Homeless Action Plan Services for People who are Homeless

1
Homeless Action PlanServices for People who are
Homeless

• Presented by
• Technical Assistance Collaborative, Inc.
• April 23, 2009

2
Overview

• Des Moines is developing a long range action plan
  for people who are homeless.
• Access to health, substance abuse, and mental
  health services is critical to the success of
  permanent supportive housing and other strategies
  to end and prevent homelessness.
• There are three steps in the planning process
• Define essential elements of a good services
  system based on what people actually need.
• Use the above definition to identify and document
  gaps and problems in the current service system
• Develop strategies and action steps to close the
  gaps and move towards the defined good services
  system. This includes definition of the roles,
  responsibilities, and interrelationships among
  the components of the system, and the access
  points to benefits and services.

3
What do People Need?

• Same as everyone else, but more serious because
  of health risks of homelessness and inadequate
  access to care
• Also more serious because of multiple and
  long-term disabilities requiring multiple
  different interventions and supports
• Health risks made more serious by
• Poverty
• Substance abuse
• Mental illness 25 year difference in life
  expectancy
• Trauma
• Exposure to bad weather damp, cold, etc.
• Poor diet
• Systemic barriers to access to health, mental
  health and substance abuse care

4
What do People Need?

• People who are homeless need access to
• Psychiatric treatment and mental health supports
• Substance abuse treatment and on-going supports
• primary health care (prevention, screening for
  risk factors, assessment, wellness)
• Acute care (health emergencies, trauma care)
• specialty health care (OBGYN, Orthopedics,
  Endocrinology)
• Long term care for chronic health conditions
  (Diabetes, COPD)
• Rehabilitative care (PT, OT, etc.)
• May need community supports to facilitate access
  to and utilization of any of the above

5
What specific mental health services are needed?

• Crisis response and stabilization
• Inpatient treatment
• Outreach/engagement
• Case management
• Psychiatric evaluation and treatment
• Medications
• Outpatient counseling
• Community supports skill building
• Peer supports peer counseling
• Employment supports

6
What specific substance abuse services are needed?

• Crisis response and stabilization
• Detoxification (social, non-medical, and medical)
• Motivational interviewing and engagement
• Intensive outpatient
• Residential treatment
• Opiate treatment methadone
• Other medications (Naltrexone)
• Employment supports
• Oxford house
• Peer supports, AA, NA, etc.

7
For both MH and SA

• Need different services and approaches for
  children, youth, parents, single adults
• Need competency in co-occurring conditions
• Need competency in trauma
• Need cultural/linguistic competence
• Need services geared to difficult to reach
  people, including those who are homeless
  (outreach and engagement, mobile services, harm
  reduction, flexible community supports, etc.)
• Need immediate/timely access to services

8
Current Resources General Health

• Primary Health Care Health Care for Homeless
• Best source of primary and specialty health
• Provides screening, care coordination, follow up
• Could assist with access to benefits
• Emergency Departments (MH and SA, as well as
  general acute health conditions and trauma care)
• Iowa Lutheran
• Mercy
• Broadlawns

9
Current Resources Substance Abuse

• MECCA
• OP, IOP
• Transitional housing
• Center for Behavioral Health
• Opiate treatment
• Methadone
• Bernie Lorenz Recovery House for Women
• Powel Center

10
Current Resources Mental Health(Hand out PCHS
Provider Network List)

• Crisis team 20/7/365 phone limited mobile
  response
• Broadlawns (inpatient, psychiatry, outpatient,
  psychiatric emergency response)
• Eyerly-Ball (psychiatry, outpatient)
• Child Guidance Center (psychiatry, outpatient)
• MH presence in jail
• Assertive Community Treatment (Medicaid only)
• Residential services
• Case management service management
• Employment services
• Skills building community living supports

11
System is not well coordinated

• Mental Health
• Medicaid Magellan
• Medicaid primary health and mental health are
  separate
• State bills county non-federal share of many
  disability services
• Non-Medicaid Polk County Health Services
• No formal funding or administrative linkages to
  either primary health or substance abuse
• DHS MH block grant assuming funding for
  mobile crisis
• Substance abuse
• Separate funding and management system from
  Mental health and primary health
• Magellan manages funding for substance abuse, but
  not integrated with MH within the Magellan
  contract
• Few reliable mechanisms for transitioning youth
  to the adult system (PCHS has team and services
  for small number of transitioning youth)
• Potential disconnect at re-entry from jail/prison

12
Current Reality Limited Money and Limited Access

• For mental health, wait list for uninsured
  (non-Medicaid) for any types of services except
  crisis, outpatient, meds, and inpatient
• Same for substance abuse long waits,
  particularly for residential treatment
• Services narrowly targeted difficult to
  establish priority for people with DV or other
  trauma, family adjustment issues, other mental
  health issues not related to serious diagnoses,
  etc.
• Hospital emergency departments are overwhelmed
  (and perhaps unwelcoming)
• Some providers are not geared up to serve people
  who are homeless or who have multiple
  disabilities do not have applicable
  competencies
• Some providers do not deliver mobile services
  expect people to come to the service site

13
What other factors create barriers to accessing
mental health and substance abuse services?

• Little housing no foundation for
  care/treatment/follow-up
• Lack of benefits - uninsured (MA, SCHIP HAWK-I,
  VA, etc.)
• Severely limited resources for MH and SA
  treatments and on-going services
• Few clear access points and rules for
  eligibility or priority for service access
• Poor communications between systems (foster care,
  juvenile justice, substance abuse, mental health,
  etc.)
• Lack of transportation
• Prior bad experiences with system
• Service models and approaches that are not
  tailored to people who are homeless

14
Discussion What really works and what are the
issues and gaps?

• Access to benefits eligibility?
• Access to primary and specialty health services?
• Access to Substance Abuse services?
• Access to Mental Health services?
• Access to transitional services for youth?
• Coordination of service access and follow-up
  across multiple services and payer sources?

15
Discussion How well are mainstream services
linked to permanent supportive housing?

• Primary health?
• Crisis response and stabilization?
• Tenancy supports?
• Substance abuse?
• Mental Health?
• Case Management and care coordination?
• Peer supports?

16
Summary what are the priority gaps in the
current system?

• Health?
• Substance abuse?
• Mental health?
• Housing supports?
• Other community resources?
• Mechanisms to facilitate and support to access to
  multiple benefits and services?

17
What solutions might be included in the long
range plan?

• Engagement harm reduction, motivational
  strategies
• Mobile services
• Assignment of medical/clinical home lead agency
• Cross system case management
• Housing support teams
• Defined priority access to limited resources
• Interagency agreements and cross system protocols
• Cross system competency building on co-occurring
  disabilities, co-morbidity of medical conditions,
  trauma, cultural competence, transitioning youth,
  etc.

18
Another Possible Solution One Stop Center(s)

• Single front door to multiple benefits and
  services no wrong door
• One stop and be defined as a set of functions
  that could be implemented in several places,
  including shelters, rather than in a single
  building or location (PCHS does this with
  designated access points)
• The functions might include facilitation of
  multiple benefit eligibility determinations
  facilitation of access to service resources from
  multiple agencies and funding sources direct
  support for people going through the application
  process advocacy for priority status for access
  to community services and other resources etc.