# Presentation: 840291

## Collaborative Initiative to Help End Chronic Homelessness

**Satellite Broadcast **
**February 19, 2003**

## Introduction

**Pat Carlile**
**Deputy Assistant Secretary,**
**Community Planning and Development**

## Overview

**Introduction**
**Comprehensive Approach**
**Programs – HUD, HHS, and VA**
**Evaluation**
**Question and Answer **

## Highlights

**Focus on chronically homeless**
**Joint initiative**
**$35 million**
**Application deadline: April 14**

## Definition of Chronic Homelessness

** ****	****“****An **_**unaccompanied**_** homeless individual with a disabling condition who has either:**
**a) been continuously homeless for a year or more    ****OR**** **
**b) has had at least 4 episodes of homelessness in the past 3 years.” **

## Target Population

**Focus: chronically homeless**
**Additionally:  Up to 10% **
**  ****(or $3.5 million) will be for disabled homeless families**

## Definition for Disabled Homeless Family

**  ****Correct Definition:**
**  “****An adult person with a disabling condition (as defined in the NOFA) who is accompanied by at least one dependent child.”  **

## Important Facts

**This initiative focuses on chronic homelessness**
_**Not**_** part of HUD’s Continuum of Care competition**
**Collaboration between HUD, HHS and VA programs**

## Initiative Overview

**Philip Mangano, Director**
**Interagency Council on Homelessness**

## Section 1 Comprehensive Approach

**Mary Silveira, ICH Staff**
** ****Interagency Council on Homelessness**

## Purpose

**Demonstrate that all partners are working in collaboration to integrate housing and services for chronically homeless persons and disabled homeless families**

## Purpose

**Demonstrate that all four core elements provided – permanent housing, mental health and substance abuse treatment, primary care, and veterans services, even if funds are not requested for all four elements**

## Eligible Applicants

**Lead applicant must be nonprofit or public entity, and partners must meet agency criteria**
**Lead applicant must submit the consolidated application, and must coordinate the consortium for the life of the grant**

## Application Review – Threshold Criteria

**Applicants are eligible **
**Application addresses four core elements**
**Application received on time**
**Application is complete**
**Application conforms to instructions for format (page limits, etc.) **

## Scoring

**Comprehensive Approach  100 points**
**Section 1 – HUD  ****	****	****    30 points**
**Section 2 – SAMHSA  ****	****    25 points**
**Section 3 – HRSA ****	**** ****	****    25 points**
**Section 4 – VA ****	****	****   **_**20 points**_
**	****TOTAL****	****	****	****	**** 200 points**

## Scoring (cont.)

**  ****If an application is deficient in any one agency-specific section (defined as scoring below 40% of the allotted points for a section), the entire application is disqualified**

## Scoring (cont.)

**Each agency will review its section of each application.  If an application passes each agency’s threshold and technical merit reviews, it moves to an interdisciplinary, interdepartmental review team for scoring of the Comprehensive Approach.**

## Rating Criteria – Comprehensive Approach

**Documentation of Need and Extent of the Problem – 10 points**
**Understanding of population**
**Preliminary estimate of number of chronically homeless persons in the target community and method**
**Community resources available and gaps identified**

## Rating Criteria – Comprehensive Approach

**Soundness of Approach/ Appropriateness of Delivery System – 25 points**
**Method of addressing needs **
**Extent of comprehensive services and permanent housing available**
**Quality of comprehensive approach**
**Enrollment in mainstream resource services**

## Rating Criteria – Comprehensive Approach

**Capacity of Applicant and Partners – 20 points**
**Capacity of lead applicant and partners**
**Past performance in managing funds**
**Ability to address service needs of those not eligible under this NOFA**

## Rating Criteria – Comprehensive Approach

**Appropriateness of Budget and Fiscal Controls – 15 points**
**Cost-effectiveness**
**Resources required**
**Maximization of non-grant revenue, leveraging resources, and total dollars per client/unit**

## Rating Criteria – Comprehensive Approach

**Collaboration – 20 points**
**Level of coordination**
**Systematic plan to enroll clients in mainstream resources**

## Rating Criteria – Comprehensive Approach

**Adequacy/Appropriateness of Evaluation Plan – 10 points**
**Proposed approaches for gathering quantitative and qualitative information on target population**
**Existence of data collection system**

## Reporting and Evaluation

**Lead applicant must submit annual progress reports and a final report to ICH and agencies including:**
**Extent to which barriers reduced for target population**
**Number of clients served**
**Revisions to benchmark estimate of  target population**

## Section 2 – HUD

**John Garrity, Director**
**Office of Special Needs Assistance Programs**

## Purpose of Initiative

**Help end chronic homelessness**
**	****Except for a small portion of disabled homeless families, ****all**** funds must be used to assist ****	****those who are ****chronically homeless**

## Who are the Chronically Homeless?

-  	**“****An **_**unaccompanied**_** homeless individual with a disabling condition who has either:**
**a) been continuously homeless for a year or more    ****OR**** **
**b) has had at least 4 episodes of homelessness in the past 3 years.” **

## HUD Section

**$20 million in McKinney-Vento Act funding**
**Funding only for **_**Permanent Housing**_** for chronically homeless persons**

## HUD Section

**All housing projects must be proposed under either the Supportive Housing Program (SHP) **_**or **_**the Shelter Plus Care (S+C) Program**

## SHP - Eligible Applicants

**Private nonprofit organizations**
**States**
**Units of local government**
**PHAs**
**Community Mental Health Centers**

## S+C – Eligible Applicants

**States**
**Units of local government**
**PHAs**

## SHP – Eligible Components

**Permanent Housing**
**Safe Havens**

## S+C – Eligible Components

**Tenant-Based**
**Sponsor-Based**
**Project-Based without Rehabilitation**

## Project Terms

**SHP:  All projects = 3 year terms**
**S+C:  All projects = 5 year terms**

## Eligible Activities

**SHP –**
**Acquisition**
**Minor Rehabilitation**
**Leasing****	**
**Operating Costs**
**Administration Costs (5%)**

## Eligible Activities

**S+C – **
** ****Rental Assistance**
** ****Administration of rental    **
**     ****	****assistance (8%)**

## Ineligible Activities

**SHP – **
**New Construction**
**Moderate or Substantial Rehabilitation**
**Supportive Services**

## Ineligible Activities

**S+C –**
**Everything other than Rental Assistance is ineligible**

## Special Provisions - HUD

**HUD funds limited to $2 million to any 1 project or any 1 applicant**
**Only NEW SHP and S+C projects funded**
**Grantees required to link residents with mainstream supportive services**

## Special Provisions – HUD (cont.)

**All SHP and S+C match requirements apply:**
**SHP **
**- 100% cash match for acquisition and rehabilitation**
**- 25% cash match for operating costs**

## Special Provisions – HUD (cont.)

**All SHP and S+C match requirements apply:**
**S+C**
**100% cash or in-kind match for   **
**  ****services**

## Special Provisions – HUD (cont.)

**Applicants must coordinate with local Continuum of Care (CoC) homeless planning body serving the area where project is proposed, and certify this coordination through the CoC Certification**
** **

## Application Threshold Factors– HUD Section

**Applicant eligibility**
**Project eligibility (activities, population, costs)**
**Fair Housing and Civil rights compliance**

## Application Rating Criteria HUD Section

**Capacity:  Applicant housing  experience and prior housing performance**
**Timeliness:  Demonstrated ability of applicant and project sponsor to initiate and implement project rapidly**

## Application Rating CriteriaHUD Section (cont.)

**3. Quality:  Demonstration that     **
**	****housing is appropriate to needs of chronically homeless persons**

## Application Rating Criteria HUD (cont.)

**10 points each for Capacity, Timeliness, and Quality**
**Only applicants scoring 12 or more points in the HUD section (and passing in all other sections of the application) will be rated for Comprehensive Approach**

## Application Rating Criteria  HUD (cont.)

**Applicants not requesting HUD funding must still demonstrate how permanent housing will be provided for target population**

## Application Forms - HUD

**Section A (Project Narrative) must be completed by all applicants, even if not requesting HUD funding**
**Applicants for HUD funds also complete Sections B-J for SHP and Sections B-H for S+C**

## Application Forms –    HUD (cont.)

**Special attention should be given to Section I (Budget) for SHP and Section F (Budget) for S+C**

## Certifications - HUD

**SF 424**
**Applicant Certification**
**Consolidated Plan**
**Continuum of Care Certification**
**Coordination with Mainstream Resources**
**Discharge Planning Certification**
**Lobbying Disclosure**

## Section 3 - SAMHSA

**Michael English, Director**
**Division of Services and Systems Improvement**

## SAMHSA Purpose

**To ensure delivery of effective**
**mental health and substance abuse services to the target population. Through reliance on mainstream programs for funding behavioral health services to the maximum **
**extent possible**

## SAMHSA Eligibility

**States, political subdivisions, Indian tribes and tribal organizations, and public or non-profit entities; (threshold requirement)**
**Lead agency need not be provider;**
**Must involve one or more MH/SA provider(s) with two years’ licensure and experience. (threshold requirement)**

## SAMHSA Funding and Restrictions

**Year 1 – up to $700,000**
**Year 2 – 70%**
**Year 3 – 40%**
**Years 4-5 (if applicable) – 0%****(i.e., get mainstream financing)**
**Services, not housing**
**MH and SA, not other conditions**

## SAMHSA Allowable Activities

**Outreach & engagement**
**ACT/ICM**
**Supportive Housing**
**SA Treatment (detox, residential, intens. outpt.) **
**MH Treatment (Meds, outpt, psychotherapies, etc)**
**Parent skills Trng.**
**Child care & family support**
**Transportation**

**Integrated Tx. For Co-Occurring**
**Motivational Interventions**
**Modified Therapeutic Communities**
**Self-Help **
**Psychosocial rehab.**
**Income support**
**Supportive Employment**
**Discharge planning**

## SAMHSA Resources

**On the Web**
**Evidence-based and promising practices**
**Comprehensive, integrated system of care.**
**National Resource Center on Homelessness**
**Corporation for Public Housing et al.**

## SAMHSA Review Criteria (25 points)

**Match of proposed service to need (10)**
**accessibility, coordination and integration.**
**Plan to access mainstream financing (7)**
**feasibility and readiness**
**ability to bill**
**continuation criteria too**

## SAMHSA Review Criteria (25 points)

**Local evaluation plan (3)**
**process evaluation**
**output and outcome data**
**revenues**
**Project management (5)**

## SAMHSA Post-Award Requirements

**Attend meeting, accept TA**
**Submit reports/data**
**Comply with GPRA**
**Do local evaluation, cooperate with national evaluation**** **
**Serve people well**

## Section 4 - HRSA

**Jean Hochron, Director**
**Health Care for the Homeless Program,**
**Bureau of Primary Health Care**

## Purpose

**	****Increase access to integrated primary health care and related services**

## Eligible Applicants - HRSA

**Section 330 Health Centers ONLY:**
**Community Health Centers**
**Migrant Health Centers**
**Health Care for the Homeless programs**
**Public Housing Primary Care programs**
**Healthy Schools Healthy Communities programs**

## Amount Allocated - HRSA

**$3 million in FY 2003 (pending Congressional appropriation)**
**FY 2004 through completion:  continued support at FY 03 level (pending appropriation)**
**No more than $300,000 per project per year**

## Program Description - HRSA

**Required Services:**
**Primary health care**
**Arrangements for emergency health services**
**Referral for inpatient hospitalization**
**Case management services**

## Program Description – HRSA (cont.)

**Outreach services**
**Entitlement eligibility assistance**
**Supplemental/additional services, including oral health services**
**Coordination with other providers of services, including mental health and substance abuse providers**

## Program Description – HRSA (cont.)

**Application must include information on:**
**Location of services**
**Service setting**
**Subcontracting/referral arrangements to ensure availability of services**
**Coordination with other providers involved in collaboration**

## Special Provisions - HRSA

**	****Must include signed memoranda of understanding for all subcontractor and referral arrangements**

## Threshold Criteria - HRSA

**Must be a Section 330 health center**
**Must not be designated as exceptional/high risk**
**Must submit description of primary care delivery system even if no HRSA funds are requested**

## Rating Criteria – HRSA

**Project Summary****	****   8 points**
**Project Plan****	****     ****	**** 15 points**
**Readiness****	****	****      ****	****   **_**2 points**_
**TOTAL****	****	****	****	**** 25 points**

## Budget - HRSA

**3 year budget required**
**Demonstrate how third party revenues will be accessed/used**
**Budget request must not supplant other funds**

## Forms Required - HRSA

**SF-5161 specifically for the HRSA request**
**Include copy of FY 02 Health Center Notice of Grant Award (NGA)**

## Post-Award Requirements - HRSA

**Post-award technical assistance on primary care services will be provided**
**Grantees must budget for/attend one technical assistance meeting per year for each year of the project**

## Section 5 - VA

**Pete Dougherty, Director**
**Homeless Veterans Programs**

## Purpose – VA

**  ****Funding will be awarded to the VA facility that partners with the applicant to provide services to chronically homeless veterans housed in or being provided services through the collaborative.**

## Eligible Applicants – VA

**Nonprofit or public entities**

## Amount Allocated – VA

** ****Up to $5 million for a period of three years**
** ****Approximate amount equivalent to the proportionate yearly salary of FTE to provide care**
** ****Funding to VA facility**

## Program Description – VA

** ****Necessary and appropriate ****	****care**
** ****Chronically homeless veterans**
** ****Medical/mental health**
** ****Benefits**
** ****Vocational Development**
** ****Referrals**** **

## Special Provisions – VA

** ****If expected not to serve a veteran population, applicant must demonstrate in the this section of the application why veterans will not be participating**

## Threshold Criteria – VA

**Forms, time and adequacy**
** ****Nonprofit or public entity**
** ****Eligible population**
**Chronically homeless veterans**

## Rating Criteria – VA

**Rating Criteria and Points**
**Need; Up to 5 points**
**Identified gaps**
**Understanding of population and unmet need**

## Rating Criteria – VA

**Rating Criteria and Points**
** ****Plan; up to 10 points**
** ****Nature of the ****	****	****   collaboration**
** ****Sustaining collaboration**
** ****Linkage of collaboration with overall project concept and design**

## Rating Criteria – VA

**Rating Criteria and Points**
** ****Ability; up to 5 points**
** ****Past similar experience and extent of these activities**

## Budget – VA

**Budget**
** ****Amount allocated will be ****	****based on determined FTE ****	****needs**
** ****Funding allocated to local   ****	****VA facility**

## Section 5 –VA

**Forms Required**
** ****Narrative**
** ****MOA**
** ****Jointly signed**
** ****Specifics of agreement**
** ****Levels of service and outcomes**

## Outcomes Performance Evaluation

**Robert Rosenheck MD**
**Director, VA Northeast Program Evaluation Center**
**Yale Medical School**

## Objective

**Provide site-by-site description of:**
**Program implementation**
**Clients  served (demographic and clinical)**
**Service provided: Treatment and supports**

## Objective (cont.)

**Document long-term outcomes: **
**Housing (quality, stability)**
**Health**
**Quality of life**
**Identify project features associated with desired outcomes**

## Who will collect data?

**VA employees will be hired to conduct all assessment interviews**
**Assuming sites will be located near VA facility.  Alternative staffing may be considered, if necessary (e.g. contract with local university or agency)**

## Who will collect data? (cont.)

**VA will prepare Internal Review Board materials (informed consent for participation of human subjects)**
**No cost to programs**
**Supported by VA, HUD and HHS**

## What will lead agency need to do?

**Conceptualize intervention in two phases:**** **
**Phase I: Outreach**
**Phase II; Intensive treatment and housing placement**
**Complete **_**first contact form**_**, documenting basic characteristics of all clients**

## What will lead agency need to do? (cont.)

**Identify limited number of **_**portals of entry**_** through which clients enter intensive phase**
**Facilitate contact between VA evaluator and clients**
**Maintain close coordination to support efforts of VA evaluator**

## Relationship to Local Evaluation Requirements

**Sites will be given data from their site annually (without individual client identifiers)**
**National evaluation data can be used to fulfill requirements for client description and outcome assessment**

## Evaluation Design

**Descriptive outcome study**
**Screening will describe all clients screened for the initiative**
**Baseline and quarterly assessments every three months for up to three years**
**Assess housing, health status, service use**