Responding to Unmet Needs

2005

Annual

Report

Milwaukee, Wisconsin

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Our Mission

To ensure that men, women and children

in the Greater Milwaukee area who are homeless or at risk of homelessness

will receive the quality health care, housing and supportive services

they need in order to live at the highest possible level of self-sufficiency.

Health Care for the Homeless

will work to achieve this mission through advocacy, outreach, prevention, public awareness,

collaborative relationships with other service providers

and contracting for or providing a quality, cost-effective

continuum of direct services.

Table of Contents

Executive Director’s Review 3

The Challenges 4

Survey Highlights 5

Services Provided 6-7

2005 Populations Served 8

Staff Making a Difference 8

Financial Overview 9

Board of Directors 10

Collaborators and Partners 10

Contributors and Supporters 11

Organizational Snapshot

Founded in 1984, Health Care for the Homeless of Milwaukee, Inc. became a Federally-Qualified Health Center in 1995.

Lee Carroll, Executive Director — Lee@HCHM.com

Administrative Offices/ Community Support and Social Service Programs

711 West Capitol Drive Milwaukee, WI 53206

Telephone 414- 374-2400 Telefax (414) 374-7903

Recovery Behavioral Health Clinic

(and Case management Programs) 210 West Capitol Drive Milwaukee, WI 53212

Telephone 414- 727-6320 Telefax (414) 727-6321

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2005 Review: Responding to Unmet Needs

From the Executive Director

Across the nation in 2005, community health centers like Health Care For The Homeless (HCHM) faced the challenge of assisting a variety of populations affected by difficult life circumstances who were rendered homeless, and who required immediate response to deal with their needs for health care, housing and supportive services. A survey of the Milwaukee area that was conducted in 2004 by Health Care For The Homeless showed that the face of the homeless and those at risk is increasingly no longer simply personified by the stereotypical skid-row image. Those who experience homelessness are often innocent children. Others in-clude people of diverse educational backgrounds, racial and age classifications, and those at risk of homelessness due to addictions, job losses, medical, financial and other factors. On some level, being human involves living with uncertainty. But as each of us becomes aware of the vulnerability we all may face due to unforeseen circumstances, it should be easier to understand the ongoing concerns that confront our fellow citizens. Many cannot readily afford or access health care, oftentimes despite their best efforts. All human beings require various basic resources to promote quality of life. When needs for food, safety and shelter are elusive, people face overwhelming stress on a daily basis. The adjustment aspects related to sudden loss and displacement can take a toll on mental health and physical functioning. That’s why it’s crucial to focus on both short-term and long-term solutions to assist those affected by chronic homelessness, as well as those whose lives are suddenly changed overnight, whether by a Hurricane Katrina or Rita, or other unpredictable events. Rather than overlook the suffering of others, compassion makes it possible to consider their needs as being important like our own. The theme of this report focuses on addressing unmet needs and the trilogy of overlapping services offered by Health Care For The Homeless that are crucial to overall well-being: health care, housing and supportive services. In 2005, we were fortunate to have the resources to serve over 17,000 patients/clients, whether on a limited or extended basis. Some of the numbers represent duplicated clients, as indicated by those receiving services through several of our programs (see pg. 8 under the “Program Utilization” section). Unfortunately, the number of those becoming homeless in the Greater Milwaukee area and nationwide, continues to grow. Our ability to provide services to those in need is made possible by various federal, state, county and other grants or con-tracts. We have many devoted staff and affiliated providers. We benefit tremendously from various organizations and individuals who donate their time, money and other resources. We extend appreciation to all for their continued support.

Thank you,

Lee Carroll

Cover Photo: Street Outreach Worker John Lampkins drives one of the vans used by HCHM staff to reach those

in need of services, stopping at various shelters and on major streets of the Greater Milwaukee area.

HCHM obtained permission from clients for use of their photos in this 2005 Annual Report.

This publication was coordinated and designed by Fannie LeFlore,

a Milwaukee-based Writer/Editor and Corporate Communications Consultant.

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Understanding the Challenges: Perspectives from Various Sources

Nationally Approximately 3.5 million individuals nationwide experience homelessness each year. The homeless include families with children, single adults, teenagers and elderly individuals of all races. The primary cause of homelessness is a lack of affordable housing. Over 5 million low-income households have serious housing problems due to high costs, substandard housing conditions or both. — The National Alliance to End Homelessness Locally Based on information from a Continuum of Care Consortium of HUD providers, shelters and other service groups for the homeless, the estimated number of Milwaukee’s population affected by homelessness is 15,000 to 20,000 individuals, including those living on the streets, those episodically homeless, in transitional housing or at-risk of becoming homeless. — HCHM of Milwaukee One Man’s Personal Story A Jan. 8, 2006 article in the Milwaukee Journal-Sentinel, “One day at a time,” featured the plight of a homeless man, Edward L. Ross, 40, who was appreciative to have a place to stay at the Milwaukee Rescue Mission. Among other things, Mr. Ross described the human costs, including a profound sense of loneliness he perceived among people in general at shelters, and the desperation of those who live on the streets, particularly when the weather is cold. Milwaukee Rescue Mission (MRM) is a private, non-profit organization and the largest homeless shelter in the State of Wisconsin, with on average more than 200 men and about 100 women and children who stay there each night, according to MRM Executive Director Patrick Vanderburgh. A Family’s Journey A man in his mid-40s who had several family members across generations under the same roof lived in housing that had been condemned, but wanted a way to keep all his relatives together. Due to a lack of proper documenta-tion, the relatives were unable to go into shelters without having to be split up. HCHM worked with the family by providing various supportive services and assistance with housing relocation that allowed the family to stay together. — John Lampkins, Street Outreach Worker with Health Care For the Homeless

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Highlights From Health Care For The Homeless Survey

A comprehensive Survey/ Needs Assessment was conducted by HCHM in conjunction with several agencies and volunteers. A total of 761 homeless adults in Milwaukee were interviewed the week of Sept. 11, 2003, primarily in shelter settings. Results showed:

Race Age

∗ 71% African-American * 39% were over 45 years old

∗ 23% Caucasian * 28% were under age 35

∗ 6% Hispanic/Other

Employment

∗ 21% were employed

∗ of those, 59% earned $8 or less hourly

∗ 72% used public transportation to get to work

Education

∗ 37% had less than high-school education

∗ 35% had GED or H.S. diploma

∗ 19% some college

∗ 9% college/tech graduates

Health

∗ 71% reported seeing a doctor while homeless

∗ of those, 37% saw a doctor 5 times or more

The Linkage of Comprehensive Services to Meet the Needs of Our Clients Based on our history of service, we know that working with those who are homeless is not a simple matter. When it comes to our clients’ needs, covering all the basics matter more than anything else. Those who don’t have the basics — food, shelter, clothing, etc. — often exist each day feeling a deficit due to unmet needs. Threats to well-being and various stressful conditions result in people primarily focusing most of their attention and energy on survival. Attending to their basic needs requires providing services that are comprehensive in scope. Coordinated and consistent assistance helps minimize additional risks that potentially impact physical and mental health, and overall functioning. This, in essence, is the meaning of providing a “safety net.” Although providing access to primary health care is our central mission, Health Care For The Homeless understands the need to maintain linkages between healthcare, housing and supportive services. This enables us to coordinate assistance that is both practical and meaningful, allowing us to remain responsive to our clients based on their specific needs at a given time.

Housing Health Care Supportive Services

Chronic Homelessness

Findings related to a subset of

the populations surveyed:

∗ 35% of people surveyed were considered chronically homeless (defined as four or more lifetime episodes or being homeless for one year or longer)

∗ Of the chronically homeless, 2/3 are male and 1/3 female

∗ 63% of the CH said they needed mental health services

∗ 67% of the CH said they needed AODA services

∗ 12% of the CH indicated that they had spent the previous night outside or in a public or abandoned building

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Social Service Programs Outreach

Traditional Outreach: Serves individuals in finding shelter or those who choose not to seek lodging in community shelters. Outreach workers aid clients in obtaining identification, retrieving birth certificates, claiming SSI (Supplemental Security Income) benefits, and by offering referrals to medical service. Clothing, sleeping bags, hygiene kits, housing and food are also provided as needed. A-STREET Outreach: A mobile unit responds to dispatches from the 211 Help Line regarding homeless families in the Milwaukee area. Once dispatched, the staff assesses the precipitating situation. Clients may be placed in emergency shelters and referred to a case manager, placed in temporary or permanent housing, and/or given access to housing and employment resources. Pregnancy Outreach: The focus of this program is to reduce infant mortality by assuring that high-risk women who, due to incarcera-tion or homelessness, receive early pre-natal care. Services are provided on the street as well as through a case manager located at the Milwaukee County Jail. Pregnant women are provided with access to medical care, housing, and nutrition. Pre-Natal Care Coordination (PNCC): This program provides medical care, immunizations, nutrition planning and parenting education during pregnancy, from conception to birth, as well as transportation and translation services to women and families needing prenatal care.

HIV/ AIDS Services HIV Rapid Test: Rapid Response testing is available in all Health Care for the Homeless funded primary care clinics. The Rapid Response test provides test results in 20 minutes. The person conducting the test also provides counseling and education related to HIV. A reactive (positive) test result will require further testing of the individual to determine a definitive HIV status. Assistance in obtaining specialized medical care is provided following a confirmed positive HIV test result. Ryan White – HIV Case Management: Funded through the Ryan White Title II program, case management services are provided to persons living with HIV/AIDS. The case manager is a resource for clients in obtaining Social Security benefits, housing, medical care, support groups, advocacy and other needed services. Behavioral Health Programs

Recovery Behavioral Health Clinic Outpatient Mental Health Clinic: The Outpatient Mental Health Clinic provides psychiatric and psychotherapy services on a traditional outpatient basis. Services are provided through a variety of funding sources, Medicaid, Medicare, private insurance, HMOs, and a sliding fee scale. Substance Abuse Services: Alcohol and Other Drug Abuse (AODA) Counseling services are provided on a traditional out-patient basis. Services are available through a variety of funding sources, Medicaid, Medicare, private insurance, HMOs, and a sliding fee scale.

Behavioral Health Case Management Targeted Case Management (TCM) Program: Supports individuals with severe and persistent mental illness referred by Milwaukee County to live independently in the community to the extent that is possible. Case managers provide assessment, monitoring and service coordination. Consumers are assisted with housing; legal services; medical, mental health and substance abuse services; money management; employment and training; benefit advocacy; activities of daily living; social network development; and, crisis intervention. Homeless Assistance Program (HAP): Case Management is provided to individuals who are homeless at the time of admission. Consumers must have a mental illness. Referrals are generally made by the American Red Cross, or the community shelter system. Community Support Program (CSP): An assertive community treatment program model that assists adults with serious and persistent mental illness who are homeless, or at risk for homelessness, to live independently. Clients receive assistance with housing, obtaining psychiatric services, employment and/or training, individual or group counseling, budgeting, and access to medical and/or dental services. Referrals are made through the Service Access to Independent Living (SAIL) program of the Milwaukee County Behavioral Health Division.

Services Provided by Health Care For The Homeless

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HCHM Services Continued... Housing Families Assisted in Transitional Housing (FAITH): A housing with case management program model for single mothers and their children. Participants contribute 30% of their income toward their housing expense. Housing Opportunities for People with AIDS (HOPWA): This program provides funding for housing individuals with HIV/AIDS. Clients contribute 30% of their income toward their rent. Individuals are referred through their HIV case manager and must be able to live independently. Primary Health Care

Primary Medical and Dental Care Sites St. Ben’s Homeless Clinic, 1027 N. 9th St., Milwaukee Walker’s Point Community Clinic, 611 W. National Ave., Milwaukee Angel of Hope Clinic, 209 W. Orchard St., Milwaukee The Salvation Army Clinic, 1730 N. 7th St., Milwaukee Primary Dental care is provided at Madre Angela Dental Clinic, 1308 S. Cesar Chavez Dr., Milwaukee Walk-ins are welcome at all of the clinics.

This is HCHM’s main administrative office, with various

outreach, housing and supportive services for clients.

This building houses our Recovery Behavioral Health Clinic (BH)

for mental health, AODA and case management programs.

Executive Director Lee Carroll (standing) works

with Administrative Assistant Gail Paschall.

John Lampkins, Street Outreach Worker,

has worked for HCHM for six years.

BH Staff Shalanda Driver and Liz Aldred (right).

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In 2005, we served 17,110 patients/clients. The following categories represent the range of users/ participants:

Female — 49% Male — 51%

African American — 51%

Caucasian — 24% Hispanic — 22%

Asian — 2% Native American — 2%

Speaks Spanish as Primary Language —– 20% \

RIAsthma — 3% Diabetes — 14%

Hypertension and Heart Disease — 14% Mental Health and Substance Abuse — 69%

HCHM POPULATIONS SERVED

A discussion among staff and clients in a group ther-

apy room, with Psychotherapist Sue Sigl (standing).

A client receives information from Nurse Katie

DeSpears.

Dr. Eleazar San Agustin (right) with a client.

PROGRAM UTILIZATION IN 2005

PRIMARY DIAGNOSIS

USERS BY RACE/ ETHNICITY

USERS BY GENDER

OUTREACH: Adults — 2,294

Children (0-18 years) — 4,042

OUTPATIENT BH TREATMENT SERVICES: Mental Health — 1,796

Substance Abuse — 1,318

CASE MANAGEMENT SERVICES: Prenatal Care Coordination — 202

Mental Health/AODA — 442 Special Populations — 70

PRIMARY HEALTH & DENTAL CLIENTS: 5,330

SPECIALIZED TESTING-HIV: 803

IMMUNIZATIONS: 766

TRANSITIONAL HOUSING: 47

TOTAL SERVED IN ALL COMPONENTS: 17,110

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2005 Financial Overview

Federal Homeless Health Care & Case Mgmt. Grants $1,947,744 31.00 Federal/State Homeless HIV & Housing Grants 435,277 7.00 State Homeless Health Care Grants 319,422 5.00 State Shelter Subsidy Grant 366,607 6.00 Milw. County Homeless Mentally Ill Grants 1,488,541 24.00 Milw. County Housing & Outreach Grants 306,443 5.00 Third-Party Reimbursements 1,294,635 21.00 Private Donations, Foundations & Combined Health Appeal 24,000 .50 Program Income, Building Rentals, Interest & Misc. 38,000 .50 Immunization Grant 5,132 0 TOTAL 6,225,801 100.0%

Medical, Mental Health and Dental 3,303,985 55.00 Street Outreach & Client Services 1,586,471 27.00 Crisis & Transitional Housing 536,601 9.00 Administration & Development 555,744 9.00 TOTAL 5,982,801 100.00% Net From Operations 243,000

INCOME (UN-AUDITED)

Source Amount Percentage

EXPENSES (UN-AUDITED)

Activity Amount Percentage

“ Individuals come to our Recovery Behavioral Health clinic for medications and counseling, but leave with a clinical home: a group of staff that provide support in every area of the person's life. There is no task that is not ours to address. Unconditional positive regard is our practice. We take pride in working with these individuals, and we don't give up. ”

— Liz Aldred, A.M., LCSW, Director of Behavioral Health Services for HCHM

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2005 HCHM Board of Directors

and their Professional/Other Affiliation

Officers:

Samuel Akpan, Ph.D., Board President City of Milwaukee

Peter Carlson, Board Vice President Aurora Behavioral Health

Jarrod Johnson, Board Treasurer Aurora Health Services

Members:

James Hill University of Wisconsin - Milwaukee

Mary Jirku-Weber

Marketing Consultant

J. W. Jones-Robinson Self-Employed Business

Cletus Pfab Consumer

Suzanne Ring-Wagner

Kindred Health Care

Patricia Shirley Milwaukee County, Retired

Pauli Taylorboyd

University of Wisconsin – Milwaukee

Tim Walsh, R.Ph. Serve You Custom Prescription Management

Our Collaborators and Partners * Columbia-St. Mary’s Hospital — St. Ben’s Homeless Clinic and Madre Angela Dental Clinic * St. Luke’s Hospital — Walker’s Point Community Clinic * St. Francis Hospital — Angel of Hope Clinic * Aurora Health Care — The Salvation Army Clinic * The Salvation Army * American Red Cross, Milwaukee Chapter * Genesis Detox * Impact * Social Development Commission — Family Crisis Center * Sojourner Truth House * University of Wisconsin -- Milwaukee

“The problems and the needs are so

great that without having agencies work together, we won’t even scratch the surface in dealing with the issue of homelessness and the

associated challenges. We as the board consider our role to be one of ensuring collaboration with other agencies in the area, and participating with the community in providing services and being

responsive to those who need help.”

— PETE CARLSON, Health Care For The Homeless

Board President as of January 2006

Mr. Carlson is the Administrator of Aurora Psychiatric Hospital and

Aurora Behavioral Health Services.

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Our Contributors and Supporters in 2005

Elizabeth Aldred William M. Arnold Alfred Bader Janet C. Balding Julianne R. Bauer Hermione G. Bell Myra A. Bezella Dori Bibo Joyce Binder Bonnie Bruch Sharon Bukowski Sharon Buss Shirley Campbell Elliot Cantor & Karen Berman Peter Carlson

Colin Casey Karen Chadwick Cynthia J. Cherney Dick Chudnow Maureen K. Conaty Dana Corporation William A. Daub Frederick DeBoe Colleen Dimas Dr. Martin Luther Church Suzanne Eckart Tawana Elim Jonathan A. Evans Alan L. Evinrude Edwin Foster Bruce A. Golden Ruth Goren

Lee Carroll Miguel Pro Jesuit Community Linda Mikolainis Gowdar Murthy John Nienhuis Marie Nienhuis Una B. Ortell Susan O'Shea Mr. & Mrs. G. John Pandl Richard Passman Anissa Perkins Margaret A. Polikowski Carol Richards Jennie Roberts Mr. & Mrs. Cambric Robinson,Sr. Vera L. Roddy Gregory J. Rogalinski Mary Ross Sandy Rozga Laura M. Ruiz Kathy Sansone

Roland P. Schroeder & Mary L. Mowbray

Greater Milwaukee Foundation / Harold & Dorothy Singer Fund

Gross-Yaksh VFW Post 6498 Donald E. Haack, Sr Cheri Hafferkamp Stephanie Hall Donna Hammes Robert L. Harris Veronica M. Heaney Laurel Henschel

James & Christine Hill Sonia Hill David Holton

Mr. & Mrs. Rich ard W. Herzfeld

Monique D. Howard Gail Hoyt Lori Jacobson Bob Jakubiak Patricia Jerominski Jarrod Johnson Deborah Landis Charles Leasum Alan E. Lesak Mary Lou Lindquist MATC Athletic Department Mary Ann Mayer Messmer High School Theology Students David K. Meyer

Mike Sebastian Rachel R. Sellnow Sheila G. Semrou Mr. & Mrs. Gary Shapiro Linda M. Simko Bert M. Sisk Juanita Smith Carol Starr Barbara A. Stemm Jean M. Stern Ireene Sullivan Billie Tadysak Pauli Taylorboyd UW Credit Union David D. Vincent Mary P. Watkins Lakish Weatherall George Wendorf Wigwam Mills Judy Wilke Louise M. Windsor Jean M. Wojnar Cindi Wood WTMJ -TV Patrick D.Yunke

Other Organizational Contributors:

Abbott Laboratories, Inc. and Employees

AstraZeneca Pharmaceuticals Co.

Bristol-Myers Squibb Co.

Community Health Charities

Eli Lilly & Co.

Forest Pharmaceuticals, Inc.

Glaxo-Smith–Kline Pharmaceutical

Healthy Foundation

Janssen Pharmaceutical, Inc.

Ortho-McNeil Pharmaceutical

Pfizer, Inc.

TAP Pharmaceuticals, Inc.

Wyeth Pharmaceuticals

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Health Care For The Homeless of Milwaukee, Inc. 711 W. Capitol Dr. Milwaukee, WI 53206

TO:

Donations to Health Care For The Homeless are tax-deductible.