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INDIANA PERMANENT SUPPORTIVE HOUSING INITIATIVE
2 0 0 9 N C S H A A W A R D F O R C O M B A T I N G H O M E L E S S N E S S
SUPPORTIVE HOUSING – IT WORKS!
IHCDA STRATEGIC PLAN
Core strategic value: Stop funding programs and start funding solutions
Strategic Goals Ending Long-Term Homelessness
Aging in Place
Sustainable Development
Comprehensive Community Development
IPSHI PARTNERS
Indiana Housing and Community Development Authority
Division of Mental Health and Addiction
Office of Medicaid Planning and Policy
Department of Child Services
Department of Corrections
FSSA Transformation Work Group
Indiana Planning Council on the Homeless
Corporation for Supportive Housing
Great Lakes Capital Fund
Indiana Council of Community Mental Health Centers
IPSHI –Technical Assistance
Corporation for Supportive Housing
Technical Assistance Collaborative
ABT Associates
Barbara Ritter, MSHMIS
Denny Jones, Indiana University School of Medicine
JoAnn Miller, Purdue University
Megan Maxwell, Community Services IHCDA
The Face of Homelessness
On any given night, approximately 9,000 Hoosiers are
experiencing homelessness. (2010 Point in Time Count)
Persons with severe mental illness account for about 28 percent of all sheltered homeless persons.
Persons with chronic substance abuse issues make up 39 percent of sheltered adults.
Veterans represent about 15 percent of the total sheltered adult population.
Persons with HIV/AIDS account for 4 percent of sheltered adults and unaccompanied youth.
Victims of domestic violence constitute 13 percent of all sheltered persons.
40% of heads of households were in Foster Care (2008 AHAR)
The Face of Homelessness
Forty-three percent of individuals entering a shelter during a particular year are already homeless—that is, on the street or living in a different shelter
Of those not already homeless, the most common path into homelessness is leaving someone else‘s housing unit, and
About one in five homeless individuals comes from an in-patient medical facility or a correctional facility.
Just over 40 percent of both homeless men and women stay in an emergency shelter for a week or less during a one-year period.
70 percent stay no more than a month.
The median length of stay is 14 or 15 days. • (2007 AHAR)
Current System is Costly and Ineffective
Research indicates that approximately 15 to 18% of people who experience homelessness are chronically homeless.
This 15 to 18% consumes more than 60% of all homeless services – leaving the homeless services systems struggling to effectively serve those who could exit homelessness relatively quickly.
Dennis P. Culhane, University of Pennsylvania
Why Permanent Supportive Housing?
For decades, communities have ―managed‖ homelessness without addressing the underlying cause.
Emergency and institutional systems are significant sources of care and support, yet they discharge people, many with disabilities, into homelessness .
Government is spending hundreds of millions of dollars per year, yet homeless rates are growing .
oThe state‘s $1.9 M Emergency Shelter Grant served 18,000 unduplicated people in 2007, only 28% left shelter to permanent stable housing.
What is Permanent Supportive Housing?
A cost-effective combination of
permanent, affordable housing with services that help people live more
stable, productive lives.
PSH is for People Who:
Are experiencing long-term homelessness.
Cycle through institutional and emergency systems and are at risk of long-term homelessness.
Are being discharged from institutions and systems of care.
Without housing, cannot access and make effective use of treatment and supportive services.
Housing and Services
Housing
Permanent: Not time limited, not transitional.
Affordable: For people coming out of homelessness.
Independent: Tenant holds lease with normal rights and responsibilities.
Services
Flexible: Designed to be responsive to tenants‘ needs.
Voluntary: Participation is not a condition of tenancy.
Independent: Focus of services is on maintaining housing stability.
Paradigm Shift – Housing First
Permanent Supportive Housing within a housing first model.
―Housing first‖ strategy operates under the philosophy that safe, affordable housing is a basic human right/service need and not a reward.
Stable, permanent, affordable housing is a prerequisite for effective mental and medical health care and treatment for addiction.
It offers the stability needed for individuals and families to achieve their highest level of independence.
Permanent Supportive Housing Works
Local and national studies have demonstrated that PSH is effective in serving those with most significant barriers who have cycled in and out of costly systems for years. Highlights of PSH results: Reduced Medicaid reimbursement per tenant using medical
inpatient services by 71% (Connecticut Demonstration Model Highlights, 2002).
Reduced days in state correctional facilities by 84% (Culhane, Metraux,
Hadley, New York, NY, 2002).
Reduced emergency room visits 57% (Martinez, Burt, Oakland, CA,
2004).
Reduced psychiatric in-patient days 60.8% (Culhane, Metraux, Hadley,
New York, NY, 2002).
Reduced hospitalization admissions by 77% (Mondello, Gass,
McLaughlin, Shore, Portland, ME, 2007).
Permanent Supportive Housing Works
PSH results in the following: (continued)
Reduced detox visits by 82% (Perlman, Parvensky, Denver, CO 2006)
Engaged in employment and volunteer activity 62% (Long, Amendolia, Oakland, CA 2003).
Increased income by 69% (Mondello, Gass, McLaughlin, Shore, Portland, Maine, 2007).
Decreased income from general assistance and veterans benefits by 25 - 36% (Long, Amendolia, Oakland, CA 2003).
Enhanced community development with increased neighborhood property values in 8 of 9 projects (Connecticut Demonstration Model Highlights, 2002).
Increased housing stability with 75 – 85% still housed after 1 year (CSH) and of those leaving 1/3 ―graduate‖ to increased independence (Wong et al., 2006 HUD Report) .
Supportive Housing is Cost Effective
New York, NY Study reported costs of $17,276 to provide supportive housing to each tenant per year, but generated $16,282 in annualized savings. If reinvested in PSH, 95% of costs would be covered. (Culhane, Metraux, Hadley, 2002).
Maine Study reported a net cost savings of $93,436 for 99 individuals. (Mondello, Gass, McLaughlin, and Shore, 2007).
Denver Study found a net cost savings of $4,745 per person with projected savings of $711,750 for 150 individuals. (Perlman, Parvensky, 2006).
Rhode Island Study estimated a net savings of $8,839 per person for 48 individuals for a total of $424,272. (Hirsch & Glasser, 2008).
Portland Study found savings of $15,006 per person. The estimated cost savings for 293 eligible individuals would total $4,396,758. (Moore, 2006).
Current System is Costly and Ineffective
To do nothing is expensive. It costs the City of Indianapolis $32,560 annually in the public health
and criminal justice systems to respond to needs of the average homeless person with mental illness and/or substance abuse issues.
Doing nothing adversely effects multiple systems:
oCriminal Justice/ CorrectionsoCommunity Health Providers and HospitaloHousing /NeighborhoodsoFamilies / Foster CareoEconomic /Workforce Development
Bringing the costs home
Can we really afford to do nothing?
0.00
5,000,000.00
10,000,000.00
15,000,000.00
20,000,000.00
25,000,000.00
30,000,000.00
35,000,000.00
40,000,000.00
94 494 894 1200 1435 1435 1435
IPSHI Unit Production
IPSHI Cost Savings
Medicaid, Shelter and Incarceration Costs of Long-Term Homeless
IPSHI Cost
IPSHI Cost (Capital, Operating, and Services) compared to the Costs of Long-Term Homelessness Associated with Emergency Systems: Medicaid, Shelter and Incarceration
Indiana‘s Tool for Creating Permanent Supportive Housing
Indiana Permanent Supportive Housing Initiative
A private/public venture cutting across state agencies, nonprofit constituencies, private foundations and the for profit sector.
o Spearheaded by:
Indiana Housing and Community Development Authority
Division of Mental Health and Addiction
Corporation for Supportive Housing
Great Lakes Capital Fund
Indiana‘s Tool for Creating Permanent Supportive Housing
Six-year project to adopt national best practices into an Indiana model for permanent supportive housing.
The initiative aims to create at least 600 supportive housing units within Indiana over the three-year Demonstration Project (2008-2010).
After the initial demonstration project is evaluated, long-term funding mechanisms and policies will be put in place to create an additional 800 units (2011-2013).
New finance/funding model for PSH
Indiana‘s Tool for Creating Permanent Supportive Housing
Target Units2008: 160
Measure Outcomes
Phase 1 StrategiesDevelop New Model
Develop Financial Model for Capital and Operataing Costs
Set Aside Capital and Operating Resources
Phase 1
2008
Taget Units2009: 2002010: 240
Measure Outcomes
Phase II StrategiesTest Model
Devvelop Financial Model for Service Delivery
Develop and Redirect Resources for Service Model
Phase II
2009 -2010
Demonstration Project
2008 -2010
Evaluate Demonstration ProjectsDimensions of Quality
Arizona MatrixImprove Assessment Tools and Triage
Develop Best Practices from IPSHIRecovery Model
Measure Outcomes
Establish New Target Units800
Expand to SOF
Expansion Project2011-2013
Indiana Permanent Supportive Housing Initiative
IPSHI-Building a PSH Infrastructure
Provider
Capacity
Development, Behavior Health, and Homeless
Assistance Community
State Agency
Collaboration –Policy and funding
priorities
Community Support
Government, Foundations, and Community
Leadership & Champions
Funding –Capital, Operating
, ServicesNew Supportive Housing Units
IPSHI Goals
Reduce the number of individuals and families who are experiencing long-term homeless and cycling in and out of emergency systems.
Reduce the number of individuals who become homeless after leaving state operated facilities by creating community-based housing and services.
Expand the reach of PSH to new communities.
Improve communities by ending long-term homelessness through community-based partnerships around safe, decent housing.
IPSHI Goals
Increase the capacity and the number of non-profits providing supportive housing at the local level.
Improve the connection between behavioral health, housing, employment, and healthcare systems.
Improve the quality and cost-effectiveness of the homeless delivery system.
Establish housing as a provision of recovery
IPSHI Target Population
Income Expectations: Permanent Supportive Housing is targeting extremely low income households (30 percent Area Medium Income and below).Housing Status: Four part definition
1. Individual or Family Resides in:
• In places not meant for human habitation, such as cars, parks, sidewalks, abandoned buildings (on the street
• In an emergency shelter• In transitional housing for homeless persons who originally came
from the streets or emergency shelters• In any of the above places but is spending a short time (up to 90
consecutive days) in a hospital or other institution
IPSHI Target Population
Housing Status: Four part definition Continued
1. Individual or Family Resides in:
• Is being discharged within a week from an institution, such as a mental health or substance abuse treatment facility, Community Mental Health Center residential facility or a jail/prison, and no subsequent residence has been identified and the person lacks the resources and support networks needed to obtain housing.
• These are individuals who could live independently in the community, if provided with supportive housing, and who would be at risk of street or sheltered homelessness, if discharged without supportive housing.
IPSHI Target Population
2. Individuals and families who are currently housed but are at imminent risk of becoming homeless. (No more than 18% of the units within a specific program can be subsidized with the IHCDA Project Based Voucher Program for individuals and families who are currently housed but at imminent risk.) Risk factors include:
o Eviction within two weeks (including family and friends)
o Residing in housing that has been condemned
o Sudden and significant loss of income
o Sudden and significant increase in utilities
o Physical disabilities and other chronic health issues
o Severe housing cost burden (greater than 50%)
o Homeless in the last 12 months
o Pending foreclosure of rental housing without resources to find new housing
o Overcrowded housing
o Credit problems which preclude household obtaining housing
o Significant medical debt
IPSHI Target Population
3. Young adults, ages 18-24, who are diagnosed with a serious mental illness and are being treated in Indiana State Operated Facilities; or are leaving or have recently left foster care. These are individuals who could live independently in the community, if provided with supportive housing and who would be at risk of street or sheltered homelessness, if discharged without supportive housing.
AND
4. Has an adult head of household with a disabling condition. Disabling condition means a diagnosable substance use disorder, serious mental illness, or chronic physical illness or disability, including the co-occurrence of two or more of these conditions.
IPSHI Target Population
A Permanent Supportive Housing household is a household in which a sole individual or an adult household member has a serious and long-term disability that:
Is expected to be long-continuing, or of indefinite duration;
Substantially impedes the individual‘s ability to live independently; .
Could be improved by the provision of more suitable housing conditions; and
Is a physical, mental, or emotional impairment, including an impairment caused by alcohol or drug abuse, post traumatic stress disorder, or brain injury; is a developmental disability, as defined in section 102 of the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 USC 15002); or is the disease of acquired immunodeficiency syndrome or any condition arising from the etiologic agency for acquired immunodeficiency syndrome
IPSHI Target Population
IPSHI Funding will prioritize projects serving HUD defined Chronic Homeless and other
Housing First projects focused on rapid re-housing individuals out
of shelter, street and places not fit for human habitation.
IPSHI Triage to Supportive Housing
Housing of Origin
Crisis
At-Risk Living Situations (doubled up, abusive, unsafe, etc)
Emergency Shelter
Streets
In-Patient Treatment or Hospitalization
Incarceration
Supportive
HousingTemporary Setting
Transitional Housing and Transition in Place
Halfway House
Group Home Housing with Minimal Supports
Independent Apartment –market rate or subsidized
Reconnection with family and back to housing of origin
Homeownership
Rapid Re-Housing and Prevention
Triage to Supportive Housing
The Indiana Regional Homeless Triage Project
Focus on improving access and triage into housing and services for persons who are homeless in Indiana.
Asks Continuums of Care from across the state to come together and discuss their current and needed resources to house persons and families who are homeless.
This year long project will kick off in May 2010.
IPSHI Triage to Supportive Housing
IRHTP Goals
• Develop a comprehensive system map of housing and services for the State of Indiana –Critical Time Intervention model
• Create an intercept model for triage and assessment by region
• Provide technical assistance and training tailored to the individual needs of each region
• Integrate IHOPE into each community
Key Strategies
Supportive Housing Providers need:
• Capital
Bricks and Sticks
One time funds
• Operating
Funding to support building operations
Typically provided through a subsidy
• Supportive Services
Medicaid MRO
Grants and contracts to fund staff salaries
Key Strategies
Develop financial models for housing and services.
Develop effective State policies for permanent supportive housing.
Promote a public/private partnership to fund and support PSH.
Create a pipeline and build local capacity through the Indiana Permanent Supportive Housing Institute.
Key Strategies
Convene a funders council to support pipeline of projects.• Leverage existing resources for PSH.
• Develop new funding resources (public and private).
• One stop to access multiple funding streams for new projects.
IPSHI Building Blocks
Continuum of Care
Planning Process
And Local 10-Year
Plans to End
Homelessness
Indiana Supportive
Housing Institute
Local Capacity Building
Inter Agency Policy
and Planning:
CSH Partnership
IPCH
DMHA – TWG
McKinney Vento CoC
Application(s)
Policy and Planning
Housing and Service
Resource Planning
Dedicated funding
Streams for PSH
Joint State RFP
For
PSH Projects
Engaging
PSH Developers:
Tax Credit Developers
CDC’s
CHDO’s
Homeless Housing Org.
Engaging
Service Delivery
Network:Health
Employment
VA
Criminal Justice. Etc.
Homeless Data
And Homeless
Assistance System
Evaluation Data
Strategic Plan for PSH
for Next 6Years
State Funders Council
for PSH
Capital
Operations
Service
TRACKING
PROGRESS
Ongoing Evaluation of
PSH Projects
And
Homeless Assistance
System
IHCDA‘s Commitment to Date
IHCDA is committed to reducing the number of homeless individuals cycling through Indiana‘s systems of emergency care
with the following support:
Dedicates IHCDA staff for supportive housing
Creates policy and system change to support PSH
Prioritizes Funding for PSH
Promotes Inter-Agency Understanding of the Priorities
Funds CSH‘s Presence in Indiana
Funds Indiana Permanent Supportive Housing Institute
Works with other federal, state and local initiatives that have similar goals
Works with foundations and private sector to develop resources
IPSHI Achievements to Date
Capital funds Modified the QAP to fund supportive housing through the
LIHTC program
Set aside HOME and Development funds
Stimulus funds
Operating Funds
State Admin Plan revised to project base 20% of vouchers for supportive housing projects
Working with other local PHAs to project base vouchers for supportive housing
BOS McKinney Vento funds tied to IPSHI process
IPSHI Achievements to Date
Service Model Development
DMHA advanced IPSHI through the Division's Transformation Initiative
Goal of Transformation is to transform Indiana's Mental Health and Addiction system to a Recovery Based Model that focuses on providing meaningful, consumer and family-centered services
Will discuss this in more detail later in presentation
IPSHI Achievements to Date
Working with Connected by 25 and Department of Child Services to expand focus on youth aging out of foster care and to seek opportunities for new federal funding sources
Finance Project will leverage and redirect Chafee funds and other resources to IPSHI projects
Jim Casey Foundation developing strategy to duplicate Connected by 25 Model across the state
Working with Department of Corrections to develop a demonstration project identifying those individuals released from prison who are most at risk of homelessness
Reach In project
Robert Wood Johnson Foundation providing seed money
IPSHI Service Delivery Model
A subcommittee of the State‘s Mental Health Transformation Work Group (TWG) agreed to work with CSH and the Technical Assistance Collaborative (TAC) to identify a Model Service Delivery System in Indiana that integrates the goals of the State‘s Transformation Work Group (TWG)
Built on State‘s efforts to improve the finance and delivery system of mental health services through re-defined Medicaid Rehabilitation Option (MRO) covered services
Redefined housing not as an amenity, but a recovery based service
IPSHI Service Delivery Model
Developed a Crosswalk which integrates MRO recovery based model with CSH dimensions of quality in supportive housing and serves as a guide for aligning MRO eligible services with the services needed in supportive housing
Identified the amount of gap funding for services not covered under Medicaid – either because of eligibility restrictions, timeliness of coverage or services not covered
Applied for SAMHSA Mental Health Transformation Grant (MHTG) to assist with funding the gap
Key Findings of ‗08 and ‘09 Institute Team Feasibility Study
The use of MRO under the new recovery model works as a principle resource for supportive housing in Indiana
Those centers that participated in the study see supportive housing as a strategic and worthwhile endeavor
The service funding gap represents between 20 and 25% of total costs as units are coming on-line
The gap is only 5% after a person has been in housing for a year
Over time, a majority of participants can be made eligible for Medicaid
At best, 75% will SSI or SSDI benefits
Opportunity for system transformation with upfront support of the gap
IPSHI Service Delivery Model
$-
$2,000,000.00
$4,000,000.00
$6,000,000.00
$8,000,000.00
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SAMHSA MHTG
State Funding of Gap
MRO Funding of IPSHI
Potential Service Funding for IPSHI Pipeline
IPSHI Service Delivery Model
Assist State in developing a Supportive Housing Policy
Identify resources to provide capacity building and training for community mental health centers and institute team partners as they transition to new model
Pursue strategies for closing the financial gap for services
ISPHI FUTURE
OUR VISION IS TO
END, NOT MANAGE
HOMELESSNESS