SAN DIEGO HOUSING FEDERATION WEAVING TOGETHER A COMPREHENSIVE APPROACH TO WELLNESS October 13, 2016

County of san diego Vision Living Safely Thriving Building Better Health

Whole person wellness PROJECT ONE FOR ALL WHOLE PERSON CARE PILOT DRUG MEDI-CAL HEALTH HOMES

Health, Housing, and Human Services Local implementation Health, Housing, and Human Services

SAN DIEGO’S PROPOSED TARGET POPULATION People who are high utilizers of health services AND are experiencing homelessness, or are at-risk of homelessness AND have one or more of the following: Chronic Physical Health Conditions Serious Mental Illness Substance Use Disorder The target population locally identified for the Whole Person Wellness pilot are people who are high utilizers of health services and are homeless or at-risk of homelessness, and have one or more of the following conditions: Serious Mental Illness, highlighted, which includes some of the Project One for All population; Substance Use Disorder; and Chronic Physical Health Conditions, such as heart disease & stroke, diabetes, and lung disease We will be working with the health plans to better estimate how many people would be part of this pilot. We currently anticipate that this population would be up to 1,000 people over the course of the entire pilot. While there is some overlap with the Project One for All population, Whole Person Wellness will also serve people who may not fall within Project One for All, such as individuals who repeatedly cycle through emergency departments due to unstable chronic health conditions and who may have a substance use disorder. Plan to serve about 400/year, total of 1,050 over course of pilot

partners In order to ensure the success of this effort, the County is partnering with a diverse array of stakeholders and partners, separate from Project One for all. These partners include those from the health sector (all Medi-Cal health plans, the Hospital Association, and community clinics), the housing sector (Regional Continuum of Care Council, San Diego Housing Commission), community organizations (211 and San Diego Health Connect), consumer advocacy through Legal Aid Society, and philanthropic foundations (Alliance Healthcare Foundation and San Diego Foundation). The County will oversee the project by contracting for services, coordinating the technology approaches to improve care, and ensuring that the project results in measurable changes in utilization among this population, in partnership with our community stakeholders and participants. Logos to add: San Diego Foundation (maybe)

Wellness: an Integrated approach components Outreach and Engagement System Navigation and Services Housing and Supports Performance Measurements

Wellness: an Integrated approach Outreach and engagement Outreach workers to engage people in services and housing:

Wellness: An integrated approach SERVICES Aging and Independent Services Probation Healthy and Housed Individual Housing Mental Health Providers Substance Abuse Providers Community Clinics CBOs Health Plans Benefits Child Welfare Services

Wellness: an integrated approach HOUSING Partnering with housing authorities, cities, and the private sector to establish housing region-wide The third component of Project One for All is Housing. Housing the homeless with serious mental illness requires the availability of housing resources like vouchers or subsidized rental units, as well as the support of private sector rental market partners to provide this critical path home. The County will build upon previous investments in housing, including our veteran housing programs, landlord incentive programs, and major investments in capital costs, for this facet of Project One for All. It is important to note that the 1,250 individuals we are seeking to serve and house are located throughout San Diego County, in multiple jurisdictions. We need the active engagement of all 18 cities, 6 housing authorities shown in the slide, and the community based housing providers for this to be successful.

Wellness: an integrated approach hOUSING Partnering with housing authorities, cities, and the private sector to establish housing region-wide Beyond providing housing subsidies, we have to have landlords in the community committed to providing housing for this population. This requires working with landlords to provide incentives for them to accept Project One for All participants into their housing units. We are allocating $2.6 m for landlord engagement activities which may include things such as leasing bonuses and security deposits, holding fees, and the provision of dedicated staff liaisons to offer immediate assistance to the landlord in the event that any issues arise with a Project One for All participant. To measure our progress in getting our target population housed, we’ll be looking at how many of our homeless individuals with serious mental illness are entering shelter within 3 months of outreach; how many are becoming permanent housed within 6 months; and how many are able to retain that housing at the 6 and 12 month markers.

Wellness: an integrated approach Challenges Treatment Capacity/Workforce Availability of Housing As with any innovative initiative of such a magnitude, Project One for All has challenges. We have included funds for expansion of programs to support Project One for All, but there is always the danger that the need will exceed the capacity. Regionally, having a sufficiently trained and experienced workforce to work with this population may be a challenge. Of course with a less than 3% vacancy rate in our county, a key risk is the availability of housing for Project One for All participants. It is critical that we actively partner with jurisdictions throughout the region and actively incentivize landlords and property managers to partner with us on this initiative And, as always, we will be keeping an eye out for policy changes at the State and Federal level that could impact local operations. We closely monitor any possible changes to prepare for potential effects on our local programs.

Next steps Now: Project One for All Fall 2016: Drug Medi-Cal Decision January 2017: Whole Person Implementation 2018: Health Homes December 2020: Waiver Expires