WVBHPC Mission: to improve the mental health system and function as a catalyst of change in that system. (2008)

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1 West Virginia Behavioral Health Planning Council (WVBHPC) April 16, 2015 Saint John XXIII Pastoral Center Charleston, WV Meeting Notes WVBHPC Vision: The West Virginia Behavioral Health Planning Council is a unified voice that promotes wellness, recovery, and resiliency for all West Virginians. (2012) WVBHPC Mission: to improve the mental health system and function as a catalyst of change in that system. (2008) Executive Committee Meeting (Executive Committee Members only) Attendees: Ardella Cottrill Angie Ferrari Joyce Floyd Heather Hoelscher Ted Johnson Tom Kimm J.K. McAtee Pete Minter Aaron Morris Bob Musick Linda Pauley Phil Reed James Ruckle Nancy Schmitt Patrick Tenney Vanessa VanGilder Richard Ward Amanda Sisson, Presenter Martha Minter, Staff Jenny Lancaster, Staff Welcome, Introductions and Review of Agenda Linda Pauley, WVBHPC Chair, opened the meeting and participants introduced themselves. Executive Committee: Submitted application for technical assistance to develop an orientation manual. Request for Letter of Commitment SAMHSA has a grant for a consumer support technical assistance center. Council was asked for a letter of commitment to send with State grant application. State submitted a letter and asked remaining drop in centers to sign. Executive Committee decided the Council should submit its own letter explaining that council does not do direct services (other than Leadership Academy), but will support the work. Minutes: Review of January 15, 2015 Meeting Minutes Nancy Schmitt made motion to accept minutes; Bob Musick second; all approved Brochures: Reviewed WVBHPC Brochures Anyone who needs copies of the brochures - contact Jenny Lancaster jenny@terzettocreative.com

2 Question about doing brochures in alternative format; Aaron to contact Kathy Young and send information to Linda. WV I/DD Waiver - Public Comment: WV Intellectual/Developmental Disabilities Waiver 5 year renewal application is available for public comment until 5 pm on April 24, NAMI Chapter in WV Discussion about National Alliance on Mental Illness (NAMI) possible chapter in WV Discussion about issues NAMI supports such as forced outpatient treatment; some members are on different sides of policy issues than NAMI May be issues we can work together on. WVBHPC 2014 Year End Activity Report Participants reviewed WVBHPC 2014 Activity Report Discussion about gaps in membership youth/families, certain regions, etc. Would like to show more activities in upcoming years. James has corrections to the Activity Report. Activity Report to be posted online. Presentation: Practices in Ending Homelessness in WV Amanda Sisson, West Virginia Coalition to End Homelessness (Arranged by Heather Hoelscher and Adult Services Committee) [SLIDES ATTACHED] Reviewed WV Coalition to End Homelessness and its role in WV Reviewed key players in policy and practice toward ending homelessness US Interagency Council on Homelessness Opening Doors first comprehensive strategy to prevent and end homelessness Four Continuums of Care in WV (1) Wheeling/Weirton Coalition to End Homelessness; (2) Huntington Cabell Wayne Continuum of Care; (3) Kanawha Valley Collective; (4) WV Balance of State Continuum of Care HEARTH Act Definitions of Homelessness/Eligibility for HUD-funded Homeless Housing Programs WV CoC Funding Emergency Shelter, Transitional Housing, Rapid-Rehousing, Permanent Supportive Housing Typology of Homelessness Initiatives that Work: Coordinated Entry, Prioritization, Using HMIS, Zero: 2016 Housing First HMIS Shared data system (Homeless Management Information System) Legislative Updates 2015 Legislative Session Members reviewed pertinent bills passed by 2015 Legislature Jason Flatt Act 2012 amended to educate personnel on suicide of persons in schools State Dept. of Ed receives a 5 year federal grant to keep services in schools

3 Opioid Treatment Guidelines - discussion about one size fits all issues because some folks are now unable to get the medication they need. TANF bill Secretary to report to Legislative Oversight Commission about what sanctions were applied and why BMS Services review process through independent board Exemption of veteran owned businesses from certain fees for Secretary of State to start businesses Opioid Antagonist Act (NARCAN) passed Establish community based services for juveniles for certain non-violent offenses Good Samaritan Law cannot arrest person who calls 911 for friend if they only have misdemeanor (rather than felony) Creation addiction treatment pilot program using drug court program (special program for offenders) Jamie s Law Suicide prevention bill Committee and Agency Reports Ardella Membership Looking for families of children and youth Angie MSPCAN conference identified a couple families Vickie Mays (Clarksburg) / Danny/Tammy Lacy (Charleston) Aaron and J.K. are trying to get youth involved Heather Hoelscher Adult Services Committee Committee is meeting monthly via GoTo meeting Tom Kimm / Heather Hoelscher / Ted Johnson / Dr. Aldis Herb Linn (WVU) presented to Council request to add to committee Looking at homelessness in WV addressing discriminatory policies requested WVCEH/Amanda Sisson to present Peer support specialists Dr. Sullivan / Dr. Berry substance abuse / medication assisted treatment (Suboxone) Dr. Aldis has requested that Dr. Sullivan present at upcoming council meeting Lack of assistance to smaller clinics around the state Therapy piece in place; long waiting list for therapists Honor Michelle Tomen for getting Jamie s Law passed - encourage suicide prevention in schools. Ask Michelle to present at July meeting Want to interface with Children s Services Committee want school based mental health to stay a priority Focus on gathering anecdotal information on barriers to treatment Would like to post a satisfaction survey online Ardella Children/Families Committee Phil Reed and Ardella Cottrill will be attending Youth Mental Health First Aid Training in Fairmont on April 18, 2015 Tucker County facility is closing Nancy Schmitt attended a Trauma Informed Care Training Child Help, New Health Care Alliance, WVU Healthcare, Chestnut Ridge, WVDHHR - 5 sessions training Training Kit training people to respond after Katrina Richard Ward Div. of Rehabilitation Services Mental Health Awareness Month

4 Announcements / Other Events: Passion to Action Free educational training WV Court Improvement Program (CIP) Child Abuse/Neglect and Juvenile Law Cross Training Conferences o July 20-21, 2015 Charleston Marriott o July 23-24, 2015 Bridgeport Conference Center o Training.pdf 2015 Disability Caucus / WV State of Independent Living Council o June at Marriott o Youth/Leadership Skills o Advertising packages available o WV Leadership Academy o Clarksburg Caperton Center April 22, 23, 24 o Beckley, WV May 2015 o Huntington, WV September 2015 WV Advocates is looking for new members PAMI looking for new members FAST (Families Advocacy Support and Training) is having a children s mental health awareness walk on May 14, 2015 from 11 am 1 pm in Huntington. Contact Bill Albert Legal Aid in WV Fair Shake Network Light It Up Blue on April 21, 2015 at Appalachian Power Park Fair Shake Network Yard Sale on May 9, 2015 at East End July 16 th WVBHPC Meeting (rescheduled for July 23, 2015) Honor Michele Komen Heather Hoelscher made a motion to honor Michelle Toman for Jamie s Law and Tom Kimm - second Check-out and Evaluations Adjourn

5 Advocates to Prevent and End Homelessness Practices in Ending Homelessness in WV West Virginia Coalition to End Homelessness, Inc. 929 West Main Street, Bridgeport, WV facebook.com/wvceh

6 You will learn: the roles WVCEH play in West Virginia, basic Federal policies that govern how we do business, homeless housing funding streams in WV, the basics of homelessness and the traditional response, the true cost of homelessness, some things that work to end homelessness.

7 Don t put your phone Feel free to Tweet, Post and/or share your thoughts and questions today!

8

9 Key Players in Policy and Practice toward Ending Homelessness United States Interagency Council on Homelessness (strategic vision) U.S. Department of Housing and Urban Development (funds and policy) National Alliance to End Homelessness (best practices) State Coalitions, State Interagency Councils, and Continua of Care

10 USICH Opening Doors

11 USICH Opening Doors

12 The West Virginia Coalition to End Homelessness

13 Our Tenets 1. The only solution to homelessness is housing 2. Homelessness is incredibly costly and housing is much less so. 3. Anyone can be housed. 4. Limited resources must be focused on those who require it the most.

14 West Virginia HUD Designated Continua of Care

15 Continuum of Care There are 4 in West Virginia

16 Homeless Emergency Assistance and Rapid Transition from Homelessness Act HEARTH: Changing how we do business since 2009 Programs Systems Activities Outcomes Shelter Prevention Transitioning Rapidly Re-Housing

17 How are communities measured under HEARTH?

18 Who do we serve and what housing is available in WV?

19 Homeless Definition Eligibility for HUD-funded Homeless Housing Programs

20 Defining Chronic Homelessness Eligibility factor for Several Different Permanent Housing Types Chronically Homeless Individual Chronically Homeless Family

21 2014 WV Continuum of Care Funding WV Balance of State KVC (Charleston) Huntington/Cabell/ Wayne Northern Panhandle Permanent Supportive Housing $2,814,088 $933,095 $1,340,655 $257,698 Rapid Re-Housing $134,783 $0 $0 $0 Transitional Housing $271,492 $92,952 $208,175 $135,796 Supportive Services Only $0 $246,156 $107,595 $135,796 HMIS $389,746 $63,999 $34,853 $11,200 Safe Haven $0 $0 $127,066 $0

22 Emergency Shelter Meant to act as a temporary, emergency triage until the next step in more permanent housing is available. The focus should always be on housing. Shelter should not be the destination. Could play an important role in coordinated access, with some program tweaks. Many current rules in place make it difficult for shelters to act as true triage centers for the most vulnerable people. Many are ESG and DHHR funded. Many are also faith-based Total of 1,545 Beds in WV in 2014

23 Transitional Housing A months of housing subsidy with case management. The placement of homeless individuals and families from either the streets, or shelters, into projectbased, or leased rental housing with case management, with a goal of exit to permanent housing. Generally viewed as not an effective intervention because it is very costly and operates on the premise of housing-readiness. Considered a lower priority for federal funding, and re-tooling to Rapid Re-Housing or Transition in Place models is being encouraged. No FY2015 ESG funding will be allocated to TH. 589 beds in WV in 2014

24 Rapid Re-Housing Designed to greatly reduce the time from homelessness to housing, particularly effective for families and in rural areas. FY Total of $594,000(ESG: RRH and Prevention), $3,296,500 (SSVF) in funds in West Virginia.

25 Permanent Supportive Housing A long-term housing subsidy with intensive case management. The placement of homeless individuals and families from either the streets, shelters, or transitional housing into project-based, or leased rental housing with intensive case management. Designed to greatly reduce chronic homelessness, lessen the cost of high-acuity homelessness, and prevent death on the streets. Considered a housing first initiative, and has been proven to be more effective when sobriety is not a pre-condition of housing. Generally for high-acuity individuals and families who have physical or cognitive disabilities, and/or a history of substance use and mental illness. Total of 1,401 Beds in West Virginia A large percentage of this type of housing is specifically for those who are defined as Chronically Homeless

26 How are we doing with using what we have?

27 Let s take a little trip back to 2002

28 You wandered into a shelter. We maybe let you in. If you were sober, or stayed sober, we let you stay. For a LONG time. But if you continued to use drugs, drink, or disobey the rules, we put you back out on the street. If you continued to behave, we let you stay longer, or we even moved you on to Transitional Housing. We did life skills, budgeting, and other stuff to prepare you for the real world. Then you stayed on the street a really long time, and maybe went to multiple shelters and the process would repeat itself if you couldn t get sober or follow the rules. And, you stayed homeless

29 We went on hunches. We weren t and in some places still aren t, able to determine if you need our service or not. We maybe helped you get an apartment. But that was mostly your responsibility only after you were ready for an apartment. But If you followed the rules, you got to stay. And stay, and stay, and stay We prided ourselves on filling beds. Rules were, and still are, there for your safety, and our safety. Safety First, for sure! If we got you out, we didn t follow up. Our peers monitored us, so that worked well! As long as we measured shelter nights and meals, all was good Right?

30 But, there was (is) a problem Hard to serve people stayed on the street Easy to serve people stayed in the shelter That cost us a lot of money That cost us a lot of money as a state and as communities Law enforcement, ER, Shelters, Crisis, In- Patient, Outpatient, State Hospitals, etc. Utilities, meals, case mgt., life skills, computer labs, shelter workers, etc.

31 We were paying top $

32 To kill people

33 We were (and in some places, still are) doing this:

34 The Typology of Homelessness

35 Some actual cost numbers

36 Initiatives that Work Coordinated Entry, Prioritization, Using HMIS, Zero: 2016

37 How do we change our Crisis Response System to Homelessness? Coordinated Entry, the CoC s responsibility under HEARTH A centralized or coordinated process designed to coordinate program participant intake, assessment, and provision of referrals across a geographic area. Covers the geographic area, is easily accessed by individuals and families seeking housing or services, is well advertised, and includes a comprehensive and standardized assessment tool. (24 CFR Section 578.3) It is the responsibility of each CoC to implement CI&A in their geographic area.

38 The goals of Coordinated Entry Helps people move through the system faster Reduces new entries into homelessness Improves data collection and quality, provides accurate information on what kind of assistance consumers need Reduces the overall cost of homelessness on the system as a whole. Uses a housing first philosophy.

39 Building Block of Coordinated Entry ACCESS Clear path to services, transparent eligibility criteria, screening people in, not out. ASSESS Common forms (VI-SPDAT), attempt to divert, then provide intervention ASSIGN Clear priorities, consistent referral process, vacancy information available ACCOUNTABILITY Oversight of process, monitor program and system outcomes

40 The Vulnerability Index-Service Prioritization Decision Assistance Tool: VI-SPDAT WVCEH Executive Director and Assistant Director are both OrgCode approved SPDAT trainers

41 Dimensions of the VI-SPDAT

42 VI-SPDAT Scoring Bands Single VI-SPDAT Family VI-SPDAT Diversion (can solve their own homelessness) Rapid Re-Housing (or short-term intervention) Permanent Supportive Housing/Housing First (intensive, long-term supports)

43 Why is Prioritizing Important Move away from first come, first serve which relies on who is lucky enough to get the service With limited resources, time and money, we need to invest in those people who DO need our help From ideal candidates, we need to triage which person would most benefit from the service next. Prioritization is on-going and results in the better referrals, service delivery and outcomes

44 The housing first philosophy

45

46 Coordinated Entry on the Ground

47 Homeless Management Information System (HMIS)

48 What does HMIS do? Allows the aggregation of client-level data across homeless service agencies to generate unduplicated counts and service patterns of clients served HUD s National Data and Technical Standards establish baseline standards for participation, data collection, privacy and security Implementation of HMIS is a requirement for receipt of Department of Housing and Urban Development (HUD) McKinney-Vento and CoC funding

49 HMIS in West Virginia Between 9,000-11,000 records per year. Open Statewide System with the exception of client level case notes and Entry/Exits from HOPWA providers 315 total users in 80 agencies with a total of 273 programs. Agencies as varied as HUD programs, shelters, food pantries, free clinics, rapid re-housing, and faith-based.

50 Prioritization with the VI-SPDAT in HMIS 1 2 Back to Step

51 Zero: 2016

52 What do the numbers look like so far? January 2015: Veteran placements: 23 Chronic placements: 20 February 2015: Veteran placements: 19 Chronic placements: 13 March 2015: Veteran placements: 19 Chronic placements: 18 We need to house 716 Veterans (79 per month) by December 2015 to END Veteran homelessness in the Balance of State CoC. We need to house 304 Chronic (14 per month) by December 2016 to END Chronic homelessness in the Balance of State CoC.

53 The WVCEH s Direct Service Programs

54 WVCEH PATH Service Area Region 4 Region 2

55 The Philosophy of WVCEH s PATH Program

56 WVCEH PATH Admission and Discharge Criteria The admission to WVCEH s PATH Program follows the Legislative criteria for PATH enrollment which is people who; 1. (A) are suffering from serious mental illness; or (B) are suffering from serious mental illness and from substance abuse; and 2. are literally homeless or at imminent risk of becoming homeless. The discharge criteria is admission to some type of permanent housing either through direct provision (RRH) or through a referral to other housing options.

57 WVCEH PATH Data WVCEH Path Clients 3/1/14-2/28/15 Total Receiving Outreach (Contact or Engagement) Total Directly Housed through WVCEH RRH All PATH Clients exiting to some type of Permanent Housing (20%) 62 (31%) Enrolled PATH Persons 87 Number of total services provided 418

58 WVCEH PATH Data-Demographics Homeless Status WVCEH PATH 3/1/14-3/1/15 At Imminent Risk 4% At Risk of Homelessness 13% Literally Homeless 83% Staying or living in a friend's room, apartment or house 4% Staying or living in a family member's room, apartment or house 7% Psychiatric hospital or other psychiatric facility (HUD) 4% Top Previous Residences WVCEH PATH 3/1/14-3/1/15 Transitional Housing Hotel or Motel paid 3% for with Emergency Shelter Voucher 20% Hospital or other residential non- psychiatric medical facility (HUD) 3% Place not meant for habitation 59%

59 WVCEH PATH Data-Mainstream Benefits and Income WVCEH PATH Clients Income Past 30 Days Client doesn't Client refused know (HUD) (HUD) 1% 1% Data not collected (HUD) 1% Yes (HUD) 45% No (HUD) 52% WVCEH PATH Clients Non-Cash Benefits Past 30 Days Client refused (HUD) 1% Data not collected (HUD) 2% Client doesn't know (HUD) 2% No (HUD) 28% Yes (HUD) 67%

60 WVCEH PATH Data-Acuity Data WVCEH PATH Outreach VI-SPDAT Six Month Average Interactions by Acuity Marker Month Average Number of Trips to the ER 6 Month Average Number of Police Interactions 6 Month Average Trips to the Hospital an in Ambulance 6 Month Average Number of times Crisis response system was used 6 Month Average Number of Times Hospitalized as Inpatient

61 WVCEH PATH Data-Acuity Data PATH Outreach VI-SPDAT Scoring Total Persons with Experience by Acuity Marker Been taken to a hospital against your will for a mental health reason? Gone to the ER because you weren't feeling 100% well emotionally or because of your nerves? Spoken with a mental health professional in the last six months because of your mental health? Had a serious brain injury or head trauma? Been told you have a learning disability or developmental disability? Have any problems concentrating and/or remembering things? Experienced abuse, trauma, assult which has caused your homelessness

62 The Goals of WVCEH s Rapid Rehousing Program

63 WVCEH Rapid Re-Housing Data WVCEH RRH Clients 3/1/14-2/28/15 Total Receiving Outreach (Contact or Engagement) 31 Total Receiving Rapid Re-Housing 90 Persons with Disabilities Total Directly Housed through WVCEH RRH Positive Exit Destinations Severely Mentally Ill, 16 Chronic SA, and 17 Other Disability 90 90% to Rental by Client, no subsidy Number of total services provided average of $86.33/service

64 WVCEH Rapid Re-Housing Acuity Data VI-SPDAT Prescreen Scores and Average Acuity Markers VI-SPDAT Prescreen Score Average Interactions with Police Hospitalized as an Inpatient Average Trips to the ER Average Trips to Hospital in an Ambulance

65 In conclusion We can end homelessness in WV. Homeless service providers must be on the same page and committed to coordinated entry, prioritization and diverting people before they enter homelessness We, WVCEH, have the tools, experience and resources to help communities and providers do the right thing, in the smartest, most cost effective way.

66 Questions? Amanda Sisson Assistant Director Advocates to Prevent and End Homelessness WV Coalition to End Homelessness, Inc. 929 West Main Street Bridgeport, WV (office) (fax) wvceh.org