May 2018 Housing First Harm Reduction v2

1 Supportive Housing TrainingMay 20189:00 1:00pm1 SAPCK ristine GlazeDPH SAPCK ristine GlazeDPH SAPCG ermeen DuplessisDPH SAPCG ermeen DuplessisDPH SAPCS aloniki JamesDPH SAPCS aloniki JamesDPH SAPC2 Your TrainersSharon Rapport Associate Director CSHC aliforniaSharon Rapport Associate Director CSHC aliforniaSusan LeeSenior Program ManagerCSHLos Angeles, CASusan LeeSenior Program ManagerCSHLos Angeles, CANoah FaySenior Program ManagerCSHS eattle, WANoah FaySenior Program ManagerCSHS eattle, WA3 Advancing Housing Solutions ThatImprove lives of vulnerable peopleMaximizepublic resourcesBuild strong,healthy communities4 Improving Lives Veterans high-utlizers criminal justice involved individuals child welfare involved families older adults transition aged youth5 Maximizing Public ResourcesPublic SystemsCSH collaborates with communities to introduce Housing solutions that promote integration among public service systems, leading to strengthened partnerships and maximized resources.

2 Maximized Resources6 Supportive Housing is the SolutionHousing: AffordablePermanentIndependentSupport:Fl exibleVoluntaryTenant-centeredCoordinate dSupportive Housing combines affordable Housing with services that help people who face the most complex challenges to live with stability, autonomy and We DoCSH is a touchstone for new ideas and best practices, a collaborative and pragmatic community partner, and an influential advocate for supportive ofBusinessTraining & EducationPolicy ReformConsulting & AssistanceLendingresearch-backed tools, trainings and knowledge sharing powerful capital funds, loan products, development expertisecustom community planning, cutting-edge innovations systems reform, policy collaboration and advocacy 89 Today s AgendaUnderstand where supportive Housing fits in LA's big pictureUnderstand where supportive Housing fits in LA's big pictureDefine Supportive Housing .

3 Identify benefits and key componentsDefine Supportive Housing , identify benefits and key componentsDefine Housing First and share harm Reduction techniquesDefine Housing First and share harm Reduction techniquesIntroduce homeless services agencies and CES leads to SAPC providers in each SPAI ntroduce homeless services agencies and CES leads to SAPC providers in each SPA10 Icebreaker!1112151617 Whole Person Care (LA County) 2017 20 Drug Medi Cal Organized Delivery System (LA County) 2017 20 Health Homes Program (CA, LA County) 2019 Payment reformSource: Wesley Yin, UCLA, NBER mental healthbehavioral healthhousingcriminal justicecapitated managed care payments acutepost acutechronic diseaseMedical careSocial determinantsLT care(SNF, B&C)preventive care (primary care)transportationfood18 STATE and LOCAL HOUSINGRESOURCESM easure H (2017 27) $ B over 10 yrs($355 M annually) for implementing services and local subsidies LA County (quarter cent sales tax)Proposition HHH (2017 27) $ B over 10 yrsfor projects to create 10,000 SH units City of LA (bond)Affordable Housing Fund (2016 ) Allocation: Y1/2/3/4/5 = $20/40/60/80/100M thereafter.

4 At least 75% AH/up to 25% RRH LA CountyNo Place Like Home ( First NOFA in 2018) $2 B for development of SH for persons in need of mental health services and experiencing homelessness California (bond)State Housing Package (Jan 2018 ) SB2: Building Homes and Jobs Act, $ B over five yearsfor permanent state source of funding for AH SB 3: $4 B state Housing bond Nov 18 ballot 13 other bills to streamline /ensure AH development to meet state Housing needsAB 74: Housing for a Healthy CA (Jan 2018 ) $20 M per year in capital and subsidies from National Housing Trust Fund tied to WPC & HHP for chronically homeless frequent user Medi Cal beneficiaries FEDERAL, STATE, LOCAL HEALTHCARE RESOURCESH ousing for Health (DHS, DMH, DPH) Outreach, Intensive Case Management Services, Bridge Housing LA CountyWhole Person Care LAPilot (DHS 2016 20) $ B over 5 yrsfor high cost, high need Medi Cal beneficiaries 10,000 housed by 2020 LA County / under CA 1115 Medi Cal WaiverFlexible Housing subsidy Pool (DHS) Local rental subsidies funded by DHS, Conrad N.

5 Hilton Foundation, DMH, Probation, Care 10,000 high utilizers by 2020 LA County Drug Medi Cal Organized Delivery System (2016 20) New case management and field based substance abuse treatment services LA County / under CA 1115 Medi Cal WaiverHealth Homes Program (July 2019 ?) New Medi Cal benefit for integrated, person centered service delivery system for populations with complex, chronic conditions Serve approx. 10,000 beneficiaries experiencing homelessness per year CMS CA /under ACA Health Homes OptionINTEGRATED SERVICESRENTAL SUBSIDIESHOUSING CAPITALFULL ARRAY OF INTEGRATED SERVICES IN SUPPORTIVE HOUSING19E8 Emergency shelters (LAHSA)B7 Interim Housing (LAHSA, DHS)Recuperative care (DHS, Private)Recovery beds (DPH SAPC)Interim/Bridge HousingCES E6 Countywide outreach system (LAHSA, DHS)Outreach TeamsPathways to Services & Housing for Hospital Frequent Users Experiencing Homelessness in Los Angeles CountyOutreach & EngagementD7 ICMS Services (DHS HFH, DHS ODR, DMH, DPH)WPC LAHomeless Care Support Services (DHS)DMC ODS (DPH SAPC) Case management, field based services for DMC clientsIntegrated Case Management ServicesCES Leads: Homeless Services & BH ProvidersReferral PartnersNonprofit & Private Hospitals MCO: Care Direct to SUD ProvidersMCOs.

6 Health Net, Anthem, Care 1st, Kaiser, MolinaDHS HospitalsFQHCs, CHCs, IPAs, Recuplow acuity CES matchesAccess PointsInterim / Bridge Housing Perm. Housing Intensive Case Management Services Federal subsidies (HUD) D7 Local subsidies (Measure H) DHS flexible Housing subsidy Pool subsidies (FHSP)Rental Subsidies City (Prop. HHH) County (Affordable Housing Fund, Meas H) State (NPLH, State Housing Package)Supportive Housing : CapitalB3 Rapid Rehousing (LAHSA) shallow subsidiesRapid Rehousingdotted lines = in progressLAHSA: Los Angeles Homeless Services AuthorityHealth Agency: DHS, DMH, DPH SAPC high acuity CES matches20 Recuperative Care (DHS)Shelters (LAHSA)Interim Housing (DHS, LAHSA)CES Housing OptionsDetox Facilities (SAPC)21 Case load 1:15 Case load 1:1522 What is PermanentSupportive Housing ?Decent, safe, and affordable community-based Housing that provides residents with the rights of tenancy under state/local landlord tenant laws and is linked to Voluntary, flexible support and services designed to meet residents needs and HousingHousing2 Housing2 Supportive Services3 Supportive Services3 Property and Housing Management1 Property and Housing Management1 Project s relationship to the community4 Project s relationship to the community4 How do you describe supportive Housing ?

7 24 How do you describe supportive Housing ?PermanentAffordableAffordableInd ependentIndependentFlexibleFlexibleVolun taryVoluntaryTenant-Centered25 High Quality Supportive Housing A variety of Housing models exist with common factors including:Located in within safe neighborhoods with close proximity to: transportation employment opportunities services shopping, recreation and have a lease identical to those of tenants who are not in supportive are voluntary and focus on ensuring that tenants can obtain and thrive in stable Housing , regardless of barriers they may Housing and its tenants are good neighbors, contributing to meeting community needsand goals whenever Housing OutcomesDoes Supportive Housing Work?27 Supportive Housing OutcomesDoes Supportive Housing Work?YES!28 Supportive Housing OutcomesState of the Literature 2002-2016 There are at least 32 known studies from 2002-2016 that focus on various subpopulations in supportive to Supportive Housing Studies Chronically HomelessSubstance UsersMental Health ConditionsFrequent Users of HealthcareYoung AdultsOthersOthers29 Supportive Housing OutcomesSupportive Housing Improves Lives Supportive Housing Improves Lives Housing stabilityEmploymentMental and physical healthSchool attendance30 Supportive Housing OutcomesSupportive Housing Generates Cost Savings to Public Systems, including decreased use Housing Generates Cost Savings to Public Systems.

8 Including decreased use sheltersHospitalsEmergency roomsJails and prisons31 Supportive Housing OutcomesSupportive Housing Benefits CommunitiesSupportive Housing Benefits CommunitiesImproves the safety of neighborhoodsBeautifies city blocksIncreases or stabilizes property values over time32 Supportive Housing OutcomesTenants have social and community connections. Tenants have social and community connections. Tenants stay stay improve their physical and mental improve their physical and mental increase their income and increase their income and are satisfied with the services and are satisfied with the services and Housing ModelsSingle SiteScattered Site34 Scattered Site ModelBuildScattered SiteLease35 Targeting: Supportive Housing vs. Other ModelsMarket Rate Housing Those who can pay market-rate rent without a subsidyAffordable Housing Low-income Prioritization can happen for sub-popuationsPerm.

9 Supportive Housing (PSH) Very vulnerable Chronically homelessPerm. Supportive Housing (PSH) Very vulnerable Chronically homelessRapid Rehousing (RRH) Most homeless families Newly homelessTransitional Housing (TH) Non-disabled, high barrier Desire structured treatmentEmergency Shelter (ES) Interim Housing <30 days while waiting for housingPrevention Targets those at-risk who actually enter system36 Housing ContinuumHow Supportive Housing DiffersHousing TypeEmergency ShelterTransitional HousingRapid RehousingPermanent Supportive HousingAgreementHouse RulesProgram AgreementLease or Sub-LeaseLease or Sub-LeaseLiving ArrangementsCongregateLivingCongregateLi ving or Single SiteScattered SiteSingle or Scattered SiteTime LimitShort-TermTime Limited 24 monthsShort-TermPermanentTypical ServiceDeliveryLimited access to servicesDirected,required, intensive servicesTailored, tapered servicesTailored, comprehensiveservice packageOperationsNonprofit Provider serves as service and property managerNonprofit Provider serves as service and property managerPrivate Landlords with services delivered Property Managers/ Owners.

10 Nonprofit Service ProviderHow Supportive Housing Differs37 Key Components of Supportive Housing 1 Targets households with multiple barriers1 Targets households with multiple barriers2 Provides unit with lease3 Housing is affordable4 Engages tenants in flexible , voluntary services5 Coordinates among key partners6 Supports connecting with community381 Targets households with multiple barriersChronically homelessChronically homelessHomelessHomelessAt risk of homelessnessAt risk of homelessnessCycling through systemsCycling through systemsExiting institutionsExiting institutionsSupportive Housing is for people who Provides unit with a leaseCommon Misconceptions: Section 8 Who MUST be screened out by Housing Authorities for public Housing and Section 8 programs? Individuals subject to lifetime registration under a state sex offender registration program. Individuals convicted of the manufacture or production of methamphetamine in federally assisted Housing .