Community Solutions for Individuals Facing Homelessness

Presented by

Thomas Walker, M.A.

Dr. John (“Jack”) E. Felch, Jr.

About the Presenters:

Tom Walker, MA. Prior to beginning work in managed care, Tom served as co-chair of Allentown/ Northeast Pennsylvania's Regional Homeless Advisory Board and is a founding member of Allentown/ Lehigh County Commission to End Chronic Homelessness. The Commission’s efforts decreased street homelessness in Allentown 80% -- down from 150 individuals at a point in time to 30 individuals at a point in time within seven years. Tom is the former Health and Human Services Director of The Lehigh Conference of Churches.

Dr. John (“Jack”) E. Felch, Jr. is the Executive Director of The Lehigh Conference of Churches, located in Allentown, PA. Founded in 1954 on the principle that working together churches can do more to improve the lives of “the least among us” than any one church can do alone. Five of the programs of the Conference of Churches are designed to keep individuals and families threatened with homelessness in their homes or to move individuals and families from homelessness to permanent housing. Over 3,000 households are assisted annually.

Learning Objectives

1. Recognize successful homeless outreach and engagement on the local level

2. Examine the important link between Health Management Organizations and Non-profit Organizations, particularly for people living with a serious mental illness and facing homelessness

3. Evaluate proven community-level systems, protocols and constructs to address the needs of the homeless

What is homelessness?

There is more than one “official” definition of homelessness

In the U.S., the total number of persons who experience homelessness may be as high as 2 million. There are four federally defined categories under which individuals and families may qualify as homeless: 1) literally homeless; 2) imminent risk of homelessness; 3) homeless under other Federal statutes; and 4) fleeing/attempting to flee domestic violence.

HUD encourages communities to focus on those who are among Category 1, “literally homeless.” Defined as “lacking a fixed, regular, and adequate nighttime residence.”

Resource: Definitions of Homelessness for Federal Program Serving Children, Youth, and Families

Million Dollar Murray

Malcolm Gladwell's February 13, 2006 article in The New Yorker, Million-Dollar Murray, follows a Reno, Nevada homeless man named Murray Barr

Strategy to End Chronic Homelessness in Ten Years

Source (From Left to Right): http://articles.mcall.com’; http://www.lehighvalleylive.com

Allentown/ Lehigh County Commission to End Chronic Homelessness

10 Year Plan

In January of 2006, representatives of the City of Allentown and the Lehigh County Conference of Churches met to discuss the city’s unsheltered homeless. During this meeting the homeless persons living underneath the city’s Eighth Street Bridge where of particular concern due to the unsanitary conditions found in this location. In order to address these concerns, Allentown Mayor Ed Pawlowski appointed a Commission to End Chronic Homelessness charged with developing a ten-year plan to end chronic homelessness in the City.

http://www.allentownpa.gov/Portals/0/files/CommunityDevelopment/ENDCHRONICHOMELESSNESS.PDF

Homelessness and Health

“It is not surprising that those experiencing homelessness are three to four times more likely to die prematurely than their housed counterparts, and experience an average life expectancy as low as 41 years.”

Source: NATIONAL HEALTH CARE FOR THE HOMELESS COUNCIL https://www.nhchc.org/

The Social Determinates of Health

Dr. Jim O’Connell, Boston University, Creator of Homeless Vulnerability Index: “The painfully obvious lesson for me has been the futility of solving this complex social problem solely with new approaches to medical or mental health care…I dream of writing a prescription for an apartment, a studio, an SRO, or any safe housing program, good for one month, with 12 refills.”

…Medicaid does not pay for HOUSING!!!

Economics of Homelessness

"Because, at the end of the day, it costs, between shelters and emergency rooms and jails, it costs about $40,000 a year for a homeless person to be on the streets.“ – Former U.S. Secretary of HUD, Shawn Donovan

Shelter Costs •$8,000 more per bed/year than providing a HUD Voucher (http://www.huduser.org/portal/publications/povsoc/cost_homelessness.html)

Emergency Room Costs •Homeless have 36% longer hospital stays (Salit et al, 1998)

Court/Jail/Police Enforcement Costs Average annual cost per inmate in PA: $32,986 (Source: PA DOC, 2013)

A Changing Social Policy

Advancing Access to Affordable Housing as a Means to Maximize Opportunities for Community Living On September 30, 2011, the Centers for Medicare & Medicaid Services (CMS) announced the award of $1,980,000 in grants to six States to develop sustainable partnerships with State Housing Agencies under the Real Choice Systems Change Grant Program. These grants will result in long-term strategies to provide permanent and affordable rental housing for people with disabilities who receive Medicaid services, who are homeless and participants under the CMS Money Follows the Person Demonstration.

Updating Medicaid Information Relevant To Homeless Individuals In conjunction with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), CMS has updated A Primer on How to Use Medicaid to Assist Persons Who are Homeless to Access Medical, Behavioral Health, and Support Services. http://aspe.hhs.gov/daltcp/reports/2014/PSHprimer.pdf In anticipation of changes stemming from the Affordable Care Act, the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), contracted with Abt Associates in October 2010 to conduct a study to explore the roles that Medicaid, Health Centers, and other HHS programs might play in providing services for people who had experienced chronic homelessness before moving into permanent supportive housing (PSH). This study examined the intersection of three pieces of a complex puzzle that if assembled correctly can end chronic homelessness: (1) chronic homelessness itself; (2) permanent supportive housing; and (3) Medicaid's potential to fund health-related services for people experiencing chronic homelessness or living in PSH. The report can be found here: Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practice from the Field (2014): http://aspe.hhs.gov/daltcp/reports/2014/EmergPrac.pdf Source: http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/balancing/homelessness-initiatives.html

Homelessness at a point-in-time in Allentown/ Northeast PA

From 2010 to 2014, the number of homeless adults living with a serious mental illness increased 660% at a Point-in-Time across the region.

Chart Data Source: https://www.hudexchange.info/hdx/guides/ahar

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Program Goals, Profile and Services

Collaborative Model

Purpose:

Increase availability and effectiveness of housing and behavioral support interventions for homeless individuals who are hospitalized through Magellan Behavioral Health of PA, Inc.: OTP-based psychosocial treatment, collaborative stepped behavioral health care, and expert consultation, including continuous quality improvement and outcomes consultation The Lehigh Conference of Churches: Street outreach, Food/Nutrition, Access to free healthcare, Pharmaceutical Assistance, Transportation, Job Training, Day program/ Drop-in Center, Benefits Case Management, Intensive Case Management, Housing Case Management, Permanent Supportive Housing or Rental Assistance

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HOPE ICM Pilot program profile

Age Range 18+

Diagnosis Serious Mental Illness

Referrals Hospitals, Community, Self

Length of Stay 9 Months

Qualifications Homeless

Adult TCM Matrix

Census Serve 20 individuals at a point in time

Housing , Services and Evaluation are Separate

•Vulnerability Assessment

•Housing Needs Assessment

•Managed Care Oversight

It is not required for an individual to be in case management to receive housing. Individuals are assessed for Vulnerability, and Consent to Treatment.

Participants are then assessed for the level of housing support needed. Housing Choice options may include Emergency Shelter/ Hotel voucher, referrals to County Housing Authority, or HUD VASH, transitional housing, recovery housing, short-term rental assistance, permanent supportive housing.

HOPE ICM Program Goals

Goals for individuals receiving Intensive Case Management delivered through Project HOPE ICM

1. Improved housing stability, skills and income

2. Improved emotional health and functioning

3. Reduced acute inpatient hospital days resulting in reduced cost of care

Critical Time Intervention Approach

Structured and time-limited intervention in three phases (nine months).

•Phase one is “transition to the community”

•Phase two is “try out”

•Phase three is “transfer of care”

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Population Profile

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Population profile

A closer look

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Forty-one individuals were enrolled in the HOPE ICM program between March 1, 2014 and Feb. 28, 2015. Baseline for participants:

48.8%

53.7%

9.8%

2.4%

31.7%

47.0%

4.7% 2.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Depression Screen Anxiety Thought Disorder Alcohol Use

Percentage of Members Self-Reporting Positive Behavioral Symptom Screens at Baseline

(Lower numbers indicate better health.)

HOPE ICM Members All Magellan Public Sector Members

A closer look

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Forty-one individuals were enrolled in the HOPE ICM program between March 1, 2014 and Feb. 28, 2015. Baseline for participants:

34.39

40.75

52.40

56.71

39.82

47.16

61.11 58.32

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

Emotional Health Physical Health Overall Health Strengths

CHI Self-Report Health Outcome Scores at Baseline (Higher scores indicate better health.)

HOPE ICM Members All Magellan Public Sector Members

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Pilot Program Data Collection and Outcomes

Program outcomes

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Forty-one individuals were enrolled in the HOPE ICM program between March 1, 2014 and Feb. 28, 2015. Following are key outcomes for participants:

Program outcomes

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A closer look at emotional health outcomes

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15.8%

3.3%

13.6% 13.4%

4.4%

-3.1%

8.9%

6.7%

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

Emotional Health Physical Health Overall Health Strengths

Percentage Improvement on CHI Self-Report Health Outcome Scores: HOPE ICM vs. All Magellan Public Sector (higher is better)

HOPE ICM Members All Magellan Public Sector Members

A closer look at emotional health outcomes

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-23.6%

-12.1%

-29.0%

-2.5%

-17.4%

15.7%

-18.9%

-10.4%

-35.0%

-30.0%

-25.0%

-20.0%

-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

Behavioral Symptoms Depression Screen Anxiety Thought Disorder

Percentage Reduction in CHI Self-Report Positive Behavioral Health Symptom Screens: HOPE ICM vs. All Magellan Public Sector (lower is

better)

HOPE ICM Members All Magellan Public Sector Members

Program outcomes

September 14, 2015 MH Presentation Toolbox 26

Program outcomes

September 14, 2015 MH Presentation Toolbox 27

September 14, 2015 MH Presentation Toolbox 28

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Conclusion

September 14, 2015 MH Presentation Toolbox 31

Conclusion

Ken’s story

July 2015 Ken’s Story 32

Ken, Age 55

“The HOPE ICM program didn’t give up on me. I got care for my addiction, my mental health, my physical health, and found my spiritual being. In time, I was able to reconnect with my mother and my daughters. “The Lehigh Conference of Churches helped me get housing and get Social Security benefits. Today, I go to church and attend the fellowship community for maintaining my sobriety. It’s been almost a year since my last drink. I am putting a plan in place to help other people without homes. No one should go hungry like I did. I want to put food packages together for the homeless.”

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Resources

State-led Process (PHAC) with Regional Decision Making Control (RHAB) Competitive Grants (NOFA) and Formula Program Source: http://community.newpa.com/housing-and-development/homelessness-in-pa/

The Homeless Assistance Process in PA

On any given day, over

15,000 Pennsylvanians are

Homeless.

Resource: Continua of Care Contacts

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Vulnerability Assessment

Based on 100K Homes Campaign and Dr. Jim O’Connell’s Research

Services in Supportive Housing

SAMHSA List of Evidence-based Practices and Innovations

• Illness, Management and Recovery • Housing First • Critical Time Intervention • Assertive Community Treatment • Motivational Interviewing and Enhancement Therapies • Integrated Dual Disorders Treatment (IDDT) • Permanent Supportive Housing • Recovery and Wellness • Trauma Informed Care • Supported Employment

http://homeless.samhsa.gov/channel/evidence-based-practices-and-innovations-509.aspx

Speaking nonprofit

Capacity-building To bring funds and expertise to strengthen

nonprofits with demonstrated success so those organizations could

do even more to improve the lives and opportunities of clients served

Donor-centric Donor retention

Alignment Leadership, board and committee has a unified vision

Self-sufficiency means families are able to meet their basic needs without having to rely on any public or private assistance

Logic Model is a tool used by funders, managers, and evaluators of programs to evaluate the effectiveness of a program (Theory of Social Change)

Accountability Framework/Matrix/Model Project management - RACI

Community-driven action i.e., Social determinates of health

Target(ed) Public presence; Mission/vision; Donor/partners

Impact GuideStar, a rating system for non-profits

Stakeholder Could be another organization, an organizational member, or client

“Do you speak nonprofit? A primer on sector buzzwords and jargon” by Jodie Shupac, 2012.

https://charityvillage.com/Content.aspx?topic=Do_you_speak_nonprofit_A_primer_on_sector_buzzwords_and_jargon#.Ve3yr02YaUk

Confidentiality Statement for Providers

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The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

Thank you