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National Alliance To End Homelessness Ending Homelessness: Plan, Act, Succeed. Housing Chronically Homeless People: HOUSING FIRST Programs in Philadelphia. Presented by: David Dunbeck Horizon House, Inc. July 18, 2006. Housing First Programs “New Keys” and “Home First”.

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housing chronically homeless people housing first programs in philadelphia

National Alliance To End Homelessness

Ending Homelessness: Plan, Act, Succeed

Housing ChronicallyHomeless People:HOUSING FIRST Programs in Philadelphia

Presented by: David Dunbeck

Horizon House, Inc.

July 18, 2006

housing first programs new keys and home first
Housing First Programs“New Keys” and “Home First”

Replicated the model used by the Pathways to Housing Program

  • Quick access to subsidized apartments
  • Intensive clinical support services using an Assertive Community Treatment (ACT) Team (accept 5 individuals per month)
  • Recovery using a Harm Reduction Model
  • Consumer choice is key
    • Representative payee; home visits
new keys
New Keys
  • Started March, 2003
  • Funding:
    • Services –
      • SAMHSA Treatment for Homeless grant (3 years-ended 2005)
      • Medicaid fee-for service billing through city/state Targeted Case Management Systems
    • Housing –
      • HUD SHP grant – 25 units (3 years, renewable)
      • HUD SPC grant – 35 units (5 years, renewable)
new keys target population
Chronically street homeless

Dual diagnosis – serious mental illness and drug/alcohol addiction

Housing and services for up to 65 consumers

Intentionally took the consumers who had not been successful in any other treatment programs

Most frequent contact with outreach

Highest number of refusals of service

New Keys Target Population
home first
Home First
  • Started January, 2004
  • Chronic Homeless Initiative grant:
    • Services –
      • SAMHSA (3 years)
      • VA (year-to-year) expire 2006
      • HRSA (3 years)
      • Medicaid fee for services through city/state Targeted Case Management systems (at end of grants)
    • Housing –
      • HUD SHP grant – 70 units (3 years, renewable)
home first target population
Chronically homeless, shelter users

Serious mental illness. May have co-occurring drug/alcohol addictions, physical disabilities

Capacity: Services for 90, housing for 75

Intentionally took the consumers who had not been successful in any other housing or treatment programs and had high system utilization

Home First Target Population
housing first outcomes
Currently, we have 152 consumers assigned to New Keys and Home First:

113 are housed in their own apartments

18 are in housing process and living in shelter

9 are being engaged through outreach

7 are incarcerated (2 still have apartments)

4 are in long-term hospitalization

2 are in nursing homes

1 is living with family

Housing First Outcomes
housing first outcomes8
As of 2/28/06:

126 clients had lived in at least one apartment

1st apartment

70/126 were successful in their 1st apartment (56%)

2nd apartment

24/47 were successful in their 2nd apartment (51%)

Cumulatively, 94/126 successful in their 2nd apt. (75%)

3rd apartment

12/14 were successful in their 3rd apartment (86%)

Cumulatively, 106/126 successful by their 3rd apt. (84%)

Housing First Outcomes
housing first outcomes9
Impact of Housing on Mental Health:

Of those ever housed (and receiving services):

79% showed improvement

18% stayed the same

3% deteriorated

Of those not housed (but receiving services):

20% showed improvement

70% stayed the same

10% deteriorated

Housing First Outcomes
housing first outcomes10
Impact of Housing on Substance Use:

Of those ever housed (and receiving services):

57% showed improvement

34% stayed the same

4% deteriorated

Of those not housed (but receiving services):

15% showed improvement

70% stayed the same

15% deteriorated

Housing First Outcomes
housing first outcomes11
Impact of Housing on Overall Life Status:

Of those ever housed (and receiving services):

84% showed improvement

12% stayed the same

4% deteriorated

Of those not housed (but receiving services):

50% showed improvement

35% stayed the same

15% deteriorated

Housing First Outcomes
slide13

Safety

Staffing

Housing

Managing expectations/

pressures

Behavioral Health

Maintaining the model

Funding

The forest/the trees

Physical Health Needs

Employment

Costs

things we ve learned15
These programs are expensive and there are a lot of hidden costs:

Staffing costs

Cost for furnishings

Apartment damages

Unpaid rents

Exorbitant utilities

Socialization costs

Research/data analysis

Things We’ve Learned:
slide16
Housing First is still a good investment!

BUT…

  • Preliminary analysis shows significant (>50%) reduction in inpatient hospitalizations, detox, and rehab after engaging in services and/or getting housing.
things we ve learned17
It’s a challenge to introduce “housing first” in an agency and division that also provide “traditional” homeless and treatment services:

Values

Harm reduction

Client choice

Hiring

Co-location of facilities

Things We’ve Learned:
things we ve learned18
There are advantages and disadvantages to having housing services in a different agency than treatment services:

Good cop/bad cop

Values

Harm reduction

Client choice

Landlord issues

Damages

Things We’ve Learned:
things we ve learned or are still trying to figure out
Money Management:

Is it really therapeutic to be representative payee for your consumers?

Or would it be better to let another agency be the representative payee?

Things We’ve Learned (or are still trying to figure out):
things we ve learned20
SAFETY

must be a critical consideration

when implementing a

housing-first program.

FACT: You are controlling (some of) the money of an active substance user who also has a diagnosis of serious mental illness.

Things We’ve Learned:
things we ve learned21
Address Safety concerns by:

Establishing:

Boundaries, behavior expectations for consumers

Policies and procedures for staff

Consequences (i.e., discharge)

Training Staff

Proactively considering safety in your space planning

Things We’ve Learned:
things we ve learned22
Safety training: Understanding behavior; intervening before behavior escalates.

Lalemand Behavior Scale:*

Agitated

Disruptive

Destructive

Dangerous

Threat of Lethal

* From the Non-Aggressive Psychological and Physical Intervention (NAPPI, Inc.)

Things We’ve Learned:
slide23
Good assessments are a good investment!

Take the time to perform a thorough assessment (including physical health) at the beginning.

Don’t drop the “physical health” ball – use your nurses!

Dealing with long unmet physical health needs can be a powerful engagement tool!

Things We’ve Learned:

slide24
Staffing

It takes special people to do housing first:

Hiring good staff

120% turnover in first year

Maintaining the “revolution”

Keeping good staff

TRAIN, LISTEN, SUPPORT

Things We’ve Learned:

slide25
We built sustainability into our grants….but, we still weren’t prepared for the transition:

It’s always going to be a painful process, but don’t wait until you need to bill fee-for-service to begin the transition:

“Pull the bandage off”

Do the necessary procedures, paperwork, etc. fully from the beginning – it’s easier to transition with only 5, 10, or 20 consumers (and associated paperwork) than with 155 consumers!

Things We’ve Learned:

slide26
My new mantra:

“Defend the program,

but don’t become defensive”

Things We’ve Learned:

housing first future growth
“Welcome Home”

Start-up December 2006

Services and housing for 60

Philadelphia 10-Year Plan to End Homelessness

Proposes “housing first” for 360 (currently at 150)

Housing First – Future Growth
contact information
Horizon House, Inc.

1201 Chestnut St., 12th floor

Philadelphia, PA 19107

215-636-0606

David Dunbeck, Director of Homeless Services, [email protected]

Carla Williams, Director of ACT, [email protected]

Contact Information
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