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AB 109: Realignment and MHSA Housing Anne Cory Corporation for Supportive Housing MHSA Housing Program TA Webinar January 25, 2012 www.csh.org www.csh.org.

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Presentation on theme: "AB 109: Realignment and MHSA Housing Anne Cory Corporation for Supportive Housing MHSA Housing Program TA Webinar January 25, 2012 www.csh.org www.csh.org."— Presentation transcript:

1 AB 109: Realignment and MHSA Housing Anne Cory Corporation for Supportive Housing MHSA Housing Program TA Webinar January 25,

2 What to Expect Today Not a full explanation of Realignment Focus on MHSA Housing Program impact How to apply what we’ve learned in the Housing Program to meeting your community’s needs under realignment Housing lens 2

3 Agenda for Webinar Introduction to Realignment –Criminal Justice Realignment –Other Realigned Programs  Opportunities for Mental Health Staff  Why We Should Care About Housing?  CSH Programs: Returning Home Initiative and FUSE 3

4 Introduction to Realignment The 2011 realignment plan shifts responsibility and funding for numerous programs from state to local levels. Revenues for local management of programs exceed $6 billion per year. Realignment revenues are deposited into a complicated series of accounts in the new Local Revenue Fund Counties are agitating for commitment of adequate revenues long term. 4

5 Criminal Justice Realignment Realigned Criminal Justice Programs include: –Adult offenders and parolees; –Court security; –Pre-2011 juvenile justice realignment; –Misc. local public safety grant programs. 5

6 Realignment of Health and Human Services Programs Mental Health Managed Care EPSDT Drug and Alcohol Programs Foster Care and Child Welfare Services Adult Protective Services CalWORKS/Mental Health Transfer 6

7 What Does Realignment Look Like at the Local Level? Need for substance abuse treatment services Need for mental health services Numbers are not matching projections No benefits sign-ups before return to community Dropping off offenders at Mental Health Department Law enforcement lacks knowledge to assess and refer appropriately Intense focus on criminogenics and recidivism 7

8 How Does it Look in Your Communities? Challenges Loose ends Collaboration Successes 8

9 What Issues Can You Address at the Local Level? Discharge Plan: The discharge plan should include probationers’ or parolees’ treatment and other service needs. Probation and parole conditions should be the least restrictive necessary. Probationers and parolees with mental illness or co-occurring disorders should be supervised by probation officers and parole agents with specialized mental health training and reduced caseloads. 9

10 What Issues Can You Address at the Local Level? Probation officers and parole agents should should: –reorient the supervision process from enforcement to intervention and ensure that it is community-based. –ensure that probationers and parolees with mental illness receive the services and resources in their discharge plans and are connected to a 24-hour crisis service. –Develop working agreements with community-based service providers to increase coordination of supervision and treatment goals and to ensure continuity of care once supervision is terminated. 10

11 What Issues Can You Address at the Local Level? Benefits enrollment – asap Access to psychiatric medications Enrollment in service programs (probationers are eligible for MHSA services, parolees are not) 11

12 12 What are the Barriers at Release? No identification, SSI, birth certificate No disability determination Definitions of homelessness can exclude people coming from correctional settings Hard to access health or mental health services Lack of affordable housing resources and access issues Limited income Legal and illegal discrimination (criminal record, mental illness, substance use, homelessness, poverty, race) Post traumatic stress disorder, difficulty reintegrating Family reunification issues, particularly for women

13 Opportunities for Mental Health Staff Planning through Community Corrections Partnerships Community Corrections Partnership recommends local plan for realignment implementation to county board of supervisors. –Executive Committee of CCP: Chief Probation Officer, Chief of Police, Sheriff, District Attorney, Public Defender, Superior Court Presiding Judge, County health & human services representative. 13

14 14 Opportunities for Mental Health Staff Counties have a lot of discretion on how to use funds: –State providing per parolee amount, per inmate amount, plus additional funding for “innovative” alternatives to incarceration. Opportunity to weigh in to influence how funding is spent (i.e., diversion programs, housing, services, etc.)

15 Why Should We Care About Housing? Task Force for Criminal Justice Collaboration on Mental Health Issues: Final Report RECOMMENDATIONS FOR CHANGING THE PARADIGM FOR PERSONS WITH MENTAL ILLNESS IN THE CRIMINAL JUSTICE SYSTEM APRIL

16 Why Should We Care About Housing? Many individuals with mental illness are released from jail and prison without housing arrangements, making it nearly impossible to succeed in managing their mental illness. The California Department of Corrections and Rehabilitation (CDCR) reports that, at any given time, 10 percent of the state’s parolees are homeless. The percentage of parolees who are homeless ranges from 30 percent to 50 percent in major urban areas such as San Francisco and Los Angeles. 16

17 Why Should We Care About Housing? Appropriate housing in the community at the time of release is critical for successful reentry for offenders with mental illness since it serves as the foundation from which this population can access treatment and supportive services. Every offender with mental illness leaving jail or prison should, as a part of his or her discharge plan, have in place an arrangement for safe housing. 17

18 What Can We Do About Access to Housing? Take on the role of housing advocate for the releasee, and ensure that community partners are doing so as well. Establish agreements with housing programs, including supportive housing, to develop a housing referral network. 18

19 What Can We Do About Access to Housing? Make MHSA Housing Program units available to offenders with mental illness. Ensure that your county plan includes equal access to MHSA housing for offenders with mental illness. 19

20 AB 826 Sponsored by CSH & Housing California Authored by Toni Atkins Funding since FY for program Department of Corrections & Rehabilitation (CDCR) calls the “Integrated Services for Mentally Ill Parolees” program. RFP in 2009: –Mental health services for mentally ill parolees in community. –Unclear whether housing costs could be funded. 20

21 AB 826 Bill would use funds now used for ISMIP to create a supportive housing programs for parolees with mental illness at risk of homelessness. Specifically, would— –Identify inmates at risk of homelessness and parolees who are currently homeless as potential participants; –Offer services to some participants before release to parole; and –Provide housing subsidies and services to participants 21

22 CSH Work: Housing for Criminal Justice- Involved Individuals

23 23 Corporation for Supportive Housing CSH is a national non-profit organization that helps communities create permanent housing with services to prevent and end homelessness. CSH advances its mission through advocacy, expertise, innovation, lending, and grantmaking.

24 Why We Do It: Lavelle’s Story  Lavelle has been arrested more than 150 times, largely for quality-of-life crimes  He suffers from schizophrenia, depression, and drug addiction  Has had inconsistent mental health care and multiple encounters with drug treatment programs  He has spent most of the last 12 years on a revolving door between streets, shelter, hospitals, and jail 24

25 CSH’s Frequent User Systems Engagement (FUSE) Initiative

26 The FUSE Premise Thousands of people with chronic health conditions cycle in and out of crisis systems of care and homelessness - at great public expense and with limited positive human outcomes. Placing these people in supportive housing will improve life outcomes for the tenants, more efficiently utilize public resources, and likely create cost avoidance in crisis systems like jails, hospitals and shelter. 26

27 27 The Beginning: New York City FUSE Demonstration program matching “frequent fliers” with permanent supportive housing and enhanced services. 190 frequent users of jail and shelter, identified through pre-generated data match DHS DOC Neither System

28 The Blueprint for FUSE

29 Three Pillars, Nine Steps 29 Data-Driven Problem- Solving Cross-system data match to identify frequent users Track implementation progress Measure outcomes/impact and cost-effectiveness Policy and Systems Reform Convene interagency and multi-sector working group Troubleshoot barriers to housing placement and retention Enlist policymakers to bring FUSE to scale Targeted Housing and Services Create supportive housing and develop assertive recruitment process Recruit and place clients into housing, and stabilize with services Expand model and house additional clients

30 Cross-System Data Match Provides Recruitment List 30 0Q7?240M 1&$F041% 10N01&1? LA8&28&$ L&81!NA8 A2OFAN(1 0187&1?3 NAMECLIENT_IDDOC_LOSDHS_LOSSHELTERDOCFacility Zeilinger, L USICHEMTC Hobson, B DESCBBKC Kanis, B ComSolRMSC Cho, R CSHEMTC

31 Results of Cross-System Data Match 31 Source: Urban Institute (2009) DHS DOC Neither System

32 Implementation through Collaboration PartnerRole NYC Dept of CorrectionData matching, program oversight, policy advocacy, service enhancement funding, facilitate jail in- reach NYC Dept of Homeless ServicesData matching, program oversight, policy advocacy, service enhancement funding, facilitate shelter in-reach NYC Dept of Health and Mental Hygiene Services and operating funding and program oversight CSHProgram design, assembled and coordinated funding, program oversight and troubleshooting, TA/training, NYC Housing Authority / Housing Preservation and Development Provide Section 8 vouchers JEHT Foundation / Langeloth Foundation Provided funding for service enhancements and evaluation NYC Office of Management and Budget Program oversight John Jay College / Columbia University Program evaluation 32

33 Assertive Recruitment Through Jail, Shelter, Hospital In-Reach 33 CourtsJail/PrisonStreetHospitalDetox Alcohol/Drug Treatment Shelter Psychiatric Hospital

34 Supportive Housing Section 8 Housing Choice Vouchers (or State rental assistance programs) + Mobile Intensive Case Management Services Unit set-asides in new supportive housing buildings or existing supportive housing with turnover Providers trained in Motivational Interviewing, navigating criminal justice system, harm reduction, recognizing “symptoms” of incarceration 34

35 Stabilization through Services Low case manager-to-client ratio (1:10 – 1:15) Case manager role as “client advocate” and “failure preventer” Emphasis on reduction of “risky behaviors” Non-judgmental, client-centered counseling Team approach to services delivery 35

36 “Systems Change” Through Case Coordination Monthly implementation monitoring meetings to track recruitment, housing placement, housing retention, and recidivism prevention Case conference and intervention in cases of re- arrest or re-hospitalization Wraps “system of care” around tenants with supportive housing provider in central coordinating role 36

37 Measure Outcomes and Cost- Effectiveness Crisis services use ($) 2 years before FUSE — Crisis services use ($) 2 years after FUSE — FUSE cost over 2 years = Net Savings of FUSE over 2 years 37

38 Getting to Policy Adoption and Scale Bringing FUSE from pilot to full policy: –Early engagement of policymakers, budget officials around the FUSE “experiment” –Communication of outcomes and cost- offsets –Advance redirection of public spending from jails, shelters, etc. to supportive housing 38

39 Sites Implementing or Planning FUSE Replications 39 Implementing FUSE Planning FUSE

40 Prior Research on High / Frequent Users Hopper et. al. (1997) found that long-term homeless persons with severe mental illness experienced an “institutional circuit” that includes shelters, jails, ED, detox Kuhn and Culhane (1998) found that approximately 10% of shelter users in New York City were ‘episodic’ users of shelter –These individuals are “more likely to be non-White, and to have mental health, substance abuse, and medical problems.” –“Much of the periods they spend outside of shelter may be spent in hospitals, jails, detoxification centers, or on the street. Indeed, one could argue that part of the very reason that these individuals do not become chronically homeless or long-term shelter residents is their frequent exit to inpatient treatment programs, detoxification services, or to penal institutions. Nevertheless, these clients often find their way back to shelters.” Culhane et. al. (2002) found that homeless persons with serious mental illness cost $41,000 annually through usage of emergency public systems Ford (2005) identified 61 frequent flyers of a FL county jail, of whom 82% were homeless,100% had substance abuse history, and 51% had a mental health history Gladwell (2006) described individual who cost roughly $1 million in public service utilization 40

41 Characteristics & Service Needs of Jail-Shelter Frequent Users Believed to have high rates of co-occurring and complex issues: –Alcohol and substance use (approx. 80%); earlier data matches found high utilization of crisis drug treatment services (i.e. Medicaid-reimbursed detox) –Mental health issues (est %), including serious mental illnesses (est %) Criminal offenses largely consists of low-level misdemeanors (i.e. “quality of life” crimes), with minor felony histories 41

42 Characteristics & Service Needs of Jail-Shelter Frequent Users Histories of transience and high level of involvement in multiple systems and services Providers report: –Lack of trust in service providers and inconsistent benefits enrollment –Comparatively high occurrence of behavioral issues and lower degrees of independent living skills –Individuals are difficult to keep in one place and need nearly constant hand-holding as they navigate systems involvement 42

43 Research Suggests that Housing with Services Can Break the Cycle Intensive service models such as Assertive Community Treatment or Intensive Case Management reduce recidivism Supportive housing significantly reduces involvement in jails and prisons (along with shelter, hospitals, etc.) among homeless persons with serious mental illness 43

44 44 Housing Criminal Justice Social Services Health and Behavioral Health Employment Fractured Systems

45 45 Aligning Multiple Systems for Better Results Supportive Housing Criminal Justice NYS DOC NYC DOC PAROLE PROBATION Bridge Rental Support Client Identification Transitional Case Management Health and Behavioral Health Mental Health Support Services Housing Support ACT Teams Housing HUD Shelter + Care Public Housing Authorities Section 8 Social Services Shelter Plus Care NY/NY III Service Contracting through Criminal Justice/Human Service Agencies Employment Employment Initiatives both Federal and Local

46 CSH Returning Home Initiative CSH's Returning Home Initiative started in 2006 and applies the FUSE model in communities across the country. Initiatives integrate the systems and resources of criminal justice, behavioral health, and housing agencies. CSH partnered with a number of leading researchers, including the Urban Institute, the John Jay College of Criminal Justice, the University of Minnesota and Columbia University. 46

47 CSH Returning Home Initiative: Early Findings A 39% reduction in the number of days in county jail for participants in Hennepin County. A 50% reduction in the number of days in jail for participants in New York, compared to a comparison group. A 43% reduction in the number of nights spent in shelter by participants in Hennepin County over the course of 22 months. 47

48 CSH Returning Home Initiative: Early Findings Preliminary findings from New York show that after 12 months, only 16% of the program group had any shelter admission compared to 98% of the comparison group. Preliminary findings from New York show lower rates of alcohol and drug abuse—specifically injection drug use—among people in the program. In addition, the proportion of people with earnings and/or entitlements is much higher for people in the program. 48

49 To Learn More About CSH, FUSE and Returning Home Anne Cory x208 And help with the MHSA Housing Program 49


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