Mayor’s Advisory Commission on Homelessness February 21, 2007 Tarrant Regional Water District
Handouts: 2006 SHP Allocation 2007 Homeless Census Data Supportive Housing Saves HOPE Newsletter
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Agency Day Resource Center for the Homeless Mental Health Mental Retardation Tarrant County Tarrant County Samaritan Housing Inc. Volunteers of America Texas, Inc. Housing Authority of the City of Fort Worth Presbyterian Night Shelter of Tarrant County, Inc. MHMR of Tarrant county Homeless Services Tarrant County TBLA 114 Cornerstone Assistance Network Texas Inmate Services, Inc. The Salvation Army All Church Home for Children, Inc. SafeHaven of Tarrant County Open Arms House Arlington Life Shelter The Community Enrichment Center, Inc. Volunteers of America Texas, Inc. Housing Authority of the City of Arlington YWCA of Fort Worth and Tarrant County SafeHaven of Tarrant County Dental Health for Arlington, Inc. Tarrant County ACCESS for the Homeless Grapevine Relief and Community Exchange (GRACE) Tarrant County Samaritan Housing, Inc. SafeHaven of Tarrant County Tarrant County Cornerstone Assistance Network Mental Health Mental Retardation of Tarrant County SafeHaven of Tarrant County Arlington Life Shelter Legal Aid of NorthWest Texas, Inc. Housing Authority of the City of Fort Worth Housing Authority of the City of Fort Worth Housing Authority of the City of Fort Worth Housing Authority of the City of Fort Worth Housing Authority of the City of Arlington Type SHP SHPR SHPR SHPR SPC SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SHPR SPCR SPCR SPCR SPCR SPCR 2006 Allocation $704,494.00 $120,090.00 $85,617.00 $165,601.00 $355,320.00 $181,077.00 $93,536.00 $1,067,602.00 $102,942.00 $109,468.00 $322,293.00 $113,922.00 $108,491.00 $9,958.00 $70,523.00 $212,889.00 $129,686.00 $281,981.00 $113,793.00 $31,090.00 $29,370.00 $149,805.00 $24,237.00 $248,729.00 $59,275.00 $121,252.00 $194,624.00 $78,871.00 $25,515.00 $97,879.00 $16,532.00 $1,045,284.00 $221,916.00 $221,916.00 $1,802,376.00 $123,480.00
SHP Application Request Difference 704,494.00 $0.00 120,090.00 $0.00 85,617.00 $0.00 165,602.00 ($1.00) 322,380.00 $32,940.00 181,078.00 ($1.00) 93,536.00 $0.00 1,067,602.00 $0.00 102,942.00 $0.00 109,469.00 ($1.00) 322,293.00 $0.00 113,922.00 $0.00 108,491.00 $0.00 9,958.00 $0.00 70,700.00 ($177.00) 212,889.00 $0.00 129,686.00 $0.00 281,981.00 $0.00 113,793.00 $0.00 31,090.00 $0.00 29,370.00 $0.00 149,806.00 ($1.00) 24,237.00 $0.00 248,729.00 $0.00 59,275.00 $0.00 121,253.00 ($1.00) 194,624.00 $0.00 78,872.00 ($1.00) 25,515.00 $0.00 97,880.00 ($1.00) 24,680.00 ($8,148.00) 956,580.00 $88,704.00 259,692.00 ($37,776.00) 259,692.00 ($37,776.00) 1,646,904.00 $155,472.00 104,076.00 $19,404.00 $8,628,798.00 $212,636.00
FORT WORTH / ARLINGTON / TARRANT AREA CONTINUUM OF CARE
Point-in-Time Count of the Homeless: January 25, 2007 Unsheltered Emergency Shelter Transitional Housing Permanent Supportive Housing TOTALS ∆% ∆# 2006 2007 350 203 -42.00% -147 1,635 1,049 -35.84% -586 1,179 1,626 37.91% 447 1,044 1,164 4,208 4,042 11.49% 120
HOUSING DEPARTMENT MAYOR’S ADVISORY COMMISSION ON HOMELESSNESS
THE CITY OF FORT WORTH * 1000 THROCKMORTON STREET * FORT WORTH, TEXAS 76102
817-392-7507 * 817-392-7328 www.fortworthgov.org/homelessness
Supportive Housing is Cost Effective
January 2007 Three studies show that the net public cost of providing permanent supportive housing for homeless people with mental illness and/or addictions is about the same or less than the cost of allowing them to remain homeless. Homelessness causes illnesses and makes existing mental and physical illnesses worse, leading to expensive treatment and medical services. Permanent supportive housing improves physical and mental health, which reduces the need for these services, particularly expensive inpatient mental health care and hospitalization. Permanent supportive housing helps tenants increase their incomes, work more, get arrested less, make more progress toward recovery, and become more active and productive members of their communities.
New York, NY In New York City, each unit of permanent supportive housing saved $16,282 per year in public costs for shelter, health care, mental health, and criminal justice. The savings alone offset nearly all of the $17,277 cost of the supportive housing.
Exhibit 1: Annual Cost of Supportive Housing vs. Homelessness
Costs per Homeless Individual $14,000 $12,000 $10,000 $8,000
$6,358 $6,229 $4,907 $4,596 $12,520 $11,596
Costs with Supportive Housing
$2,613 $1,822 $1,378 $1,013
Homeless Shelters State Mental Non-Federal Hospitals Hospital Costs Medicaid Inpatient Medicaid Outpatient
Prisons and Jails
Source: The Impact of Supportive Housing on Services Use for Homeless Persons with Mental Illness in New York City. Dennis Culhane, Ph.D., Stephen Metraux, M.A., Trevor Hadley, Ph.D., Center For Mental Health Policy & Services Research, University of Pennsylvania. Data from 4,679 NY/NY placement records between 1989-97.
Denver, CO The Denver Housing First Collaborative targets people who have been homeless for long periods of time, many of whom live on the streets, and moves them into permanent housing. The program reduced the public cost of services (health, mental health, substance abuse, shelter, and incarceration) by $15,773 per person per year, more than offsetting the $13,400 annual cost of the supportive housing.
Exhibit 2: Annual Costs Before and After Entering Supportive Housing
$7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $0
$2,628 $1,726 $821 $899 $214
Incarceratio n Emergency Ro o m Outpatient Inpatient Shelter
$1,767 $1,321 $874 $0
Source: Denver Housing First Collaborative: Cost Benefit Analysis And Program Outcomes Report. Jennifer Perlman, PsyD, and John Parvensky. Colorado Coalition for the Homeless. December 2006.
Portland, OR Portland’s Community Engagement Program provides housing and intensive services to homeless individuals with mental illness and addictions. The program reduced the cost of health care and incarcerations from $42,075 to $17,199. The investment in services and housing during the first year of enrollment was averaged to approximately $9,870. This represents a 35.7% ($15,006 per person) annual cost saving for the first year following enrollment in CEP.
Exhibit 3: Annual Cost Before and After Entering Supportive Housing
Source: Estimated Cost Savings Following Enrollment In The Community Engagement Program: Findings From A Pilot Study Of Homeless Dually Diagnosed Adults. Thomas L. Moore, PhD. Portland, OR: Central City Concern. June 2006.
$50,000 $40,000 $30,000 $42,075 $20,000 $10,000 $0 Pre-Entry Post-Entry $17,199 $9,870
Supportive Housing Services
HHOPE Team Helps Chronically Homeless Persons with Serious Mental Illness
Robert Paulson, Ph.D.
Department of Child & Family Studies Louis de la Parte Florida Mental Health Institute University of South Florida http://cfs.fmhi.usf.edu
The HHOPE Team…
Saves Broward County over $500,000 Shows fidelity to the ACT Model Improves coordination of services for participants and consumer choice Moved 86% of it’s participants into permanent housing Confirms strong satisfaction of participants with HHOPE
Formation of the HHOPE Team
The HHOPE team was formed as Broward County’s model program funded jointly by five federal agencies as part of an eleven site demonstration of programs to end chronic homelessness. Here in Broward County, an assertive community treatment team (ACT) which provides 24/7 care to up to 100 chronically homeless persons with serious mental illness was formed as the chosen intervention. This team based approach includes specialists in mental health, supported employment, and substance abuse treatment as well as a nurse and general case managers. Seven agencies partnered together to hire the members of the team and form the Steering Committee which provides oversight to the Project. The seven agencies are Broward Addiction Recovery Center
With federal funds from the Department of Housing and Urban Development (HUD), the Health Resources Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Veterans Administration (VA), the Broward County community was able to implement a pilot program for persons experiencing chronic homelessness, Housing and Health Options Provide Empowerment (HHOPE) For more information on HHOPE, contact Steve Werthman at 954-357-6101.
(BARC), Broward Partnership for the Homeless, Inc (BPHI), Henderson Mental Health Center, North Broward Hospital District, Broward County Elderly and Veterans Services, the VA and the Broward County Housing Authority which provides the housing vouchers for participants. The Broward County Homeless Initiative Partnership and the Florida Department of Children’s and Family Services District office are also integrally involved in the project. The HHOPE team began enrolling participants in April of 2004 and now serves 43 persons. Since that time the program has been very successful in improving the lives of the people served. This comes despite the number of hurricanes which stopped their normal operations so they could be sure all participants were safe and recovered from the storms. The loss of many affordable housing units because of the price increases after the hurricanes has made their job much more difficult, making their success even more remarkable.
The agencies making up the HHOPE Team are
• Broward Addiction Recovery Center
HHOPE Participants Are Self Supporting, Housed and Saving Broward County Over a Half Million Dollars
As of May 2006, 86% of those admitted to the HHOPE Program have been • Broward Partnership for the living in permanent supported housing Homeless, Inc for over one year. Eighty-eight percent • Henderson Mental Health are now self-supporting. Self-supporting Center, refers to consumers who live in subsi• North Broward Hospital dized housing and are able to pay their District, portion of the rent and their daily living • Broward County Elderly expenses. There were also significant Veterans Services savings in hospitalization, jail time and • The VA shelter days. Of the 12 participants the North Broward Hospital District was able to match in its data base there was an 65% reduction in the cost of hospital days resulting in $160,792 in cost avoidance. Similarly, for all participants, there was a 97% reduction in the number of days in jail for a cost avoidance of $327,250. There was a 65% reduction in the use of shelter bed days after admission to the HHOPE program for savings of $104,040. The total cost avoidance is close to six hundred thousand dollars ($592,082) that would have been spent on services to these persons without the HHOPE Program. As the chart shows, the HHOPE program cost per day is the cheapest of all these alternatives Comparison of Cost Per Day besides being a Per Person by Service Type far better qual$2,500 ity of life for the $2,000 $2,000 participants.
$1,500 $1,000 $500 $0 Jail HAC Centers NBHD Inpatient Psychiatric ACT Team Hospital Supportive Housing $456 $125 $55 $49
The HHOPE Team Shows Fidelity to the ACT Model
Two fidelity checks of the teams operations were conducted after 18 months and two years. The fidelity check uses a nationally recognized instrument and process for determining whether or not the HHOPE team had implemented the model correctly. Three major areas are examined, the human resources and structure of the organization, the teams relationship with other parts of the system, and the nature of its services. On a scale of 1-5 with 5 being perfect fidelity the team scored 4.2 at baseline and improved to a 4.4 six months later. This meant that the team was providing services in the proper staff/client ratio of 1-10, was available 24 hours/seven days a week, provided its services in the community in the participants homes or other natural settings, and in general were providing comprehensive services to its participants in a team approach.
Hospitalization Jail time Shelter beds Total Estimated Savings $160,792 $327,250 $104,040 $592,082
HHOPE Team Improves Coordination of Services for Participants
Recent federal reports have highlighted the fragmentation of the service system for persons with serious mental illness. This fragmentation results in consumers being referred to multiple agencies with the expectation that they will be able to find transportation to these different agencies. It also means that consumers seeking help need to tell their painful stories multiple times and considerable duplication of paperwork as well as the possibility that there will be conflicting information and contradictory or duplicative services. This is an especially hard burden on persons who have been chronically homeless and mentally ill and are trying to adjust to the totally different lifestyle required to stay in permanent housing. HHOPE participants were asked 18 questions 1. Provider gives services I need
100% 80% 60% 40% 20% 0% Some Mostly Very much
10% 50% 40%
about the coordination of the services they had received six months prior to receiving HHOPE services (baseline) and then at one year after entering the HHOPE Program. Participants reported marked changes between baseline and the one year follow up on all of the questions. For example, the number of persons reporting they received the services they needed tripled from 30% to 90% after one year in the program. Before HHOPE only 60% said they had to find services on their own while one year later that had decreased to 12%. Similarly, only 9% at baseline said paperwork had been kept to a minimum and increased eight fold to over 70%. Overall, HHOPE participants found their services to be better coordinated to a significant degree.
HHOPE Team Welcomed by Existing Service Providers
As the “new kid on the block” the HHOPE team had to establish relationships with the existing service systems. Six months after the team was established they filled out a questionnaire asking them eleven questions about their relationships with 24 separate agencies. The questions covered various aspects of the relationship such as cooperation, accessibility, information sharing, and responsiveness. At six months the team indicated it had good relationships with all the community funded partners. One year later the relationships between the HHOPE Team and all of the agencies improved. There were no aspects of the relationships which were considered problematic. There were improvements in all areas. It is clear that the agencies providing services have been cooperative and the HHOPE team has been successful in establishing longstanding good relationships with them which are improving over time.
2. Providers work together to meet my goals
100% 80% 60% 40% 20% 0% Only a little Some Mostly Very much
Participants Indicate Strong Satisfaction with their HHOPE Team Interaction
Best practices for serving adults with serious mental illness are recovery oriented and reflect client centered practice. This means the program believes people can recover and lead normal lives in the community and that participants should be given choices in all aspects of their lives, including the services they receive. Because this principle was so important to the program model a 33 question instrument was given to participants who agreed to participate in the evaluation exploring all phases of the services they received from HHOPE. Four major areas were explored: • Were services offered in a timely manner and did participants have good access to those services? • Did participants have choice around the specific nature of the services and were they involved in the design of their treatment plan and the services they received? • Were their wishes respected and were they treated as any person without mental illness would be treated? • Was receipt of one service contingent on receiving another service or particular behaviors (e.g. taking medications)? Even in the initial report, which followed the first participants who had been admitted into the program while HHOPE was just getting started and the team still had a lot to learn, the participants had considerable choice in all of the areas. In the follow up which included participants entering later into the program the team’s performance continued to improve. The vast majority of the participants indicated that services were offered promptly. Over 90% said the HHOPE staff were available when they had a crisis. The participants were also extremely positive about their choice in how services are delivered. Over 80% felt their individual needs and choices determined the service they received often or always, and they were usually asked about what was important to them in choosing different kinds of services. The participants said they were treated respectfully. For example, 92% said the staff respected their choices and 100% said the staff respected their right to privacy. Similarly, the vast majority of the participants reported that their access to services was not restricted by whether or not they received other services or by their behavior (e.g. taking medications), as would be true for persons who did not have mental illness.
“This program saved my life”
As the project’s grant funds end this year, the steering committee is working with the community to ensure that the team’s operations are maintained. All of the Partners and Broward County are strongly supportive of these efforts. Given the successful implementation of the program, the successful housing of over 40 formerly chronically homeless persons, and the cost savings to the rest of the system, it is important to sustain this program.