The Integration of Housing and Addiction Services

Speakers Janette Kawachi, Ph.D Director of Innovations and Research CSH Lori Criss Associate Director The Ohio Council of Behavioral Health and Family Rachel Post Policy Director Central City Concern Katrina Frierson Founding Executive Director Mending Hearts

Improve lives of vulnerable people Maximize public resources Build strong, healthy communities Advancing housing solutions that: About CSH

Background Housing as a Platform for Recovery Housing and Treatment Philosophies: –Housing First/Harm Reduction –Abstinence-Based Models Opportunities for Integration: –Recovery Oriented Systems of Care (ROSC) Movement –National Health Reform

Substance Use and Housing Leadership Forum October 6-7, 2014 Washington, DC Conveners: CSH and the National Council for Behavioral Health Goals : -Create a collective vision and agenda for action -Learn and share emerging and best practices across fields -Assess the evidence and identify key research questions -Identify barriers to integration -Policy recommendations and next steps

Mending Hearts Trina Frierson Executive Director

Mission Mending Hearts’ mission is to provide shelter, hope and healing to women who may be homeless due to addiction and/or co- occurring mental health and substance- related disorders.

Overview of Mending Hearts Founded in April, 2004, Mending Hearts started with a small house for seven women who needed supportive, sustainable recovery services. Within the next ten years, Mending Hearts moved to West Nashville, is located on four blocks, expanded to house 80 women, and offers a full continuum of care including three apartments for Moms with Kids.

Mending Hearts’ Continuum of Care Level I – Independent Living Level II – Transitional Living Level III – Supportive Living with Intensive Outpatient Level IV – Residential Treatment

Level IV Mending Hearts’ Residential Treatment Program Residents are in Residential Treatment 24 hours a day, 7 days a week and live in home-like apartments with other women. Treatment goals include chemical abstinence stabilization, mental health issues and relapse prevention. Length of stay: 14 to 28 days depending on need Licensed by the State of Tennessee

Level III Mending Hearts’ Supportive Living with Intensive Outpatient Treatment Residents live in Transitional Housing and attend IOP 3 times a week for 3 hours each session All services and treatment of IOP are directed toward providing essential education and treatment components while allowing residents to apply their newly acquired skills within "real world" environments. Length of stay in IOP: 8 to 10 weeks depending on need Licensed by the State of Tennessee

Level II Mending Hearts’ Transitional Living Program Residents live in home-like 2 bedroom apartments and share a bedroom with one other woman Structured environment with curfews, house rules, meeting requirements, and individual counseling if needed Meet regularly with a Case Manager

Level II – Continued Must find employment If on disability, must volunteer two days per week Specialty groups and meetings available on campus: –Double Trouble in Recovery – co-occurring 12 steps –Parenting – certified by the State –Seeking Safety – trauma group –Re-Entry Groups – for those who have been incarcerated –Educational Groups – covering life skills

Level I Mending Hearts’ Independent Living Program Residents live in a large house with other women but have their own private bedroom with bathroom, a large community room and kitchen Two-Phase program – Partial and Independent –Partial – less structured than other levels but with a curfew –Independent – no curfew but asked to check in with Case Manager for safety purposes –Must have employment or be on disability

Level I - Continued Have a Case Manager assigned to them to help with support, reviewing obstacles, and planning for permanent housing. Weekly House Meetings held with Case Manager Have peer-lead Double Trouble in Recovery meetings and other 12 step meetings House Mayor assigned for day-to-day issues Individual counseling available if needed

What makes Mending Hearts unique? Full continuum of care Treatment services provided in-house Many specialty groups Home-like atmosphere in apartments with private or semi-private bedrooms Close working relationships with other community resources Each resident receives a medical and psychiatric assessment on admission

For more information: Trina Frierson, Executive Director Mending Hearts, Inc rd Avenue North Nashville, TN

Central City Concern Rachel Post Public Policy Director

About Central City Concern Who we serve – those experiencing homelessness and extreme poverty Who we are – Formed in 1979 as a 501(c)3 non-profit organization providing housing, health and employment services to more than 13,000 unduplicated individuals yearly 46% of our employees self-identify as in recovery from substance use disorders; 25% have experienced Central City Concern’s programs first hand. What we believe – every person we serve has unique skills & talents that can enrich the health, security, sustainability, and quality of life for us all.

Homelessness Addictions Mental Illness Chronic Health Problems Trauma Lack of Insurance Unemployment Criminality Supportive Housing Direct access to housing which supports lifestyle change. Transformative Care Integrated Healthcare Services highly effective in engaging people who are often alienated from mainstream systems. Positive Peer Relationships Relationships that nurture & support personal trans-formation and recovery. Legitimate income for self-sufficiency Attainment of income through employment or accessing benefits.

Documented outcomes Housing First 60% reduction in emergency services Reduced utilization of emergency department Reduced utilization of detox units Reduced utilization of corrections beds

Choice Matters Commitment to People, not Models Point of entrance- Street Assertive Community Treatment 1:10 Primary Serious Mental Illness Co-occurring substance use Primary healthcare coordination Acquisition of Benefits and Entitlements Permanent Rental Subsidy Scattered Site Transportation Support Socialization programming Supported Employment Point of entrance- Detox or Residential Peer Recovery Mentor 1:30 Self-initiated Substance use treatment Co-occurring mental health Community (congregate) housing Supported Employment Recovery Community Supports Short-term Rent Assistance Support in securing permanent and often felony friendly housing Fellowship HF/Permanent Supportive Housing Recovery Community Housing

B’s Timeline Chronic late stage alcoholic homeless in Portland, OR-(suicidal/committed/hospital) Hitchhike-drift around country (NV/OR/CO/WI etc. Jail: LA/OK/FL/OR US Army SC, GA, NJ, Germany Hitchhike around country staying 1 day to 6 months: FL/OK/AK/CA/NM/AL/TX/KS etc. High school drop out-factory-cook jobs- married/divorced-age Began use of Alcohol/Drugs age 14 Addiction ( ) Transitional ( ) Recovery (1985- Current) Alcohol and Drug Free Housing (2) Everett Hotel/Estate Hotel Twelve Step Program Treatment: Outpatient (2) Treatment: Residential (3) Sobering Station (8) Detox: (7) Today: Director of Detoxification Services 2 years: hired at CCC months: moved to studio apt 90 days Outpatient/first job cook recovery club /rented fair market SRO Estate Twelve Step Program 90 Days ADFC Estate Hotel Increased alcohol and drug useIncreased alcohol and drug use

Recovery Community Housing Residents –91% assessed at ASAM level 2 (intensive outpatient) –Alcohol was primary substance used by 50% of residents, followed by heroin (27%) –64% used multiple substances, with alcohol & marijuana being the most common combination –76% were uninsured –59% reported recent criminal history (past 5 years)

Recovery Housing Outcomes residents served in 202 units Over 30% chronically homeless 68% successfully completed alcohol and drug tx 64% of those exiting had earned income or SSI 62% exited to Permanent Housing Average of 89% remained housed and in recovery12 months post exit

Recovery Housing: Ohio’s Effort to Expand Policy and Financing Lori Criss Associate Director

Housing Policy Barriers for People with SUDs Addiction is not recognized as a disability by the Social Security Administration. People disabled solely or primarily by substance use disorders do not have access to: o Medicaid and Medicare o Project Based Section 8 Housing for the disabled o Income Benefits (SSI) o Vocational Rehabilitation Services o Collateral Sanctions

Ohio’s Historical Approach to Affordable Housing Policy for People with Disabilities Many state agencies have programs, policies and financing to support housing, including capital funding, rent subsidies, and operating funds. Ohio did not traditionally targeted resources to housing specifically designed to meet the needs of persons recovering from substance use disorders. Most notably, in 2009, Ohio adopted the Permanent Supportive Housing (PSH) Framework as a mechanism to end homelessness and institutionalization for chronically homeless persons and families with significant, long-term disabilities.

Building a Flexible Array of Housing Options for People with Substance Use Disorders Requires: recovery-focused housing where people who are actively seeking sobriety can find safety in an alcohol- and drug- free setting affordable, mainstream housing where people can be safely housed and motivated toward recovery at their own pace

 actively working to daily live alcohol- and drug-free lives.  desire a safe and structured living environment with others who share recovery social norms including the goal of sobriety.  want to engage in support, services, or treatment to further their recovery.  at-risk of homelessness because they are exiting treatment, incarceration, military duty or are living in a home or neighborhood that puts them at risk for continued substance use. Who is Recovery Housing for?

Individual Recovery Housing Properties in Ohio From Vision to Reality: Building Recovery Housing Policy in Ohio 2012: Ohio Council, OhioMHAS, peers, treatment providers, housing partners, local government began planning for policies & resources for recovery housing 2014: Recovery housing included in Ohio law, first grants provided for recovery housing, and Ohio Recovery Housing founded as Ohio’s affiliate of the National Alliance for Recovery Residences 2015: ORH begins inspecting and certifying recovery housing in Ohio as meeting quality standards 2013: Ohio Council publishes Environmental Scan of Recovery Housing in Ohio

Recovery Housing and Ohio Law 2014 “Recovery Housing” means housing for individuals recovering from drug addiction that provides an alcohol and drug-free living environment, peer support, assistance with obtaining drug addiction services, and other drug addiction recovery assistance.  RH is a required element in local continuum of care  Must be owned and operated by community addiction services providers or other nongovernmental organizations  Requires protocol for administrative oversight, quality standards, policies and procedures including house rules for its residents to which residents must agree to adhere  State must submit a plan for a resource hub on RH in Ohio to Ohio General Assembly  New investment of $10 million

National Alliance for Recovery Residences ___________________________ Comprehensive nomenclature National standards to promote quality Certification program 19 state affiliate organizations NARR

Recovery Residences: 4 Levels of Support Peer Elected Peer Monitor Staff Supervised Residential Treatment

Why Recovery Housing? Why Now? Despite challenging social and economic trends, several factors offer opportunities to support and expand recovery housing.  Moving from acute care to chronic disease model  Health reform, Medicaid expansion  Payment reform, integrated care  Increasing attention to opiate crisis and need for extended recovery environments

Contact: Lori Criss