HUD Recovery Housing Policy Brief: Understanding the Impact and Potential for Health Centers

The intent of the HUD Brief is to outline expectations of how HUD funded Recovery Housing should be designed, operated, and integrated in a Continuum of Care’s system of addressing substance abuse disorders and other vulnerabilities impacting the population facing homelessness and housing instability. An individual’s choice should govern whether a homeless household enters into Recovery Housing and this type of housing should not be the sole option in any system. HUD believes that the Recovery Housing model can produce positive outcomes and meet specific needs of those with substance abuse disorders within a homeless system, when both choice and a core set of criteria and characteristics are clearly defined and followed.

Health Works!

Health Works! provides integrated behavioral health and primary care services to all Pathways DC clients through an on-site, walk-in Unity Health Care clinic, ACT peer health educators, and a RN nutrition specialist. Integrated health staff provides services in three ways, first through community outreach, second, in client’s homes lastly at medical appointments in the clinic. Health Works also provides onsite wellness groups in diabetes education, nutrition, and healthy relationships and community wellness events, all of which partner with Unity Health Care’s Nurse Practitioner to provide brief group education in preventive care and health management.

10th Decile Project

The 10th Decile Project is a collaborative effort in Los Angeles County to connect frequent users of emergency health services to housing and appropriate care. More than 25 organizations, including five Health Center Program grantees, are involved in six neighborhood networks throughout the county to address the needs of the top 10% highest-cost, highest-need individuals experiencing homelessness in the community.

Integrated Care for the Chronically Homeless

The Houston Integrated Care for the Chronically Homeless Initiative was born out of the Texas 1115 Medicaid Waiver program and the City of Houston Health and Human Services Department. The 1115 Waiver incentivized the development of innovative care delivery models and created new funding pools to ensure providers are reimbursed for providing quality care to vulnerable individuals. The new care delivery models are designed to meet the goals of improved access, increased coordination of care, improved health status, and reduced costs.

FUSE Washtenaw County, MI

Bring together community partners from a variety of sectors to connect frequent  users to housing, healthcare, and care coordination is both the goal and lasting  outcome of the Frequent Users Systems Engagement (FUSE) initiative in  Washtenaw County, Michigan – a subgrantee of the CSH’s Social Innovation.

The FUSE project targets individuals who meet threshold criteria for frequent  utilization of crisis systems, including homelessness or housing instability, low  income, behavioral health conditions, chronic physical health conditions, and  frequent emergency room utilization and/or hospitalizations.

Improving Care for Medically Complex Patients: Medical Respite & Supportive Housing

Medical respite programs are as unique as the individuals and communities they serve. From shelter-based care to stand-alone facilities, medical respite provides a transition for those exiting the hospital who have no permanent residence and are not well enough to return to the street. Hospital partners have seen the benefit of medical respite programs as they not only stabilize health needs, but also reduce hospital readmissions. In addition to providing necessary care, this transitional step is an opportunity to connect vulnerable individuals to permanent housing. This profile highlights two programs that have exemplified how medical respite care can be an effective bridge to supportive housing. Strong involvement between the health center and their local Continuum of Care, including through the coordinated assessment process, results in high rates of discharge to supportive housing.

This Profiles Bridging Health & Housing features Yakima Neighborhood Health Services, Yakima, WA  and Circle the City, Phoenix, AZ .

Promising Practices for Health Centers: Serving Youth Experiencing Homelessness

Preventing and ending homelessness among youth is currently a national focus and local priority in communities across the country. Health centers play a key role, both in connecting this population to housing and providing needed health services for this vulnerable population.This Profiles Bridging Health & Housing features Hennepin County, Public Health, Minnesota & Outside In, Portland, Oregon

Moving On Profile: San Francisco

The Moving on Initiative (MOI) is an important part of the City’s strategy to address homelessness.

MOI creates opportunities for stable permanent supportive housing tenants who no longer need or want onsite services, providing the option to move into private market housing with rental subsidy. This will free up units for currently homeless families and individuals who need housing combined with services. Based on national best practices, the City and the San Francisco Housing Authority (SFHA) are collaborating to create the first pilot program.

Moving On Profile: San Diego

San Diego County Behavioral Health Services (BHS) and CSH are working together to implement a Moving On initiative with the San Diego Housing Commission (SDHC). BHS contracts with Full Service Partnerships (FSPs) that provide Assertive Community Treatment and housing supports to individuals with serious mental illness, many of whom are homeless or at-risk of homelessness when they enter the program. The FSPs use a Housing First approach and utilize a variety of housing options including Independent Living Homes (ILHs), subsidized units that were developed with BHS funding, master-leased units, and other market rate housing to ensure that clients are housed quickly after they enter the program. A significant portion of the FSP clients rely on SDHC housing subsidies or on subsidies that are provided from BHS program funds.

The average monthly enrollment for all of the contracted FSP programs is over 1200, and BHS estimates that 10 -15% of these clients are clinically stable and could access psychiatric care in the community but remain in the program to maintain housing supports. Because of this, the FSP programs are experiencing a gridlock as there are limited affordable housing options in San Diego County for clients who are clinically able to exit permanent supportive housing but lack the income to afford market rate housing. While some FSP clients have obtained tenant-based subsidies from the SDHC, the need for additional housing subsidies persists. BHS is pursuing a Moving On strategy to help fill that gap and provide additional subsidies, as well as open up slots for new FSP clients who need permanent supportive housing.

SDHC has proposed a pilot Moving On program that will offer 25 housing subsidies to stable clients who are able to exit their FSP program and access community services to address their mental health needs. BHS, CSH, and SDHC are working together to develop a service model to provide transitional services to former FSP clients with the goal of maintaining permanent affordable housing.

Moving On Profile: Returning Home Ohio

Returning Home Ohio (RHO), is a supportive housing  program funded by the Ohio Department of Rehabilitation and Correction (ODRC) serving Ohio’s returning prison population, specifically those individuals exiting state prison homeless or at risk of homelessness and who also have a disability. The program began as a pilot launched in 2007 and after five successful years in operation, the RHO was adopted as a permanent program of ODRC in 2012. At that same time, ODRC requested CSH implement a process that would limit tenancy funded through ODRC in order to prevent extensive lengths of stay in housing supported by ODRC and to allow for a certain percentage of turnover to make room for new participants. CSH responded to this request by establishing a workgroup of CSH staff and RHO grantees to discuss the formation of a Moving-On initiative instead of imposing an arbitrary time limit on housing for all participants. In this way, the program would include an intentional focus on maximizing self -sufficiency for individuals in the program with periodic assessments that move them toward the ultimate goal of moving them on to more independent living. This allowed for a more individualized process whereby tenants could move on only if and when they are ready, rather than according to a pre-determined exit timeline for all participants.

At the same time, Home for Good was created via a partnership between CSH, ODRC and Ohio Housing  Finance Agency (OHFA). Home for Good is a dedicated pool of money used for rental  subsidy for those RHO tenants needing long-term supportive housing and who would not be eligible for a traditional subsidy due to their criminal background. It was designed as a safety net for very vulnerable RHO tenants who would otherwise remain under ODRC rental assistance for a lengthy period of time or be taken off that assistance and be at risk of homelessness and/or re-incarceration. The Home for Good rental subsidy positively impacted the development and structure of the RHO Moving-on program as it offered an additional resource for tenants.