Promoting Better Health and Housing: An Integrated Approach to Supporting Vulnerable People By Marty Hansen, Associate Director of SAMHSA Community Consortium Challenges of Homelessness The National Coalition for the Homeless estimates that approximately 20 to 25 percent of single homeless adults suffer from some form of severe and persistent mental illness.1 Additionally, up to 50 percent of homeless adults have substance use issues,2 and one-third has co-occurring diagnoses with both mental health and substance use disorders.3 These rates rise among homeless veterans, with approximately 76 percent experiencing alcohol, drug, or mental health problems.4 Numerous studies over the past two decades have shown the importance of stable housing in overall health and life outcomes. Permanent supportive housing, for highly challenged homeless populations, has proven to be a cost-effective intervention that significantly reduces more expensive alternatives (that is, emergency rooms, hospitals, and jails). Local Leaders Seek Integrated Service Solutions To capitalize on this, the Substance Abuse and Mental Health Services Administration (SAMHSA) Chicago Community Consortium (SCCC) aims to increase systems-level capacity to coordinate and integrate recovery-oriented models of care that improve health and housing stability outcomes for people in Cook County who have experienced homelessness and live with (a) serious mental illness and/or (b) long-term histories of substance or alcohol use. SCCC is a collaboration of more than forty organizations (advocacy, mental health, substance use, health care, social service, housing service, and homeless coalition groups at both local and state levels), as well as representatives of city, county, state, and federal government agencies. The AIDS Foundation of Chicago (AFC) leads this initiative. Strategic Plan Launched Over the past eighteen months, nearly one hundred public and private stakeholders from four major service sectors (supportive housing, coordinated care, benefits and entitlements, and homeless outreach) participated in the creation of the SCCC strategic plan. The plan aims to
1
National Coalition for the Homeless. Fact Sheet: Mental Illness and Homelessness. 2009. US Department of Housing and Urban Development. Homelessness: Programs and the People They Serve. 1999. 3 Substance Abuse and Mental Health Services Administration. Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illness and Co-Occurring Substance Use Disorders. 2003. 4 National Coalition for the Homeless. Fact Sheet: Homeless Veterans. 2009. 2
implement twenty-three recommendations by 2016, to promote better health and housing outcomes for the target population. SCCC typifies the spirit that housing is a foundation for health, one that is echoed in SAMHSA’s national goals: enhanced health- and recovery-oriented service systems of care, greater availability of permanent supportive housing and related services, and increased opportunities for those with substance use issues and mental-health disorders. SAMHSA and the consortium believe that everyone deserves the chance to lead a purposeful life that is integrated into the community.5 6 But there are threats to these cross-sector initiatives, including Illinois’ fiscal woes and federal sequestration, to name just two. Improvements in Health Care Bolster Plan Despite such challenges, the SCCC’s strategic plan is strengthened by working in synergy with several exciting local, state, and federal initiatives, including Chicago’s Plan 2.0 to End Homelessness, the Affordable Care Act (ACA), CountyCare, Medicaid expansion, and the Illinois Department of Healthcare and Family Services’ pilot Innovations Project, which develops new coordinated care entities that will bring the ACA’s medical home concept into broader practice. From Planning to Implementing AFC will play three major roles in achieving the plan’s twenty-three recommendations:
Monitoring progress of innovations already underway, such as CountyCare. Supporting collaborative efforts, such as assisting with initiatives to help individuals reconnect with entitlement programs after leaving jail. Leading implementation of recommendations, particularly in outreach where AFC already plays an important coordinating role.
The SCCC will meet at least twice annually to review and assess progress toward the plan’s twenty-three recommendations over the three-year implementation process. AFC consortium staff will publish quarterly reports at aidschicago.org to keep stakeholders and the community informed.
5
John O’Brien. “Leading Change – A Plan for SAMHSA’s Roles and Actions. 2011-2014. Strategic Initiative #4: Health Reform.” Pp. 48-58 (draft 10/01/2010). SAMHSA website. Accessed December 10, 2012. http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf. 6 Kevin Malone. “Health Reform and Behavioral Health” (presentation). SAMHSA Homeless Grantees Conference. Washington, D.C. August 1-2, 2012.
The following is an unabridged version of the plan. If you’d like to read the full report, please click here.
SAMHSA CHICAGO COMMUNITY CONSORTIUM Strategic Priorities and Recommendations By June 2016, the SAMHSA Chicago Community Consortium will achieve four strategic priorities for people in Cook County who have experienced homelessness and live with (a) serious mental illness and/or (b) long-term histories of substance or alcohol use.
1. Increase the number and variety of supportive housing units for the target population Provide more and a greater variety of supportive housing units, in order to reduce homelessness, improve housing stability, address special needs, and decrease costs 1.1 By December 2013, survey the variety of services in permanent supportive housing available to and desired by participants 1.2 By December 2014, identify and establish at least three models of supportive housing programs that provide workforce development, and assist residents with employment, entrepreneurship, volunteer, and/or other meaningful activities 1.3 By June 2016, increase the number of permanent supportive housing units/subsidies for the target population by at least four hundred 1.4 By June 2016, establish fifty bridge housing units—that is, apartments with specialized supports for members of the target population leaving long-term incarceration 1.5 By June 2016, develop a home-sharing program that provides at least one-hundred units to members of the target population 1.6 By June 2016, make available two-hundred existing units by moving on at least twohundred existing permanent supportive housing or group home residents into independent living apartments
2. Enroll the target population into coordinated care services Enroll the target population into coordinated care that adequately addresses its complex health needs, improves health outcomes, promotes overall well-being, and contains and/or reduces costs 2.1 December 2013, establish an informed estimate of the number of individuals in our target population
2.2 By December 2013, enroll at least five-thousand individuals of the target population into CountyCare 2.3 By December 2014, identify and evaluate at least three models that integrate medical, behavioral, and in-home health care services into coordinated care, including a strategy for shared electronic health information and simplified billing for reimbursement of Medicaid services 2.4 By December 2014, ensure that the Medicaid coverage for substance use and mental health treatment is sufficient to meet the needs of the target population 2.5 By June 2015, enroll all eligible individuals in the target population who are in jails into Medicaid and coordinated care services, effective upon release 2.6 By June 2016, enroll at least 75 percent of individuals in the target population into coordinated care services that are well-funded through Medicaid and other sources
3. Simplify and expand eligibility for and access to benefits, services, and housing Streamline and expand the target population’s eligibility for and enrollment in benefits to improve access to health care, housing, and supportive services 3.1 By December 2013, enroll at least one-thousand members of the target population into the Chicago Central Referral System, and at least another eight-hundred individuals by June 2016 3.2 By December 2013, help members of the target population leaving jail reconnect with Medicaid, SSI/SSDI, and VA benefits 3.3 By December 2013, secure Social Security presumptive eligibility for SSI/SSDI benefits for persons with schizophrenia in the target population 3.4 December 2014, ensure that at least 90 percent of the target population is enrolled in Medicaid, including Medicaid expansion, and that the process for enrollment is streamlined and accessible 3.5 By December 2014, expand access to benefits and services for the target population through “one door� opportunities
4. Increase and strengthen outreach to link the target population to housing and health services Provide more and improved outreach to assure that the target population can access needed housing and health services 4.1 By December 2014, support the work of outreach teams by providing them with the necessary tools, resources, and worker-to-participant ratios 4.2 By December 2014, ensure that all homeless outreach workers are trained in eligibility procedures according to SSI/SSDI Outreach Access and Recovery (SOAR) best practices. This will happen within sixty days of employment 4.3 By June 2015, ensure that at least 50 percent of the target population with serious mental illness and substance use disorders is engaged in services that match their level of need/choice 4.4 By June 2016, at least 50 percent of the target population served by outreach teams will be housed 4.5 By June 2016, ensure that all homeless outreach teams have access to adequate clinical support and include persons in recovery 4.6 By June 2016, establish fifteen short-term emergency units with specialized supports for the target population who are homeless or unstably housed