# Presentation: 166553

## Preventing Chronic Homelessness

**What Works?**
** **

## Why Address Prevention?

- Strategies to prevent new cases or “close the front door” to homelessness are as important to ending homelessness as services to help those who are already homeless re-enter housing
- The challenge is targeting efforts toward those who will become homeless without the preventive intervention

## Why Focus on Mainstream Programs?

- People who experience chronic homelessness are heavy users of expensive mainstream services
- Levels of disability and poverty make them likely to be eligible for mainstream programs
- Approaches that work for this subgroup may make mainstream services more accessible for others

## Prevention of Chronic Homelessness

- 	Involves identifying key individual- and system-level risk factors and targeting prevention efforts to specific subgroups

## Risk Factors for Chronic Homelessness

**Individual Risk Factors **
- Chronic health conditions, mental illness and/or substance use disorders
- Limited or no social support networks
- Domestic violence and other victimization or trauma-related factors
- Family instability as a child (out-of-home placement, family homelessness, incarceration of a parent)
- Combat experiences for veterans
**System-Based Risk Factors**
- Discharge from jail, prison, hospital, shelter, detox, residential substance abuse treatment, and foster care
- Lack of permanent affordable housing
- Very low or no income

## Key Prevention Strategies

- Development, implementation and monitoring/ enforcement of discharge policies that prevent homelessness (zero-tolerance policies)
- Access to supportive services coupled with housing
- Pilot programs for ex-offenders (in-reach, housing assistance, post-release support services )
- Creating/setting aside housing for people exiting mental health institutions, other at-risk populations (e.g., substance abusers)

## The Role of Discharge Planning in Preventing Chronic Homelessness

- 	Discharge planning, linked to affordable housing and aftercare, is a “promising practice” for the prevention of chronic homelessness—particularly for people with health and behavioral health disorders

## Discharge from Institutions

- 	Data from Massachusetts showed that people coming into shelters were well-known to the State’s mainstream systems
- 18-24 year olds aging out of State services
- Ex-offenders released from State or county facilities with no place to go
- People from detox at the beginning of their recovery
- People with serious mental or physical illnesses released directly from a hospital

## Best Practice Strategies

- Develop and implement system-wide policy that prevent discharges to shelters or streets
- Focus on the individual—use stays in hospitals and correctional facilities as opportunities to engage, assess, and plan
- Ensure continuity of care when transitioning from one provider to another

## Best Practice Strategies

- Employ “boundary spanners” who understand and can cross agency lines
- Help individuals access housing
- Develop housing expertise within mainstream systems
- Provide bridge subsidies and priority access to Section 8
- Help individuals access services
- Link people to services or teams (ACT, CTI) that provide or broker services
- Help individuals gain access to benefits before they are released

## Best Practice Strategies

- Collaboration and partnerships
- Get stakeholders to the table
- Find champions, develop incentives, stress cost savings
- Accountability
- Hold systems/providers accountable for outcomes
- Establish indicators with realistic benchmarks
- Incorporate standards into contracts

## Best Practice Examples...Transition Specialists/Boundary Spanners

*New York State’s *Office of Mental Health funds pre-release coordinators and a transition case management team to provide services to inmates with mental illnesses released from State prisons. Services include:
- “In-reach” visits
- Linking to community housing and treatment providers
- Coordination with Division of Parole
*King Co. Seattle’s* mental health and addiction services division funds 4 liaisons to work with staff and patients at the State hospital to facilitate transition planning

## Best Practice Examples...Accessing Housing Options

*Hawaii’s *Mental Health Division provides temporary rent subsidies to homeless patients being discharged. Section 8 rules revised to give preference to people who are homeless or receiving bridge subsidies
*Kentucky* made persons being discharged from State hospitals a priority population for Section 8
*New York* State’s Office of Mental Health has mandated that individuals at high risk for homelessness receive priority for housing, case management, and Assertive Community Treatment

## Best Practice Examples...Continuity of Care and Service Access

- Critical Time Intervention and Short-term ACT Services are evidence-based practices for people who have experienced chronic homelessness
- Provide intensive clinical services for 6-12 months during and following transition from shelters, hospitals, or jails
- Proven effective in maintaining residential stability and linkage to mainstream treatment and other support services *after* intervention is scaled back or withdrawn

## Best Practice Examples...Collaboration and Partnerships

*Maryland* Mental Hygiene Administration funds transition planning services for incarcerated individuals with serious mental illnesses and co-occurring disorders who are homeless
- Seed money is provided to 23 jurisdictions that have developed interagency advisory boards and agreements specifying services community agencies will provide to ensure successful re-entry

## Best Practice Examples...Accountability

*New Hampshire* banned discharges to shelters in a new hospital discharge planning policy
*Massachusetts* mainstream systems (corrections, mental health, etc.) evaluate contractors on performance measures where homelessness is a negative outcome and housing is a positive outcome. Outcomes are tied to incentives and disincentives in each system
*City of Philadelphia* and *Massachusetts* are reducing shelter beds by providing incentives for providers to provide prevention services and supports in housing. Shelter providers are penalized if a former client reappears in the shelter system

## 	Best Practice Examples...Youth in Transition

- The Federally-funded Independent Living Program for youth transitioning from foster care allows up to 30% of funds to be used toward housing for youth until they reach the age of 21
*Illinois’* Department of Youth and Families’ Youth Housing Assistance Program provides housing advocacy and cash assistance to youth aging out of foster care.  Housing advocates throughout the State assist with locating affordable housing and accessing social services.  Grants to cover start-up costs (e.g., security deposits) and partial housing subsidies are available

## States and localities are collaborating with criminal justice re-entry initiatives to provide housing and post-release support services

Blended funds to create and provide new housing for formerly incarcerated persons

Re-allocation of Criminal Justice/Corrections capital funding to housing agency

Provision of Corrections/Parole funds to subsidize supportive housing for former inmates

Cross-training for improved discharge planning

- Blended funds to create and provide new housing for formerly incarcerated persons
- Re-allocation of Criminal Justice/Corrections capital funding to housing agency
- Provision of Corrections/Parole funds to subsidize supportive housing for former inmates
- Cross-training for improved discharge planning

- 	Best Practice Examples...Re-Entry for Ex-Offenders

## Best Practice Examples...Post-Detox/Pre-Recovery Support 

*Massachusetts’* Bureau of Substance Abuse Services (BSAS) supports two programs to prevent homelessness and relapse for individuals leaving detoxification without a recovery home bed or other housing in place.  Both provide services and transitional housing for an average of 30 days

## Housing is Critical!

*“...**the greatest challenge is not in the discharge planning process itself, which involves assessing individuals and linking them to services, but in the development of sufficient housing & services...” **(SAMHSA Expert Panel Meeting Summary)*
- Providing housing subsidies that target those with worst case housing needs (e.g., people who experience chronic homelessness) is probably warranted
- Studies have shown for more disabled populations (people with mental illnesses and/or substance use disorders) access to permanent housing with supportive services is effective