Anne Cory Corporation for Supportive Housing MHSA Housing Program TA Webinar January 25 2012 wwwcshorg What to Expect Today Not a full explanation of Realignment Focus on MHSA Housing Program impact ID: 380743
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Slide1
AB 109: Realignment and MHSA Housing
Anne Cory
Corporation for Supportive
Housing
MHSA Housing
Program
TA Webinar
January 25, 2012
www.csh.orgSlide2
What to Expect Today
Not a full explanation of Realignment
Focus on MHSA Housing Program impact
How to apply what we’ve learned in the Housing Program to meeting your community’s needs under realignmentHousing lens
2Slide3
Agenda for Webinar
Introduction to Realignment
Criminal Justice Realignment
Other Realigned Programs
Opportunities for Mental Health Staff
Why We Should Care About Housing?
CSH Programs: Returning Home Initiative and FUSE
3Slide4
Introduction to Realignment
The 2011 realignment plan shifts responsibility and funding for numerous programs from state to local levels.
Revenues for local management of programs exceed $6 billion per year.
Realignment revenues are deposited into a complicated series of accounts in the new Local Revenue Fund 2011.Counties are agitating for commitment of adequate revenues long term.
4Slide5
Criminal Justice Realignment
Realigned Criminal Justice Programs include:
Adult offenders and parolees;
Court security;Pre-2011 juvenile justice realignment;
Misc. local public safety grant programs.
5Slide6
Realignment of Health and Human Services Programs
Mental Health Managed Care
EPSDT
Drug and Alcohol ProgramsFoster Care and Child Welfare ServicesAdult Protective Services
CalWORKS
/Mental Health Transfer
6Slide7
What Does Realignment Look Like at the Local Level?
Need for substance abuse treatment services
Need for mental health services
Numbers are not matching projectionsNo benefits sign-ups before return to communityDropping off offenders at Mental Health Department
Law enforcement lacks knowledge to assess and refer appropriately
Intense focus on
criminogenics and recidivism
7Slide8
How Does it Look in Your Communities?
Challenges
Loose ends
CollaborationSuccesses
8Slide9
What Issues Can You Address at the Local Level?
Discharge Plan:
The
discharge plan should include probationers’ or parolees’ treatment and other service
needs.
Probation
and parole conditions should be the least restrictive
necessary.
Probationers
and parolees with mental illness or co-occurring disorders should be supervised by probation officers and parole agents with specialized mental health training and reduced caseloads.
9Slide10
What Issues Can You Address at the Local Level?
Probation
officers and parole agents should
should
:
reorient
the supervision process from enforcement to
intervention
and ensure that it is community-based.
ensure that probationers and parolees with mental illness receive the services and resources in their discharge plans and are connected to a 24-hour crisis service.
Develop w
orking
agreements
with community-based
service providers
to
increase
coordination
of
supervision
and treatment goals and to ensure continuity of care once supervision is terminated.
10Slide11
What Issues Can You Address at the Local Level?
Benefits enrollment –
asap
Access to psychiatric medicationsEnrollment in service programs (probationers are eligible for MHSA services, parolees are not)
11Slide12
12
What are the Barriers at Release?
No identification, SSI, birth certificate
No disability determination
Definitions of homelessness can exclude people coming from correctional settings
Hard to access health or mental health services
Lack of affordable housing resources and access issues
Limited income
Legal and illegal discrimination (criminal record, mental illness, substance use, homelessness, poverty, race)
Post traumatic stress disorder, difficulty reintegrating
Family reunification issues, particularly for womenSlide13
Opportunities for Mental Health Staff
Planning through Community Corrections Partnerships
Community Corrections Partnership recommends local plan for realignment implementation to county board of supervisors.
Executive Committee of CCP: Chief Probation Officer, Chief of Police, Sheriff, District Attorney, Public Defender, Superior Court Presiding Judge, County health & human services representative.
13Slide14
14
Opportunities for Mental Health Staff
Counties have a lot of discretion on how to use funds:
State providing per parolee amount, per inmate amount, plus additional funding for “innovative” alternatives to incarceration.
Opportunity to weigh in to influence how funding is spent (i.e., diversion programs, housing, services, etc.)Slide15
Why Should We Care About Housing?
Task
Force for Criminal Justice
Collaboration on
Mental Health Issues:
Final
Report
RECOMMENDATIONS
FOR CHANGING THE PARADIGM FOR PERSONS WITH MENTAL ILLNESS IN THE CRIMINAL JUSTICE SYSTEM
APRIL
2011
15Slide16
Why Should We Care About Housing?
Many individuals with mental illness are released from jail and prison without housing arrangements, making it nearly impossible to succeed in managing their mental illness.
The
California Department of Corrections and Rehabilitation (CDCR) reports that, at any given time, 10 percent of the state’s parolees are homeless.
The
percentage of parolees who are homeless ranges from 30 percent to 50 percent in major urban areas such as San Francisco and Los Angeles.
16Slide17
Why Should We Care About Housing?
Appropriate housing in the community at the time of release is critical for successful reentry for offenders with mental illness
since it serves as the foundation from which this population can access treatment and supportive services.
Every offender with mental illness leaving jail or prison should, as a part of his or her discharge plan, have in place an arrangement for safe housing.
17Slide18
What Can We Do About Access to Housing?
Take on
the
role of
housing advocate
for the
releasee
,
and ensure that community partners are doing so as well.
Establish
agreements with housing programs, including supportive housing, to develop a housing referral
network.
18Slide19
What Can We Do About Access to Housing?
Make MHSA Housing
Program units available to offenders with mental
illness.
Ensure
that
your county plan includes equal access to
MHSA housing for
offenders with mental
illness.
19Slide20
AB 826
Sponsored by CSH & Housing California
Authored by Toni Atkins
Funding since FY 2007-08 for program Department of Corrections & Rehabilitation (CDCR) calls the “Integrated Services for Mentally Ill Parolees” program. RFP in 2009:
Mental health services for mentally ill parolees in community.
Unclear whether housing costs could be funded.
20Slide21
AB 826
Bill would use funds now used for ISMIP to create a supportive housing programs for parolees with mental illness at risk of homelessness.
Specifically, would—
Identify inmates at risk of homelessness and parolees who are currently homeless as potential participants;Offer services to some participants before release to parole; and
Provide housing subsidies and services to participants
21Slide22
CSH Work: Housing for Criminal Justice-Involved IndividualsSlide23
23
Corporation for Supportive Housing
CSH is a national non-profit organization that helps communities create permanent housing with services to prevent and end homelessness.
CSH advances its mission through
advocacy
,
expertise,
innovation
,
lending,
and
grantmaking
. Slide24
Why We Do It: Lavelle’s Story
Lavelle has been arrested more than 150 times, largely for quality-of-life crimes
He
suffers from schizophrenia, depression, and drug addiction
Has
had inconsistent mental health care and multiple encounters with drug treatment programs
He has spent most of the last 12 years on a revolving door between streets, shelter, hospitals, and jail
24Slide25
CSH’s Frequent User Systems Engagement (FUSE) InitiativeSlide26
The FUSE Premise
Thousands of people with chronic health conditions cycle in and out of crisis systems of care and homelessness - at great public expense and with limited positive human outcomes.
Placing these people in supportive housing will improve life outcomes for the tenants, more efficiently utilize public resources, and likely create cost avoidance in crisis systems like jails, hospitals and shelter.
26Slide27
27
The Beginning:
New
York City FUSE
Demonstration
program matching “frequent fliers” with permanent supportive housing and enhanced services.
190 frequent users of jail and shelter, identified through pre-generated data match
DHS
DOC
Neither System Slide28
The Blueprint for FUSESlide29
Three Pillars, Nine Steps
29Slide30
Cross-System Data Match Provides Recruitment List
30
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Results of Cross-System Data Match
31
Source: Urban Institute (2009)
DHS
DOC
Neither System Slide32
Implementation through Collaboration
Partner
Role
NYC Dept of Correction
Data matching, program oversight, policy advocacy, service enhancement funding, facilitate jail in- reach
NYC Dept of Homeless Services
Data matching, program oversight, policy advocacy, service enhancement funding, facilitate shelter in-reach
NYC Dept of Health and Mental Hygiene
Services and operating funding and program oversight
CSH
Program design, assembled and coordinated funding, program oversight and troubleshooting, TA/training,
NYC Housing Authority / Housing Preservation and Development
Provide Section 8 vouchers
JEHT Foundation / Langeloth Foundation
Provided funding for service enhancements and evaluation
NYC Office of Management and Budget
Program oversight
John Jay College / Columbia University
Program evaluation
32Slide33
Assertive Recruitment Through Jail, Shelter, Hospital In-Reach
33Slide34
Supportive Housing
Section 8 Housing Choice Vouchers (or State rental assistance programs) + Mobile Intensive Case Management Services
Unit set-asides in new supportive housing buildings or existing supportive housing with turnover
Providers trained in Motivational Interviewing, navigating criminal justice system, harm reduction, recognizing “symptoms” of incarceration
34Slide35
Stabilization through Services
Low case manager-to-client ratio (1:10 – 1:15)
Case
manager role as “client advocate” and “failure preventer”Emphasis on reduction of “risky behaviors”
Non-judgmental
, client-centered counseling
Team approach to services delivery35Slide36
“Systems Change” Through Case Coordination
Monthly implementation monitoring meetings to track recruitment, housing placement, housing retention, and recidivism prevention
Case
conference and intervention in cases of re-arrest or re-hospitalizationWraps “system of care” around tenants with supportive housing provider in central coordinating role
36Slide37
Measure Outcomes and Cost-Effectiveness
Crisis services use ($) 2 years before FUSE
— Crisis services use ($) 2 years after FUSE
— FUSE cost over 2 years
= Net Savings of FUSE over 2 years
37Slide38
Getting to Policy Adoption and Scale
Bringing FUSE from pilot to full policy:
Early engagement of policymakers, budget officials around the FUSE “experiment”
Communication of outcomes and cost-offsets
Advance
redirection of public spending from jails, shelters, etc. to supportive housing
38Slide39
Sites Implementing or Planning FUSE Replications
39
Implementing FUSE
Planning FUSESlide40
Prior Research on High / Frequent Users
Hopper et. al. (1997) found that long-term homeless persons with severe mental illness experienced an “institutional circuit” that includes shelters, jails, ED,
detox
Kuhn and
Culhane
(1998) found that approximately 10% of shelter users in New York City were ‘episodic’ users of shelter
These individuals are “more likely to be non-White, and to have mental health, substance abuse, and medical problems.”“Much of the periods they spend outside of shelter may be spent in hospitals, jails, detoxification centers, or on the street. Indeed, one could argue that part of the very reason that these individuals do not become chronically homeless or long-term shelter residents is their frequent exit to inpatient treatment programs, detoxification services, or to penal institutions. Nevertheless, these clients often find their way back to shelters.”
Culhane
et. al. (2002) found that homeless persons with serious mental illness cost $41,000 annually through usage of emergency public systems
Ford (2005) identified 61 frequent flyers of a FL county jail, of whom 82% were homeless,100% had substance abuse history, and 51% had a mental health history
Gladwell
(2006) described individual who cost roughly $1 million in public service utilization
40Slide41
Characteristics & Service Needs of Jail-Shelter Frequent Users
Believed to have high rates of co-occurring and complex issues:
Alcohol and substance use (approx. 80%); earlier data matches found high utilization of crisis drug treatment services (i.e. Medicaid-reimbursed
detox
)
Mental health issues (est. 30-50%), including serious mental illnesses (est. 25-40%)
Criminal offenses largely consists of low-level misdemeanors (i.e. “quality of life” crimes), with minor felony histories
41Slide42
Characteristics & Service Needs of Jail-Shelter Frequent Users
Histories
of transience and high level of involvement in multiple systems and services
Providers report:Lack of trust in service providers and inconsistent benefits enrollment
Comparatively high occurrence of behavioral issues and lower degrees of independent living skills
Individuals are difficult to keep in one place and need nearly constant hand-holding as they navigate systems involvement
42Slide43
Research Suggests that Housing with Services Can Break the Cycle
Intensive service models such as Assertive Community Treatment or Intensive Case Management reduce recidivism
Supportive housing significantly reduces involvement in jails and prisons (along with shelter, hospitals, etc.) among homeless persons with serious mental illness
43Slide44
44
Housing
Criminal Justice
Social
Services
Health and Behavioral Health
Employment
Fractured SystemsSlide45
45
Aligning Multiple Systems for Better Results
Supportive Housing
Criminal Justice
NYS DOC
NYC DOC
PAROLE
PROBATION
Bridge
Rental Support
Client Identification
Transitional
Case
Management
Health and Behavioral Health
Mental Health Support Services
Housing Support
ACT Teams
Housing
HUD
Shelter + Care
Public Housing Authorities
Section 8
Social
Services
Shelter Plus Care
NY/NY III
Service Contracting through Criminal Justice/Human Service Agencies
Employment
Employment
Initiatives both Federal
and LocalSlide46
CSH Returning Home Initiative
CSH's Returning Home Initiative
started in 2006 and applies the FUSE model in communities across the country.
Initiatives integrate the systems and resources of criminal justice, behavioral health, and housing agencies.
CSH partnered
with a number of leading researchers, including the Urban Institute, the John Jay College of Criminal Justice, the University of Minnesota and Columbia
University.
46Slide47
CSH Returning Home Initiative: Early Findings
A
39% reduction in the number of days in county jail for participants in
Hennepin County.A 50% reduction in the number of days in jail for participants in New York,
compared to a comparison group.
A 43% reduction in the number of nights spent in shelter by participants in Hennepin County over the course of 22 months.
47Slide48
CSH Returning Home Initiative: Early Findings
Preliminary
findings from New York show that after 12 months, only 16% of the program group had any shelter admission compared to 98% of the comparison group.
Preliminary findings from New York show lower rates of alcohol and drug abuse—specifically injection drug use—among people in the program.
In
addition, the proportion of people with earnings and/or entitlements is much higher for people in the program.
48Slide49
To Learn More About CSH, FUSE and Returning Home
Anne Cory
anne.cory@csh.org
510-251-1910 x208www.csh.org
And help with the
MHSA Housing Program
49