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Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia Presented by:David Dunbeck Horizon House, Inc. July 18, 2006 National Alliance.

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Presentation on theme: "Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia Presented by:David Dunbeck Horizon House, Inc. July 18, 2006 National Alliance."— Presentation transcript:

1 Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia Presented by:David Dunbeck Horizon House, Inc. July 18, 2006 National Alliance To End Homelessness Ending Homelessness: Plan, Act, Succeed

2 Housing First Programs New Keys and Home First Replicated the model used by the Pathways to Housing Program Quick access to subsidized apartments Intensive clinical support services using an Assertive Community Treatment (ACT) Team (accept 5 individuals per month) Recovery using a Harm Reduction Model Consumer choice is key Representative payee; home visits

3 New Keys Started March, 2003 Funding: Services – SAMHSA Treatment for Homeless grant (3 years-ended 2005) Medicaid fee-for service billing through city/state Targeted Case Management Systems Housing – HUD SHP grant – 25 units (3 years, renewable) HUD SPC grant – 35 units (5 years, renewable)

4 New Keys Target Population Chronically street homeless Dual diagnosis – serious mental illness and drug/alcohol addiction Housing and services for up to 65 consumers Intentionally took the consumers who had not been successful in any other treatment programs Most frequent contact with outreach Highest number of refusals of service

5 Home First Started January, 2004 Chronic Homeless Initiative grant: Services – SAMHSA (3 years) VA (year-to-year) expire 2006 HRSA (3 years) Medicaid fee for services through city/state Targeted Case Management systems (at end of grants) Housing – HUD SHP grant – 70 units (3 years, renewable)

6 Home First Target Population Chronically homeless, shelter users Serious mental illness. May have co- occurring drug/alcohol addictions, physical disabilities Capacity: Services for 90, housing for 75 Intentionally took the consumers who had not been successful in any other housing or treatment programs and had high system utilization

7 Housing First Outcomes Currently, we have 152 consumers assigned to New Keys and Home First: 113 are housed in their own apartments 18 are in housing process and living in shelter 9 are being engaged through outreach 7 are incarcerated (2 still have apartments) 4 are in long-term hospitalization 2 are in nursing homes 1 is living with family

8 Housing First Outcomes As of 2/28/06: 126 clients had lived in at least one apartment 1 st apartment 70/126 were successful in their 1 st apartment (56%) 2 nd apartment 24/47 were successful in their 2 nd apartment (51%) Cumulatively, 94/126 successful in their 2 nd apt. (75%) 3 rd apartment 12/14 were successful in their 3rd apartment (86%) Cumulatively, 106/126 successful by their 3rd apt. (84%)

9 Housing First Outcomes Impact of Housing on Mental Health: Of those ever housed (and receiving services): 79% showed improvement 18% stayed the same 3% deteriorated Of those not housed (but receiving services): 20% showed improvement 70% stayed the same 10% deteriorated

10 Housing First Outcomes Impact of Housing on Substance Use: Of those ever housed (and receiving services): 57% showed improvement 34% stayed the same 4% deteriorated Of those not housed (but receiving services): 15% showed improvement 70% stayed the same 15% deteriorated

11 Housing First Outcomes Impact of Housing on Overall Life Status: Of those ever housed (and receiving services): 84% showed improvement 12% stayed the same 4% deteriorated Of those not housed (but receiving services): 50% showed improvement 35% stayed the same 15% deteriorated

12 Things Weve learned! (Usually the hard way!)

13 Housing Safety Funding Behavioral Health Costs Employment Managing expectations/ pressures Physical Health Needs Staffing Maintaining the model The forest/the trees

14 Housing First + ACT is not the same as ACT Things Weve Learned:

15 These programs are expensive and there are a lot of hidden costs: Staffing costs Cost for furnishings Apartment damages Unpaid rents Exorbitant utilities Socialization costs Research/data analysis Things Weve Learned:

16 Housing First is still a good investment! BUT… Preliminary analysis shows significant (>50%) reduction in inpatient hospitalizations, detox, and rehab after engaging in services and/or getting housing.

17 Its a challenge to introduce housing first in an agency and division that also provide traditional homeless and treatment services: Values Harm reduction Client choice Hiring Co-location of facilities Things Weve Learned:

18 There are advantages and disadvantages to having housing services in a different agency than treatment services: Good cop/bad cop Values Harm reduction Client choice Landlord issues Damages

19 Money Management: Is it really therapeutic to be representative payee for your consumers? Or would it be better to let another agency be the representative payee? Things Weve Learned (or are still trying to figure out):

20 Things Weve Learned: SAFETY must be a critical consideration when implementing a housing-first program. FACT: You are controlling (some of) the money of an active substance user who also has a diagnosis of serious mental illness.

21 Things Weve Learned: Address Safety concerns by: Establishing: Boundaries, behavior expectations for consumers Policies and procedures for staff Consequences (i.e., discharge) Training Staff Proactively considering safety in your space planning

22 Things Weve Learned: Safety training: Understanding behavior; intervening before behavior escalates. Lalemand Behavior Scale:* Agitated Disruptive Destructive Dangerous Threat of Lethal * From the Non-Aggressive Psychological and Physical Intervention (NAPPI, Inc.)

23 Good assessments are a good investment! Take the time to perform a thorough assessment (including physical health) at the beginning. Dont drop the physical health ball – use your nurses! Dealing with long unmet physical health needs can be a powerful engagement tool! Things Weve Learned:

24 Staffing It takes special people to do housing first: Hiring good staff 120% turnover in first year Maintaining the revolution Keeping good staff TRAIN, LISTEN, SUPPORT Things Weve Learned:

25 We built sustainability into our grants….but, we still werent prepared for the transition: Its always going to be a painful process, but dont wait until you need to bill fee-for-service to begin the transition: Pull the bandage off Do the necessary procedures, paperwork, etc. fully from the beginning – its easier to transition with only 5, 10, or 20 consumers (and associated paperwork) than with 155 consumers! Things Weve Learned:

26 My new mantra: Defend the program, but dont become defensive Things Weve Learned:

27 The Goal:

28 Housing First – Future Growth Welcome Home Start-up December 2006 Services and housing for 60 Philadelphia 10-Year Plan to End Homelessness Proposes housing first for 360 (currently at 150)

29 Contact Information Horizon House, Inc Chestnut St., 12 th floor Philadelphia, PA David Dunbeck, Director of Homeless Services, Carla Williams, Director of ACT,


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