# Presentation: 173666

## Mainstream Substance Abuse Services for Homeless Individuals and Families in Massachusetts

**Matthew R. Cornish **
**Director, Administration and Finance**
**Department of Public Health **
**Bureau of Substance Abuse Services**

**Notes:**
The Bureau of SA Services, DTA and DMH have been offering targeted services to homeless individuals and families for many years.  This presentation is an overview of the services provided by the BSAS, including collaborations with other EOHHS agencies and other partners.

## HUD Partnership ProjectsMcKinney Emergency Shelter Grant Program

**Case Management & Transportation at Shelters**
**Tenancy Preservation**
**Case Management for Women Ex-offenders**
**Post-Detox/Pre-Recovery Home Services**

**Notes:**
	This number includes admissions to all services in the system, so the same individual is counted as many times as modalities he was served in.

## HUD Partnership ProjectsMcKinney Supportive Housing

**Residential Rehabilitation Services**
**Street Outreach**
**Subsidies for homeless women in recovery services**
**Supportive Housing for 18 - 24 year old “Young Adults”**

**Notes:**
The Bureau of Substance Abuse Services at the DPH has promoted multiple homeless initiatives.  Substance abusing homeless clients have been prioritized and their numbers have shown an increase in treatment over the years.  
In this presentation I will share with you a summary of our continuum of care and the services targeted to homeless individuals and families.

## HUD Partnership ProjectsContinuum of Care

**Post-Detox / Pre-Recovery Home Services**

**Notes:**
Since 1997, the Bureau has funded 3 drop-in centers that provide self help and psychoeducational groups, HIV counseling, substance abuse referrals, primary care referrals and outreach.
Outreach progs.
Since 1994, as part of a federal grant, the Bureau has funded outreach workers at DTA’s homeless service office, for s.a. assessment and referral and HIV/AIDS education.
	Outreach programs to at risk substance abuse clients with mental health issues were started in Greater Boston, FY ‘95 in collaboration with DMH, MRC, DMR and other EOHHS agencies. Originally, in the Housing Options Program (HOP) there were 30 HUD Shelter + Care subsidies, for substance abusing clients.  These individuals received housing search and stabilization case management services, which were BSAS funded. ($50,511), through an Interagency Service Agreement (ISA) with DMH and its subcontractors.  In SFY ‘99 the BSAS funded (40,000) for a substance abuse case management specialist, via the DMH ISA and HomeStart, Inc. to provide case management services for 20 City of Boston Shelter + Care subsidies.
 In SFY ‘00, DHCDE added additional 30 HUD subsidies for BSAS and BSAS provided the matching case management funds (15,000 annualized).
	In SFY ‘00 BSAS committed resources to expand van/street outreach services, which target homeless substance abusing clients in Cambridge.  In SFY ‘02 BSAS supports an FTE nurse for Cambridge Health Carefor the Homeless at $60,000 (state $

## HUD Partnership Projects

**Aggressive Treatment & Relapse Prevention (ATARP)**
**Housing Options Program**

**Notes:**
The Dept of Transitional Assistance is responsible for funding emergency shelters across the state.
	The Bureau has funded 3 wet shelters for more than 10 years in Worcester, Lawrence andCambridge.  Each shelter has outreach staff to assess readiness for treatment, refer clients into treatment, provide psycho-ed groups on substance abuse and HIV/AIDS
	Since 1999, regional Shelter,Education,Assessment, Referral and Coordination for Homeless (Search) workers (five serve Boston, four in other areas) support substance abuse outreach in shelters and the community. The search workers work for a  vendor of outpatient services and are placed in shelters, offering s.a. assessments and psycho-educational groups to assess TX readiness and refer shelter clients to TX programs. They served app. 4,000 last year, ( SFY 02 $698,000)
	Federal Emergency Shelter grant funding is provided to shelters to provide case management and support services to address substance abuse within three homeless shelters, and other case management services for homeless clients in order to prevent/reduce homelessness. ($574,391)
Since 1996, the Bureau has provided shelters from $400,000 to $700,000 to pay for overflow bed.s.
	9 family substance abuse shelters are being managed by the Bureau via an Interagency Service Agreement (ISA)withr DTA for a total of 75 units for families, mostly mothers and their children.  DPH contracts with the Institute for Health and Recovery to coordinate these services.

## BSAS Mainstream ServicesTreatment

**Ambulatory Services**
**Narcotic Treatment**
**Acute Treatment Services***
**Transitional Support Services***
**Residential Rehabilitation Services***
**Substance Abuse Shelters for Individuals***
**Supportive Housing**
**Youth Intervention & CHINS**

**Notes:**
Massachusetts has a system of medically supervised detoxification centers.(As opposed to hospital detoxes on one end and social detoxes on the other).
In addition to the existing beds in the system, since SFY ‘99 the Bureau has funded 20 beds in a specialized facility in Boston and in two detoxes outside of Boston for homeless clients.  In order for these detoxes to accept clients, they have to have a certificate from a shelter indicating a client’s homeless status. That way we can guarantee that the beds are  used for their intended purpose. (SFY ‘02 $500,000).
About 85% of detoxes are paid by Medicaid, either by managed care or emergency aid. The Bureau of Substance Abuse Services is the payor of last resort.

## BSAS Mainstream ServicesTreatment (cont’d)

**Criminal Justice Services**
**Youth Residential Services**
**D.U.I.L.**
**Community-based Case Management***
**S.E.A.R.C.H.***
**Tewksbury Stabilization and Transition Services***
**Total Immersion Programs (T.I.P.)**
**Boston Outreach, Education, & Drop-in Services***

**Notes:**
	Federal funds were secured, in a collaboration between the Massachusetts Housing and Shelter Alliance and BSAS, for 50 post detoxification/pre-recovery home stabilization beds and case management for homeless clients outside of Boston.
	MHSA contracts for the beds and provides statewide coordination, and BSAS procured intensive case management within the recovery home system to support the clients.
	Sites in Brockton, Springfiled, Worcester and Framingham 
	$496,052 of federal funding and $82,500 of matching funds.have been renewed through 2003.

## BSAS Mainstream ServicesPrevention

**Regional Prevention Centers**
**Youth Programs**
**MassCall**

**Notes:**
	Transitional Support Services (TSS) is a new modality in this state that was created as a response to a service gap. 268 TSS beds have been opened at the sites on the screen.  
	 We  found that people leaving detoxes would end up in the streets, shelter or an unsafe environment when there were no beds available in Recovery Homes.  The recovery homes have constant waiting lists.  
	This new service has proven to be very beneficial.  Clients coming out of detoxes have a safe place to stay in a sober environment, with case management services.At least 33% of the beds are expected to be utilized by homeless individuals.  
	 Recovery Homes have informed us that they clients are more “ready” to that service and have longer lengths of stay

($7.3 million in SFY ‘02). 

## BSAS Mainstream ServicesStatewide Support Services

**Training Center**
**Tobacco Services**
**S.H.A.R.E. Loan***
**Sober Housing Search***
**SPHERE**
**Substance Abuse Help Line**
**Women’s Services***
**Youth Prevention Support Services**
**Prevention Support Services**
**H.O.P.E.**
**Mass Council on Compulsive Gambling**

**Notes:**
	8 units of transitional housing at Elizabeth Stone House, Fitchburg, for recovering women - partially funded by the Fitchburg Housing Authority, with supportive services from the Bureau  ($60,000)
	For homeless recovering women and their families, partially funded  by a HUD federal grant with matching supportive services and resources from DPH/BSAS. WHAT IS MBHP & MHFA COLLABORATION?
	These houses have been developed through the SHARE loan program, with federal funds. EXPLAIN SHARE LOAN PROGRAM.

## The Problem

**Homeless statistics and substance abuse service needs assessment**
**Access to mainstream services**

**Notes:**
	Since FY ‘98 BSAS has collaborated with the DMH and obtained funding from federal HUD resources for 60 units of Aggressive Treatment and Relapse Prevention (ATARP) supportive housing for dually diagnosed DMH patients.

## BSAS Homeless Service Initiatives

**Emergency Overflow Shelter Funds**
**Family Substance Abuse Shelters**
**Acute Treatment Services**
**Transitional Support Services**
**S.E.A.R.C.H.**
**S.A.S.I.**
**Recovery Homes**

**Notes:**
	Since FY ‘98 BSAS has collaborated with the DMH and obtained funding from federal HUD resources for 60 units of Aggressive Treatment and Relapse Prevention (ATARP) supportive housing for dually diagnosed DMH patients.

## BSAS Homeless Service Initiatives (cont’d)

**Residential Rehabilitation Ex-offender Expansions**
**Tewksbury Stabilization & Transition**
**S.H.A.R.E. Loan Program**
**Sober Housing Search**
**Case Management and Street Outreach**
**Supportive Housing for 18-24 year olds**

**Notes:**
	In FY ‘98 recovery home beds were expanded to accommodate clients leaving the criminal justice system who often end up in shelters if s.a. services are not available.  In SFY ‘02, these services were expanded, adding 38 new beds to the system (with the procurement of an additional $584,000 worth of funding)
	There are three vendors offering this service in 3 different regions of the state.	
	Through this contract, a new listing of sober houses will be developed for the state.

## Collaborative Relationships

**Commissioner’s Homeless Task Force**
**Homeless Pilot Initiative**
**EOHHS Homeless Task Force**
**Continuum of Care Meetings**
**Policy Development**

**Notes:**
	In FY ‘98 recovery home beds were expanded to accommodate clients leaving the criminal justice system who often end up in shelters if s.a. services are not available.  In SFY ‘02, these services were expanded, adding 38 new beds to the system (with the procurement of an additional $584,000 worth of funding)
	There are three vendors offering this service in 3 different regions of the state.	
	Through this contract, a new listing of sober houses will be developed for the state.

## RESULTS

## RESULTSAcute Treatment ServicesFY1999 - FY2001

**Total admissions increased by 5%**
**Homeless admissions increased by 11%**
**Regional Data**
**Boston Region  ****	****FY’01****	****46.9%****	****(increase of  1%)**
**Central Mass****	****FY’01****	****24.6%   (increase of 43%)**
**MetroWest****	****FY’01  ****	****45.6%  ****	****(increase of 22%)**
**Northeast****	****	****FY’01   ****	****13.8%****	****(decrease of 6%)**
**Southeast****	****	****FY’01****	****14.5%****	****(increase of 4%)**
**Western Mass****	****FY’01 ****	****16.8%****	****(increase of 3.1%)**

**Notes:**
	In FY ‘98 recovery home beds were expanded to accommodate clients leaving the criminal justice system who often end up in shelters if s.a. services are not available.  In SFY ‘02, these services were expanded, adding 38 new beds to the system (with the procurement of an additional $584,000 worth of funding)
	There are three vendors offering this service in 3 different regions of the state.	
	Through this contract, a new listing of sober houses will be developed for the state.