1. 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

2. 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.

3. 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.

4. 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.

5. 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

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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Questions?