Best Practices for Preventing and Ending Homelessness in Central Alabama

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1 Best Practices for Preventing and Ending Homelessness in Central Alabama

2 A Snapshot of Birmingham s Homeless Population Total Chronically Homeless Severely Mentally Ill Chronic Substance Abuse

3 Keys for Successful Stabilization Best Practice for Continuum of Care Success Best Practice for Housing Program Success Best Practice for Increasing Economic Security

4 Promising Best Practices Vulnerability Measurements Navigation Centralized Intake System Evaluations Housing First Wet Houses SOAR Alternative Staffing Organizations Harm Reduction Supported Employment

5 Vulnerability Measurements Vulnerability Index Used for identifying and prioritizing the street homeless population for housing according to the fragility of their health. 1 Helps providers to determine homeless clients health statuses by identifying mortality risks. Vulnerability Assessment Tool Used to measure a homeless person s vulnerability to continued instability. 2 Contains a mortality risk scale similar to that of the Vulnerability Index Provides a more holistic view of vulnerability Highlights the need for stable housing as the cornerstone of quality healthcare. 1 Vulnerability Index: Prioritizing the Street Homeless Population by Mortality Risk

6 Vulnerability Measurements: Markers Vulnerability Index 3+ hospitalizations or emergency room visits in a year 3+ emergency room visits in the previous three months Aged 60 or older Cirrhosis of the liver End-stage renal disease History of frostbite, immersion foot, or hypothermia HIV+/AIDS Tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical condition Vulnerability Assessment Tool Survival Skills Basic Needs Indicated Mortality Risks Medical Risks Organization/Orientation Mental Health Substance Abuse Communication Social Behaviors Homelessness

7 Vulnerability Measurement Models Vulnerability Index Santa Barbara County, California Over 181vulnerable individuals and family members have been housed since 2011 Vulnerability Assessment Tool Memphis, Tennessee Over 100 people surveyed since October 2013 and around 70 individuals were deemed vulnerable 7 permanent housing providers agreed to prioritize housing to the most vulnerable individuals

8 Why have Vulnerability Measurements? Distinguish between the groups of people more likely to die on the streets Tailor healthcare services Highlight economic burden due to sustained emergency care Prioritize housing to meet the immediate needs of the most vulnerable

9 Navigation Natural Supports Who are Navigators? Peer support workers Outreach Workers Case Workers Formerly homeless Do whatever it takes

10 Navigation Model Project H3, a program of Arizona Coalition to End Homelessness In 2011, 47 clients were placed in permanent supportive housing Harm reduction techniques were utilized Clients were partnered with navigators 98 percent of participants remained in housing after a year Results indicated lowered incarceration rates, decreased instances of substance use, and increased participant quality of life.

11 Why have Navigation? Provides clients with peer/mentor to guide them throughout stabilization process Allows clients a medium in which to connect with friends and family, case manager, and outreach support Provides employment for formerly-homeless individuals in which they can make a difference

12 Centralized Intake What is it? A place or means to connect clients, such as a walk-in center or a call center A screening and assessment process and tools to gather and verify information about the person and his/her housing and service needs and program eligibility A process and tools for referral of the person to appropriate programs or agencies; and in some cases, a process and tools for making program admissions decisions.

13 Types of Centralized Intake Mixed Centralized Intake San Francisco, Connecting Point Two step intake process 1. homeless family calls hotline for phone intake 2. attends in-person appointment for in-depth interview; then family is provided services Single Location Centralized Intake Hennepin County, Minnesota CoC Only one access point for homeless individuals and families Multiple Location Centralized Intake Alameda County, California CoC Eight Housing Resource Centers distributed throughout county to access intake Standardized intake, assessment, and referral procedures and tools, often in the context of shared HMIS data collection and reporting Phone-Only Centralized Intake Interfaith Hospitality Network of Greater Cincinnati Call 381 SAFE (7233) to speak to an intake specialist. This intake specialist will make appropriate referrals into a partner agency s program.

14 Why have Centralized Intake? Help ensure that people get the services they need Allow staff to focus more on serving clients and less on gathering information and filling out forms Improve cost efficiency by replacing duplicative intake functions with a single approach Promote coordination among service agencies

15 System Evaluations What are System Evaluations Measurements intended to gauge specific outcomes for housing stability and CoC success Data-driven

16 Examples of System Evaluations Columbus Model Community Shelter Board Michigan Coalition to End Homelessness Rating Scale: Average length of stay Cost per household Cost per successful housing outcome Employment status at exit Households served Housing retention Housing stability Interim housing stability Movement Negative reason for leaving Pass program certification Recidivism System occupancy rate Successful housing outcomes Turnover rate 3 Outcomes Measurements: Housing Self Sufficiency Financial Stability Employment Mental Health Treatment Substance Abuse Treatment 3 Community Shelter Board (2013). The Columbus Model: Performance Measurement & Evaluation

17 Why have System Evaluations? To understand how current programs are working to achieve intended outcomes To increase CoC transparency To drive program improvement and share information between partner agencies share successful ideas To communicate and advocate for community support To keep everyone on the same page goal is to prevent and end homelessness

18 Harm Reduction What is it? 5 Harm reduction is a set of practical strategies that reduces negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use, to abstinence Harm reduction strategies meet drug users where they re at, addressing conditions of use along with the use itself. Utilizes individual focus and psychoeducation as means to reach clients. 5 Principles of Harm Reduction. Harm Reduction Coalition. N.p., n.d. Web. 27 June

19 Harm Reduction Models Los Angeles California s Lamp Community Relapses are tolerated so long as they do not affect other clients Units range from private to semi-private cubicles for Safe Haven and transitional housing units. Scattered site housing is used for its permanent supportive housing units Chicago, Illinois North Side Housing Utilize interim housing and permanent supportive housing Sobriety or medication compliance is not required to access services 50-bed capacity for interim housing and scattered-site units for permanent supportive housing

20 Why have Harm Reduction? Accepts clients when they present for services, regardless of substance use status Provides clients a safe place to stay without fear of expulsion due to substance use Helps direct clients towards stabilization, helping to mitigate unhealthy outcomes due to substance use

21 Housing First What is Housing First? Set of programs which houses clients quickly by providing affordable rental units in which clients must comply to a standard lease agreement Targeted Candidates? 6 Clients who have mental illnesses Those who are chronically homeless Clients who use substances Type of Permanent Supportive Housing services are available but not required 6 Kertesz, S. G., Crouch, K., Milby, J. B., Cusimano, R. E., & Schumacher, J. E. (2009). Housing First For Homeless Persons With Active Addiction: Are We Overreaching?. Milbank Quarterly, 87(2),

22 Housing First Models DESC 1811 Eastlake Seattle, WA (single site) Total cost rate reduction of 53% for housed participants between 2005 and 2007 One-year client retention rate of 66% between 2007 and 2008 Pathways to Housing, Inc. New York, NY(multiple site) Studies found that Housing First costs city $57 per night to house client vs. $73 in shelter and $1185 in psychiatric hospital Has housed more than 600 people in New York alone, and the program maintains an 85% retention rate REACH San Diego, CA (multiple site) Increased costs of case management and outpatient services are offset by reduced costs for emergency services, mental health services, and criminal justice payments

23 Why have Housing First? Decreases municipal costs for housing clients per night Allows for a stable environment in which to seek treatment and move towards stability Alleviates chronic homelessness

24 Wet Houses Types of shelters or more supportive housing units for homeless clients who suffer from chronic alcohol use disorder. In these wet houses, residents are allowed to drink without the consequence of expulsion due to alcohol use While treatment and counseling services are often provided, client participation is not a requirement

25 Wet House Models DESC 1811 Eastlake Seattle, WA Clients have been hospitalized numerous times due to alcohol use and have failed to show success in abstinence-only treatment facilities 49 apartments available St. Anthony Residence St. Paul, Minnesota Late-stage chronic alcoholic men with repeated admissions to detoxification centers and a history of failure in traditional chemical dependency treatment programs 60 units available Stella Maris (emergency shelter) Belfast, Ireland Provides a high-tolerance, low-threshold service for men and women with a history of homelessness and alcohol abuse 23 bed spaces per night Single Rooms: 15 Double Rooms: 4

26 Why have Wet Houses? Provides cost-effective alternative to emergency care and jail Offers clients a stable environment in which to safely consume alcohol while connecting them to services and treatment options Alleviates homelessness for clients who abuse alcohol

27 SOAR What is SOAR? National program and best practice supported by SAMHSA Aimed to increase SSI/SSDI benefits for people living with a disability and experiencing homelessness

28 Models of the SOAR Program Park Center Nashville, TN 96% success rate with homeless individuals (318 out of 330 approved as of June 2011) Average rate of determination is 64.5 days from application date Homeless Advocacy Project Philadelphia, PA Coordinators have obtained a 99 percent approval of applications Takes an average of 32 days for 742 applicants over a four-year span. Oklahoma System Approval rates for initial submission applications are about 90 percent. Submissions are made prior to client s release from prison Prison recidivism within 3 years was 41 percent lower for those approved for SSI/SSDI than a comparison group

29 Why have SOAR? Provides income for clients, allowing them access to certain types of permanent housing and access to health insurance Reduces economic insecurity for those who are disabled and unable to work Provides immediate source of income for clients re-entering society after incarceration

30 Alternative Staffing Organizations What are They? ASOs broker temporary entry-level job placements for individuals with diverse barriers to employment. 8 ASOs function similarly to conventional staffing organizations Provide businesses with ready-to-work employees and offer jobseekers the training they need to build a resume, learn skills, and build confidence in the job market. 8 Alternative Staffing Alliance. (2008)

31 Successful ASOs Chrysalis Los Angeles, CA In 2012, 1,820 jobs were secured by clients involved in the program First-Step Staffing, Atlanta, GA Secures employment for around 300 clients per year First-Step staffed 15 satisfied businesses during 2012

32 Why have ASO s? Boosts client s economic security Provides employers with job-ready workers Steers clients towards stability

33 Supported Employment Individualized Placement and Support evidence-based model for supported employment Specifically, the IPS serves clients through the use of supported employment teams that operate within community mental health agencies. These teams work with their agency's clinical staff to coordinate services.

34 Core Principles of IPS Zero exclusion Competitive jobs are primary goal Integrated into mental health treatment teams Personalized benefits counseling Rapid job search Systematic job development Time-unlimited job supports Client-centered

35 Successful Supported Employment Program Central City Concern s Employment Access Center Portland, Oregon Available to clients by referral who live in Central City Concern housing, or who are engaged with other program areas Employment specialists tend to have an average 1:25 caseload ratio, providing as much individualized support as possible. 531 jobs were secured for people in 2012.

36 Why have Supported Employment? Helps clients find and maintain employment Boosts economic security Provides guidance and support to clients to help maintain employment

37 Moving Forward The One Roof Continuum of Care stands to gain considerably from implementing these best practices, which will enable us to: Strategically prevent and end homelessness Increase opportunities for housing, economic, and employment stability for community members Plan for better use of community resources Build a stronger community

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