Transitions to Community Living

Transitions to Community Living September 10, 2013 Robert Weaver, Project Manager Martha Are, Housing & Homelessness

Federal Focus on ADA and Olmstead • Complaint letter and DOJ findings • The State’s prioritization of investment in congregate settings at the expense of community-based settings; • Many individuals with mental illnesses have not been provided choices of where they live

State Response • On August 23, 2012 Acting DHHS Secretary Al Delia signed a voluntary agreement with the US DOJ to settle claims that the state of North Carolina had violated the American with Disabilities Act. This implementation of this project has been titled Transitions to Community Living Initiative.

Who is the Priority for Transitions to Community Living Initiative Individuals who are living in adult care homes who have a diagnosis of serious and persistent mental illness. Individuals who are referred to adult care homes with a diagnosis of serious mental illness Individuals who are in treatment in a state hospital. Individuals living in the community who have diagnosis of serious mental illness who are considering moving into an ACH

Settlement Agreement Roles MCO and DHHS In-reach Diversion Transition planning Housing slots with rental assistance and transition supports ACT fidelity Supported employment Quality Assurance and Performance Improvement Independent Reviewer

Pre-Screening and Diversion • Use of Pre-admission Screening and Annual Resident Review (PASRR) by January 2013 to identify individuals with MH needs seeking admission to ACH • If identified MH need, referred to LME-MCO for care coordination and linking to services as well as development of a community integration plan.

In-Reach • Coordinated by LME-MCO • Use of certified peer specialists • Adult Care Homes and State Psychiatric Hospitals • Recurrent in-reach • Begin with ACH determined at risk of being an IMDs • Build on Money Follows the Person (MFP) experience

Transition Planning • Establish teams coordinated by LME-MCO and headed by Transition Coordinator • Development of a comprehensive person centered plan that is holistic in nature including both natural supports and treatment needs. • Establish interest list and tracking mechanism

Transition Day Responsibilities • Transition Coordinator must be available at least by phone on moving day. • MCO assumes responsibility for assisting on moving day: • Could be transition coordinator • Could be housing person • Could be peer specialist • Could contract with moving company to do heavy lifting.

Supported Housing Slots • Package of rental subsidy, one-time transition supports, community services • Total of 3,000; • First come first served and based on geographic housing availability and individual preference • Interest list up to twice the slots of current and subsequent year • Establish a Tenant Based Rental Assistance program (TBRA) • Build upon experience with targeted/key housing program

Housing Characteristics • Tenancy support services to assist in overcoming barriers to obtain housing and develop skills to maintain housing • Enable individuals with disabilities to interact with individuals without disabilities to fullest extent • Are scattered site, no more that 20% units occupied by persons with disabilities • Afford individuals choice in daily life activities • Preference for single occupancy in apartment setting • Not licensed

Transition Year Support Resources • Offered if person cannot safely and adequately meet transition-related expenses • Available only during transition year • One-time start-up costs • Utility and rent deposits • Appliances • Essential furnishings • One-time home preparation, e.g. pest eradication, cleaning

Alliance BH PBH CPHS CoastalCare ECBH EastPointe Mechlink Partners PBM Sandhills Smoky Mount Ctr WHN Total 30 20 30 31 24 31 20 20 32 33 22 293 Approved Housing Slots

Assertive Community Treatment Team (ACT) Fidelity • By July 2013 all teams must meet fidelity and will have at least 33 teams serving 3,225 individuals. • By July 2019, 50 teams serving 5,000 individuals • Tool for Measurement of Assertive Community Treatment (TMACT) fidelity scale • Service definition changes and rate revision • Training • Fidelity Review process

Supported Employment • Seeking to develop evidence based Dartmouth Individual Placement and Support (IPS) model • 100 individuals by July 2013 building to 2,500 individuals by July 2019. • Initiate with through pilot sites using state funding. Consider as b3 service in out years. • Training • Fidelity review process

Quality Assurance and Performance Improvement • Tracking length of stay, readmissions, community tenure • Personal Outcomes including: • Incidents of harm • Repeat admissions • Use of crisis beds and community hospital admissions • Repeat ED visits • Time spent in congregate day programming • Number employed, attending school, maintenance of living arrangement, engaged in community life • In-reach and discharge • Quality of Life Surveys • External Quality Review (EQRO)

Issues of Interest to Housing Developers & Managers • DOJ has a strong preference for single occupancy, which leads to a demand for one bedroom and studio units. • Roommates are ok, though DOJ does not expect many people to choose having a roommate • Only 250 of the 3000 persons housed can live in a development of fewer than 16 units that has an occupancy requirement for persons with disabilities • Cannot have requirements for a specific disability

Issues of Interest to Housing Developers & Managers • Rural areas will be more challenged in identifying appropriate, safe units • A little more flexibility with large homes broken up into smaller units • DOJ wants each tenant to have their own lease

Issues of Interest to Housing Developers & Managers • A conservative statewide estimate is at least 200-300 persons identified for Diversion each month • DOJ also expects close to 100% of these persons to be diverted to community housing rather than moving into ACHs • Only 1000 of these persons will qualify for a DOJ housing slot over the 8 years • Group homes, existing 811s, and other developments with disability status as an occupancy requirement are acceptable for all others identified through Diversion

Issues of Interest to Housing Developers & Managers • ACT Team is the most intensive behavioral health community based service • Supportive Employment has not focused on persons with mental illness prior to implementation of TCLI • Tenants who are eligible for these services will be prioritized for them

Issues of Interest to Housing Developers & Managers • Additional financial support • Supplemental Assistance – In Home • Community Living Voucher • These funds can be used to assist with rental payment since the TBRA voucher is capped at $360 • Funds can be used for other necessary expenses

Issues of Interest to Housing Developers & Managers • Quadel administers the housing voucher. The lease will be between the tenant and property; a HAP will be signed between property and Quadel • Transition Year funding will be available for deposits

Issues of Interest to Housing Developers & Managers • Tenancy Supports is a new (some would say fabulous) service • Tied to housing administrator • Non-clinical • Focuses on helping the tenant to comply with lease requirements

Issues of Interest to Housing Developers & Managers • State has an extensive contract with NCHousingSearch.com • New portals will be created, including licensed beds and restricted occupancy units • Owners/managers will be able to update both of these portals daily

Issues of Interest to Housing Developers & Managers • NCHousingSearch will also be reaching out to property owners in communities persons with housing slots are interested in living in • NCHousingSearch will also reach out to landlords that have leased to an individual with a housing slot

Questions? • Robert Weaver – General Information • 919-855-4814 • robert.weaver@dhhs.nc.gov • Martha Are – Housing and Homeless Unit: DAAS • 919-855-4994 • martha.are@dhhs.nc.gov

Transitions to Community Living