2973, TTY (800) 627-4702.
To file a complaint of discrimination, write
USDA, Director
Office of Civil Rights
1400 Independence Avenue, S.W.
Washington, D.C. 20250-9410
Phone (800) 795-3272 (voice) or (202) 720-6382 (TTY)
To file a complaint of discrimination with the Commonwealth of Kentucky, write the
EEO/Civil Rights Compliance Branch
Cabinet for Health and Family Services
Office of Human Resource Management
275 E. Main St., Mail Stop 5C-D
Frankfort, KY 40621
Phone (502) 564-7770, ext. 4107 FAX: (502) 564-3129.
Can a household receive food benefits right away?
The household may qualify for food benefits soon after applying under certain circumstances, such
as:
 The household's monthly rent/mortgage and utilities costs are more than its gross monthly
income.
 The household's gross monthly income is less than $150 and resources, such as cash or bank
accounts, total $100 or less.
 The household includes members who are migrant or seasonal farm workers.
How to get a new EBT card if lost, stolen, or damaged
EBT cards that are lost, stolen, or damaged can be reported to (888) 979-9949. This number is
available 24 hours a day, 7 days a week.
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Rights that persons experiencing homelessness have with SNAP:
 Apply without having a permanent address. Program regulations require states to assist
households that do not reside in a permanent dwelling or have a fixed mailing address in
obtaining their regular monthly benefits.
 Apply without having food preparation or cooking facilities. This regulation is particularly
helpful for homeless recipients. If a recipient lives on the street, or in a shelter that does not
have cooking facilities, they are still eligible to collect benefits and purchase their own food.
 Request expedited service. Many homeless applicants qualify for expedited service, which
requires that the agency provide food stamps within seven (7) days of the application date.
Households are entitled to expedited service when they:
 Have less than $150 in monthly gross income and liquid resources that do not exceed
$100
 Are destitute migrant households and their liquid resources do not exceed $100
 Have shelter costs (rent or mortgage payments and utilities) that exceed their gross
monthly income.
To get expedited service, verification of the applicant’s identity is required. No other verification is
needed to receive the first month’s worth of food stamps. In order to receive additional months of
food stamps, an applicant will need to verify income, resources, and expenses.

Use “any document which reasonably establishes their identity” to meet the identity verification
requirement. Examples of acceptable documentation include, but are not limited to:
 Driver’s license
 Work or school ID
 An ID for another benefit program such as Medicaid
 Voter registration card
 Wage stub
 Birth certificate
If no documentation is available, the food stamp agency can verify identity through a collateral
contact, such as a call to a homeless shelter or a case manager. Under these liberal rules, the state
agency should be able to verify information for almost any homeless client.
In addition to these rights, Kentucky is 1 of 13 states that offers a person experiencing homelessness
a shelter deduction if the person incurs some sort of rent or fee for service at the shelter in which they
are residing.
Temporary Assistance for Needy Families (TANF)
TANF is a block grant given to states from the federal government. It replaced what was once known
as welfare. Each state can name their TANF program. Kentucky calls it Kentucky Transitional
Assistance Program (KTAP). KTAP is administered by the DCBS through the Cabinet for Health and
Family Services. This provides the families who do not receive child support a monthly cash benefit
based on the number of household members for a maximum of 60 months. Tied to the monthly
benefit is a work requirement, which all families must meet unless they are excluded from this
provision. Families who participate in the work requirement enter the Kentucky Works Program.
Kentucky Works Program
Work Requirements
Single-parent households are required to participant 20 hours per week in a countable activity if the
household has a child who is under six years of age. If the youngest child is six or older, the
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household must participate for 30 hours per week in an activity (20 hours must be in a countable
activity and 10 hours can be in an allowable activity).
Single parents of children under 12 months of age may elect to be exempt from the work requirement
until the child turns 1 year of age. Parents can only take a total of 12 months of this exemption total.
Two-parent households must participate in a countable activity for 35 hours per week or 55 hours per
week if they receive childcare assistance.
Kentucky Works Activities
Hours of participation must be in one or more of the activities below.
 Unsubsidized or subsidized employment
 Work experience
 Community service programs (short-term)
 On-the-job training
 Job search and job readiness assistance (not to exceed 6 weeks in a 12-month period and no
more than 4 consecutive weeks of community service)
 Vocational educational training (not to exceed 12 months)
 Job skills training related to work
 Education directly related to employment
 Satisfactory secondary school attendance (if under the age of 21 years of age)
 Childcare services provider to individuals who are participating in community service.
Education as an Activity
In Kentucky, KTAP participants are allowed to only pursue certificate programs or two-year degree
programs. Those participants pursing bachelor’s or master’s degrees may not use school hours to
count toward their hours of participation. For these degrees, participation hours must be found in
other areas, such as employment or work experience. Participants pursuing certificate or two-year
degree programs may work toward those goals by tracking participation hours.
Ready-to-Work and Work-and-Learn programs, funded through TANF dollars, throughout the state
make education an easier option for KTAP participants. Many of Kentucky’s universities and
Kentucky Community and Technical College System have coordinators for these programs who work
with KTAP participants to help them document in-class hours, study hours, and work hours to ensure
they are meeting participation requirements. Both of these programs also have funding to offer some
work study positions to KTAP participants. (This article is about Ready-to-Work and Work-andLearn.)
KTAP participants choosing other options for education, such as an online university, may find
documenting participation hours challenging because online universities cannot verify attendance in
the class. Participants should consult with their Kentucky Works coordinator about needed
documentation. Some universities may be able to give detailed information about the hours students
are logged-in, which may help document attendance. These will be cases that will need to be
discussed at a local/individual level. If no solutions can be found for documenting class time,
participants may have to look at other options to gathering participation hours in addition to pursuing
education.
Support Services
Since the Congress passed TANF legislation in 1996, Kentucky worked to implement several support
services to assist families as they make their way to self-sufficiency. The current services are in place
to help families transition from KTAP to employment:
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



Interview outfit: Kentucky Works case managers can assist participants in purchasing an
interview outfit to wear when job searching and interviewing.
Transportation: Kentucky Works case managers can help access the transportation check
($200/month) to assist families while they are in an activity. Once KTAP discontinues with
earnings, the transportation assistance discontinues. Participants must complete a PA-33 on
a monthly basis and submit it to their case manager. This form verifies their involvement in a
countable/allowable activity and enables them to receive their transportation check.
Work Incentive Program (WIN): WIN provides $130 per month for nine consecutive months to
KTAP participants whose case discontinues due to earnings. This program is an once-in-alifetime offer. All nine months must be used consecutively. If the participant is approved for
KTAP before the nine months ends, WIN is over, and remaining months cannot be saved for
the future. Participants must turn in a form each month that verifies their employment in order
to qualify for this benefit. If the form is not turned in, the benefits will end and cannot be
accessed again.
Two-Month Income Disregard: In many cases, this is automatically given to participants when
their cases discontinue with earnings. This provides two additional months of KTAP plus their
income; however, this is also calculated for housing assistance programs as income. Once
the two months of KTAP end, participants should notify their housing agency. This is an oncein-a-lifetime offer.
Family Alternative Diversion (FAD)
FAD, administered by DCBS, is designed to divert families from KTAP. To be eligible, families must
be KTAP-eligible with a recent loss of employment, but they must have a promise of a job within three
months. FAD provides families with $1,500 to assist them until with expenses until the earned income
returns to the household. When families accept FAD, they waive their right to apply and receive
KTAP for 12 months. Families do not apply for FAD, instead they are assessed as eligible for the
program by the case manager at the time of application for KTAP.
Special Supplemental Nutrition Program for Women, Infants and Children
WIC (Women, Infants, and Children) is a federally-funded health and nutrition program for women,
infants, and children. WIC helps families by providing assistance for buying healthy supplemental
foods from WIC-authorized vendors, nutrition education, and help finding healthcare and other
community services. Participants must meet income guidelines and be pregnant women, new
mothers, infants, or children under age five.
WIC provides:
 Nutrition education and services.
 Breastfeeding promotion and education.
 A monthly food prescription of nutritious foods.
 Access to maternal, prenatal and pediatric health-care services.
Why WIC is Important
WIC saves lives and improves the health of nutritionally at-risk women, infants and children. The
results of studies conducted by Food and Nutrition Services (FNS) and other nongovernment entities
prove that WIC is one of the nation’s most successful and cost-effective nutrition intervention
programs.
Since its beginning in 1974, the WIC Program has earned the reputation of being one of the most
successful federally-funded nutrition programs in the United States. Collective findings of studies,
reviews, and reports demonstrate that the WIC Program is cost effective in protecting or improving the
health/nutritional status of low-income women, infants and children.
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The following highlights some of the findings (from the USDA Web site).
Improved Birth Outcomes and Savings in Health Care Costs
Research has shown that the WIC Program has been playing an important role in improving
birth outcomes and containing health care costs. A series of reports published by USDA based
on linked 1988 WIC and Medicaid data on over 100,000 births found that every dollar spent on
prenatal WIC participation for low-income Medicaid women in five states resulted in:
 Longer pregnancies
 Fewer premature births
 Lower incidence of moderately low and very low birth weight infants
 Fewer infant deaths
 A greater likelihood of receiving prenatal care
 Savings in health care costs from $1.77 to $3.13 within the first 60 days after birth
Improved Diet and Diet-Related Outcomes
Studies have found WIC to have a positive effect on children's diet and diet-related outcomes.
 Higher mean intakes of iron, vitamin C, thiamin, niacin, and vitamin B6, without an
increase in food energy intake, indicating an increase in the nutrient density of the diet.
 Positive effects on the intakes of ten nutrients without an adverse effect on fat or
cholesterol.
 More effective than other cash income or food stamps at improving preschoolers' intake
of key nutrients.
 Decline in the rate of iron deficiency anemia from 7.8 percent in 1975 to 2.9 percent in
1985, which the Centers for Disease Control and Prevention attributed to both a general
improvement in iron nutrition and participation in WIC and other public nutrition
programs.
Improved Infant Feeding Practices
 WIC promotes breastfeeding as the optimal method of infant feeding. Studies show:
 WIC breastfeeding policy and program activities were strengthened in the early 1990's.
 Between 1996 and 2001, the percentage of WIC mothers breastfeeding in the hospital
increased by almost 25 percent, from 46.6 to 58.2 percent.
 The percentage of WIC infants breastfeeding at six months of age increased by 61.2
percent, from 12.9 to 20.8 percent.
 For those infants who are fed infant formula, 90 percent received iron-fortified formula,
which is recommended for nearly all non-breastfed infants for the first year of life.
Immunization Rates and Regular Source of Medical Care
A regular schedule of immunizations is recommended for children from birth to 2 years of age,
which coincides with the period in which many low-income children participate in WIC. Studies
have found significantly improved rates of childhood immunization and of having a regular
source of medical care associated with WIC participation.
Improved Cognitive Development
Cognitive development influences school achievement and behavior. Participation in the WIC
Program has been shown to:

Improve vocabulary scores for children of mothers who participated in WIC during
pregnancy.

Significantly improve memory for numbers for children enrolled in WIC after the first
year of life.
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Improved Preconception Nutritional Status
Preconception nutritional status is an important determinant of birth outcome. A previous
pregnancy can cause nutritional depletion of the postpartum woman, particularly those with high
parity and short inter-pregnancy intervals. One study found:
 Women enrolled in WIC both during pregnancy and postpartum periods delivered infants
with higher mean birth weights in a subsequent pregnancy than women who received
WIC prenatally only.
 The women who received postpartum benefits had higher hemoglobin levels and lower
risk of maternal obesity at the onset of the subsequent pregnancy.
Other Improved Outcomes
WIC participation has also been shown to:
 Increase the likelihood of children having a regular provider of medical care.
 Improve growth rates.
How to Apply for WIC
Applicants for the WIC Program should contact their local health department. Applicants will generally
need to make an appointment and then visit the local health department in order to apply for WIC
services.
Applicants will be asked to provide proper ID, proof of residency, and information about their
household income.
Applicants must meet all of the following eligibility requirements:
1. Categorical Requirement
The WIC Program is designed to serve certain categories of women, infants, and children.
Therefore, the following individuals are considered categorically eligible for WIC:
Women
 Pregnant (during pregnancy and up to six weeks after the birth of an infant or the end
of the pregnancy)
 Postpartum (up to six months after the birth of the infant or the end of the pregnancy)
 Breastfeeding (up to the infant's first birthday)
Infants
 Up to the infant's first birthday
Children
 Up to the child's fifth birthday
2. Residential Requirement
Applicants must live in the state in which they apply. Applicants served in areas where WIC is
administered by an Indian Tribal Organization (ITO) must meet residency requirements
established by the ITO. When applying through a state agency, applicants may be required to
live in a local service area and apply at a WIC clinic that serves that area. Applicants are not
required to live in the state or local service area for a certain amount of time in order to meet
the WIC residency requirement.
3. Income Requirement
To be eligible for WIC, applicants must have income at or below an income level or standard
set by the state agency or be determined automatically income-eligible based on participation
in certain programs.
34
Income Standard
Kentucky’s income standard is 185 percent of the federal poverty guidelines (issued each year
by the Department of Health and Human Services).
Automatic Income Eligibility
Certain applicants can be determined income-eligible for WIC based on their participation in
certain programs, including those eligible to receive SNAP, Medicaid, K-TAP, or certain family
members are eligible to receive Medicaid or K-TAP.
4. Nutrition Risk Requirement
Applicants must be seen by a health professional, such as a physician, nurse, or nutritionist
who must determine whether the individual is at nutrition risk. In many cases, this is done in
the local health department at no cost to the applicant. However, this information can be
obtained from another health professional, such as the applicant's physician.
"Nutrition risk" means that an individual has medical-based or dietary-based conditions.
Examples of medical-based conditions include anemia (low blood levels), underweight, or
history of poor pregnancy outcome. A dietary-based condition includes a poor diet.
At a minimum, the applicant's height and weight must be measured and blood work taken to
check for anemia.
What WIC Participants Receive
All participants receive:
 Screening for nutrition and health needs.
 Information on how to use WIC foods to improve health.
 Food Instruments to buy foods that help keep participant and children healthy and
strong.
 Referrals to doctors, dentists, and programs like K-TAP, Healthy Start, and Head Start
Women receive:
 WIC foods
 Information on healthy eating during pregnancy and breastfeeding
 Breastfeeding support
Infants receive:
 Breastfeeding support or infant formula
 Immunization referrals
 Parents/caretakers receive information on taking care of babies
Children receive:
 WIC foods
 Immunization referrals
 Parents/caretakers receive information shopping, recipes, tips on feeding children
Breastfeeding
Research has shown that there is no better food than breast milk for a baby’s first year of life.
Breastfeeding provides many health, nutritional, economical, and emotional benefits to mother and
baby. Since a major goal of the WIC Program is to improve the nutritional status of infants, WIC
35
mothers are encouraged to breastfeed their infants. WIC has historically promoted breastfeeding to all
pregnant women as the optimal infant feeding choice, unless medically contraindicated.





WIC mothers choosing to breastfeed are provided information through counseling and
breastfeeding educational materials.
Breastfeeding mothers receive follow-up support through peer counselors.
Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding
mothers.
Mothers who exclusively breastfeed their infants receive an enhanced food package.
Breastfeeding mothers can receive breast pumps, breast shells, or nursing supplements to
help support the initiation and continuation of breastfeeding.
Earned Income Tax Credit (EITC)
The EITC is a refundable federal income tax credit for low- to moderate-income working individuals
and families. Congress originally approved the tax credit legislation in 1975 in part to offset the
burden of Social Security taxes and to provide an incentive to work. When the EITC exceeds the
amount of taxes owed, it results in a tax refund to those who claim and qualify for the credit.
To qualify, taxpayers must meet certain requirements (such as having earned income) and file a tax
return, even if they do not have a filing requirement. Workers without children who are very-low
income may qualify for the EITC. Working families with qualifying children who are low- and
moderate-income may qualify for the EITC.
What requirements does a worker with a child have?
 The worker (and spouse, if filing a joint return) must have lived in the United States for more
than half the tax year.
 Either the worker (or spouse, if filing a joint return) must be at least age 25 but under age 65.
 The worker (or spouse, if filing a joint return) cannot qualify as a dependent of another person.
What is a qualifying child?
The child must have a valid Social Security number and must pass all of the following tests:
 Relationship
 The child may be the son, daughter, adopted child, stepchild, or foster child of the worker, or
a descendent of any of them, such as grandchild.
 The child may be a brother, sister, stepbrother, stepsister of the worker, or a descendant of
any of them, such as a niece or nephew.
 Age
At the end of the filing year, the child was:
 Younger than the worker (or spouse if married filing jointly) and
o
younger than 19, or
o
younger than 24 and a full-time student
 Any age if permanently and totally disabled
 Residency
 Child must live with the worker in the United States for more than half of the year.
 Joint Return
 The child cannot file a joint return for the year, unless the child and the child's spouse did not
have a filing requirement and filed only to claim a refund.
For more information, including that on military personnel, visit the Internal Revenue Service.
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The Internal Revenue Service has created a network of free tax preparation sites through their
Volunteers Income Tax Assistance (VITA) program. At these sites, taxpayers can receive information
on the EITC and other tax programs, free tax preparation for many types of returns, and no pressure
to take out refund anticipation loans. This means that the taxpayer gets his/her entire refund. Most of
these sites file electronically and can arrange for direct deposit into a taxpayer’s bank account. Many
of these sites also offer financial literacy education. In a number of communities, these sites are
located at nonprofit human services organizations, senior citizen’s centers and colleges. For more
information or to find a free preparation tax site in your community, visit Assistance.ky.gov.
Low Income Home Energy Assistance Program (LIHEAP)
LIHEAP assists low-income households, particularly those with the lowest incomes that pay a high
proportion of household income for home energy, in meeting their immediate home energy needs.
In Kentucky, LIHEAP funds are disbursed by local community action programs in two different
components: (1) subsidy and (2) emergency. The subsidy is paid directly to the vendor, not to the
household. During the subsidy component, the amount of assistance is determined by formula.
During the emergency component, the amount of assistance is determined both by the amount of
assistance needed by the household and an established upper limit on the amount of assistance.
The subsidy component disburses funds in November and December to all eligible households and is
simply extra money that is paid to the utility company to assist with the household’s heating bill. Each
community action program also has arrangements with local vendors for households that heat with
coal and kerosene in order to accommodate these households. During this component, households
can apply at their local community action agency. Dates on which to apply are assigned based on a
household’s last name and are available in advance through your local community action program at
http://www.kaca.org.
The emergency component typically begins in January and runs until March or until funds are
exhausted. During this component, a household needs to be in danger of being disconnected from
their utility or running out of coal or kerosene in order to be eligible.
What is needed by a household to apply for LIHEAP?
 The household’s most recent heating bill or verification from their property owner/manager that
the heating expenses are not included in the rent. The utility bill must be in the name of one of
the household members.
 Proof of Social Security numbers or permanent residence card (Green Card) number for each
member of the household.
 Proof of the total household's income from the preceding month.
 During the crisis component, households requesting assistance for natural gas or electric must
bring a disconnect, past due, termination, or final notice. Households at or above 75 percent
of poverty level must pay a portion or copayment of the minimum necessary to alleviate the
crisis. Households whose rent includes heat must bring an eviction notice from the property
owners/manager.
Other Government Resources




Housing subsidy information is located in the section on housing.
Medicaid, Medicare, and K-CHIP information is located in the section on healthcare.
SSI/SSDI information is located in the section on income.
Veteran’s benefit information is located in the section on Veterans.
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Learning Activities and Next Steps:
 Visit your local DCBS office and get to know the staff.
 Go to DCBS to apply for SNAP and/or KTAP with your client.
 Visit your local health department and get to know their staff.
 Go to the health department with a client to assist them in applying for or recertifying for WIC.
 Find out who the Child Care Resource and Referral Agency is in your community and get to
know the staff.
 Explore childcare centers in your community. Get to know their staff and application
procedures. Find out which ones will accept childcare subsidies.
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UNIT 6: Income and Money Management
Description:
This unit presents an overview of employment services, methods of obtaining employment, disability
benefits, and methods for helping clientele increase their financial literacy skills.
Objectives:
1. At the conclusion of this unit, trainees will be able to:
2. Identify methods for obtaining employment.
3. Identify benefits for disabled individuals and how to obtain them.
4. Identify financial literacy opportunities for their clientele.
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Income
From the Chronic Homelessness Employment Technical Assistance Center “Rebuilding Lives… from
the streets to a home and job,” September 2006, “The customer-driven approach to supported
employment places an increased emphasis on the initial time that a direct service provider spends
with the customer to assist with the identification for career goals. High quality service providers must
be skilled in working closely with their customers to develop strategies for marketing their services,
establishing a rapport with the business community, interviewing employers, and conducting in-depth
job analysis of specific employment settings. Completing this process will yield an extensive amount
of information for the customer to determine if the wages, benefits, conditions, supports, and
corporate culture are sufficient for long term career development.”
Public/Private Ventures Working Ventures, “Good Stories Are Not Enough” (study period 1994 –
2002) talks about Training Inc., in Indianapolis, Indiana. Training Inc.-Indianapolis serves a variety of
participants, including TANF recipients, people receiving Veterans’ or vocational-rehabilitation
benefits, and other low-income adults. The training includes job search assistance, case
management, and at least one year of job retention assistance. The organization trains approximately
175 persons per year. Staff utilized well-developed employer and community partnerships to provide
extensive placement and job retention assistance, as well as individualized counseling and referrals
for personal issues.
Working Ventures, A Publication of Public/Private Ventures “Going to Work with a criminal Record”
Lessons from the Fathers at Work Initiative by Dee Wallace and Laura Wyckoff states: According to
the Bureau of Justice Statistics, 650,000 adults are released from American prisons each year. They
find their way to One Stops or community-based, faith-based organizations, and other organizations
that offer employment related services. These individuals are typically poorly educated, may have
serious substance abuse problems, and have difficulty finding a job. In order to assist someone to
work the key principle include learning about employer needs and preferences, assessing the job
seekers’ experience, skills and personality to make good matches, following up to ensure retention,
and taking action when problems arise on the job. (Study period 2001-2004)
Employment Services
Employment services will vary but components include assessments for cognitive ability and interest,
job readiness activities, job placement, and retention/support for the individual seeking employment.
Employment services also include relationships with the employers to link needed jobs with job
openings available and workforce needs.
Activities may include hands-on computer assistance with resume writing, life skills classes, staffsupported excursions to apply for jobs, groups that offer support for people looking for work, career
assessment, information regarding GED and other classes at local technical and community colleges,
apprenticeships, and other opportunities for developing work skills.
Contacts:
 Area Development District, Workforce Investment Boards, and One Stops
 Local organizations that have employment services
Work supports: Because many of the jobs do not provide enough income to meet basic household
expenses, people should be assisted in exploring eligibility for SNAP, WIC, childcare subsidies,
KCHIP, housing subsidies, and other support to supplement income to provide stability for the
household.
40
Office of Vocational Rehabilitation
The Kentucky Office of Vocational Rehabilitation assists Kentuckians with disabilities to achieve
suitable employment and independence. The office employs approximately 140 rehabilitation
counselors in over 50 offices covering all 120 counties in Kentucky. See the directory to contact the
office nearest you or call (800) 372-7172 (TTY) for more information.
Disability Benefits
SSDI is a monthly benefit for people who have worked in the past and paid Social Security taxes.
SSDI benefits are paid to people who are unable to work for a year or more because of their disability.
The medical requirements for disability payments are the same under both the SSDI and SSI
programs, and the same process is used for both programs to determine a disability.
SSI is a program administered by Social Security that pays monthly benefits to the elderly, the blind,
and those with disabilities and very-low income. If your client is receiving SSI, he/she will also most
likely qualify for SNAP and Medicaid. While non-medical eligibility for SSDI is based on prior work
under Social Security, SSI disability payments are based on income and resource specifications.
What does Social Security consider a disability?
Disability under Social Security is based on a person's inability to work. Your client will be considered
disabled if he/she cannot perform at the same working capacity as he/she did before, and Social
Security decides that he/she cannot adjust to other work because of his/her medical condition(s). Your
client's disability must also last or be expected to last for at least one year or to result in death.
Contacts: Organizations who have staff trained in the SSI/SSDI Outreach, Access, and Recovery
model can assist in the assessment and application process or contact the Social Security office in
your area.
Money Management
Often a crucial area of case management is helping the individual budget his or her financial
resources. Living independently means new financial responsibilities that require self-discipline and
saving for long-term purchases. Some suggestions to help case managers with budgeting are:
Work with the individual to develop a list of priorities by helping them distinguish between needs and
wants. Help them understand that money for the wants should come after the needs are taken care
of.
 Do not push your judgments or values about money.
 Be careful to not “rescue.” Work with the individual to outline possible consequences (both
positive and negative) for financial decisions.
 Do not use budgeting as a means of manipulation or punishment.
 Be aware of ethical concerns when dealing with individual on financial issues and consult with
your supervisor.
Managing on a low and/or fixed income has its challenges and requires specific skills and an
understanding of culture, experiences, and behaviors regarding spending. There are numerous
financial literacy curricula online, books, etc., to assist with money management. In working with the
homeless population, there are specific components that are essential to a curriculum. The following
are outlines of two money management training sessions adapted for the specific needs voiced by
this population. This is a result of focus groups held to research how people were keeping and
spending money, paying bills, cashing checks, tracking spending, and more. The classes are very
interactive and include several exercises and homework.
Session I
1. How Do I Spend Money?
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2. Attitudes About Money

Money memories

Fears

Values/Wants versus Needs
3. How to Budget

Income-identifying sources

Expenses: fixed, variable, and unexpected/miscellaneous

Decreasing expenses/increasing income

Using community resources to supplement your income
4. Closing

Concept of triggers

Budgeting is like a diet
Session II







Tracking expenses
Choosing a method of bill payment
Understanding your bills
Fraud/Predatory Lending
Identity theft
How to deal with collections
Credit
Case Manager's Role
Included in the sessions are expectations for case managers working with clients as to when, how
often to review and update with client, etc. It is recommended that there be a staff training regarding
budget development and use as a tool. Included in the training there needs to be a component of
developing trust with a client in this area, approaches to addressing clients on the topic in a nonjudgmental way, and the case manager’s comfort level in discussing financial matters with their
clients.
While discussing the budget with the client, the case manager is also to discuss fears, triggers, and
follow up with emotional spending. What is, how, and when to keep a spending diary.
Keeping a check register, bill payment, and credit check
 Where to keep receipts
 Keeping updated check registers
 Expectation of bringing materials with them to meetings
 Bill payment - staff need more education?
 Reading bills
 Credit check (annual credit report online)
 Old debt discussion
Recommended supplies needed:
 small notebooks for spending diary
 expandable file folders
 5” x 7” envelopes
Role of Mentor
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Volunteers working as mentors are a significant help to clients. Mentors can play a role in teaching,
accountability and support. Mentors become great advocates in the banking industry when they learn
the reality of their clients’ situations.
Payeeship
Some people receiving Social Security benefits are required to have a payee. Research your area for
social services that provide this service or that do or may consider an outreach program. If you, as
the case manager, are assigned this responsibility, here are some additional guidelines:




Continuously review the need for a Representative Payee. Remember that a basic value of
case management is to help individuals be independent and gain more control over their own
affairs. Encourage them to manage their own money as soon as possible.
Know your agency policies and procedures about Representative Payees.
Know the rules and regulations from Social Security about Representative Payees.
Make sure to plan for holidays and vacations of staff. Individuals should be able to receive
their payments in spite of staff absences or agency closings.
Learning Activities and Next Steps
 Think about the role income plays in your life and how you use your money. Create a list of the
values you place on money. Think about and write down the messages (both obvious and
subtle) about money and money management you learned as you grew up.
 Keep track of every penny you spend for a certain length of time (e.g. one week, one month).
How do where you want to spend your money and how you actually spend your money
compare?
 What financial literacy classes are available in your community? How do you access them?
Who teaches them?
 Does your agency use a financial literacy curriculum? If so, what it is? Learn how to use it.
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UNIT 7: Health Care
Description:
This unit describes special health care problems and needs of those experiencing homelessness. It
outlines access and barriers to service. It shows that housing status is directly related to physical
well-being. Poor health can be both a cause and a result of homelessness.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Understand the relationship between homelessness and health care.
2. Identify specific health care problems that are common among persons experiencing
homelessness.
3. Understand the importance of accessing entitlements.
4. Name barriers and methods of access to health care.
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SECTION 1: Homelessness and Health: What’s the Connection?
(This section titled and taken from the January 2010 Fact Sheet of the National Health Care for the
Homeless Council)
“Life on the streets is brutal and short. The average age of death for homeless people is 30
years less than that of housed people.” (James J. O’Connell, National Health Care for the
Homeless Council, 2005)
A health problem can lead to a downward spiral.
Many people are reduced to homelessness in a downward cycle that begins with a health problem
and rapidly escalates into employment problems, financial problems, and housing problems. Over
half of personal bankruptcies in the United States are the result of health issues. Many who lose their
housing double up with family and friends awhile, then move to shelters, their car, or the street once
others’ hospitality is exhausted. Increasingly, this pattern affects families and people who have never
before experienced extreme poverty.
People experiencing homelessness have complex health problems.
Without homes, people are exposed to the elements, disease, violence, unsanitary conditions,
malnutrition, stress, and addictive substances. Consequently, their rates of serious illnesses and
injuries are three to six times the rates of other people. These conditions are frequently co-occurring,
with a complex mix of severe physical, psychiatric, substance use, and social problems. Resolving
health problems is critical to resolving homelessness.
Access to care is difficult for impoverished people.
Like 47 million other Americans, the majority of homeless people do not have health insurance or the
ability to pay for needed care, so many providers will not treat them. In extreme situations, many turn
to emergency rooms although ERs are costly and inappropriate for ongoing care. Federally-funded
Health Care for the Homeless (HCH) projects provide primary care without regard to one’s ability to
pay, but these 214 health centers reach less than 1 million homeless individuals annually out of the 3
to 4 million who desperately need care. Because many homeless people have limited mobility,
completing daily priorities, such as finding something to eat or place to sleep, and histories of
mistreatment that can cause them to avoid “authorities,” HCH projects use outreach teams and mobile
clinic vans to bring them into care.
Healing and recovery are nearly impossible without a home.
Bed rest, healthy food, refrigeration for medications, and the ability to stay out of the weather are
critical to good health but unavailable to those without homes. Increasingly, the data indicate that
housing is health care.
Solutions exist.
Working from an understanding that health care and housing are fundamental human rights, the
National Health Care for the Homeless Council works with people who have experienced
homelessness, health care and service providers of all sorts as well as policy makers. Through
training, education, research and advocacy, we promote effective health care delivery practices for
homeless people, empowerment of homeless people, universal health insurance, affordable housing
and other approaches to breaking the deadly link between poor health and homelessness.
More facts on homelessness and health are available on the National Health Care for the Homeless
Council Web site.
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SECTION 2: Special Problems and Barriers
Many people experiencing homelessness may have an undiagnosed disability. Without exposure to
the appropriate medical practitioners, this could go on for a lifetime. It is desirable to assess for
disabilities and assist persons in applying for entitlements, such as SSDI or SSI if a disability can be
documented that prevents maintaining employment. The SOAR process was designed to help
streamline the disability applications of people experiencing homelessness. SOAR trainings are
conducted around the state each year and are announced in KHC’s Homeless and Support Services
eGrams (electronic newsletters). You can register to receive the training notifications around the state
every year.
At this time in Kentucky, an individual must be pregnant, a minor, or disabled in order to receive
Medicaid and Passport, the state funded health insurance. If someone qualifies for SSDI, they will
receive Medicare, which is issued by the federal government. People are more likely to get the care
they need if they have some type of insurance, so it is very important to take the step of applying for
disability benefits. There are programs available to help those without any type medical card or
insurance, however, and some of these are outlined below.
SECTION 3: Accessing Services
Health Care for the Homeless
HCH programs are health centers that provide comprehensive, culturally competent, quality primary
health care services specifically to people who are homeless. These programs include communitybased and patient-directed services that include primary care, outreach services, and access to
mental health, dental, and other health services. There are several HCH programs in Kentucky.
More information about these programs is available online.
Health Care for the Homeless programs are supported by the Health Resources and Services
Administration within the U.S. Department of Health and Human Services.
The National Health Care for the Homeless Council is a network of HCH programs across the country.
Their Web site provides a wealth of information on addressing the health care needs of people who
are homeless.
Patient Assistance Programs
Patient Assistance Programs are offered by drug manufacturers. Eligible participants may receive
coupons for medication or completely free medications. Most require that an application with
supporting documentation and a prescription be provided. There are hundreds of these programs
available. To find out if a particular drug is covered the following Web sites may be helpful:
www.needymeds.org
www.rxassist.org
The Kentucky Physician Care (KPC) Program
The KPC Program is monitored through the state of Kentucky and can help uninsured patients obtain
certain medications and receive limited office visits. It is a public/private partnership with Health
Kentucky, Inc., the Department for Community Based Services, and the Department for Public
Health.
46
KPC consists of several state and private providers (physicians, dentists, and pharmacies) who
donate their time and materials to provide free, one–time, routine care to low-income uninsured
citizens of the Commonwealth.
KPC also provides selected free prescription assistance through a partnership with several
pharmaceutical manufacturers.
How the Program Works
Applicants may apply for services at the Department for Community Based Services or by calling
(800) 633-8100. DCBS offices are located in every county in the state. Once the application is
submitted, it is sent to the KPC hotline office for processing. Once accepted into the program, the
client calls the hotline to be referred to a participating health care professional or participating
pharmacy.
Eligibility
To be eligible for the KPC Program, you must:
 A have a gross income (income before all deductions) limit of 100 percent of the federal
poverty level.
 A resource limit of $2,000.
 Not be qualified for government medical assistance programs.
 Not have health insurance or be covered by a health benefit plan as defined under Subtitle
17A of KRS Chapter 304.
Surgery on Sundays
Surgery on Sundays provides limited outpatient surgery by volunteer medical professionals in the
Lexington area. Referrals must be made by a participating provider. For more information, visit their
Web site at www.surgeryonsunday.org.
Learning Activities and Next Steps
 Find out if there is a Healthcare for the Homeless program in your community. If so, drop by
and meet the staff.
 Find out if there are clinics or other providers in your community that offer sliding fee scales or
low cost health care options. Stop by, meet the staff, and find out their eligibility requirements.
47
UNIT 8: Legal Services
Description:
This unit presents a general overview of legal services for persons who are homeless in Kentucky,
reviews eligibility requirements for Legal Aid services, and describes the range of legal resources
available to persons who are poor and/or homeless throughout the Commonwealth.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Identify what is meant by a criminal defendant’s right to legal counsel and how a poor
Kentuckian can access a public defender.
2. Describe typical legal matters pertaining to homelessness that are categorized as “civil” law.
3. Identify multiple sources of legal assistance for poor and/or homeless Kentuckians in civil legal
matters.
4. Describe the financial and programmatic eligibility requirements for Legal Aid services in
Kentucky.
5. Identify the kinds of legal forms available on the shared legal services Web site for homeless
persons who choose to or have no other option but to represent themselves in court.
48
John and Mary Edwards support their three children working in the poultry industry. Last year,
Mary had a hysterectomy with a complicated recovery ultimately resulting in her losing her job.
John’s salary alone made it difficult for them to maintain their apartment, which they rented for
ten years. They were evicted. Now the whole family lives in their car, as they are unable to
find affordable housing.
Rosa telephones you, asking whether there is a safe place available for her to live with her sixyear-old son. She refuses to disclose her last name, address, or any other identifying
information, whispering that her husband whom she says is at work, threatens to take the son
and disappear forever if she leaves him.
Isaiah is a 50-ish man with one arm who lives on the streets. He seems a little confused, but
says he is a Veteran. He wonders if you can help him “find a job and a place to settle down for
the winter.”
Just as all other persons in Kentucky, people of limited financial resources can sometimes benefit
from legal services. They many need help with matters of child custody, intimate partner violence, or
securing benefits, as well as dealing with complicated lending practices, eviction, and foreclosure. All
of these issues affect families’ abilities to maintain stable, secure housing and prevent their falling into
homelessness.
The purpose of this module is to provide case managers working with persons regarding
homelessness with information to link their clientele with essential civil legal services or basic
information to support clients in representing themselves in the civil legal system.
Criminal legal matters. The constitution guarantees all defendants in criminal matters the right to
legal counsel. The Kentucky Department of Public Advocacy is responsible for the public defenders
in the Commonwealth.
Civil legal matters. There is no comparable constitutional guarantee to counsel in civil legal matters.
However, our country’s founders’ ideal of equal justice for all applies. In a nation of laws, we work to
ensure that all are treated fairly.
The civil legal arena is a broad one. It includes matters such as family law, elder law, immigration and
naturalization, consumer protection, as well as the securing of benefits. For the poor, guidance
regarding rights and responsibilities in dealing with complex bureaucracies is especially important.
There are multiple sources of civil legal assistance for the poor in Kentucky. This module will provide
information about four different types of legal resources:
1.
2.
3.
4.
Regional legal aid services
Private attorneys providing pro bono services
Special legal projects and legal clinics
Support materials for clients representing themselves (pro se)
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Regional Legal Aid Services
Throughout its history, our society has grappled with how to provide adequate legal services for the
poor. The first legal aid society was established in New York City in 1921. Now there are 934 such
organizations throughout the country, four in Kentucky.
Kentucky Legal Aid, Legal Aid of the Bluegrass, AppalRed, and the Legal Aid Society currently
provide 201 staff members, 92 of them attorneys, to meet the civil legal needs of their clients. The
four agencies share a common Web site, which shows the counties they serve and their office
locations and contact information. This Web site also has an extensive “public law library” of
commonly asked questions about civil matters such as divorce, child custody, lending practices,
repossession, and eviction. The site also includes forms clients can use when representing
themselves, which will be discussed further below.
Eligibility Information
Eligibility for the regional legal service agencies is determined by income, type of legal problem, and
the availability of appropriate staff to take the client’s case. Financial eligibility is limited to those
whose annual income is equal to or below 125 percent of the annual federal poverty level, which can
be found at the U.S. Department of Health and Human Services Web site at http://aspe.hhs.gov.
Federal poverty guidelines usually change annually in the spring. Agencies then go through their own
change implementation processes. To avoid confusion, case managers should refer clients whose
incomes are close to 125 percent of the federal poverty level to their regional legal service agency to
make the eligibility determination.
Program eligibility is determined in a few simple ways. First, legal service agencies are forbidden by
federal statute from taking the following kinds of cases: criminal cases; class actions; liability or other
fee-generating cases; cases involving issues of abortion, redistricting, or euthanasia; or challenging
conditions of confinement in jails or prisons. Local legal service agencies’ Boards of Directors
determine their program priorities by surveying the client community, surveying local service
providers, and scanning their communities for threats to stability of local families and individuals.
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Based on their analysis, typical current priorities with their programs are:
Priority
1. Support for families
Programs
A. Assist families with domestic violence
B. Assist grandparents raising grandchildren
2. Preserving the home
A. Assist tenants with wrongful lockouts/evictions
B. Assist homeowners facing foreclosure
C. Assist nonprofit groups that build affordable
housing units
3. Maintaining economic security
A. Assist in obtaining govt. benefits: SNAP,
Medicaid, KTAP, UI
B. Assist in consumer disputes and bankruptcies
C. Assist in tax disputes with IRS
4. Safety, security, and health
A. Assist nursing home residents with care- related
issues
B. Assist homeless persons with access to services,
housing, and medical care
5. Population with special
vulnerabilities
A. Seniors
B. Persons with HIV
C. Veterans and their families
Priorities such as these keep the agencies’ focus on critical legal needs, emphasize stability for
individuals and families in local communities, and promote a wise use of limited resources. They also
promote transparency in decision-making in client intake. In 2009, the four regional service agencies
resolved civil legal problem in approximately 24,000 cases involving 68,000 low-income families and
children.
Who has difficulty accessing justice? The American Bar Association and state studies show that less
than 20 percent of low-income civil legal needs are currently being met. First, there are those
financially eligible Kentuckians whose legal problems fall within program priorities who go on wait lists.
Next, there are those financially eligible Kentuckians whose legal problems fall outside program
priorities, e.g., not deemed the most critical needs. Finally, there are those above the financial
eligibility guidelines—many of them working poor and some homeless—who are usually unable to
access any legal services at all.
Private attorneys providing pro bono services
You may already have professional collaborations with private attorneys in your community or through
your agency who agree to work with your clients on a pro bono basis. This would not be surprising as
the voluntary service provided by private attorneys is a crucial component of meeting the American
dream of “equal justice for all.” The shared legal services Web site through the “pro bono portal” will
also help you access private attorneys offering their services pro bono in each region of the state.
Special legal clinics
Another option in seeking civil legal assistance is the specialized legal clinic that operates in some
regions of the Commonwealth. Most focus on a specific area of civil practice. Some are shown on
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the common legal services Web site; some are not. Because some are funded with special grants, it
is prudent to contact a clinic prior to sending a client there to ensure of its operating status.
Black Lung, Mine Safety Discrimination, and Related Issues
The Appalachian Citizen’s Law Center, 317 Main Street, Whitesburg, Kentucky 41858, (606) 6333929, e-mail aclc@appalachianlawcenter.org.
Children’s Law
The Children's Law Center provides attorneys to represent young people in a variety of legal and
administrative proceedings including child abuse and neglect matters, special education and other
school issues, homelessness, juvenile justice issues, and "multi-system" cases. The Children’s Law
Center, 1002 Russell Street, Covington, Kentucky 41011, (859) 431-3313.
Domestic Violence (See the module on Domestic Violence)
The Kentucky Domestic Violence Association is a statewide organization that supports the 15
domestic violence programs in Kentucky. These 15 programs are linked with Kentucky’s Legal Aid
programs, so an eligible survivor in need of legal assistance can easily obtain a referral for free legal
aid.
Elder Law
Although all legal services agencies provide services to elders and many pro bono attorneys do the
same, the Access to Justice Foundation (in Lexington) operates a Legal HelpLine for Older
Kentuckians at (800) 200-3633. This HelpLine offers advice on legal issues, Medicare, and Medicaid
to Kentuckians who are 60 and older.
Immigration Law
The following provide legal advice and representation in immigration cases.



Maxwell Street Legal Clinic, 201 East Maxwell Street, Lexington, Kentucky 40508,
(859) 233-3840
Catholic Charities of Louisville, 2911 South Fourth Street, Louisville, Kentucky 40208, (502)
637-9097
Kentucky Refugee Ministries, 969 Cherokee Rd # B, Louisville, Kentucky 40204, (502) 4799180
Support materials for clients representing themselves (pro se)
Some clients will choose to represent themselves in court or have no choice but to do so. Sometimes
tasks may seem deceptively simple. We encourage agencies to work in partnership with their local
legal services provider to anticipate implications of general legal problems for homelessness.
The following categories of legal forms can be downloaded from the legal services Web site, under
Self-Help Forms. There is a video on the Web page instructing you on how to complete the forms.
Collection Agency "Stop Contact" Letter - The Fair Debt Collections Practices Act gives you the right
to send a letter to a collection agency telling them to stop contacting you. This form helps you create
a "stop contact" letter.
Criminal Record Expungement - Interactive forms are free for low-income individuals seeking a
criminal record expungement in Kentucky.
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Divorce
Self-Help Divorce Forms
Selected Jefferson County Forms – These forms may be useful if your client has been granted a
divorce in Louisville (Jefferson County) and is interested in contempt orders or in modifying child
custody, primary residence, child support, and visitation.
Spanish Language Divorce Without Children - Formas interactivas para parejas que están buscando
un divorcio en Kentucky y no tienen niños menores.
Earned Income Tax Credits for Low-Income Working Kentuckians - determine if your client is eligible
for money from the federal government.
In Forma Pauperis (Waiver of Court and Service Fees) - An interactive form that will produce the
documents needed to request a waiver of filing fees from the court.
Landlord/Tenant
Security Deposit Demand Letter - An easy to use interactive form to produce a letter addressed to
previous property owners/managers demanding the return of the security deposit.
Sample Letters to Landlord - Letters that can be complete and sent to a property owner/manager to
address problems with security deposits, eviction, utility service shut-off, etc.
Living Wills - An interactive form to complete a Living Will expressing wishes about the end of life
medical treatment.
Name Change Petition - An interactive form to help with a name change for self or child(ren) in
Kentucky.
Small Claims - Free, interactive court forms for Small Claims cases for low-income individuals.
Practice Comment
Searching for civil legal assistance can seem frustrating if you do not already have a network (a net
that works). One effective way to build a legal network is to end every conversation with this question,
“If you can’t help me (or my client), can you suggest someone else who can?”
Write the answer down, and follow up. Encourage your clients to do the same. Please build a
network (a net that works) of like-minded potential collaborators to support your clients and each
other. Invite everyone in the network for coffee and food just to get to know each other, not to ask for
anything. Attorneys who get to know case managers will become comfortable asking for your
assistance in accessing supports for their clients. Mutual relationships build enduring networks.
Learning Activities & Next Steps
 Locate your local Legal Aid office. Meet the staff, learn about the types of cases with which
they work, and their referral process.
 Figure out how the pro bono system for civil legal assistance works in your community.
 Local your local Public Defenders office. Meet the staff and learn about their general
operations.
 Take a tour of your local courthouse, learn where various offices are, and meet some of the
staff.
 Check out some of the self help legal forms referenced in this section.
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UNIT 9: Safety
Description:
This unit presents tips to ensure case manager safety, ideally through prevention, but also in the
event an unsafe situation arises. It discusses prevention/preparation, assessment, deescalation/intervention, and post-crisis return to baseline. An effective case manager is safer, and a
safe case manager is more effective.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Identify ways to prevent crisis situations and be prepared in the event a tense situation arises.
2. Reinforce their assessment abilities and understand the value of assessment as a continual
practice.
3. Identify de-escalation strategies to use during various levels of escalated behavior.
4. Describe safety tips that they will implement in their day-to-day routine.
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Although this section focuses on the threat posed by people, it is crucial that case managers not treat
their clients as a safety risk. Doing this damages rapport, causes the case manager to be less
effective, and could result in an environment that is less safe. Case managers must maintain a
healthy balance of preparedness, awareness, and self-preservation while not losing the compassion
and trust that is so important to what we do.
SECTION 1: Why do People Become Aggressive?
There are several reasons that a person may become aggressive. None of them automatically lead to
aggressive behavior but it is important to be aware of them to aid in preparation and assessment.









Intoxication: A person who is intoxicated has lower inhibitions, impaired impulse control, and
may be more disposed to respond aggressively.
Mental Illness: There is a debate whether a correlation exists between mental illness and
violence. Some literature shows that persons with a mental illness are no more likely to be
aggressive than those without a mental illness. However, certain symptoms of mental illness
(e.g. command hallucinations) may lead to aggression.
When threatened: When a person’s safety, family, or basic needs, such as food and shelter,
are threatened, they are more likely to respond with aggression.
Environment: An environment that is subject to extreme temperature, is chaotic, or otherwise
uncomfortable may elicit aggressive behavior.
Stress: A person under a significant amount of stress may have a tendency to be more
aggressive.
Developmental Age: The lower a person’s developmental age, the more likely he/she will lash
out. Part of the reason for this is the person may lack the communication skills to verbalize
needs.
Physical: People in pain or experiencing other physical discomfort may be more likely to
exhibit aggression.
Frustration: When extremely frustrated a person may become more aggressive.
Power, intimidation, or to obtain something: A person may become aggressive to feel
powerful or to obtain something they want, such as valuables.
SECTION 2: Prevention/Preparation
The best way to ensure safety is to prevent crises, and the key to prevention is preparation.
Agency Policies and Procedures
A good plan for employee safety starts with appropriate agency policies and procedures. Case
managers should be familiar with their agency’s safety policies. If policies are unclear or absent, case
managers should speak with their supervisor.
Job-Specific Protocols
For larger agencies where homeless services case management is only one of multiple services,
specific protocols should be established that address the unique circumstances faced by case
managers. Become very familiar with these protocols and discuss them regularly within the homeless
services team.
Situation Specific Plan
It is important for case managers to have situation specific plans for each visit. Prior to the visit, the
case manager should consider where the visit is taking place, what safety risks may be present, how
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well he/she knows the client, if there is anything that might predispose the client to aggressive
behavior, and what he/she will do if the situation becomes unsafe.
Personal Plan
Know yourself.
Know how you react to unsafe situations, how you deal with stress, and whether your tendency is to
exhibit a fight-or-flight response when in a dangerous situation. By knowing yourself you will be
capable of controlling your reactions and remaining calm so you can more effectively handle any
situation.
Have the right mindset.
Maintaining good physical, mental, and emotional health fuels a mindset that leads to effectiveness
and safety. Your commute to and from work can act like a filter. During your trip to work you filter out
what is stressful at home and in your personal life so you are better prepared for the day. This allows
your observation skills, assessment, reaction, and behavior to be optimized. Similarly, on your way
home, you filter out any negative things that have happened that day so you can enjoy your family,
friends, and personal activities.
Safety Tips for Effective Case Management
These tips are compiled from many different resources.
Office Setting
 Create a comfortable environment, e.g., temperature, minimal waiting.
 Know your agency or office safety plan.
 Only meet with people in the office when there are other staff close
 If the client can only meet you at a time when no one else can be in the office, take the client
on a walk or arrange the meeting for a public place, such as a fast food restaurant or coffee
shop, and tell the client you will pay for their drink
 Arrange your furniture so you have an easy escape route; it’s also good if the client has easy
access to an exit.
 Don’t position yourself so there is someone between you and the exit.
 Keep your work space safe, with nothing that could be used as a weapon easy to grab e.g.,
staplers, hole punches, scissors.
 Don’t position your desk so your back is to the door.
 If you will have someone you are concerned about in your office have a barrier between you
and the person e.g., the desk, a table.
 When meeting with a client you are concerned about alert other staff prior to the meeting so
they can check on you.
Community Setting
 Do your own work about your fears about a particular setting. Be a critical thinker. Are your
fears based on evidence or myths and stereotypes? Are they warranted and cause to rethink
the visit?
 How much is fear of the unknown influencing your feelings? Is there someone you can talk
with about the situation before you make your visit?
 Be confident, walk with purpose, and be aware of body language.
 Be alert and aware of your surroundings.
 Be aware of possible hiding places and keep away from them.
 Know where you are so if you have to call for help you can give your location.
 Keep aware of possible safe places nearby e.g., stores, community centers.
 Be aware of friendly, welcoming people to whom you could turn for help.
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Be aware of others who may pose a danger to you.
In multi-story buildings, use the elevator rather than an enclosed staircase. Look in the
elevator before entering and take the next one if it looks unsafe. If a suspicious person enters,
get off before the door closes. If that’s not possible, stand near the control panel and, if
something happens, push all the buttons.
Park where you can easily get out, back into parking spots, and be aware of at least two exits
to the parking lot.
Park in a well-lit place.
Don’t park directly in front of the home.
Have your keys ready so you can quickly get into your car.
Keep your car in good working condition.
Keep your doors locked and windows closed while driving.
Keys can be used as a weapon if held protruding between your fingers with your hand in a fist
to ward off attackers.
Have your cell phone easy to access and ready to call for help, if highly concerned have 9 and
1 dialed into your phone and be prepared to dial the last 1 if faced with danger.
Dress professionally so it is obvious that you are in the setting for a business reason rather
than a social event.
Wear clothing that allows you to move easily and quickly.
Do not wear fancy or expensive clothing or jewelry that will attract unwanted attention.
Wear a nametag or carry something that identifies you, especially if you are from an agency
that would be seen as a positive force in the neighborhood.
Do not wear things around your neck that can be used to choke you.
Don’t have valuables, purses, bags, etc., in your vehicle where others can see them.
Put valuables in the trunk of your car before you get to the destination.
Don’t carry too many things or things that you can’t bear to lose if you have to drop them to
run.
Create a buddy system so someone else knows where you are, when you should be there,
and when you should be finished with the visit. They should know the make, model, and color
of your vehicle, your license plate number, your cell and home phone numbers, and contact
information for the client(s) being visited.
Drive by the area first to see what’s going on and who’s hanging around.
Listen from outside of the door for disturbances.
Stand to the side of the door, not directly in front of it when knocking.
Introduce yourself clearly.
Make yourself aware of the potential exits, keep the door unlocked if possible, and have a
clear path to the exit.
Keep your cell phone in your possession; don’t put it in your purse or on the table.
Greet people as you walk through the neighborhood so you might be seen as someone
friendly. These people may become good allies and a source of important information.
SECTION 3: Assessment
Assessment is a continuous process that evaluates all areas of what you do. It means perpetually
educating yourself about you, your work environment, your clients, and your clients’ environment.
This process facilitates trust, comfort and confidence within a situation, yourself, your client, and the
rapport between you and your client. By doing this, you can develop individualized plans for different
situations and clients.
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BUILDING RELATIONSHIPS/INCREASING KNOWLEDGE
 Get to know yourself
 What are your strengths (in dealing with clients, tense situations, etc.)?
 What areas do you need to improve to minimize your risk and increase effectiveness?
 How do you feel about your client, the environment, others in the environment, etc.?
 What is important to you?
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Get to know your client
 What are your client’s strengths?
 Find out some situations where your client has dealt effectively with frustrations and tense
situations?
 What is going on in your client’s life that may be helpful in de-escalating a situation or
increased tension?
 Does the client have any triggers that cause increased tension?
 Does the person have a history of violence? (What kind of violence, towards whom, etc.?)
 Does the person have internal feelings associated with violence (fear, grief, anger, etc.)?
 Does the person have physical factors associated increasing the likelihood of violence (lack
of sleep, substance use, exhaustion, brain trauma, physical discomfort, physical disability,
mental illness, etc.)?
 Does the person have access to weapons?
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Get to know your agency
 What are the policies on meeting with clients (in the home, alone in the office, if you don’t
feel comfortable, etc.)
 What are your options if you don’t feel comfortable (buddy system, alternate meeting place,
etc.)
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Get to know the environment
 What is a good time to meet with your client?
 Are there safe people around that you can go to for help?
 Are there unsafe people around to look out for?
 Are there safe places to go if a situation goes bad?
 Are there other places to meet with the client or to take the client if the situation gets tense?
 Are there things going on in the surrounding area to look out for (gang activity, drug activity,
etc.)?
 Keep informed of things that help or hinder situations
 Are there things happening in the community, the news, etc., that may improve or worsen
the client’s situation?
 What drugs are current and do you know the signs of their presence and use (e.g. meth,
meth labs)?
DURING A VISIT, BEFORE A CRISIS
 You should constantly be assessing the person, situation, and environment before a crisis
happens. Do what you can to minimize the risk based on your assessment. Consider, before
the crisis, about who are people who can assist the client in distress, and what coping and
self-soothing skills have worked for the client previously. How can you help the client mobilize
these strengths?
 Will the cause of the visit likely increase the potential for aggression (forced removal, giving
bad news, removal of basic needs, etc.)?
 Assess yourself
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 What is your mood?
 How do you feel about this visit?
 What do you know about this client, environment, etc.?
Assess the person
 What is the client’s mood
 Does the person appear to be intoxicated
 Does the person appear to be upset (pacing, raised tone of voice, distracted, clenched fist,
fidgety, etc.)
 Look for changes in behavior (may not always appear agitated)
Assess the environment
 Is the environment comfortable?
 Does the environment have excessive energy, are people agitated?
 Are there others around who may be of help or to look out for?
 Are there places you might go with the client if the situation becomes tense?
 Where are potential exits?
 If no exits are easy to get to, are there other safe places (e.g. lock self in bathroom)?
 Are there any weapons around?
 Are there signs of drugs?
 Are there any animals that may be dangerous?
DURING AN ESCALATION/CRISIS
It is so important to remain as calm as possible so you can be alert, assess what is going on, and be
able to act suitably.
Assess yourself
 Are you calm?
 What is your body language saying?
 What is your fight-or-flight response doing to you?
 What do you know about this client or environment that may help the situation or make it
worse?
Assess the person
 What is the level of agitation and what de-escalation techniques may be useful?
 Is the person within striking distance?
 What signs of aggression is the person exhibiting (yelling, clenched fist, glaring, withdrawal,
etc.)?
 What is contributing to or causing the aggressive behavior (being told “no,” trying to convey
information, intoxication, symptoms of mental illness, command auditory hallucinations, or
paranoia, etc.)?
 Is anything exacerbating the aggression (discomfort, feeling trapped, loud environment, etc.)?
Assess the environment
 What’s your escape plan?
 Are there any weapons the aggressor may try to use against you?
 Is there anyone else around who may be another threat, victim, or a help?
 Is there anything around that you can use to defend yourself (barriers, things to pick up to
block blows, etc.)?
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POST ESCALATION/CRISIS
Assess yourself
 Are you physically ok?
 Are you emotionally ok?
 What can you do to care for yourself?
 Are there agency policies regarding an incident you need to implement?
Assess the aggressor
 If it is a client and you are still present
 Is it an opportunity to praise his ability to calm?
 Is he/she physically and emotionally ok?
 Is there still some tension that may escalate if not properly handled?
 What plans do you both need to make to debrief?
Assess the environment
 Is the environment now safe?
 If there are others present, are they physically and emotionally ok?
 Do these other persons have an opportunity to debrief and come to terms with what has
occurred?
 If there has been violence of any kind with children present, what provision will be made for
follow-up?
SECTION 4: De-escalation/Intervention
GENERAL RULES
 Stay calm
 Remember what you’ve learned during all assessment phases
 Put into practice any plans/protocols you have in place
 Your agency policies
 Your situational plan
 Your plan to counter your fight-or-flight reaction
IF AN INDIVIDUAL’S BEHAVIOR ESCALATES
 Speak in calm, clear, direct language
 Be aware of your volume, tone, and rate of speech
 Speaking in a low volume can make the person have to concentrate to hear you and cause
him to lower their volume.
 Tone should be appropriate to the message being portrayed by the individual.
 The rate should not be too fast to give the perception of loss of personal control.
 Eliminate excessive stimuli wherever possible (loud music, TV’s, etc.).
 Don’t tell the person to “calm down.”
 Allow the person an escape route, don’t trap them.
 Listen to what the person is saying behind the aggressive tones.
 Be empathetic.
 Take responsibility for your mistakes.
 Don’t use strict ultimatums, allow the person to make choices.
 Use “I” rather than “you” language.
 Maintain an open mind, refrain from judging, don’t accuse, don’t belittle.
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Redirection (distracting or changing the subject) and humor can sometimes work but be
cautious as they can also backfire. Don’t use these techniques unless you know the person
well and are confident in the situation.
Maintain a calm, comfortable posture but be prepared to move quickly if the individual
escalates quickly.
Maintain eye contact to show interest and involvement.
Be cautious about touching the person unless you know him well and it is appropriate.
IF AN INDIVIDUAL BECOMES THREATENING
 Use the same communication tips mentioned above for when someone is upset although the
language and message may be more direct.
 Remember the rule of 5 if the individual is imminently aggressive and enraged. Words should
be no more than 5 letters long, and sentences should be no more than 5 words long.
 Stay out of striking range (both hitting and kicking).
 Maintain a non-threatening stance, slightly turned, and not directly in front of aggressor.
 Be prepared to run or move quickly; have feet slightly apart, be on the balls of your feet, and
have knees slightly bent.
 Eye contact to show interest and involvement is good but look for cues from the person to see
if she wants eye contact and act accordingly.
 Have arms ready to block any blows (not crossed, in your pockets, etc.).
 Don’t turn your back to the person.
 Movements should be slow and apparent.
 Do not touch the person.
IF ATTACKED
 Protect yourself.
 If attacker is someone you know and is enraged, the two most likely words to be heard are
their name and “Stop!”
 Escape and run, and yell “Fire!” (People are more likely to call for assistance to protect them
than to respond to a vague “Help!”)
 Protect yourself from head injuries; block blows with arms or objects.
 If you fall, block the blows with your feet and legs.
 If you cannot block the blows with your legs, get into a fetal position and block your head with
your hands and arms, and block your mid-section with your arms and legs.
 Use any self-defense tactics you have learned.
 If the aggressor has a weapon, do not reach for it.
 If your arm is grabbed, twist your arm quickly towards the person’s thumb.
 If you are choked with someone’s hands (i.e. not a headlock), raise both of your arms straight
up and turn quickly-your arms and shoulders to break the hold.
 If you are bitten, push into the bite; don’t pull away
 If your hair is pulled, press down on the persons hand with both of yours and hold on.
SECTION 5: Post Crisis/Return to Equilibrium
Part of handling a crisis is knowing what you will do after it has passed to return yourself to your
baseline.
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What will you do immediately after a crisis?
Everyone handles this time differently. Some like to talk to others; others need some time to
themselves. Some want to take a walk, while others might sit quietly in their office. Whatever works
for you, do it.
At some point shortly after the crisis, it is important to talk to your supervisor to debrief and go over
what can be done to avoid future situations.
What will you do after the day is finished and you go home?
Again, this is different for each individual. You might go for a run, eat a good meal, talk to a friend,
watch some T.V., or take a nap. What is important is that you do something that helps you relax,
relieve stress, and prepares you for another day.
What will you do to maintain a lifestyle that helps you be prepared and manage stress?
Self-care is so important, particularly in this field. Many people in this line of work expend all of their
energy on taking care of others, and, unfortunately, neglect themselves. Take the time to maintain
and refuel your body and your mind; you will be happier and better prepared to help those you serve.
Learning Activities and Next Steps
 Review your agency’s safety procedures.
 Create and follow a self-care plan.
 Talk with your supervisor and colleagues about crisis management, what they have needed
the most in their work, what types of situations have arisen for them, what solutions have
worked for them and any other questions you have.
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UNIT 10: Mental Illness
Description:
This unit presents the federal and state definitions of mental illness, the different types of mental
illnesses, and the medications and medication management of mental illness. Topics discussed
include diagnostic criteria, symptoms of mental illness, and potential side effects of medication.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Identify federal and state definitions of severe mental illness.
2. Describe the different types of severe mental illness.
3. Identify potential side effects of medication.
4. Identify ways to increase adherence to medication.
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SECTION 1: Definitions: Who are Persons with a Mental Illness?
The federal definition of severe mental illness, published in the Federal Register, May 20, 1993:
“Adults with a serious mental illness are persons:
• age 18 and over,
• who currently or at any time during the last year, have had a diagnosable mental, behavioral,
or emotional disorder of sufficient duration to merit diagnostic criteria specified within the
Diagnostic and Statistical Manual of Mental Disorders.
• that has resulted in functional impairment which substantially interferes with or limits one or
more major life activities.”
These disorders include any mental disorders (including those of biological etiology) listed in the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of
Diseases equivalent with the exception of DSM V-codes, substance use disorders, and
developmental disorders, unless they co-occur with another diagnosable serious mental illness.
All of these disorders have episodic, recurrent, or persistent features; however, they vary in terms
of severity and disabling effects.
Functional impairment is defined as difficulties that substantially interfere with or limit role
functioning in one or more major life activities including basic living skills (e.g. eating, bathing,
dressing); instrumental living skills (e.g. maintaining a household, managing money, getting
around the community, taking prescribed medication); and functioning in social, family, and
vocational/educational contexts. Adults who would have met functional impairment criteria during
the referenced year without the benefit of treatment or other support services are considered to
have serious mental illnesses.
Kentucky’s statutory definition (KRS 210.005) defines mental illness as follows:
“‘Mental illness’ means a diagnostic term that covers many clinical categories, typically including
behavioral or psychological symptoms, or both, along with impairment of personal and social
function, and specifically defined and clinically interpreted through reference to criteria contained
in the Diagnostic and Statistical Manual of Mental Disorders (Third Edition) and any subsequent
revision thereto, of the American Psychiatric Association. ‘Chronic’ means that clinically
significant symptoms of mental illness have persisted in the individual for a continuous period of at
least two (2) years, or that the individual has been hospitalized for mental illness more than once
in the last two (2) years, and that the individual is presently significantly impaired in his ability to
function socially or occupationally, or both.”
Psychiatric diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders
4th Edition, Text Revision (DSM-IV). The manual is published by the American Psychiatric
Association and covers all the mental health disorders.
The manual lists the known causes for the disorders, as well as, statistics in terms of gender, age at
onset, prognosis, and some research concerning the optimal treatment approaches. The diagnosis is
separated into five axes. Each axis represents an aspect of functioning.
Axis I
Clinical Disorders (Includes all mental health conditions except developmental
disorders and personality disorders.)
Axis II
Personality and Developmental Disorders
Axis III General Medical Conditions (Used to report any major medical conditions that may
be relevant to treatment of the mental health disorder.)
Axis IV Psychosocial and Environmental Problems (For example, problems with primary
support group, social environment, educational problems, housing problems,
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Axis V
economic problems, occupational difficulties, legal difficulties, or transportation
difficulties.)
Global Assessment of Functioning (A general indicator of the individual’s overall
level of functioning.)
A person may suffer from more than one Axis I disorder. The majority of diagnoses that fall within the
criteria of severe mental illness are found on Axis I; however, Axis II psychiatric disorders may qualify
if there are sufficient functional difficulties, an extended duration of problems, and continued reliance
upon publicly funded services and supports (Hodge & Giesler, 1997).
Another classification system found in many medical settings is the Tenth Revision of the International
Classification of Diseases (ICD-10). The World Health Organization developed the ICD-10 to classify
diseases and other health problems. Although it is less detailed than the DSM, it is the official
international classification system for psychological disorders. The codes and terms used in the
DSM-IV are fully compatible with the ICD-10.
SECTION 2: Types of Mental Illnesses
Presentation of Severe Mental Illness
It is important to remember that individuals with a severe mental illness are not symptomatic all the
time. If not entirely symptom free, they may have a low level of symptoms that are, at times,
manageable. It is important for case managers to have some awareness of, and knowledge about,
the various types of serious mental illnesses and to be able to recognize symptoms.
Psychotic Disorders
The common characteristics of these disorders are symptoms that center on problems of thinking.
The DSM-IV-TR describes two broad categories of symptoms: positive and negative.
Positive symptoms represent the presence of something extra that people do not ordinarily
experience, including delusions, hallucinations, disorganized speech, and bizarre behavior.
Negative symptoms represent the absence of something that people ordinarily experience,
and is evidenced by affective flattening, poverty of speech, social withdrawal, and decline in
personal hygiene and grooming.
The most prominent (and problematic) symptoms of psychotic disorders are delusions and
hallucinations.
Delusions are false beliefs that significantly hinder a person’s ability to function. For example,
they may believe that people are trying to hurt them, or they may believe they are someone
else (a CIA agent, God, Superman, etc.).
Hallucinations are false perceptions that can appear in any sensory modality–visual, auditory,
olfactory, gustatory, tactile, or mixed. The most common hallucinations associated with
psychotic disorders are auditory and are often experienced by the consumer as “hearing
voices.”
Types of Psychotic Disorders
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Schizophrenia: This is one of the most common of the psychotic disorders and one of the most
devastating in terms of the effect it has on a person’s life. Symptoms may include hallucinations,
delusions, disorganized speech, grossly disorganized or catatonic behavior, social withdrawal, lack of
interest, and poor hygiene.
Schizoaffective Disorder: Another psychotic disorder in which symptoms that meet the criteria for
schizophrenia are present and during which, at some time, there is either a Major Depressive
Episode, or a Mixed (Manic) Episode concurrent with symptoms of schizophrenia.
Delusional Disorder: A psychotic disorder in which a person experiences a non-bizarre delusion for at
least one month. This type of delusion involves a situation that could occur in real life (for example,
being followed or watched, poisoned, loved at a distance, or having a spouse that is cheating on
them).
And other psychotic disorders such as Brief Psychotic Disorder, Substance Induced Psychotic
Disorder, and others.
Mood Disorders
The disorders in this category include those where the primary symptom is a disturbance in mood,
where there may be inappropriate, exaggerated, or a limited range of feelings or emotions.
Everyone gets down sometimes, and everybody experiences a sense of excitement or emotional
pleasure. However, when a person has a mood disorder, feelings or emotions are to the extreme.
Many consumers with mood disorders function very well in outpatient settings though they may be
hospitalized for brief periods.
Depression: Instead of just feeling down, the consumer might not be able to work or function at
home, they might feel suicidal, lose their appetite, and feel very tired or fatigued. Other symptoms
may include loss of interest, weight changes, changes in sleep and appetite, feelings of
worthlessness, loss of concentration, and recurrent thoughts of death.
Mania: This includes feelings that would be more towards the opposite extreme. There might be an
excess of energy where sleep was not needed for days at a time. The consumer may be feeling “on
top of the world,” and during this time, the consumer’s decision - making process might be
significantly impaired and expansive, they may experience irritability and have aggressive outbursts,
although the consumer might think they were perfectly rational.
Bipolar Disorder: A person with Bipolar disorder cycles between episodes of mania and depression.
These episodes are characterized by a distinct period of abnormally elevated, expansive, or irritable
mood. Symptoms may include:
 inflated self-esteem or grandiosity
 decreased need for sleep
 more talkative than usual
 flight of ideas or a feeling that their thoughts are racing
 distractibility
 increase in goal-directed activity
 excessive involvement in pleasurable activities that have a high potential for painful
consequences (i.e. sexual indiscretions, buying sprees)
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Individuals who have recurring manic episodes will frequently have a problem keeping jobs or having
stable relationships. Their behavior may get them into financial trouble or even result in criminal
charges. When experiencing mania, the person will often have great difficulty making decisions that
are in their best interest.
The depressive phase of this illness can also be quite devastating and if the depressive episode
follows a manic episode, the contrast can be unbearable. Individuals with Bipolar Disorder can
experience severe depressive symptoms and may at times be a significant risk for suicide.
Personality Disorders
Individuals with Personality Disorders have symptoms and personality traits that are enduring and
play a major role in most, if not all, aspects of the person’s life. These individuals have personality
traits that are inflexible and cause impairment in social or occupational functioning or cause personal
distress. Symptoms are evident in their:
 thoughts (ways of looking at the world, thinking about self or others)
 emotions (appropriateness, intensity, and range)
 interpersonal functioning (relationships and interpersonal skills)
 impulse control
Personality disorders are listed in the DSM-IV-TR under three distinct areas, referred to as “clusters.”
The clusters are listed below with the types of symptoms or traits seen in that category and the
specific personality disorders included in each cluster:
Cluster A – Odd or eccentric behavior. It includes: Paranoid, Schizoid, and Schizotypal
Personality Disorders.
Cluster B – Dramatic, emotional, or erratic behavior. It includes: Antisocial, Borderline,
Histrionic, and Narcissistic Personality Disorders.
Cluster C – Anxious, fearful behavior. It includes: Avoidant, Dependent, and ObsessiveCompulsive Personality Disorder.
Individuals with Personality Disorders from Cluster B often have a dramatic presentation and exhibit a
high level of use of services including hospitalization. It is important to do a careful needs
assessment with these individuals to make sure they can benefit from case management services. It
may be contraindicated to provide a long-term supportive service. However, they may benefit from
short-term targeted services, such as referrals to vocational programs, assistance with paperwork for
entitlement programs, etc.
SECTION 3: Medication and Medication Management
This section is focused on providing basic information about medicines. This section is not intended
to make case managers “experts” in medication; physicians and other healthcare professionals spend
many years learning about medications, and a brief training as this will not substitute for this
expertise.
Rather, this section is intended to help case managers understand the importance of medications,
some of the warning signs of problematic side effects, and a few tips on improving medication
adherence.
Why take medications?
Medications are prescribed to modify chemicals in the body whose failure to operate correctly
produces symptoms.
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What do medications do?
Nerve cells communicate with each other and with other cells in the body by the use of chemicals
called neurotransmitters. Most of the medications people with mental illness take alter how the nerve
cells utilize these neurotransmitters. The theory is that problems with neurotransmitters underlie
many of the symptoms of mental illnesses.
Symptoms
Impaired Judgment: Poor neurological functioning causes problems in logical thinking, clear
understandings about cause-and-effect relationships, and awareness of the consequences of one’s
actions. The result is often poor life decisions. On a day-to-day basis, impaired judgment is often the
most disabling of all of the symptoms of mental illness.
Impaired Object Relations: Individuals with mental illness have impairments in their ability to
empathize with others and to respond appropriately in social interactions with others (interpersonal
relationships). On a day-to-day basis, impairments in object relations have devastating
consequences to successful functioning and quality of life.
Impaired Impulse Control: Individuals with mental illness may have difficulty resisting impulses, and
may say and do things that create problems for them in the community, with law enforcement, and in
relationships with others. The flip side of impaired impulse control is impairment in volition; individuals
may have difficulty initiating and following through on tasks and activities of daily life.
Labile or Flat Affect: People may be hyper-reactive emotionally, or display little or no emotional
reactivity. Labile or flat affect may not reflect people’s internal experience; the expression of emotion
is disordered, not necessarily the subjective experience of emotion
Depersonalization: Experiences of unreality and distortions in perceptions. Individuals may have a
sense of being outside themselves, of a tilting or other strange perception of external reality, of a
slowing or speeding up of the passing of time, a dullness or numbness, etc. People often have a
difficult time describing depersonalization experiences, but episodes of depersonalization are very
disruptive to day-to-day functioning.
Anxiety: A physiologically-based increase in arousal that produces extreme discomfort. Anxiety is not
the same as worrying, although excessive worrying may occur as the result of anxiety. Anxiety is the
least effectively treated symptom in most programs that serve people with mental illness, and causes
immeasurable suffering.
Obsessive-Compulsive Symptoms: Obsession consists of thoughts that tend to pervade a person’s
consciousness that interfere with other cognitive tasks. Compulsions are actions an individual feels
compelled to carry out that have little or no functional value.
Aggressiveness: May occur as a result of the effect of one or more of the symptoms previously
discussed, such as, persecutory delusions combined with impaired judgment, anxiety and impaired
impulse control. Medications may be prescribed to reduce aggressiveness, although the medication’s
action is actually aimed at the underlying symptoms that may be producing the aggressiveness.
Medication
Medications are prescribed to reduce or eliminate symptoms. Some symptoms may be effectively
ameliorated by medication (hallucinations or florid delusions), while others may be only minimally
affected (impaired judgment, impaired object relations). While symptom reduction is the desired effect
of medications, many psychiatric medications also have unintended effects.
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Unintended Effects
Unintended effects are often referred to as “side effects.” Sometimes side effects are so severe as to
be called “adverse effects.” Negative side effects can significantly reduce people’s quality of life, and
some can be dangerous to people’s health. Some of the medications that people take are intended to
treat the side effects that are caused by the medications that they are taking to treat their symptoms of
mental illness.
Side Effects
The Patient’s Reality:
The drugs I had taken for so many months affected every part of my body. My eyes kept going
out of focus, especially when I tried to read. My mouth was dry, my tongue swollen, my words
slurred. Sometimes I forgot what I was trying to say. My body was puffy. I hadn’t menstruated
in months, and was able to move my bowels only with enormous amounts of laxatives. I had
no energy at all. If walking around in a constant haze is supposed to be tranquility, I was
successfully tranquilized. ~Judi Chamberlin
Side effects may be unavoidable with certain medications, but case managers should be alert to the
signs of side effects, and should let the physician or nursing staff know that these side effects have
been observed.
Some of the side effects that you should watch for are…
Sedation, Drowsiness, Lethargy - Many medications can have the effect of sedating people, making
them drowsy and lethargic.
Dry mouth - Many medications cause dry mouth, which may in turn lead to problems with hydration,
such as water intoxication.
Sexual dysfunction - Men may experience impotence and/or inability to ejaculate. Women’s inability
to experience pleasurable sexual activity may also occur. A rare but dangerous side effect in men is
priapism.
Constipation or diarrhea - Disruption of the digestive system is a common side effect.
Insomnia - Some medications may cause sleep disturbances, which are often characterized by early
awakening in the early hours of the morning.
Weight gain - Some of the newer anti-psychotic medications often produce significant weight gain,
and may also contribute to the development of Type 2 Diabetes.
Increased risk for sunburn - It is important to be aware that some medications cause people to be
particularly susceptible to sunburn, and they may need additional protections when outside.
Abnormal Movements - A variety of kinds of abnormal movements may occur with some medications,
including movements of the mouth, the hands and fingers.


Akathesia - Characterized by restlessness and an inability to be still.
Dystonia - An acute side effect characterized by muscle spasms, which are a “stone”-like
tightness in the head, neck, and eyes (requires immediate medical attention).
69

Parkinsonism - Symptoms include masked facies, slowed movement, a shuffling gait, rigidity,
and drooling.
Agranulocytosis - Occurs in some people who take clozapine (Clozaril). It involves a rapid and
dramatic drop in the white blood cell count and produces a dangerous susceptibility to infection. A
drop in white blood cell count may also occur with other medications.
De-Personalization - Just as de-personalization may be a symptom of mental illness, it can also occur
as a side effect of medication. People experiencing this may talk about not feeling like themselves,
feeling “dead inside,” etc.
Tardive Dyskenesia - A type of abnormal movement disorder that occurs frequently with some of the
older medications and often involves movements of the mouth and tongue, tremor and stiffness, and
can be irreversible. Tardive Dyskenesia is usually the result of long-term administration of the older
medications. Newer medications are often given in hopes of reducing the occurrence.
Neuroleptic Malignant Syndrome - A medical emergency, which usually has a rapid onset, that may
cause extreme stiffness of the body and is accompanied by an increase in body temperature up to
105 °F. Individuals with this side effect may have trouble walking or standing, may show delirium, or
otherwise be incoherent. This is a very dangerous condition that occasionally occurs, most often with
older medications and can be fatal.
SECTION 4: Emergency Services
Behavioral health emergency refers to any impairment in functional behavior that results in an
immediate threat to the health and safety of the individual. Ideally, these services will preserve
community placement and prevent institutionalization or increased level of care. The Regional MHID
Board is responsible for providing behavioral health emergency responses to all citizens living in their
jurisdictions, regardless of diagnosis or priority population group or agency of origin.
One of the ways this is provided is through 24-hour crisis and information lines. Each Regional MHID
Board operates a 24-hour crisis and information line to respond to emergencies in their region. These
1-800 lines are also TTY accessible for the person who is in crisis and also may be deaf or hard of
hearing. Staff for these lines typically receive specialized training on how to respond to persons who
are in crisis.
Each Regional MHID Board has, at a minimum, an on-call system set up staffed by qualified mental
health professionals who are credentialed to complete certifications pursuant to KRS 202A (see
below). Regions vary in the other types of services available after hours, particularly for persons who
may be in need of a face-to-face evaluation but do not meet criteria for involuntary treatment. Many
Regional MHID Boards have chosen to utilize their crisis program funds to develop sophisticated
after-hour mobile crisis services by either mental health professionals or case managers that provide
services in schools, hospitals, or other off-site locations. For a listing of Regional MHID Boards, areas
served, and 24-hour Crisis and Information Lines, see appendix III.
Hospitalization
The criteria for hospitalization of the mentally ill falls under Kentucky Revised Statutes, specifically,
KRS 202A, which can be accessed at http://www.lrc.ky.gov/KRS/202A00/CHAPTER.HTM.
The following sections deal with who can be admitted, the types of involuntary admissions, and how
long a person can be hospitalized.
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202A.026 Criteria for involuntary hospitalization
No person shall be involuntarily hospitalized unless such person is a mentally ill person:
(1) Who presents a danger or threat of danger to self, family or others as a result of the
mental illness;
(2) Who can reasonably benefit from treatment; and
(3) For whom hospitalization is the least restrictive alternative mode of treatment presently
available.
202A.028 Hospitalization by court order
(1) Following an examination by a qualified mental health professional and a certification by
that professional that the person meets the criteria for involuntary hospitalization, a judge
may order the person hospitalized for a period not to exceed seventy-two (72) hours,
excluding weekends and holidays. For the purposes of this section, the qualified mental
health professional shall be a staff member of a regional community mental health or
mental retardation program, unless the person to be examined is hospitalized and under
the care of a licensed psychiatrist, in which case the qualified mental health professional
shall be the psychiatrist if the psychiatrist is ordered, subject to the court's discretion, to
perform the required examination.
202A.031Seventy-two-hour emergency admission
(1) An authorized staff physician may order the admission of any person who is present at,
or is presented at, a hospital. For the purposes of this subsection only, a hospital may
include any acute care hospital that is licensed by the Commonwealth. Within twenty-four
(24) hours (excluding weekends and holidays) of the admission under this section, the
authorized staff physician ordering the admission of the individual shall certify in the
record of the individual that in his opinion the individual should be involuntarily
hospitalized.
Responsibilities of the Regional MHID Boards related to involuntary hospital admissions are also
covered under Administrative Regulations, specifically 908 KAR 2:09, which can be accessed at
http://www.lrc.ky.gov/kar/TITLE908.HTM.
Section 7. Community Mental Health - Mental Retardation Centers Responsibilities
(1) Under the authority of KRS 210.040(7) and (8), the cabinet may delegate to the
community mental health - mental retardation centers the responsibility to plan, prepare
written protocols, and coordinate services as provided within KRS Chapters 202A and
202B and 645.120.
(2) The center shall:
(a) Designate facilities for the purpose of conducting evaluations by qualified mental
health professionals;
(b) Notify providers of transportation services, district judges and the cabinet of the
identity and location of the facilities that are designated for the purpose of
evaluating individuals;
(c) Make qualified mental health professionals available twenty-four (24) hours per
day, seven (7) days per week at designated facilities to perform evaluations;
(d) Conduct evaluation requested by facilities within three (3) hours of the time of the
request unless extensions of time are negotiated between the facility and the
centers; and
(e) Assist the facility in referring the individual to a hospital for treatment if the
evaluation criteria are met and the individual has not been admitted to the
hospital where the evaluation is conducted.
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Crisis Stabilization Programs
Each Regional MHID Board in Kentucky has developed a crisis stabilization program. Some are crisis
units of 7-8 beds, others are mobile programs that serve the person in the community. Many regions
have chosen to develop beds in alternative settings than the crisis stabilization units, for the overnight
care for someone who is in crisis. The beds may be located in a personal care home or even
emergency apartments.
The criteria for adults who may be served by these crisis programs are:
 18 years of age
 Voluntary admission
 Behavioral health diagnosis or Axis I Diagnosis or exhibits acute symptoms of mental illness
 Not at imminent risk of harm to self or others and willingness to sign “no harm” contract
 Not intoxicated beyond .05 blood alcohol content
 Able to perform activities of daily living with minimal assistance or does not require nursing
facility level of care
 Medically stable
 Able to self-administer medications
 No pending criminal charges
Things that would exclude a person from the program include:
 Actively and intensely suicidal/homicidal
 Serious criminal charges
 Intoxication
 Medically fragile
 Victims of domestic violence seeking protection
 In need of housing services only
 Sexual perpetrator
Learning Activities and Next Steps:
 Find out who provides community mental health treatment in your community and what their
intake procedure is. Go and introduce yourself to their staff.
 Find out who provides inpatient mental health treatment (hospitalization) and what their intake
procedure is.
 Find out what crisis services are available in your community and where they are.
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UNIT 11: Substance Abuse
Description:
Nearly one-half of homeless men (47 percent) and 16 percent of homeless women experience alcohol
use disorders (Johnson, 1995). Homeless individuals who abuse alcohol and other drugs are quite
susceptible to liver disease, gastrointestinal ailments, tuberculosis, seizures and other neurological
disorders, hypertension, cardio-pulmonary diseases/disorders, and HIV/AIDS infection (Johnson,
1995). Furthermore, the combined chances of alcohol, drug, and mental health problems anytime in a
homeless person's life are estimated at 30 percent (Burt, Aron, Douglas, Valente, Lee, & Iwen,
1999).*
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Understand
a.
The factors important in the lives of homelessness individuals.
b.
The culture of the homeless.
c.
The homeless in a cultural context.
d.
What screening is, why it should be conducted, and some of the commonly used tools.
2. Recognize the ways in which the problems of homelessness and alcohol use disorders
interact and the prevalence of these co-occurring processes.
3. Become familiar with modifications of alcohol treatment approaches that enhance
effectiveness with homeless populations.
*Information in this unit excerpted from the National Institute on Alcohol Abuse and Alcoholism:
Alcohol Use Disorders in Homeless Populations available at
http://pubs.niaaa.nih.gov/publications/Social/Module10DHomeless/Module10D.html
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The Relationship of Alcohol and Homelessness
The relationship of alcohol and drug use to homelessness is interactive and iterative in that it is both a
cause and an effect of homelessness (Johnson & Cnaan, 1995). It is difficult for an individual with
limited financial resources to remain in stable housing. When significant proportions of those financial
resources are spent on alcohol or other substances, maintaining stable housing becomes even more
difficult. However, it is difficult for an individual to focus on substance abuse treatment when basic
survival needs for food and shelter are precariously and unreliably met. The stress and danger
associated with homelessness also may feed back into the cycle of relying on alcohol or other
substances as a coping strategy. Homelessness may result from poorly planned discharge from
residential treatment, institutionalization, hospitalization, or incarceration related to substance
involvement. There is also evidence that alcohol use among the homeless may provide some
secondary benefits. James Spradley (1970), an anthropologist working in Seattle during the 1960s,
found that the intermittently employed men living on skid row used alcohol as a source of
camaraderie. Here alcohol was an adaptation to life on the streets, as well as a cause of becoming a
"vagabond."
Traditional treatment options are not generally effective with the homeless population (Johnson &
Cnaan, 1995). Providers do not seek out homeless alcohol abusers and may be reluctant to treat
homeless persons because of unpredictable behavior, high-risk medical problems, and extensive
demands/needs (Lubran, 1990). Alcohol and addiction treatment programs historically provided very
little in the way of progressive levels in community-based care and support for homeless clients, and
state agencies have historically provided funding for very few services (Johnson & Cnaan, 1995).
Notable breakthroughs are attributed to the National Institute on Alcohol Abuse and Alcoholism
(NIAAA), and NIAAA and National Institute on Drug Abuse collaboration funding of demonstration
projects for homeless persons with alcohol and drug problems.
Treatment of Substance Abuse Problems Among the Homeless
There appears to be no definitive treatment strategy for alcohol-related intervention with homeless
individuals. However, common elements of successful interventions include:
 The integration of substance abuse and mental health services.
 Easy access to entering the program and avoiding disruption in making transitions (e.g., from
detoxification to longer term residence).
 The provision of intensive case management.
 The type of programs provided (e.g., recreational programs).
 Special emphasis on the provision of housing at the conclusion of treatment.
 Retention of homeless individuals in substance abuse programs by listening to their critiques
of other treatment programs, and making programmatic adjustments (Orwin, Garrison-Mogren,
Jacobs, & Sonnefeld, 1999).
Several treatment modalities have been or are currently being tested for efficacy with homeless
populations experiencing alcohol use disorders. These include outreach, Motivational Interviewing
(MI), intensive case management, stabilization programs, therapeutic communities within shelters,
and transitional and supportive housing for the formerly homeless. Confronting treatment barriers is
also an important strategy.
Outreach
Outreach is a first step for making contact with people living out-of-doors. The outreach worker, who
may be traveling on foot or by vehicle, offers the homeless individual social contact, food, referrals,
and advocacy. An interesting example of outreach work and its subsequent evaluation was the Park
Homeless Outreach Project in New York City (Ukeles Associates, 1995). Teams of workers became
acquainted with the homeless men, women, and couples who occupied three Manhattan parks
74
(including one park housing Gracie Mansion, the Mayor's official residence). During the two-year
project, the outreach teams made contact with almost every homeless park dweller (N=283). The
teams succeeded in connecting 89 of these individuals with services, including detoxification, alcohol
and drug treatment, entitlement programs, and temporary shelters. They placed 24 clients into
permanent or transitional housing.
The project was less successful in linking individuals to permanent housing; after 6 months, only 3 of
the 24 park dwellers placed in housing were known to be still sleeping indoors. Nevertheless, many
lessons were learned from this outreach project. For example, it was important for an individual
outreach worker to concentrate on a very specific geographic location in the park before trusting
relationships could develop. The worker needed to have regular hours in the park, but also had to be
flexible and come to the park as needed. Cellular phones helped the outreach workers link the client
directly and immediately with service providers when they were ready to move forward. Once the
clients were housed, it was important for the outreach worker to stay in touch with them and find new
housing if the first placement did not work out.
Screening for Substance Abuse
Types of Instruments
Two types of alcoholism-screening instruments are available. The first type includes self-report
questionnaires and structured interviews; the second type includes clinical laboratory tests that can
detect biochemical changes associated with excessive alcohol consumption. The value of a
screening instrument for measuring alcohol problems or other conditions is related to its sensitivity
and specificity. Sensitivity refers to a test's accuracy in identifying people who have an alcohol
problem (i.e., people with the condition test positive). Specificity refers to the test's effectiveness in
identifying people who do not have an alcohol problem (i.e., people without the disease test negative).
No screening instrument is perfect. It is not possible to optimize both sensitivity and specificity in the
same screening instrument. The likelihood of over identifying alcohol use disorders occurs with
increased sensitivity and the possibility of missing people who have an alcohol problem grows with
increased specificity. Despite these limitations, research supports the use of formal screening
instruments to increase the recognition of alcohol problems (5,9).
Questionnaires
Screening instruments vary in their ability to detect different patterns and levels of drinking and in the
degree of their applicability to specific subpopulations and settings (2). This section compares
features of some of the most widely used screening questionnaires. Detailed information is available
at the NIAAA Web site at http://www.niaaa.nih.gov.
The CAGE questionnaire (10) has been evaluated in several studies, showing sensitivities ranging
from 43 to 94 percent for detecting alcohol abuse and alcoholism (5). CAGE is well suited to busy
primary care settings because it poses four straightforward yes/no questions that the clinician can
easily remember and requires less than a minute to complete. However, the test may fail to detect
low but risky levels of drinking (5). In addition, CAGE often performs less well among women and
minority populations (11,12).
The performance of CAGE can be improved by incorporating questions about the quantity and
frequency of drinking, as recommended by NIAAA in The Physicians' Guide to Helping Patients With
Alcohol Problems (13). A study found that the screening strategy suggested in the Physicians' Guide
effectively identified alcohol abuse and dependence in a general population sample (14). The same
approach also demonstrated better sensitivity and similar specificity compared with CAGE alone
among African American patients in an urban emergency room (15).
75
The Alcohol Use Disorders Identification Test (AUDIT) (16) also incorporates questions about quantity
and frequency of alcohol use. In contrast to CAGE, AUDIT compares favorably with other instruments
in detecting risky drinking but is less effective in identifying alcohol abuse and alcoholism (5,17).
Originally developed for primary care settings, AUDIT has proven useful among medical and
psychiatric inpatients, in emergency rooms (17), and in the workplace (17–19). AUDIT is relatively
free of gender and cultural bias (11,17,20). In addition, it shows promise for screening adolescents
and older people, populations in which standard screening instruments produce inconsistent results
(12,17,21–23). The major disadvantage of AUDIT is its length and relative complexity; clinicians
require training to score and interpret the test results (3).
Screening pregnant women for alcohol use has become increasingly important in light of new
research showing that even low levels of prenatal alcohol exposure can harm the fetus.
Unfortunately, although approximately 20 percent of women consume some alcohol during
pregnancy, maternal drinking can be difficult to detect (24). At least two questionnaires are available
that are appropriate for pregnant women, both derived in part from CAGE. T–ACE (25) takes
approximately one minute to complete and is more accurate than AUDIT for detecting current alcohol
consumption and risky drinking, as well as a history of past alcoholism; however, it is less specific
(24). The five-item TWEAK (26) performs similarly to T–ACE (24) and can be used to detect a range
of drinking levels from moderate to high-risk consumption (27).
Motivational Interviewing
Many homeless individuals with alcohol problems spend much of their day meeting basic survival
needs in the laissez-faire, low-demand agencies of soup kitchens, day centers, and shelters. These
environments provide ideal locations and critical opportunities to utilize interventions designed to
increase an individual's motivation to change. Motivational Interviewing is a relatively new therapeutic
approach (Miller & Rollnick, 1991) for reducing or eliminating alcohol consumption and other addictive
behaviors across a number of diverse populations. This approach could be adapted for use with the
homeless, but it should be noted that its use has not been subjected to adequate empirical testing
with this population. The five basic principles of motivational interviewing are: (1) expressing
empathy, (2) developing discrepancy, (3) avoiding argumentation, (4) rolling with resistance, and (5)
supporting self-efficacy (Miller, Zweben, DiClemente, & Rychtarik, 1992). Clients are helped through
MI to move from the stages of pre-contemplation to contemplation, and then to determination, action,
and maintenance (Prochaska & DiClemente, 1982).
Developing discrepancy refers to the therapeutic aim of increasing clients' ambivalence regarding
their current behaviors and the extent to which they would like to avoid negative consequences in the
future. For example, many homeless individuals express great love and affection for their children.
Most cannot live with their children because of their lifestyle. This painful discrepancy between the
personal goal of maintaining close contact and the reality of the situation can increase the individual's
motivation to change. Another discrepancy is the homeless individual's love of freedom to come and
go at will, but their lives become very circumscribed as a function of interaction with shelters, services,
and their communities.
Supporting self-efficacy is an important social work function. Homeless individuals often feel
powerless and invisible. Many express the sentiment that there is no way out of the situation and that
people who have tried to help have not succeeded. MI helps individuals set realistic, achievable
goals, which in turn strengthens their belief and confidence in their own ability to change. MI with the
homeless should incorporate flexibility concerning issues that the individual thinks are most important.
Although a lack of suitable, stable housing, the abuse of alcohol or other substances, or mental health
problems may seem to be the most critical needs to an outsider, the priorities of the homeless
individual may be quite different. In one of the few published assessments of homeless persons'
76
needs, Acosta and Toro (2000) found that safety, education, transportation, medical/dental needs,
and job training/placement were rated as more important than housing, mental health, and substance
abuse treatment in a probability sample of 301 homeless adults. An important principle in any
intervention with homeless individuals involves beginning with issues most salient to the client or
"beginning where the client is."
Intensive Case Management
The case management model can be particularly useful for life in shelters and on the streets, where
services are fragmented and the homeless individual has to be continually on the move. In particular,
substance abuse treatment and psychological help must be combined with helping the client meet
survival needs: food, stable housing, and employment and/or receipt of financial benefits (Stahler,
1995). Integral to the case management approach is the development of the trusting relationship that
is at the core of helping the homeless individual utilize the services that may be available (McMillan &
Cheney, 1992).
When case management has been tested within the ideal conditions of research where there is
typically a high quantity and quality of services, it has been shown to be efficacious. However,
outside of these ideal study conditions, there are often not enough case managers to serve each
client. Homeless individuals must often take the initiative of seeking out the case manager, checking
in frequently to learn the status of their cases (for example, the availability of a bed in detoxification
unit, a bed in a transitional housing unit, or progress on legal matters). Case management intensity is
often related to the level of funding for treatment programs for the homeless; this level is often directly
related to the degree of advocacy for this stigmatized population.
Stabilization Programs/Therapeutic Communities
Two approaches tried with homeless substance abusers involve modifying emergency shelter areas
into safe and substance-free environments. The philosophy in both the stabilization program and the
therapeutic community is to offer an alternative to homeless individuals who are ready to work on
alcohol/drug problems. The critical aspect is that these alternatives do not require the homeless
individual to leave the shelter setting, which the client may not be ready to do.
Stabilization programs inside shelters offer substance-free zones for individuals who have completed
detoxification, but still have no place to live. In a study of such programs within two Boston shelters,
Argeriou and McCarty (1993) found the rates of success to be 63.5 percent. This rate was
comparable to that of post-detoxification in traditional substance abuse programs. Clients who
completed stabilization programs decreased their substance use and experienced longer lag times to
relapse compared to clients who did not complete the stabilization. The utilization of shelters for
substance abuse stabilization represents a cost-effective way to provide services to the homeless
population. Shelters represent "windows of opportunity" to engage the homeless client in substance
abuse treatment. These stabilization programs are still in existence ten years after the initiation of the
project (Argeriou, 2000).
The therapeutic community (TC) approach is a well-known residential treatment strategy wherein the
community of other individuals in recovery becomes the major support network. The classic TC relies
on intensive group sessions, with members often confronting each other concerning their need to
change in order to live in the "outside world," substance free. The TC approach has been modified to
meet the needs of homeless, mentally ill, substance abusers. The modifications include more
individualized, more flexible, and less intense intervention than is typically found in standard TC
programs (Swan 1997). The Center for Therapeutic Community Research studied 342 homeless
persons who entered the modified TC program. These clients were found to have successful
outcomes in terms of reduced drug use and criminal behavior and an increased ability to find and
retain jobs (Sacks and De Leon, 1997).
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Transitional/Supportive Housing
By the mid-1980s, a pattern was developing in the U.S., in which some homeless individuals
experienced repeated episodes of shelter living. Many of these individuals were unable to make a
successful transition from shelter to apartment living and needed more support to maintain permanent
housing. Through funding from HUD, non-governmental community organizations developed housing
strategies to support the homeless in their quest for secure housing. These strategies included
transitional housing, generally consisting of housing with two years of services; and supportive
housing, which is housing with the provision of services for an open-ended period of time. Transitional
and supportive housing may be provided in one physical space (e.g., apartments built in former
factories, such as Montreal's "Ma Chambre," or "My Sister's Place" in Hartford) or it may be provided
in scattered apartments in publicly or privately owned buildings. A key aspect is that services are
brought in to individuals or families who have access to affordable transitional/supportive housing. In
many communities, the provision of transitional and supportive housing is much preferred over
building more emergency/ temporary shelters, which are often viewed with fear and suspicion.
Confronting Barriers to Services for the Homeless
A social worker beginning to work with homeless individuals very quickly confronts barriers to services
that are inherent in the homeless person's world. For example, individuals in need of access to
financial assistance (e.g., SSI) may not have their birth certificate. Other important papers may have
been lost during frequent transitions between shelters and the street. A client may be difficult to
locate due to multiple moves between shelters that are a part of many communities' policies toward
the homeless. If a person wants to enter a treatment program, he or she may not have insurance
coverage, and there may be very few beds set aside for indigent individuals. Compounding these
problems is a generalized dislike of homeless individuals, who may be dirty and are generally blamed
for their homeless state. Working with homeless individuals requires fortitude and commitment.
In addition to advocating for homeless individuals on a case-by-case basis, social workers can join
coalitions for the homeless or other advocacy groups. These types of activities can effect system
changes that benefit many homeless individuals. For example, shelters in some cities close for the
summer. Although other shelters may absorb a certain number of homeless persons, many
individuals will begin what becomes a lifetime pattern of living out-of-doors. Similarly, in some cities, a
permanent address is necessary to receive benefits. Coalitions that consist of both homeless
individuals and service providers can join forces to advocate for change in these systems.
Summary
In summary, treatment services for homeless persons with alcohol use disorders range from the
outreach offers of engagement in a human relationship [e.g., the Park Homeless Outreach Project in
New York City (Arete Corporation, 1995)], to the more formalized treatment programs inside shelters.
The help may be in the form of case management or motivational interviewing. These techniques
may be delivered in agencies such as soup kitchens, shelters, and day programs, where the
homeless meet their basic survival needs.
Alcohol and drug recovery programs may also be wedded to transitional or supportive housing, which
offer the individual a way out of homelessness. To be effective, any and all services delivered to
homeless individuals must be guided by the individual's own goals and priorities. This means that
intervention goals must be flexible, adaptive, and include improved screening, assessment, and
diagnosis, along with harm reduction approaches and provision of respite or safe zones. Program
development must also take into account the perspectives, culture, experiences, and wishes of the
homeless population. Homeless individuals should be involved in the development and revision of the
services they use.
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Learning Activities and Next Steps
 What substance abuse treatment and recovery programs exist in your community? Find out
the eligibility requirements and meet the staff.
 Where and when are NA/AA and other support groups meeting?
79
UNIT 12: Domestic Violence
Description:
This unit presents basic information, including myths about domestic violence in the United States and
legal definitions pertinent to Kentucky. Survivors of domestic violence often need supportive services
and emergency shelter in order to escape an abusive relationship. Understanding the issue and
resources available are important first steps in assisting a survivor. Often, survivors must work within
the legal system, which can be both frightening and confusing. In many areas, a domestic violence
advocate can be most helpful.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Define domestic violence according to Kentucky law.
2. Define Emergency Protective Order and Domestic Violence Order.
3. Identify reasons that survivors of domestic violence often stay in an abusive relationships.
4. Identify myths concerning domestic violence.
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What is the legal definition of domestic violence in Kentucky?
Kentucky law (KRS § 403.720) defines "domestic violence and abuse" as the occurrence of one or
more of the following acts between "family members" or "members of an unmarried couple."
 Physical injury
 Sexual abuse
 Assault
 Putting someone in fear of immediate physical injury, sexual abuse, or assault
Destruction of physical property alone is not considered domestic violence, unless it is combined with
threatening behavior.
Note: You cannot get a protective order against a boyfriend whom you do not have a child with and
have never lived with, since that does not fit the definition of a "member of an unmarried couple."
More information is available online at
http://www.womenslaw.org/laws_state_type.php?id=10049&state_code=KY#content-3802.
Mandatory Reporting: In Kentucky, the law requires mandatory reporting of spouse abuse, child
abuse, and abuse of those adults unable to protect themselves, such as the elderly or perhaps a
person with a disability. Any person having reason to believe a married person of any age has been
abused or neglected by their spouse must report it to the Cabinet for Health and Family Services. For
more information, review the Kentucky Domestic Violence Association (KDVA) Web site at
http://www.kdva.org/resources/dvlaws/dvlawsmr.html.
Legal Documents: A protective order is a paper that is signed by a judge and tells the abuser to stop
the abuse or face serious legal consequences. It offers civil legal protection from domestic violence to
both female and male victims. In Kentucky, an immediate temporary order is known as an emergency
protective order (EPO) and a final, long-term order is known as a domestic violence order (DVO).
Barriers to Escaping an Abusive Partner
Including but not limited to:
 Love
 Hope for change
 Fear of retaliation
 Nowhere to go
 Economic realities
 Children
 Isolation
 Preservation of the family
 Religious beliefs
 Lack of adequate services
“Why do women stay?” It is the most frequently asked question of battered women’s advocates.
However frequent, this is not the most important question asked about domestic violence. The
question should focus on why men batter women.
Leaving is a process. Most women who are battered will escape and return several times before
escaping permanently. Women must be shown patience and know that each time they escape and
return, they are becoming wiser. Studies indicate that most battered women do eventually escape
permanently (Okun, 1986).
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Myths about Domestic Violence
MYTH: Domestic violence does not affect many Americans.
FACT: A woman is beaten every 15 seconds in the United States.
MYTH: Battering is only a momentary loss of temper.
FACT: Battering is the use of violence and other forms of abuse to establish power and control in a
relationship.
MYTH: Drugs and alcohol cause the violence
FACT: Addictions are used as excuses to free a batterer from responsibility for his behavior.
MYTH: Battered women provoke the violence.
FACT: No one can be responsible for another person’s deliberate choices and actions.
MYTH: It is easy for a battered woman to leave her abuser.
FACT: Women who leave abusers are at 75 percent greater risk of being killed by the abusers than
those who stay.
MYTH: After a woman leaves an abusive partner, the abuse stops.
FACT: Separated women are 3 times more likely, and 25 times more likely than divorced women
living with their husbands, to be victimized by their batterers.
MYTH: Stress causes battering.
FACT: Stress does not cause abuse. Some batterers experience stress, but many men under stress
never batter. Even if a practitioner helps a batterer reduce his stress, the violence will
continue or eventually resume because the batterer still feels entitled to assault his partner.
Resources





Kentucky Domestic Violence Association http://www.kdva.org/
KDVA Member Programs http://www.kdva.org/memberdvprograms.html
Adult Protective Services
http://chfs.ky.gov/dcbs/dpp/Adult+Protective+and+General+Adult+Services.htm
Child Protective Services http://chfs.ky.gov/dcbs/dpp/childsafety.htm
National Domestic Violence Hotline (800) 799-SAFE (7233) or (TTY) (800) 787-3224
Learning Activities and Next Steps
 Find your regional domestic violence shelter. Meet the staff and learn about their referral
process and services.
 Educate yourself on the signs and symptoms of physical, emotional, and sexual abuse.
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UNIT 13: Veterans
Description:
This unit presents an overview of basic military terms as related to veterans and the resources
available to them.
Topics include how to confirm if someone is a veteran; types of discharges; resources related to
employment, health, legal, and financial assistance; seeking federal benefits; and accessing records.
Objectives:
At the conclusion of this unit, trainees will be able to:
1. Identify resources for Veterans.
2. Describe the primary documents needed to verify military service.
3. Identify the various levels of discharge from military service.
4. Identify primary agencies that offer assistance to Veterans including homeless Veterans.
5. Identify primary services and assistance to Veterans including homeless Veterans.
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Help for Veterans
This section includes resources that can help your Veteran clients back on their feet. Remember to
check the phone book for local, county, and state agencies that know what services are available in
the area to assist Veterans. Some organizations may have waiting lists, require an interview, or have
specific rules about who they serve. You may even ask if your client’s name can be put on a waiting
list as their release date approaches.
How do I confirm if someone is a Veteran?
If you served in the military, you received a document called a DD-214 upon discharge. The DD-214
stands for Department of Defense Form 214, which is a record of military service. This document will
provide a variety of information including dates of service and discharge status. An Honorable
Discharge will be clearly written on the document. To receive most VA services, an Honorable
Discharge is needed.
What type of discharges are issued?
The Department of Defense assigns five types of discharges. At the top is the Honorable Discharge
and at the bottom is the dishonorable Discharge. In between are the General Discharge, the Otherthan-Honorable Discharge, and the Bad Conduct Discharge. A Bad Conduct Discharge usually
results from conviction at a court martial, special or general. A Dishonorable Discharge results from a
general court martial.
What does the VA require to be eligible for VA services?
The VA requires two years of honorable military service after 1980 and an Honorable Discharge for
eligibility to receive services. Prior to 1980, one day of military service and an Honorable Discharge is
required.
What if a discharge is not Honorable, can it be upgraded?
Discharges such as Under Honorable Conditions and General Discharges can be upgraded to
Honorable but it takes time. The Federal VA Benefits Branch can help with this process. Other-thanHonorable and Dishonorable are very difficult to change.
Toll-Free Numbers
Crisis and other toll-free numbers are often listed in the front cover or first few pages of the phone
book. You may also want to check under “Social Services” in the blue or yellow pages.
Department of Veterans Affairs www.va.gov
Benefits (800) 827-1000
Medical Centers (877) 222-8387
Where to Start
For Veterans Only
State Departments of Veteran Affairs provide many services, which differ from state-to-state, but may
include assistance with the benefits claims process, readjustment counseling, crisis intervention,
loans, family counseling, and employment assistance. Check the front of the phone book under
“State Government, Veteran Affairs,” or go online in Kentucky to http://Veterans.ky.gov/ or outside of
Kentucky to www.nasdva.com.
Housing
It is important for Veterans to know they have a place to go when released. The first step in returning
to the community is finding a place to stay. This section includes ways to locate emergency shelter,
transitional programs, and permanent housing assistance. Transitional or temporary housing can
serve as a step toward full independence upon release. However, there are often waiting lists, so you
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should ask about applying as soon as possible. If you have a homeless Veteran client, emergency
assistance is available.
Emergency and Transitional Housing
Every VA Medical Center has a homeless Veteran services coordinator who is responsible for helping
homeless or at-risk Veterans. To find the VA Medical Center serving your area, look in the blue
pages of the phone book under “United States Government, Veteran Affairs,” call the VA (toll-free) at
(877) 222-8387, or visit www.va.gov under “Veterans Health Administration,” then “Locate a VA
Medical Center.”
Each VA hospital in Kentucky has a HUD-Veterans Affairs Supported Housing (VASH) program. To
be eligible, your client must qualify for VA health care. This will be determined by the hospital. Simply
call the hospital and ask to speak to someone in the HUD-VASH program.
Finding Employment
Disabled Veterans Outreach Program (DVOP) and Local Veterans Employment Representatives
(LVER) work to help Veterans find and keep jobs. DVOP specialists develop job and training
opportunities for Veterans with service-connected disabilities, linking Veterans with employers and
making sure follow-up services are provided. LVER specialists are located in state employment
offices (also called One-Stop Career Centers or Unemployment Offices.) To find a DVOP or LVER
near you, visit your state employment service office listed in the phone book blue pages under “State
Government, Employment Agencies,” or go to www.dol.gov/vets/aboutvets/contacts/main.htm.
Organizations provide employment and training services to homeless Veterans to help them get back
into the workforce through the Homeless Veteran’s Reintegration Program (HVRP). Organizations
provide job search, counseling, job placement assistance, remedial education, classroom and on-thejob training, and referral to supportive services. To find out if there is a program near you, call the
Veteran’s Employment and Training Service (VETS) state director listed for your state on the
Department of Labor Web site at www.dol.gov/vets/aboutvets/contacts/main.htm.
The VA’s Vocational Rehabilitation and Employment services help Veterans with service-connected
disabilities by providing job training and counseling to those who have an employment handicap.
Services include help finding a job, on-the-job training, job development, and vocational training. If
your client is not eligible for these services, a VA counselor may help you find other options, goals, or
programs. Call (877) 222-8387 for the VA Regional Office (VARO) nearest you or go to
www.vba.va.gov/bln/vre/index.htm.
Department of Veterans Affair’s Compensated Work Therapy Program (CWT) is available to some
Veterans who have primary psychiatric or medical diagnosis and are referred from certain VA
programs. CWT provides a structured environment where clients participate in job training activities
at least 30 hours per week. Contact the local VA Medical Center to see if you qualify. Call (877) 2228387 to find the medical center nearest you.
Health
If eligible for Veteran’s benefits:
Veterans are encouraged to enroll in the VA Health Benefits system as soon as they are released.
Every VA Medical Center has a homeless services coordinator who helps Veterans and their families
find resources inside and outside the VA health care system. Call (877) 222-8387 to find the medical
center nearest you.
Substance Abuse and Mental Health Treatment
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Contact the homeless veteran services coordinator at the local VA Medical Center. Call (877) 2228387 to find the medical center nearest you.
If not eligible for Veteran’s benefits, the following sources may be able to tell you where you can go to
get help.
Financial Help
The Kentucky Department of Veterans Affairs operates the Homeless Veterans Trust Fund (HVTF).
This fund provides financial assistance to Veterans to help sustain or obtain housing. The fund can
contribute funds towards rent and utilities only. To be eligible, the Veteran must have verified
honorable service. Funds may be accessed once in a lifetime. To submit an application for these
funds contact:
Kentucky VA Homeless Outreach Coordinator
(502) 595-4447
http://Veterans.ky.gov/
The American Legion provides Temporary Financial Assistance (TFA) from its national headquarters
to help maintain a stable environment for children of Veterans. To obtain an application, look in the
phone book to contact a local post or contact the National Headquarters to find the post nearest you.
The American Legion
National Commission on Children and Youth
P.O. Box 1055
Indianapolis, IN 46206
(317) 623-1323
Legal Help
You should talk to a Veterans advocate service officer for help with discharge upgrades, seeking
benefits, and filing a VA claim.
Other Legal Issues
Most law is state-specific. Most common legal problems are governed by the law in the state where
you live or where the problem occurred. When looking for legal help, make sure the information you
find applies to your state or that the lawyer or other service provider is qualified to work in your state.
Legal Services or Legal Aid offices have staff lawyers to provide free legal help to low-income clients.
Look in the yellow pages for a local Legal Aid office or check online at
www.rin.lsc.gov/rinboard/rguide/pdir1.htm.
Women Veterans
All VA Medical Centers and many Readjustment Counseling (Vet) Centers have a designated Women
Veterans Program Manager to help women Veterans access VA benefits and healthcare services.
Call (877) 222-8387 to find the VA medical center nearest you.
All regional offices of the Veterans Benefits Administration have a Women Veterans Coordinator to
help women Veterans apply for VA benefits and assistance programs. Call (800) 827-1000 to locate
your local office or go online to http://www1.va.gov/WOMENVET/index.asp.
Many State Departments of Veterans Affairs have a designated women Veterans coordinator to help
women Veterans. Check the phone book blue pages under “State Government, Veterans Affairs,” or
go online to www.nasdva.com.
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SEEKING FEDERAL BENEFITS
The Department of Veterans Affairs publishes a booklet called “Federal Benefits for Veterans and
Their Dependents” that describes the types of benefits available and lists the addresses and phone
numbers for VA facilities nationwide. Write to your VARO for a copy. Call (800) 827-1000 or find
information about benefits and addresses for regional offices at
www.vba.va.gov/benefits/address.htm.
Eligibility for VA Benefits While Incarcerated
The ability to get most VA benefits depends on the type of discharge from the military. In general,
those discharged under honorable conditions are eligible for benefits (this includes general
discharges). Your client and their family may be able to get certain benefits while your Veteran is in
prison, but these benefits are limited if they are convicted of a felony and imprisoned for more than 60
days. Payments are not reduced for Veterans participating in work-release programs, living in
halfway houses, or under community control.
Disability compensation is money paid to Veterans who were injured or have a disease that started or
got worse during active duty. If your client is already receiving disability compensation and is in
prison, the payment will be reduced to the 10 percent disability rate beginning on the 61st day in
prison. For example, if they were receiving $201 or more before incarceration, the new payment
amount will be $120. If the disability rating was 10 percent before incarceration, the new payment will
be at the 5 percent rate. However, they can apply to have the difference awarded to eligible family
members.
VA Disability Pension is money that may be available to low-income Veterans who are permanently
and totally disabled, but not as a result of military service, and have 90 days or more of active military
service, at least one day of which was during a period of war. Payments are stopped on the 61st day
of incarceration. Your client can apply to have some of this money awarded to family members.
VA Medical Care is not provided to Veterans in prison, but VA health facilities may provide care to
Veterans after release. Contact (877) 222-8387 for the VA medical center nearest you.
Benefits for the Family
Even though Veteran can only receive part of their disability compensation while in prison, the rest
may be awarded to their family if they depend upon the Veteran’s income. This is called an
apportionment. For example, if the Veteran is rated at 80 percent disabled but can only receive the
10 percent disability rate while in prison, the dependent family may be given up to the remaining 70
percent.
The family members will only get the shared amounts if they can show financial need. This applies to
the spouse, children, or dependent parents who are applying for these benefits. Send a letter to the
VARO that has jurisdiction over the case to apply for the family to receive part of the benefits.
Benefits Payments
There is a 60-day “grace period” following a conviction when the Veteran may still receive full benefits.
To avoid an overpayment, it is important to notify the VARO immediately when the Veteran goes to
prison if they are receiving payments. If the VA is not notified and the Veteran receives
overpayments, the Veteran and their family will lose all financial payments until the debt is paid.
For example, Joe is a Veteran who receives a VA pension of $807 per month. He commits a crime
and is incarcerated, but doesn’t tell the VA right away and keeps getting paid for 6 months. Joe is
overpaid a total of $4,872. After serving his sentence of 18 months, he is released and applies to the
VA to have his pension restarted. The new pension rate is $985 per month, but the VA will use that
amount to start repaying the $4,872 debt. Joe has to go as least 5 months without that income.
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The award for compensation or pension benefits should resume from the date the Veteran is
released, as long as the VA receives notice of release within one year. This includes placement in a
community treatment center or halfway house. Remember, the VA must be notified when the Veteran
is released to restart payments.
Help with Seeking Benefits
Professional help is available for benefits or claims before the VA.


Check the blue pages of the phone book for the phone number of a county Veteran service
officer in your area, or call your county government information line to see if there is one in
your area, or go to http://Veterans.ky.gov/ to find the VA benefits representative in your area.
Many Veterans Service Organizations (VSO) have trained staff who can help with VA claims
and can legally represent Veterans before the VA. Some also help homeless and at-risk
Veterans find the support services they need. You can contact any VSO listed below to see if
there is a service representative near you, or find a list of VA-recognized VSOs online at
www.appc1.va.gov/vso/index.cfm.
The American Legion
National Headquarters
PO Box 1055, Indianapolis, IN 46206
(317) 630-1323 ♦ Web: www.legion.org
AMVETS, National Service Officers
4677 Forbes Blvd.
Lanham, MD 20706
(877) 726-8387 ♦ Web: www.amvets.org
Blinded Veterans Association
Field Service Officers
477 H. St., NW
Washington, DC 20001
(800) 669-7079 ♦ Web: www.bva.org
Disabled American Veterans National
Headquarters
3725 Alexandria Pike
Cold Springs, KY 41076
(859) 441-7300 ♦ Web: www.dav.org
Jewish War Veterans
1811 R. St., NW
Washington, DC 20009
(202) 265-6280 ♦ Web: www.jwv.org
Military Order of the Purple Heart
5413-B Backlick Rd.
Springfield, VA 22151
(703) 642-5360 ♦ Web: www.purpleheart.org
Non Commissioned Officers Association
Veterans Service Officers
NCOA National Capital Office
610 Madison St., Alexandria, VA 22314
(703) 549-0311 ♦ Web: www.ncoausa.org
Paralyzed Veterans of America
801 18th St., NW
Washington, DC 20006
(800) 424-8200 ♦ Web: www.pva.org
Veterans of Foreign Wars, National Headquarters
406 W. 34th St.
Kansas City, MO 64111
(816) 756-3390 ♦ Web: www.vfw.org
Vietnam Veterans of America
Veterans Benefits Program
1224 M St., NW, Washington, DC 20005
(301) 585-4000 ♦ Web: www.vva.org
Other Offices to Assist Veterans
Below are brief descriptions of forms needed to file for certain VA benefits. Be sure you use a return
address where mail will get to you as quickly as possible. Make photocopies of all forms for your
records before sending your packet to the VARO nearest you.
Military and Medical Records
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The military discharge document (DD 214) is needed to apply for any benefits. VA Form SF-180 is
used to get copies of military and medical records. Veterans may also complete a request online at
http://vetrecs.archives.gov.
Application for Compensation or Pension
VA Form 21-526 must be filed to apply for compensation or pension. This form, along with the DD
214 and the following forms should be mailed directly to the VARO nearest the release destination 30
to 45 days before the release.
Statement in Support of Claim
VA Form 21-4138 lets the Veteran explain why they deserve the benefits they are asking for because
of their disability or disorder. It is best to have an experienced service representative help complete
the form.
Authorization for Release of Information
If the Veteran has received medical or mental health care from anyone other than a VA medical
center and feel it may be relevant to the claim, the Veteran needs to complete VA Form 21-4142
giving permission for release of medical records to the VA.
Enrollment for Medical Benefits
VA Form 10-10EZ is used by the VA to determine receive medical benefits. The Veteran should
complete the form and bring it to the VA medical facility where they will seek evaluation for treatment.
Vocational Rehabilitation for Disabled Veterans
VA Form 28-1900 is needed to apply for the vocational rehabilitation program to help Veterans who
were disabled during their service reach maximum independence in daily living, to learn skills needed
to get a job, and to find and keep a job. Send Form 28-1900 to the VARO in your area 10 to 15 days
before their release.
Request for and Consent to Release of Information from Claimant’s Records
VA Form 70-3288 is used to get records relevant to a claim from VA facilities (regional offices,
medical centers, outpatient clinics, and vet centers). Request a fee waiver under section 38 C.F.R.
Sec. 1.526 (h), which requires the VARO to provide a Veteran with one set of his or her records free
of charge.
REPLACING PERSONAL RECORDS
There are certain personal records you must have to rent a place to live, apply for employment, open
a bank account or to request assistance from government agencies and community-based
organizations. The following are needed personal records.

Photo ID – Contact the homeless Veterans coordinator at the nearest VA medical center for
information on how to obtain a VA photo ID. State Motor Vehicle Departments provide ID
photo services for a fee.

DD 214 – Homeless Veterans are entitled to one copy of their service and medical records
free-of-charge.
Send requests to the National Personnel Records Center, Military Personnel Records, 9700 Page
Avenue, St. Louis, Missouri 63132-5100. Homeless Veterans, through their DVOP/LVER or case
manager, may fax the request for records to (314) 801-9201. Be sure to write “Homeless Veteran
case” clearly on the form.
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Veterans discharge from the Navy after December 31, 1994, and the Marine Corps after September
30, 2001, should send requests to Navy Personnel Command, PERS 312E, 5720 Integrity Drive,
Millington, Tennessee 38055-3120. Veterans may also submit their requests online at
www.vetrecs.archives.govhttp://vetrecs.archives.gov.
State Offices of Veterans Affairs often have military records of Veterans who are state residents. Go
to www.nasdva.com for contact information in your state.
The Kentucky Military Records Department may have a copy of the DD-214 on a Kentucky Veteran.
More information is available on their Web site at http://www.dma.ky.gov/hr/.
Learning Activity and Next Steps
 Find and meet your local VA representative.
 Find out which VA hospital serves your community. Make contact with their HUD-VASH and
other homeless programs staff.
 Are there other VA services in your community? What are they? Find them and meet the
staff.
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