Transcript Document

The Basics of
Permanent Supportive
Housing
February 8, 2008
State of Texas Mental Health
Transformation Workgroup
Presented by: Kelly W. Kent
CSH’s Mission
CSH helps communities
create permanent housing
with services to prevent and
end homelessness.
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CSH Products and Services
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Project-Specific Financing and Expertise
to help create supportive housing

Capacity Building
to strengthen and expand the supportive
housing industry

Public Policy Reform
to build an efficient system for producing and
financing supportive housing
Where We Work
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
National headquarters in New York.
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Local offices in Connecticut, Rhode Island, New
York, New Jersey, Ohio, Michigan, Illinois,
Minnesota, California, Indiana and Washington
DC.

Soon in Texas!

Targeted initiatives in Kentucky, Maine, Oregon,
and Washington.

CSH’s national teams assist supportive housing
practitioners across the U.S.
Why Supportive Housing?
 As many as 250,000 American households have
nowhere to call home for years on end.
 For decades, communities have “managed”
homelessness without addressing the underlying
causes.
 Government is spending hundreds of millions of
dollars per year, yet homeless rates are growing.
 Emergency and institutional systems are
significant sources of care and support, yet they
discharge people into homelessness.
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Why Supportive Housing?

Research
indicates
that
approximately 10% of people who
experience
homelessness
are
chronically homeless
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This 10% consumes more than 50%
of all homeless services – leaving
the homeless services systems
struggling to effectively serve those
who could exit homelessness
relatively quickly.
-- Dennis P. Culhane
University of Pennsylvania
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Supportive Housing Reduces Use of
and Costs for:
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Hospital inpatient care for medical and
psychiatric conditions
Hospital emergency room visits – especially for
the most frequent users of ER
Psychiatric emergency and institutional care
Residential mental health & substance abuse
treatment – especially detox
Jails and prisons
Emergency shelters
Why Should We Care?
“Million Dollar Murray” Phenomenon

Richard B. is an actual case study from Chicago, Illinois
– 42 years old and has a combined 21 years of homelessness
– 3,758 days in a mental health/hospital setting during that time
– 399 days in jail (This includes only 6 years of available data)
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The Cost of Richard B.’s Homelessness
– 3758 State Hospital Days $400 a day
$1,503,200
– 399 Jail Days
$
$70 a day
27,930
– TOTAL
$1,531,130
Average Annual Cost for Richard
$
72,910
Why Should We Care?
Example of Crisis System Costs – Columbus, OH
$1,800
$1,590
$1,600
$1,400
$1,200
$1,000
$800
$600
$451
$400
$200
$0
8
$30.48
$70.00
$59.34
$25.48
Supportive
Housing
Jail
Prison
Shelter
Mental
Hospital
Hospital
What Defines
Permanent
Supportive Housing?
A Part of a Continuum
Supportive housing works best as part of a wellfunded system of care that
1. Prevents homelessness
2. Offers shelter and emergency services to
everyone in need
3. Provides affordable housing to all.
Supportive Housing is one vital piece of the
solution to homelessness.
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What is Supportive Housing?
Supportive Housing is
PERMANENT AFFORDABLE HOUSING
combined with a range of
SUPPORTIVE SERVICES
that help
PEOPLE WITH SPECIAL NEEDS
to live
STABLE AND INDEPENDENT LIVES
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Housing + Services
 HOUSING
– PERMANENT: Not time limited, not
transitional;
– AFFORDABLE: For people coming
out of homelessness; and
– INDEPENDENT: Tenant holds lease
with normal rights and responsibilities.
 SERVICES
– FLEXIBLE:
Designed
to
be
responsive to tenants’ needs;
– VOLUNTARY: Participation is not a
condition of tenancy; and
– INDEPENDENT: Focus of services is
on maintaining housing stability.
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Supportive Housing is NOT:
 Treatment
 Transitional
 Licensed community care
 ‘Service enriched’ housing (but is a
subset of service enriched housing)
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What Populations are
Served by Supportive
Housing?
Who is Supportive Housing For?
People who:
Are homeless or at-risk of homelessness and:
 Face persistent obstacles to maintaining housing,
such as mental health issues, substance use
issues, other chronic medical issues, and other
challenges.
 Cycle through institutional and emergency
systems and are at risk of long-term
homelessness
 Are being discharged from institutions and
systems of care with no where to go
 Without housing, cannot access and make
effective use of treatment and supportive services
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Veterans
Veterans Lens:

Military discharge status - ‘good paper’

Stand-downs
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Veteran-specific resources are available, but limited
Homeless Services and Housing Lens:

Veterans may already be accessing homeless/housing
services

Outreach- identifying veterans at non-veteran focus
service points; increasing provider cultural competency
relative to armed services

Focus has been on transitional housing, not permanent,
for veterans mostly due to funding source restrictions
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Criminal Justice - Involved
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Every year, more than 650,000 people are released
from prison, and more than 7 million different people
are released from jail.
An estimated 42% of inmates in state prisons and 49%
in local jails were found to have both a mental health
and substance use issues.
More than 10 percent of those coming in and out of jail
and prison are homeless in the months prior to
incarceration.
In Washington, DC and elsewhere, estimates of people
exiting to homelessness is 30%
Unaccompanied Youth
All young people need a home, support and a springboard
into independent living, learning and work.
Some don’t get it.
Estimated 500,000-1.3 million
homeless youth (nationally).
25-40% of youth in foster care
become adult homeless (national
study).
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Quality Assurance
Principles of Best Practice
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Housing costs must be affordable to the tenant (i.e. <
30% of income towards rent)
Choice and control over one’s environment is essential
Housing must be permanent as defined by
tenant/landlord law – and housing is “unbundled” from
services
Housing and services roles are distinct
Housing must be flexible and individualized: not
defined by a “program”
Integration, personal control, and autonomy
Services are Recovery-Oriented and Adapted to the
Needs of Individuals
The Seven Dimensions of Quality
1)
2)
3)
4)
5)
6)
Administration, Management and Coordination
Physical Environment
Access to Housing and Services
Tenant Rights, Input and Leadership
Supportive Services Design and Delivery
Property Management and Asset Management
Activities
7) Data, Documentation and Evaluation
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Financing of
Supportive Housing
Supportive Service Financing

Federal
–
–
–
–
–
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HUD
Department of Health and Human Services
Department of Education
Department of Labor
Veterans Administration
State
– Variety of Unique Approaches
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Local
– Local Government
– Federal Pass-through funding
– Philanthropy
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HUD
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SHP
– Individuals or Families who are homeless and
have a disability
– Services in Permanent Supportive Housing
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HOPWA
– Low Income Persons with HIV or AIDS and their
Families
– Support services in permanent supportive housing
– Formula Grants (States and Cities)
– Competitive Grants (States, Cities, Local
Government and Nonprofits)
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Department of Health and Human Services
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Substance Abuse and Mental Health Services
Administration (SAMHSA) Mainstream/Block Grants
SAMHSA Discretionary Grants
Medicaid
Projects for Assistance in Transition from Homelessness
(PATH)
– Formula grant program that provides funding to states and
territories
– Some states have chosen to allocate a portion of PATH
funding to pay for services in supportive housing for people
who are homeless and mentally ill.
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TANF
– Homeless families or youth
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Health Center Grants for Homeless Populations
– Health Care for the Homeless
– Only first 12 months in PSH
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More on Medicaid
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Medicaid and health systems incur substantial costs providing
care to homeless people – often without achieving good
outcomes
– Costs of serving homeless people with serious mental illness
over $40,000 / year – mostly in health care systems
– Health care costs for public inebriates exceed $8,000/year
– Homeless people with co-occurring mental health and
substance use disorders are most frequent users of
emergency room care
Supportive housing significantly reduces the need for costly
emergency care and hospitalizations
– More than 50% reduction in utilization of hospitals for
medical and psychiatric care
– Health outcomes improve with better engagement in more
appropriate outpatient care
Department of Education
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Education for Homeless Children and Youth
– Formula grant to states
– Eligible activities are educational activities to
facilitate enrollment, attendance and success in
school for homeless children and youth.
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Department of Labor
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Veterans’ Employment Program or Veterans
Workforce Investment Programs (VWIA)
– Program can provide, but is not limited to, training,
retraining, job placement assistance and support
services, may also be used to support other
services that enhance the employability of
participants.
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Homeless Veterans’ Reintegration Program
(HVRP)
– Reintegrating Veterans into meaningful
employment
– Employment focused case management
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Veterans Administration
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HUD-VASH
– Partnership between HUD and the VA
– Veterans who are homeless and mentally ill and/or
those with substance abuse disorders
– Combines special set aside of HUD housing
choice vouchers with community-oriented
outreach, clinical care and case management
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VA Supported Housing Program
– VA services for homeless Veterans focused on
getting them housed and retaining housing
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Creative State Approaches
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Minnesota
– Supportive Housing Service Grant program in the
Department of Human Services
– Flexible funding to help counties and PSH
providers to leverage other funding and maximize
the use of mainstream resources to meet the
needs of people experiencing long term
homelessness.
– Regulatory changes that allow Medicaid to be
used for services
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Creative State Approaches
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Illinois
– Department of Corrections
• Funding Permanent Supportive Housing for Exoffenders
• Challenge: funding ends when parole ends
– State Departments of Veterans Affairs
• Using Domiciliary Care per diem to fund
permanent supportive housing
– State Funding for Services in Supportive Housing
• Line item in Illinois Department of Supportive
Services budget that funds permanent
supportive housing
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Financing the Supports in
Supportive Housing
Work in progress …
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No consistent approach across states
HUD SHP funding is still a major source in most places –
but availability is increasingly limited
Funding from mental health systems and Medicaid
increasingly important
Growing number of FQHC providers are getting involved
in supportive housing
Fragmentation of Medicaid coverage for health, mental
health, and substance use treatment services is a big
challenge
Key Strategies for Creating Supportive Housing
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Be willing to commit early to support leveraging.
Acknowledge provisional commitments of other funding,
and accept inherent risk.
Align requirements and processes with other systems.
Seek to proactively partner resources with other financing
– capital and services.
Encourage partnerships that leverage resources, skills
and capacity.
Underwrite the lead organization, the team, and the
housing project.
Ensure regulations do not conflict with best practices in
supportive housing.
Questions & Answers
Contact Information
Kelly W. Kent
Senior Program Manager
Corporation for Supportive Housing
Tel: 312.332.6690 ext. 17
[email protected]
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