Virginia’s Road2Home Project An Overview: Our Structure, Early Successes and Challenges August 24, 2016 Regina Hutcherson, Supervisor of Hampton-Newport News Road2Home and Carolsue McGehee, Supervisor of Norfolk Road2Home

SAMHSA Cooperative Agreements to Benefit Homeless Individuals (CABHI) Grant The purpose of this jointly funded program is to enhance or develop the infrastructure of states and their treatment service systems to increase capacity and provide accessible, effective, comprehensive, coordinated/integrated, and evidence-based treatment services; permanent supportive housing; peer supports; and other recovery support services to:   Individuals who experience chronic homelessness and have substance use disorders, serious mental illnesses (SMI), or co-occurring mental and substance use disorders; and/or     Veterans who experience homelessness/chronic homelessness and have substance use disorders, SMI, or co-occurring mental and substance use disorders.  

Virginia’s CABHI Grant   Project name: Road2Home Awarded to the Department of Behavioral Health and Developmental Services (DBHDS) 3 year, $6.8 million (2015 – 2018) 85% to local projects at Hampton Newport News and Norfolk CSB 15% to state-level infrastructure development, project oversight, and evaluation.  

Virginia Road2Home Project Goals   Local: To provide outreach to 1,200 individuals, with a focus on veterans experiencing homelessness and others experiencing chronic homelessness, who have SUDs, SMIs, or CODs, and to enroll those eligible in Medicaid and other benefits, engage them in services (including integrated behavioral and primary health care), and provide 350 of them with permanent housing. Systems- level: Virginia will expand its Governor’s Coordinating Council on Homelessness to oversee, evaluate, and apply learning gleaned from the project, ensure collaboration among state agencies and regional Continuums of Care (CoCs), adopt and implement a statewide plan for housing and health care partnerships, improve Medicaid access and services, promote evidence based practices, and expand permanent supportive housing.

Road2Home Goals   Assist individuals in the identified populations in successfully obtaining Medicaid (including GAP insurance), SSI/SSDI, Veterans’ benefits, and other mainstream resources; 2. Facilitate their access to and utilization of primary care and behavioral health services; 3. Help clients obtain permanent housing and sustain it for at least one year; 4. Develop and facilitate participants’ access to ongoing recovery supports; and 5. Increase state departments’ and local CoCs’ collaboration and targeted initiatives to end homelessness among veterans and reduce homelessness for others experiencing SMI and SUDs

Road2Home Team Staffing   Team Leader Housing Stabilization Specialist Employment Specialist Benefits Specialist Peer Specialists (2) Outreach Specialists (2) MH/SA Integration Case Managers (2)

Evidence Based Practices Critical Time Intervention (CTI) A time limited case management model focused on care transitions. Small caseloads 3 phased intervention over 6 – 9 months Focus on rapport building, connection to mainstream and natural supports Phase out of services when connections have been made and tested Local modification: may provide longer term supports when system gaps still exist Permanent Supportive Housing Each CoC’s full range of affordable and permanent supportive housing Allocation of new state PSH funding: $700,000 annually

Additional Services & Practices Additional Services Offered Additional Services & Practices SOAR Supported Employment Peer Support Behavioral Health Treatment & Rehabilitation: Crisis Stabilization Substance Abuse Detox, Short-term Residential, Intensive Outpatient, MAT Assertive Community Treatment Psychiatric Services  

Local Road2Home Progress (as of 7/31/16) Services began in January 2016 95% staffed 624 outreached, including 92 Veterans 62 housed 18 individuals offered employment Participants linked to SSI, SNAP, GAP, VA and other entitlements Staff trained in CTI, PSH Fundamentals, Motivational Interviewing, Trauma-Informed Care

Housing and Services Partnerships Coordinated Entry: Road2Home participants are presented at CoC meetings (SCAAN, SCC) for consideration for available PSH and Rapid Rehousing opportunities Resources-in-Place: PATH procedures, Landlord Lists from other PSH programs PICH-Healthcare for the Homeless Hampton Roads Community Health Center Community Services Boards Affinity HealthCare VA Medical Center Access AIDS Care PATH procedures: established outreach locations

Early Challenges Housing with funding other than our PSH (Shelter plus Care, TBRA, HUD-VASH, etc.) Medication assistance for individuals with SMI Resources with food, furniture, other household goods for non-PSH individuals. Self-certification and third-party documentation Benefits timeline Finding employment/housing with significant barriers including backgrounds, credit, RSO status

What has Worked? Finding participants! Success with housing individuals, especially with PSH support Services and support offered through the grant (outpatient mental health and substance use services, furniture, etc.) Partnership with CSBs has streamlined the process of accessing mental heath and substance use resources Team dynamic Weekly team meetings-taking advantage of individual strengths and experiences

Questions?