Presentation on theme: "National Alliance To End Homelessness"— Presentation transcript:
1National Alliance To End Homelessness Ending Homelessness: Plan, Act, SucceedHousing Chronically Homeless People: HOUSING FIRST Programs in PhiladelphiaPresented by: David DunbeckHorizon House, Inc.July 18, 2006
2Housing First Programs “New Keys” and “Home First” Replicated the model used by the Pathways to Housing ProgramQuick access to subsidized apartmentsIntensive clinical support services using an Assertive Community Treatment (ACT) Team (accept 5 individuals per month)Recovery using a Harm Reduction ModelConsumer choice is keyRepresentative payee; home visits
3New Keys Started March, 2003 Funding: Services – Housing – SAMHSA Treatment for Homeless grant (3 years-ended 2005)Medicaid fee-for service billing through city/state Targeted Case Management SystemsHousing –HUD SHP grant – 25 units (3 years, renewable)HUD SPC grant – 35 units (5 years, renewable)
4New Keys Target Population Chronically street homelessDual diagnosis – serious mental illness and drug/alcohol addictionHousing and services for up to 65 consumersIntentionally took the consumers who had not been successful in any other treatment programsMost frequent contact with outreachHighest number of refusals of service
5Home First Started January, 2004 Chronic Homeless Initiative grant: Services –SAMHSA (3 years)VA (year-to-year) expire 2006HRSA (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)
6Home First Target Population Chronically homeless, shelter usersSerious mental illness. May have co-occurring drug/alcohol addictions, physical disabilitiesCapacity: Services for 90, housing for 75Intentionally took the consumers who had not been successful in any other housing or treatment programs and had high system utilization
7Housing First Outcomes Currently, we have 152 consumers assigned to New Keys and Home First:113 are housed in their own apartments18 are in housing process and living in shelter9 are being engaged through outreach7 are incarcerated (2 still have apartments)4 are in long-term hospitalization2 are in nursing homes1 is living with family
8Housing First Outcomes As of 2/28/06:126 clients had lived in at least one apartment1st apartment70/126 were successful in their 1st apartment (56%)2nd apartment24/47 were successful in their 2nd apartment (51%)Cumulatively, 94/126 successful in their 2nd apt. (75%)3rd apartment12/14 were successful in their 3rd apartment (86%)Cumulatively, 106/126 successful by their 3rd apt. (84%)
9Housing First Outcomes Impact of Housing on Mental Health:Of those ever housed (and receiving services):79% showed improvement18% stayed the same3% deterioratedOf those not housed (but receiving services):20% showed improvement70% stayed the same10% deteriorated
10Housing First Outcomes Impact of Housing on Substance Use:Of those ever housed (and receiving services):57% showed improvement34% stayed the same4% deterioratedOf those not housed (but receiving services):15% showed improvement70% stayed the same15% deteriorated
11Housing First Outcomes Impact of Housing on Overall Life Status:Of those ever housed (and receiving services):84% showed improvement12% stayed the same4% deterioratedOf those not housed (but receiving services):50% showed improvement35% stayed the same15% deteriorated
13SafetyStaffingHousingManaging expectations/pressuresBehavioral HealthMaintaining the modelFundingThe forest/the treesPhysical Health NeedsEmploymentCosts
14Things We’ve Learned:“Housing First + ACT”is not the same as“ACT”
15These programs are expensive and there are a lot of hidden costs: Things We’ve Learned:These programs are expensive and there are a lot of hidden costs:Staffing costsCost for furnishingsApartment damagesUnpaid rentsExorbitant utilitiesSocialization costsResearch/data analysis
16BUT… Housing First is still a good investment! Preliminary analysis shows significant (>50%) reduction in inpatient hospitalizations, detox, and rehab after engaging in services and/or getting housing.
17Things We’ve Learned:It’s a challenge to introduce “housing first” in an agency and division that also provide “traditional” homeless and treatment services:ValuesHarm reductionClient choiceHiringCo-location of facilities
18Things We’ve Learned:There are advantages and disadvantages to having housing services in a different agency than treatment services:Good cop/bad copValuesHarm reductionClient choiceLandlord issuesDamages
19Things We’ve Learned (or are still trying to figure out): 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?
20Things We’ve Learned: SAFETY must be a critical consideration when implementing ahousing-first program.FACT: You are controlling (some of) the money of an active substance user who also has a diagnosis of serious mental illness.
21Things We’ve Learned: Address Safety concerns by: Establishing: Boundaries, behavior expectations for consumersPolicies and procedures for staffConsequences (i.e., discharge)Training StaffProactively considering safety in your space planning
22Things We’ve Learned:Safety training: Understanding behavior; intervening before behavior escalates.Lalemand Behavior Scale:*AgitatedDisruptiveDestructiveDangerousThreat of Lethal* From the Non-Aggressive Psychological and Physical Intervention (NAPPI, Inc.)
23Things We’ve Learned: Good assessments are a good investment! Take the time to perform a thorough assessment (including physical health) at the beginning.Don’t drop the “physical health” ball – use your nurses!Dealing with long unmet physical health needs can be a powerful engagement tool!
24Things We’ve Learned: Staffing It takes special people to do housing first:Hiring good staff120% turnover in first yearMaintaining the “revolution”Keeping good staffTRAIN, LISTEN, SUPPORT
25Things We’ve Learned:We built sustainability into our grants….but, we still weren’t prepared for the transition:It’s always going to be a painful process, but don’t 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 – it’s easier to transition with only 5, 10, or 20 consumers (and associated paperwork) than with 155 consumers!
26but don’t become defensive” Things We’ve Learned:My new mantra:“Defend the program,but don’t become defensive”