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Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia

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National Alliance To End Homelessness Ending Homelessness: Plan, Act, Succeed Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia – PowerPoint PPT presentation

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Title: Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia


1
Housing Chronically Homeless People HOUSING
FIRST Programs in Philadelphia
National Alliance To End Homelessness Ending
Homelessness Plan, Act, Succeed
Presented by David Dunbeck Horizon House,
Inc. July 18, 2006
2
Housing First Programs New Keys and Home First
  • Replicated the model used by the Pathways to
    Housing Program
  • Quick access to subsidized apartments
  • Intensive clinical support services using an
    Assertive Community Treatment (ACT) Team (accept
    5 individuals per month)
  • Recovery using a Harm Reduction Model
  • Consumer choice is key
  • Representative payee home visits

3
New Keys
  • Started March, 2003
  • Funding
  • Services
  • SAMHSA Treatment for Homeless grant (3
    years-ended 2005)
  • Medicaid fee-for service billing through
    city/state Targeted Case Management Systems
  • Housing
  • HUD SHP grant 25 units (3 years, renewable)
  • HUD SPC grant 35 units (5 years, renewable)

4
New Keys Target Population
  • Chronically street homeless
  • Dual diagnosis serious mental illness and
    drug/alcohol addiction
  • Housing and services for up to 65 consumers
  • Intentionally took the consumers who had not been
    successful in any other treatment programs
  • Most frequent contact with outreach
  • Highest number of refusals of service

5
Home First
  • Started January, 2004
  • Chronic Homeless Initiative grant
  • Services
  • SAMHSA (3 years)
  • VA (year-to-year) expire 2006
  • HRSA (3 years)
  • Medicaid fee for services through city/state
    Targeted Case Management systems (at end of
    grants)
  • Housing
  • HUD SHP grant 70 units (3 years, renewable)

6
Home First Target Population
  • Chronically homeless, shelter users
  • Serious mental illness. May have co-occurring
    drug/alcohol addictions, physical disabilities
  • Capacity Services for 90, housing for 75
  • Intentionally took the consumers who had not been
    successful in any other housing or treatment
    programs and had high system utilization

7
Housing First Outcomes
  • Currently, we have 152 consumers assigned to New
    Keys and Home First
  • 113 are housed in their own apartments
  • 18 are in housing process and living in shelter
  • 9 are being engaged through outreach
  • 7 are incarcerated (2 still have apartments)
  • 4 are in long-term hospitalization
  • 2 are in nursing homes
  • 1 is living with family

8
Housing First Outcomes
  • As of 2/28/06
  • 126 clients had lived in at least one apartment
  • 1st apartment
  • 70/126 were successful in their 1st apartment
    (56)
  • 2nd apartment
  • 24/47 were successful in their 2nd apartment
    (51)
  • Cumulatively, 94/126 successful in their 2nd apt.
    (75)
  • 3rd apartment
  • 12/14 were successful in their 3rd apartment
    (86)
  • Cumulatively, 106/126 successful by their 3rd
    apt. (84)

9
Housing First Outcomes
  • Impact of Housing on Mental Health
  • Of those ever housed (and receiving services)
  • 79 showed improvement
  • 18 stayed the same
  • 3 deteriorated
  • Of those not housed (but receiving services)
  • 20 showed improvement
  • 70 stayed the same
  • 10 deteriorated

10
Housing First Outcomes
  • Impact of Housing on Substance Use
  • Of those ever housed (and receiving services)
  • 57 showed improvement
  • 34 stayed the same
  • 4 deteriorated
  • Of those not housed (but receiving services)
  • 15 showed improvement
  • 70 stayed the same
  • 15 deteriorated

11
Housing First Outcomes
  • Impact of Housing on Overall Life Status
  • Of those ever housed (and receiving services)
  • 84 showed improvement
  • 12 stayed the same
  • 4 deteriorated
  • Of those not housed (but receiving services)
  • 50 showed improvement
  • 35 stayed the same
  • 15 deteriorated

12
Things Weve learned! (Usually the hard way!)
13
Safety
Staffing
Housing
Managing expectations/ pressures
Behavioral Health
Maintaining the model
Funding
The forest/the trees
Employment
Physical Health Needs
Costs
14
Things Weve Learned
  • Housing First ACT
  • is not the same as
  • ACT

15
Things Weve Learned
  • These programs are expensive and there are a lot
    of hidden costs
  • Staffing costs
  • Cost for furnishings
  • Apartment damages
  • Unpaid rents
  • Exorbitant utilities
  • Socialization costs
  • Research/data analysis

16
BUT
  • Housing First is still a good investment!
  • Preliminary analysis shows significant (gt50)
    reduction in inpatient hospitalizations, detox,
    and rehab after engaging in services and/or
    getting housing.

17
Things Weve Learned
  • Its a challenge to introduce housing first in
    an agency and division that also provide
    traditional homeless and treatment services
  • Values
  • Harm reduction
  • Client choice
  • Hiring
  • Co-location of facilities

18
Things Weve Learned
  • There are advantages and disadvantages to having
    housing services in a different agency than
    treatment services
  • Good cop/bad cop
  • Values
  • Harm reduction
  • Client choice
  • Landlord issues
  • Damages

19
Things Weve Learned (or are still trying to
figure out)
  • Money Management
  • Is it really therapeutic to be representative
    payee for your consumers?
  • Or would it be better to let another agency be
    the representative payee?

20
Things Weve Learned
  • SAFETY
  • must be a critical consideration
  • when implementing a
  • housing-first program.
  • FACT You are controlling (some of) the money of
    an active substance user who also has a diagnosis
    of serious mental illness.

21
Things Weve Learned
  • Address Safety concerns by
  • Establishing
  • Boundaries, behavior expectations for consumers
  • Policies and procedures for staff
  • Consequences (i.e., discharge)
  • Training Staff
  • Proactively considering safety in your space
    planning

22
Things Weve Learned
  • Safety training Understanding behavior
    intervening before behavior escalates.
  • Lalemand Behavior Scale
  • Agitated
  • Disruptive
  • Destructive
  • Dangerous
  • Threat of Lethal
  • From the Non-Aggressive Psychological and
    Physical Intervention (NAPPI, Inc.)

23
Things Weve Learned
  • Good assessments are a good investment!
  • Take the time to perform a thorough assessment
    (including physical health) at the beginning.
  • Dont drop the physical health ball use your
    nurses!
  • Dealing with long unmet physical health needs can
    be a powerful engagement tool!

24
Things Weve Learned
  • Staffing
  • It takes special people to do housing first
  • Hiring good staff
  • 120 turnover in first year
  • Maintaining the revolution
  • Keeping good staff
  • TRAIN, LISTEN, SUPPORT

25
Things Weve Learned
  • We built sustainability into our grants.but, we
    still werent prepared for the transition
  • Its always going to be a painful process, but
    dont wait until you need to bill fee-for-service
    to begin the transition
  • Pull the bandage off
  • Do the necessary procedures, paperwork, etc.
    fully from the beginning its easier to
    transition with only 5, 10, or 20 consumers (and
    associated paperwork) than with 155 consumers!

26
Things Weve Learned
  • My new mantra
  • Defend the program,
  • but dont become defensive

27
The Goal
28
Housing First Future Growth
  • Welcome Home
  • Start-up December 2006
  • Services and housing for 60
  • Philadelphia 10-Year Plan to End Homelessness
  • Proposes housing first for 360 (currently at
    150)

29
Contact Information
  • Horizon House, Inc.
  • 1201 Chestnut St., 12th floor
  • Philadelphia, PA 19107
  • 215-636-0606
  • David Dunbeck, Director of Homeless Services,
    david.dunbeck_at_hhinc.org
  • Carla Williams, Director of ACT,
    carla.williams_at_hhinc.org
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