1. Top 51 Pilot in Hennepin County Minnesota: Lessons Learned
Chris Michels
Lisa Thornquist

2. Hennepin County, Minnesota
1.2 million residents – 1/3 Minneapolis
2,300 in shelter on any given night. 1,400 are in families, 900 are single adults.
Over year, 7000 single adults in shelter.
About 500 single adults stay off and on for over a year
3,000 PSH Units for single adults – 600 turn over each year
Homeless: 1400 adults and kids in family shelter, 900 single adult
Despite the match between PSH and LTH, many don’t get into PSH.

3. Distribution of Nights in Shelter
Explain our shelter system – secure waiting – free and no time limits. People stay for years.
Half stay one week and don’t return

4. Top 51 clients identified
Top users of shelter 1/1/2008-4/15/2011
They had 47,294 nights in shelter during this time
They accounted for 8 percent of shelter capacity (we typically have 900 single adults in shelter on any given night)

5. Service Use of Top 51
It was clear that mental health was larger than what we could measure. Many never got mh services even though they needed them.

6. Top 51 Pilot 4 case managers contracted to agencies (with supervision)
2 county staff PATH homeless outreach
Steering committee of 10-12
$710,000 for 2.5 years in contracted services
Started July 1, 2012
July Dec 31, 2014
Steering committee made up of:
Shelter access, two largest free shelters, HealthCare for the Homeless, Mental Health Center, Homeless Access PATH supervisors, OEH

7. Top 51 Program Participants
55 clients selected – 49 men and 6 women
12 had been in shelter since at least 1997 – first year of record
Average first year in shelter 2002

8. Pre-Engagement Case Manager can identify client
Case Manager watches/observes a client whenever possible and identifies daily routine
Case Manager does research on client, obtains information from various sources and plans/strategizes how to approach client
Four levels – pre-engagement, early engagement, advocacy, partnership
To start, we gave the case workers the names of the people on their caseload. They went out to find them…. Not hard since they are in shelter most nights.

9. Early Engagement
Client knows Case Managers name and is aware of Case Managers role and program involvement. CM offers incentives to a client, begins to establish trust and build a relationship.
Client Assessment completed

10. Advocacy
Case Manager approaches client to discuss client needs, offers resources and support.
Client approaches Case Manager and expresses needs.
Case Manager identifies barriers through verbal interaction with client and begins plan for addressing needs and pilot goals.

11. Partnership A mutually trusting relationship has been established.
CM and client meetings have been set up and client is showing up for meeting. CM and client form common goals and plan and are actively working on client's plan.

12. Outcomes - Housing Of the original 55 clients, 34 are housed – 62%.
Clients obtained housing in various housing settings (single room occupancy, scattered site Group Residential Housing, private market housing, nursing home, transitional housing)
Almost all housed in permanent supportive housing. 4 housed with rent subsidies but no supports. 8 got LTH vouchers with no supports.
Those in housing with supports are slowly moving from the case workers on Top 51 to the supports in the housing program
One of the barriers to housing is that our housing options often required that the person be disabled. While all of them were eligible, many did not want the label of disabled. Wait until age 55.

13. Outcomes – Reduction in shelter
In first year – 55 clients reduced shelter use by 23% one year pre versus post - mostly by those housed.
Saved 2,980 bed nights – equal to the bottom 2,463 shelter users
Equivalent to opening up 8 shelter beds a night.

14. Outcomes – Health care utilization for first 20 housed

15. Outcomes – criminal justice
41 arrests in year prior to pilot. 34 arrests in first year of pilot – 17% reduction.
Of the 13 people with arrests, only 3 occurred while they were housed
Almost half the arrests were related to alcohol consumption.
Other arrests: disorderly, trespassing, panhandling. No violent crimes

16. Vignettes
Jorge – 10 years in shelter, undocumented, non-English speaker
Gus – severe mental illness
John – severe mental illness
Jorge spent over 10 years in county shelters. He had engaged with case workers on occasion but no project had the ability to take the time to stick with him and help resolve his barriers to housing. He doesn’t speak English and it was unclear whether he was in the country legally. HC Access unit connected with the Office of Multicultural Services at Hennepin County to help resolve his documentation, and he is now receiving social security and housed in GRH housing. His main barrier was that he didn’t speak English so was not able to connect with assistance to help with navigating the system.
Gus has spent years in Catholic Charities shelter, occasionally engaging with staff there. He is severely mentally ill with schizophrenia, and he came off with an attitude of “don’t talk to me.” Catholic Charities was able to switch case managers and when Doreen took over his case, he became willing to engage. Nobody knew this but he had terrible eyesight, and didn’t have glasses. Doreen was able to get him glasses so he could finally see. In turn, his hygiene improved, his disposition improved, and he became more willing to engage and look for housing options. He was able to connect with SSI and a rep payee, and was persuaded to move from the free shelter into pay for stay, and then into an apartment at Higher Ground. He is currently stably housed at Higher Ground, engaging with case management there, and actively involved in the resident community there.
Frustrating vignettes:
John was on the Top 51 list but disappeared when Catholic Charities moved from 1000 Currie to Higher Ground. The outreach team was able to locate him where he was staying, in an outdoor camp in Minneapolis. Police did a health and welfare transport on him and prepetition was contacted for self-negligence. The need for documentation for the petition for commitment was extensive, paperwork was needed from the psychiatrist he was seeing, from the Mental Health Center, and from outreach staff among others. Prepetition supported the petition but it ended with a stay of execution with no conditions. He moved back into shelter and staff continued to engage him, although he was reluctant and resistant. Top 51 case managers have shown him several places where he could live, inviting him to have a meal there and get a feel for the building and its residents. Unfortunately, he hasn’t agreed to any of the places they have shown him yet. Since summer began, he has gone back to camping in Minneapolis. He rarely accesses community resources like drop-in centers and food centers, and often eats from dumpsters. Top 51 staff are now working with the St Stephen’s outreach team to keep an eye on him, and keep him reminded of the services that are available to him.

17. Who is left to house??? Barriers of the remaining 21 yet to house
Immigration status
SPMI (especially female clients)
Individuals that have a higher thresholds of income and do not see housing as a priority
Criminal record
Chemical Dependency

18. Lessons Learned
To effectively move people into housing, it takes time.
It takes 8 months to get them into housing.
It takes another year to engage them around issues that kept them in shelter.

19. Lessons Learned
Not every client see a need to leave shelter. Dedicated case managers are needed to work with those who are not willing to leave.
Multiple Housing Options
Payment for case management services has to start before housing placement

20. Lessons Learned
Program development is an iterative process – HF should be monitored to see who it is serving and who is it NOT serving

21. For More Information Website Email www.hennepin.us/HeadingHomeHennepin