CSH Testimony to Gov's Task Force on Combating Heroin in NY

Written Comments of the Corporation for Supportive Housing (CSH)

Governor's Task Force to Combat Heroin and Prescription Drug Abuse

Submitted by Kristin Miller, Director of CSH Metro Region

Lieutenant Governor Hochul, Commissioner González-Sánchez, members of the Governor's Task Force. Thank you for the opportunity to submit testimony to this important and distinguished group of policymakers and advocates.

CSH has offered similar testimony to the New York Senate Task Force on Heroin and Opioid Addiction and applauds the efforts of New York Governor Andrew Cuomo and the Legislature, including Senator Terrance Murphy who serves on this Task Force as well, for elevating this issue and keeping it in the spotlight where it belongs.

CSH has a 25-year track record of innovation and investment in New York. Since 1991, CSH has made nearly $140M in loans to supportive housing developers for the creation of over 15,000 permanent supportive and affordable housing units in this state. Through our promotion of supportive housing, we are intimately familiar with the housing and services needs of residents who struggle with substance addiction and desperately seek stable lives to pursue recovery.

As you have undoubtedly heard again and again as you travel throughout the state, heroin and opioids are destroying people’s lives and damaging families and neighborhoods. My testimony is focused on supportive housing, a proven solution and valuable tool in our fight to stem this epidemic.

CSH this year released Supportive Housing’s Vital Role in Addressing the Opioid Epidemic in New York State , which provides a background of the opioid epidemic in New York communities and cites research showing supportive housing as a solution for individuals facing substance use disorders. Supportive housing combines affordable housing and services that help people facing complex challenges live with stability, autonomy and dignity. It has been demonstrated that through the stability found in supportive housing, people using heroin successfully avail themselves to the treatments that address their substance use disorder.[1] In fact, a study published in 2014 by the National Center on Addiction and Substance Abuse found that supportive housing was successful in reducing the use of, and costs associated with, substance abuse and crisis care services, including shelters, detox centers, jails and medical care (hospitalizations and emergency room visits). The findings suggest that individuals actively using substances can be housed successfully and stabilized without forcing treatment requirements on them.[2]

New York, too, knows supportive housing is an answer. Governor Cuomo and New York City Mayor Bill de Blasio have publicly committed to creating a combined total of 35,000 new supportive housing units in the City and throughout the rest of the state within the next 15 years.

CSH congratulates the Mayor and Governor for taking these important steps to house our most vulnerable New Yorkers. We urge this Task Force to help us ensure these new units are realized as soon as possible, and that people and communities living with the opioid epidemic have access to them and the important services they will need to achieve substance use recovery.

Housing is essential as an anchor of stability. Home forms a firm platform from which individuals can pursue the services they need. It is our responsibility to make sure our most vulnerable New Yorkers have access to the services as well as a home. That is what supportive housing provides. A person consumed by addiction can have access to the best treatments in the world, but recovery is highly unlikely if they are living on the street or in a shelter.

Without supportive housing, many individuals with opioid or heroin addiction will continue to cycle endlessly between homelessness and expensive public services delivery systems including inpatient hospital beds, psychiatric centers, detox services, jails and prisons, at an enormous public and human cost.

We ask members of this Task Force to help these individuals by ensuring that the recent commitments to new supportive housing in New York are realized, and that these resources are accessible to people struggling with substance use disorders, particularly heroin and opioid addictions.

_____________________

[1] Gray, Paul; Fraser, Penny. Housing and heroin use: The role of floating support. Drugs: Education, Prevention, and Policy. Vol. 12, Iss. 4, 2005.

[2] Neighbors, Charles; Hall, Gerod; et.al. Evaluation of NY/NY III Housing for Active Substance Users. The National Center on Addiction and Substance Abuse. 2014.

New Recommendations Released – Call for Fair Treatment for the Formerly Incarcerated

Today, CSH and 16 community partners released a set of recommendations to the New York City Supportive Housing Task Force focused squarely on the overwhelming need to ensure supportive housing for persons with criminal justice histories.

People reentering our communities from incarceration have been shortchanged in every New York State and City supportive housing agreement to date. In the face of incredible barriers, many who have served their time are confronted with a second punishment when they attempt to begin new lives but are denied access to affordable housing and the services they desperately need to stabilize. This sets off a chain of despair that often leads to homelessness, poverty and recidivism.

CSH and its partners know it doesn’t have to be this way. Of all the issues facing returning prisoners, the need to secure stable, affordable housing is one of the most essential, and supportive housing can and should play a crucial role.

Over 77,000 people were released from New York City Department of Corrections’ jails in FY 2015[1] and Mayor Bill de Blasio’s recently announced plan to add 15,000 units of supportive housing to the City provides an unparalleled opportunity to address the needs of the growing numbers of individuals hoping to rebound, rebuild and reestablish in our community.

These collaborative recommendations call for at least 15% of new supportive housing resources to be dedicated to individuals and families with criminal justice histories. CSH and its partners also recommend:

  • targeting criteria to ensure access to housing for people who need it the most
  • policies that bar discrimination and assure equal access to supportive housing for people with criminal justice histories
  • strategies to better develop the referral system for justice-involved populations
  • effective programming structure and service budget guidance

CSH and its partners believe that by including this population in the next supportive housing agreement, the City can expect reductions in recidivism, parole violations, shelter use, and use of crisis services, particularly among those who find their new home in supportive housing.

[1] NYC Mayor’s Office of Operations, Preliminary Fiscal 2015 Mayor's Management Report

Celebrating SIF Success in CT

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L-R: John Merz, Executive Director, AIDS-CT; Dannel Malloy, Governor, State of Connecticut; Sarah Gallagher, Director of Strategic Initiatives, CSH; Damian Thorman, Social Innovation Fund Director, CNCS; and Larry Oaks, New England Director, CSH

The successes and impact of the CSH Social Innovation Fund (SIF) initiative were highlighted during the Connecticut Integrated Healthcare and Housing Networks (CIHHN) Awards Dinner and Celebration held at the end of March in Hartford. Honored guests at the Dinner were Connecticut Governor Dannel Malloy, Director Damian Thorman of the Corporation for National and Community Service Social Innovation Fund, Richard Cho of the U.S. Interagency Council on Homelessness, SIF participants, and the four providers receiving awards for their work on SIF: Journey Home, Columbus House, Supportive Housing Works and New London Homeless Hospitality Center.After being introduced by Master of Ceremonies and Executive Director of AIDS-CT John Merz, CSH Director of Strategic Initiatives Sarah Gallagher welcomed everyone and spoke about the progress of SIF in Connecticut and nationally. Calling housing “a crucial piece of the healthcare puzzle,” she summed up SIF by saying it “brings together the best of what we know works in ending homelessness—data driven targeting and a housing first approach to supportive housing—with some of the most innovative solutions for improving health outcomes— care coordination, patient navigation, and direct linkages to integrated primary and behavioral health care.”

Sarah cited impressive outcomes to spotlight SIF’s progress to date:

  • SIF participants have a 92% retention rate in supportive housing.
  • 90% are actively connected to a primary health care provider.
  • 91% are actively connected to mental health care.
  • 89% to specialty care.
  • As a result, hospital emergency department use as the main source of care is decreasing for SIF participants and other service utilization patterns are trending in a positive direction.
  • Overnight hospitalizations dropped from 8.5 before housing to 2.7 in the 12 months post supportive housing placements.
  • Emergency department visits decreased from 13 pre-housing to just 5 in the 12 months post supportive housing.

In addition to positive individual outcomes, SIF’s cross-systems work has been cited by the Centers for Medicare and Medicaid Services and the U.S. Department of Housing and Urban Development as helping to advance the direction of federal policy.

Sarah also introduced a new video featuring partners, providers, funders and participants in Connecticut’s SIF initiative.

Governor Malloy praised SIF in his address, noting that without housing and access to primary healthcare services, individuals are forced to cycle through various high-cost and crisis-care public systems, costing government significant amounts of money without any improvements in personal well-being. He reiterated his Administration’s commitment to ending homelessness and said SIF is contributing to his goals of helping the chronically homeless and those veterans in need of a home and support services.

Governor Malloy said there is now a vibrant safety net in place to quickly access housing and services for any vulnerable veteran lacking a place to live.

He also pointed out the infrastructure created through SIF will ensure that when Connecticut ends chronic homelessness, the state will already have in place new models replacing the costly and ineffective ways of addressing homelessness with newer ones that provide ongoing, coordinated, and multi-disciplinary care with the appropriate housing.

Recognizing the progress SIF has made bridging gaps between housing and healthcare, Governor Malloy acknowledged that stakeholders around other vulnerable populations need to be brought together to think about the role of housing in improving outcomes through cost-effective interventions.

L-R: Sarah Gallagher, Director of Strategic Initiatives, CSH; Damian Thorman, Social Innovation Fund Director, CNCS; Alicia Woodsby, Executive Director, Partnership for Strong Communities; and Janice Elliott, Executive Director, Melville Charitable Trust

Corporation for National and Community Service SIF Director Thorman spoke to the group about how their work is fostering greater collaboration and cooperation amongst public and private providers, breaking down the “silos” that usually exist when different agencies and levels of government focus exclusively on their own goals. He noted “SIF is reducing risks and increasing the impact of government resources by using data to drive progress…all while improving people’s lives.”

Director Thorman concluded by saying that “without SIF… programs wouldn’t be making the impact they are today.”

In addition to the remarks offered by Sarah, Governor Malloy and Director Thorman, two panel discussions, one comprised of just SIF participants and the other of general stakeholders, were incorporated into the evening. The stakeholder panel was moderated by CSH Director in New England, Larry Oaks, and included: Alicia Woodsby, Executive Director, Partnership for Strong Communities; Janice Elliott, Executive Director, Melville Charitable Trust; Steve DiLella, Director of Individual and Family Support Program Unit, Connecticut Department of Housing; and Nancy Navarretta, Deputy Commissioner of the Connecticut Department of Mental Health and Addictions Services.

The ceremony commending the four providers receiving awards was moderated by Susan Lampley of the Melville Charitable Trust. Read the introductions of the four award winners by clicking here.

New Recommendations Focus is on Aging in Supportive Housing

 

CSH has been leading an Aging in Supportive Housing Learning Collaborative for the past year to determine best practices for serving an aging population in supportive housing. “Aging” is not a specific supportive housing population, but there are unique service needs and programs to best serve older people who are formerly homeless and/or leaving institutions. To that end, and on behalf of New York’s best minds in this field, CSH is sharing a brief compilation of key recommendations we recently made to the New York City Supportive Housing Task Force. A dozen organizations dedicated to promoting health and stability for our most vulnerable residents believe these recommendations support promising, healthy aging-in-place practices for future supportive housing initiatives. Also, a Core Competencies Toolkit will be released this spring and it will provide more detail on program models for aging in supportive housing.

 

 

 

Spreading the Power of FUSE

CSH convened a special peer-to-peer site visit earlier this month in Charlotte, North Carolina, that brought together a group from Iowa City, Iowa, and Mecklenburg County, North Carolina, to explore the structure and success of MeckFUSE, a housing program for homeless men and women with behavioral health issues who have been frequent users of Mecklenburg’s jail, street camps and shelters. FUSE stands for Frequent User Systems Engagement, a proven national supportive housing model from CSH.

This peer-to-peer was designed to assist Iowa City as it continues to build the foundation for its own FUSE initiative as a CSH start-up grantee. CSH is able to expand FUSE throughout the country due, in part, to generous support from the Open Society Foundations and Capital One. Both funders also help underwrite our new and free FUSE Resource Center.

While diving deeper into FUSE, participants in this peer-to-peer learning experience visited a single site supportive housing apartment building that houses the once chronically homeless.

The apartments, Moore Place, are provided as a HousingWorks supportive housing program of the Urban Ministry Center. Through the HousingWorks program, the Urban Ministry Center seeks to fulfill its mission of ending homelessness by giving the most vulnerable what they so desperately need: a home.

HousingWorks has three pathways to housing for chronically homeless individuals: Moore Place, an 85-unit apartment building that opened in February 2012; Scattered Site apartments (45 units); and, in MeckFUSE, a partnership with Mecklenburg County providing an additional 45 community-based apartments.

The HousingWorks approach is simple: give chronically homeless individuals what they need most – a safe, stable, affordable home – and then provide the wrap-around support to help them remain housed and regain lives of wellness and dignity. A team of social workers, therapists, a full-time nurse and a part-time psychiatrist provide supportive services to help each HousingWorks tenant manage the transition from long-term homelessness to housing, and to help individuals meet personal goals to ensure they never become homeless again.

HousingWorks specifically targets those individuals who have been homeless the longest, are the most vulnerable and are the most frequent users of emergency rooms, jails, shelters and other costly crisis services.

In addition to seeing Moore Place and how it transforms lives, the group from Iowa City spent two days:

  • Increasing their understanding of the core components and day-to-day operations of a FUSE program;
  • Discussing strategies for building community support for new developments and ways to maintain on-going community engagement/support of FUSE programs;
  • Better understanding MeckFUSE financing for operations, rental assistance and supportive services;
  • Learning the development process, funding sources, roles of partners and design considerations for FUSE tenants; and
  • Understanding the needs of FUSE tenants when they move into housing: service needs, apartment preferences, amenities, move-in needs and types of housing support.

To learn more about CSH FUSE, please click here.

D.C. Task Force Working on Better Shelter Plan and Supportive Housing

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Download the "What Kind of Community Do We Want" pdf by Clicking Here

Kristy Greenwalt, Director of the District of Columbia’s Interagency Council on Homelessness, and Laura Zeilinger, Director of the City of Washington Department of Human Services, recently led a task force focused on how to replace D.C. General Emergency Shelter, which houses hundreds of homeless families in our nation's capital.

As part of their Homeward D.C. plan, which lays out goals for making homelessness rare, brief and non-re-occurring, City leadership is committed to moving from antiquated, large, multi-family shelter settings, such as D.C. General,  to a system that is nimble, responsive and geographically dispersed in areas where individuals and families who find themselves homeless can better connect to natural supports and receive community-based services in their neighborhoods.

Stakeholders from across the city, including CSH, participated in the task force meetings to help develop better alternatives for families. Ideas discussed include a “bathroom in every unit” and enough room and common areas to ensure children have safe spaces to play and learn. The District leadership led the task force through the process of “costing out” different models financially, operationally and through the eyes of the men, women and children who would be in the housing and using the services.

Kristy, Laura and their teams have done a great job of balancing a vision of a “perfect” shelter system with one that would eventually end up being a small piece of the District’s overall plan to create more affordable and supportive housing resources.

The challenge they face is "the reality of the situation" as the District continues to develop its affordable housing, community-based supportive services, employment and childcare supports while moving to replace D.C. General. Sorting through these important considerations and difficult realities, the City must balance how to build a better emergency  shelter system as well as a more robust supply of affordable and supportive housing.

At a family stakeholder discussion, conducted by members of the task force, one resident best summed up what the City should be aiming for in its planning.  When asked about the need for having a “bathroom” in every unit, a mother who had been raised in a shelter setting herself said, “We don’t need shelters with a bathroom in every room, that’s too expensive...we need City dollars invested in affordable housing and supportive services...we don’t want our children to call this place (an emergency shelter) their home. We want real homes.”

 

Supportive Housing Improves Addiction Recovery

Guest Blog by Charles J. Neighbors, PhD, MBA

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Charles J. Neighbors, PhD, MBA, Director, Health Services Research, CASAColumbia

In December 2015, the Corporation for Supportive Housing (CSH) released a paper on supportive housing as a component of a strategy to manage the heroin crisis for the chronically homeless. CSH estimates there is a need for over 30,000 new supportive housing units across New York State to reverse the ever-increasing numbers of people experiencing homelessness. About 35-40% of chronically homeless people suffer from severe substance use disorders.

New York communities bear substantial public costs for individuals experiencing substance use disorders and homelessness. The recent rise in opioid use has increased this strain. Finding a way to engage homeless persons for whom substances are a barrier to housing is critical to solving the problem. One potential approach is supportive housing—housing linked with social services- which provides the support that the chronically homeless need to stay in their homes.

Research by our Center suggests that supportive housing is an effective and cost-efficient intervention for homeless individuals struggling with addiction. We evaluated a program in New York State and City that offered supportive housing to individuals not willing to commit to abstinence. The program was successful in reducing use of shelters, jail and medical services. The reductions in crisis service use were associated with considerable savings, which offset the cost of the housing program.

Recently, New York Governor Andrew Cuomo made supportive housing a cornerstone of his State of the State address, committing to creating 20,000 new units statewide over the next 15 years. These units are in addition to the 15,000 Mayor Bill de Blasio announced for New York City in November. These plans exemplify a significant commitment to addressing the longstanding problem of chronic homelessness and severe substance use disorders, and benefitting individuals and the community.

Happy Birthday, Tommy!

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Tommy Hughes in his very own apartment.

Today is Tommy Hughes' Birthday, but he already celebrated another big milestone in his life last week. On March 1, Tommy and his mother, Lisa Hughes, invited CSH staff, Nancy Mercer, and Tommy's case manager, Holly Toombs from the Henrico Community Service Board, to attend his meeting with the local Public Housing Authority where he was being assigned his housing assistance voucher. Tommy was able to access this resource because Holly pursued the Housing Choice program made available through a partnership between Virginia Housing Development Authority - VHDA - and the Virginia Department  of Behavioral Health and Developmental Services - DBHDS.

In Virginia, 200 Housing Choice Vouchers have been set aside for men and women with an Intellectual and Developmental Disability (ID/DD) who want to live in integrated community-based settings.  This resource comes, in part, as a result of a recent Department of Justice agreement where the Commonwealth pledged to do more to increase community-based housing capacity and supports for individuals with ID/DD. Prior to this settlement - similar ones have been endorsed by CSH throughout the country - ID/DD individuals in Virginia faced limited options. Their "choices" were five large outdated training centers; a Home and Community Based Waiver System (HCBS) that was stretched thin and operating with outdated rate structures; and long waiting lists and an inadequate crisis support to manage the thousands of individuals and families who were in daily need across the state. Since 2011, DBHDS has been leading the commitment to build capacity with ongoing oversight from DOJ and the courts.

CSH is excited by the progress being made in Virginia as hundreds of men, women, and families move from inadequate and antiquated institutions to community-based housing and services. The HCBS program is in the process of becoming more person centered in how it is administered, managed and financed; informed and responsive crisis services for children and adults continue to be refined and developed; and we are seeing a more effective approach toward housing and support services that is allowing individuals with ID/DD a true choice on where they want to live and which services are going to be provided to them.

But let's get back to the main reason why all of this is so important - Tommy.

Betty Ross was the Housing Specialist assigned to Tommy and his mother, who is his legal guardian. It was evident that Ms. Ross has been assigning and managing the housing voucher process for many years, and she takes her job very seriously. Immediately she sensed that Tommy and his support team were nervous and unsure of how to proceed and she immediately became an inclusive, reassuring and reaffirming force.

Ms. Ross, addressed Tommy directly as he was the identified as “Head of Household”, but she made sure his mother was aware that her voice was as important as Tommy’s. Ms. Ross explained each piece of paper thoughtfully as she asked his mother to sign for Tommy over and over again. “This is a process,” she would remind everyone in the room. “It takes time, but in the end Tommy will have a housing voucher that will provide him with a resource he can use to pay for his own home.”

Tommy was the most patient of all, smiling and collecting his papers and filing them away.  Some of the papers were very technical, but Ms. Ross made sure she provided information that was much more user-friendly like the HUD Housing Inspection handbook, which includes pictures of what the inspector is looking for at the time of the annual inspection. She also shared information about Tommy’s potential community choices, and how he could get help locating a home that would accept his Housing Choice Voucher.

When Ms. Ross learned that Tommy had identified where he wanted to live--she was well aware of the apartment complex and how it was operated. Ms. Ross was sensitive to the fact that Tommy would have medical expenses that may include housing supports, electronic surveillance services, and transportation to and from a job.

Ms. Ross asked Tommy if he had any more questions at the end of the two hour meeting, to which he responded, “No, thank you, Betty.” Tommy's mother jumped in and whispered, “Ms. Ross, Tommy, it’s disrespectful to call her by her first name.”  Tommy blushed, and Ms. Ross chimed in, “No it’s ok, I told him to call me Betty, I prefer to be called Betty.”

As we left the office, we were confident Tommy will thrive in his new home and that he had found a invaluable support in his community - his housing specialist, ‘Betty”.

Happy Birthday, Tommy - and good luck in your new home!

 

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