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INDIANA PERMANENT SUPPORTIVE HOUSING INITIATIVE 2009 NCSHA AWARD FOR COMBATING HOMELESSNESS SUPPORTIVE HOUSING IT WORKS!

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Page 1: Indiana Permanent Supportive Housing Initative

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!

Page 2: Indiana Permanent Supportive Housing Initative

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

Page 3: Indiana Permanent Supportive Housing Initative

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

Page 4: Indiana Permanent Supportive Housing Initative

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

Page 5: Indiana Permanent Supportive Housing Initative

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)

Page 6: Indiana Permanent Supportive Housing Initative

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)

Page 7: Indiana Permanent Supportive Housing Initative

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

Page 8: Indiana Permanent Supportive Housing Initative

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.

Page 9: Indiana Permanent Supportive Housing Initative

What is Permanent Supportive Housing?

A cost-effective combination of

permanent, affordable housing with services that help people live more

stable, productive lives.

Page 10: Indiana Permanent Supportive Housing Initative

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.

Page 11: Indiana Permanent Supportive Housing Initative

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.

Page 12: Indiana Permanent Supportive Housing Initative

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.

Page 13: Indiana Permanent Supportive Housing Initative

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).

Page 14: Indiana Permanent Supportive Housing Initative

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) .

Page 15: Indiana Permanent Supportive Housing Initative

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).

Page 16: Indiana Permanent Supportive Housing Initative

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

Page 17: Indiana Permanent Supportive Housing Initative

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

Page 18: Indiana Permanent Supportive Housing Initative

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

Page 19: Indiana Permanent Supportive Housing Initative

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

Page 20: Indiana Permanent Supportive Housing Initative

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

Page 21: Indiana Permanent Supportive Housing Initative

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

Page 22: Indiana Permanent Supportive Housing Initative

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.

Page 23: Indiana Permanent Supportive Housing Initative

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

Page 24: Indiana Permanent Supportive Housing Initative

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

Page 25: Indiana Permanent Supportive Housing Initative

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.

Page 26: Indiana Permanent Supportive Housing Initative

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

Page 27: Indiana Permanent Supportive Housing Initative

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.

Page 28: Indiana Permanent Supportive Housing Initative

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

Page 29: Indiana Permanent Supportive Housing Initative

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.

Page 30: Indiana Permanent Supportive Housing Initative

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

Page 31: Indiana Permanent Supportive Housing Initative

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.

Page 32: Indiana Permanent Supportive Housing Initative

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

Page 33: Indiana Permanent Supportive Housing Initative

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

Page 34: Indiana Permanent Supportive Housing Initative

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.

Page 35: Indiana Permanent Supportive Housing Initative

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.

Page 36: Indiana Permanent Supportive Housing Initative

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

Page 37: Indiana Permanent Supportive Housing Initative

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

Page 38: Indiana Permanent Supportive Housing Initative

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

Page 39: Indiana Permanent Supportive Housing Initative

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

Page 40: Indiana Permanent Supportive Housing Initative

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

Page 41: Indiana Permanent Supportive Housing Initative

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

Page 42: Indiana Permanent Supportive Housing Initative

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

Page 43: Indiana Permanent Supportive Housing Initative

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

Page 44: Indiana Permanent Supportive Housing Initative

IPSHI Service Delivery Model

$-

$2,000,000.00

$4,000,000.00

$6,000,000.00

$8,000,000.00

$10,000,000.00

$12,000,000.00

$14,000,000.00

1 2 3 4 5 6 7

SAMHSA MHTG

State Funding of Gap

MRO Funding of IPSHI

Potential Service Funding for IPSHI Pipeline

Page 45: Indiana Permanent Supportive Housing Initative

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

Page 46: Indiana Permanent Supportive Housing Initative

ISPHI FUTURE

OUR VISION IS TO

END, NOT MANAGE

HOMELESSNESS