Improving Access to Mainstream Services for Persons Experiencing Chronic Homelessness

Jointly Sponsored by
U.S. Department of Health and Human Services
U.S. Department of Housing and Urban Development
and
U.S. Department of Veterans Affairs

Slide 1:

CHARACTERISTICS & SERVICE NEEDS OF PEOPLE WHO EXPERIENCE CHRONIC HOMELESSNESS

Slide 2:

Chronic Homelessness

HHS, HUD, and VA have agreed on the characteristics of persons experiencing chronic homelessness and use the following definition in their collaborations:

• An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or has had at least four (4) episodes of homelessness in the past three (3) years.

Slide 3:

How Many?

• 80% of the estimated 2-3 million people who experience homelessness each year exit within 3-4 weeks
• 10% are homeless more episodically
• 10% experience chronic homelessness

Slide 4:

Why Address Chronic Homelessness?

• They have greater difficulty exiting homelessness on their own
• Although small in numbers, they use half of all emergency assistance for people who are homeless

Slide 5:

Who Are They?

• At least 75% male, 40% of whom are veterans
• At least 40% African American
• Tend to be older

Slide 6:

What Issues Do They Face?

• 40% have substance use disorders
• 25% have physical disabilities or disabling health conditions
• 20% have serious mental illnesses
• Many have more than one of these conditions

Slide 7:

What Prevents Them from Exiting Homelessness?

• Persistent poverty
• Lack of affordable housing
• Disabling health and behavioral health conditions
• Service system barriers

Slide 8:

Poverty

• Most rely on public entitlement programs (e.g., SSI, SSDI, VA) for income
• Even with income support, they remain below the federal poverty level
• Many do not receive benefits they are entitled to
• People who abuse substances and are not in treatment are not eligible for SSI

Slide 9:

Housing

• Lack of affordable housing options for low-income people
• People with disabilities on SSI must pay 98% of income to rent a one-bedroom unit at Fair Market Rent
• Average wait for Section 8 rental assistance is now more than two years

Slide 10:

Disability

• Have multiple needs that can’t be addressed by one system
• Burden of accessing and coordinating services and treatment falls on the individual
• Stigma and discrimination are major barriers to accessing housing and services

Slide 11:

Service System Barriers

• Service systems and funding are fragmented
• Administrative procedures are restrictive and burdensome
• Resources (housing and services) are insufficient
• Treatment and services programs often are ineffective

Slide 12:

What do they need?

• Outreach and engagement
• Comprehensive discharge planning from shelters, hospitals, and jails
• A range of housing options with flexible support services
• Clinical case management
• Integrated health and behavioral health care
  • Substance abuse treatment
  • Primary health care
  • Mental health treatment
• Income support and entitlement assistance
• Rehabilitation, training and employment services
• Life skills training
• Legal assistance
• Transportation

Slide 13:

The Challenge…

• To ensure that people who experience chronic homelessness have full access to both targeted and mainstream programs
• To address the lack of coordination among existing mainstream resources
• To ensure the implementation of proven and promising treatment and services

Slide 14:

CREATING A COMPREHENSIVE SERVICE SYSTEM

Slide 15:

Why A Comprehensive Service System?

• People who are chronically homeless have multiple needs that can not be addressed by one service system
• Needs include access to mental health services, substance abuse treatment, health care, housing, income supports and entitlements, basic life skills training, education, job training
• People who are chronically homeless experience many obstacles to accessing housing and services

Slide 16:

Goal of a Comprehensive Service System

• People who are chronically homeless can enter any service “door”, be assessed, and obtain access to the full complement of services and supports and housing that they want and need

Slide 17:

Principles for Creating A Comprehensive Service System for Homelessness

• Support concept of “No Wrong Door” to services
• Provide services determined by evidence to be effective
• Change ineffective policies or regulations
• Leverage existing resources
• Use mainstream resources
• Pursue new resources

Slide 18:

Elements of a Comprehensive System to Address Homelessness

• Prevention
• Outreach and case management
• Mental health & substance abuse treatment
• Health care
• Integrated treatments for co-occurring disorders
• Emergency shelters
• Permanent supportive housing
• Employment and education
• Culturally relevant services
• Consumer-centered services

Slide 19:

Steps to Achieving a Comprehensive Service System

• Involve Key Stakeholders
• Establish a formal plan
• Build linkages and partnerships from top-down and bottom-up
• Enhance funding and other resources
• Streamline the administration of funding
• Perform ongoing monitoring and quality assurance

Slide 20:

Involve Key Stakeholders

• Executive Branch Leaders
• State, regional, and local departments of Veterans Affairs, Housing, Mental Health, Substance Abuse, Health, Medicaid, Welfare/Social Services, Education, Homeless, Transportation, Labor, Criminal Justice
• Senior-level staff with authority to make policy and budget commitments
• Legislators
• Continuums of Care
• Providers
• Homeless or formerly homeless persons
• Advocacy groups

Slide 21:

Establish a Formal Plan —Sample Vision Statement

• To create an comprehensive system of care for persons who are chronically homeless by making optimal use of existing mainstream resources, creating new resources and improving coordination and collaboration across service and housing systems.

Slide 22:

Establish a Formal Plan —Sample Priorities/Goals

• Priority/Goal 1: Create a permanent interagency committee that will oversee the implementation of the strategic plan
• Priority/Goal 2: Realign Federal, state and local funds for developing services and housing
• Priority/Goal 3: Implement evidence-based effective services
• Priority/Goal 4: Decrease programmatic, procedural and policy barriers
• Priority/Goal 5: Develop affordable housing
  

Slide 23:

Build Linkages and Partnerships—Strategies

• Interagency Coordinating Body
• Systems Integration Coordinator
• Interagency Agreements or MOUs (e.g., linkages between mainstream providers and Continuums of Care)
• Cross-training
• Co-location of services
• Pooled/Joint Funding
• Interagency MIS/Client Tracking System
• Uniform Applications/Intake Assessments
• Interagency Service Delivery Team
• Flexible Funding
• Program Consolidation

Slide 24:

Enhance Funding and Other Resources

• Discretionary resources (e.g., general fund)
• Mainstream Federal programs (e.g., Veterans Affairs, TANF, Mental Health Block Grant, Substance Abuse Block Grant, HOME)
• Dedicated revenue stream
• Matching contributions
• Incentives

Slide 25:

Streamline Administration of Funding

• Interagency agreements
• Legislative mandates
• Pooled funding
• Separate funding but single application process
• Coordinated funding priorities

Slide 26:

Perform Monitoring and Quality Assurance

• Establish consistent data collection, performance standards, reporting requirements
• Create single point of accountability
• Tie quality assurance to funding

Slide 27:

Key Requirements for Building a Comprehensive Service System

• Develop infrastructure and leadership
• Have dedicated full-time staff person(s)
• Provide flexible funding
• Conduct ongoing planning
• Regularly update strategies and action steps