Presented by: Kristina Dixon, Foothill AIDS Project D’Sonya Oakley, LAUSD Carmen Ortiz, UCLA Student Amber Yglesias,

1. An Evaluation of the HOPWA Tenant Based Choice Voucher Program 1 Presented by: Kristina Dixon, Foothill AIDS Project D’Sonya Oakley, LAUSD Carmen Ortiz, UCLA Student Amber Yglesias, UCLA Student Foothill AIDS Project

2. 2 Foothill AIDS Project • Mission: “To improve the lives of those affected by or at risk for HIV/AIDS through comprehensive support services and to help prevent HIV infections through education and outreach.” • Vision: “To be recognized in the communities we serve as a model for the prevention of HIV through education and outreach, and for providing services to individuals affected by or at risk of HIV/AIDS.”

3. 3 Institutional Background Foothill AIDS Project FAP was founded in June of 1987 by concerned volunteers who were distressed by the absence of services for their friends and loved ones, dying of AIDS in the Eastern San Gabriel Valley and San Bernardino County.

4. Institutional BackgroundFoothill AIDS Project As of 2005: • FAP serves the Eastern San Gabriel Valley and San Bernardino County at 2 sites: FAP West (Claremont) and FAP East (San Bernardino City). • Staff: 17 Professionally trained and educated employees: 84% represents African American, and Hispanic with bilingual staff speaking Spanish and French. • Board: 12 members; 59% represents African American, Hispanic and Native American, 41% are Caucasian, and 25% represents consumers. 4

5. Services Provided by FAPFoothill AIDS Project • Comprehensive Case Management Services • Mental Health Substance Abuse Counseling • Food Pantry and Vouchers • Housing Services (STAP’s, TBHP, HEVPP) • Transportation Services

6. Program Description Foothill AIDS Project Tenant Based Choice Voucher Program • Established in 2000 • Staff: 1 Housing Coordinator, 1 Housing Voucher Coordinator, 1 Housing Specialist, 1 Eviction Prevention Counselor, 11 Referring Case Managers from 8 referring agencies, Student Volunteers • Target Population: Individuals and families in need of permanent affordable housing, who are used to paying 30 % of their income on rent and reside in or are looking to relocate to San Bernardino County. 6

7. Research QuestionFoothill AIDS Project What are the factors that enable individuals to be successful in the HOPWA Tenant Based Choice Voucher Housing Program?

8. Methodology Foothill AIDS Project • Qualitative Data Analysis - Interviews with Key Informants: 4 FAP Case Managers - Interviews with clients: 8 FAP clients • Quantitative Data Analysis - Review of 71 client files for demographic information 8

9. Qualitative Data AnalysisFoothill AIDS Project • Interviews with Case Managers at FAP • Designed an interview questionnaire consisting of 9 open-ended questions • Interviews conducted over the phone by external evaluators • Answers analyzed for common themes • Interviews with FAP clients • Designed an interview questionnaire consisting of 18 open-ended questions • Interviews conducted over the phone by internal evaluators • Answers analyzed for common themes

10. Total PopulationFoothill AIDS Project 45 Single Individuals 26 Families with 37 Children

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15. Sample Population Foothill AIDS Project Qualification & Description of Group • 3+ years enrolled in TBHP • Client receiving Case Management at FAP • 8 of 13 Successful Clients • FAP Case Managers

16. Case Manager ReportsFoothill AIDS Project Case Manager A • Caseload of 44 clients • About 10 clients in the Tenant Based Housing Program (TBHP) Case Manager B • Caseload of about 20 clients total • 4 clients enrolled in TBHP

17. Case Manager Reports Foothill AIDS Project • Agencies Provide • Support groups and counseling • Medical support: referrals, including dental, etc. • Food pantries, vouchers, etc. • Legal advice

18. Case Manager Reports Foothill AIDS Project • Common barriers that prevent maintaining permanent housing • Mental Health • Substance Abuse • Non-compliance with health care • Failure to comply with rental regulations • Not paying the rent on time • Adding unauthorized tenants

19. Case Manager Report Foothill AIDS Project • Conditions for success • Medical adherence • Compliance with TBHP regulations • Cooperation with Case Managers • Close monitoring of clients by Case Managers

20. Case Manager Reports Foothill AIDS Project • Relationship between housing & health care “Clients with permanent housing comply with medical appointments & take their medicine. Whereas people that are homeless or that are without stable housing, they have to ride the bus, and won’t comply with rules, won’t keep their doctors’ appointments nor take their medicine” Case Mgr A

21. Data AnalysisFoothill AIDS Project • Profile of Successful Client • Responsible with Financial Budget • Transportation • Support System • No Substance Abuse

22. Data AnalysisFoothill AIDS Project • Responsible With Financial Budget • “I pay my rent right on the first to ensure it is paid.” • “…I do not like to squander money.” • “I budget by prioritizing my expenses, I make sure to pay the important things first.”

23. Data Analysis Foothill AIDS Project • Transportation • All successful clients interviewed had some form of transportation • 6 own a vehicle • 1 relies on family or friends • 1 rides the bus • Case Manager A suggests that own transportation is best

24. Data AnalysisFoothill AIDS Project • Support System • All clients interviewed reported a support system • Examples • Family – Mother, Children, Grandchildren • Church – God, members, religious activities, etc. • Social Services - FAP, Case Managers, etc. • Friends & Significant Others • Support Groups “My mother stays with me and helps me out a lot. She’s my angel.”

25. Data AnalysisFoothill AIDS Project • No Substance Abuse • Substance Abuse is a Predictor of Failure to Maintain Permanent Housing • Maintenance of Sobriety, which includes 1) regular attendance of substance abuse group 2) change of life style 3) steering clear of old hang out spots 4) maintaining contact with sponsor

26. Permanent Housing & HealthFoothill AIDS Project All Clients interviewed said that permanent housing has benefited their health • Healthier eating habits • Less stress • Disease more manageable • Health is top priority “My disease is more manageable and [permanent housing] basically saved my life. I am able to live on $600 a month, eat, and feed my dog.”

27. Client SuggestionsFoothill AIDS Project • Housing Authority should be more sympathetic and understanding to those with special needs • Casemanagers should stay in contact with clients more and help them work through the system • More programs for families of those who are infected • More information on how to deal with hardships • Provide housekeeping assistance for clients when they are sick

28. Literature ReviewFoothill AIDS Project Study #1: Harkness, Joseph, Sandra J. Newman, and David Salkever. "The cost effectiveness of independent housing for the chronically mentally ill: do housing and neighborhood features matter?" Health Services Research 39 (2004): 1341-1361.  This study examines the effect that housing quality can have on the health of individuals with chronic mental illness, and also on their residential stability. • Reasons for eviction: -failure to pay rent -disruptive behavior -substance abuse Conclusion: Higher-quality housing has a positive effect on mental illness 28

29. Literature ReviewFoothill AIDS Project Study #2: California Bureau of State Audits. Los Angeles Housing Opportunities for Persons with AIDS Program: prompt spending of federal funds and program monitoring would improve services to recipients. Sacramento: California State Auditor, Bureau of State Audits (May 2000), Pg 44.  In 1999, the California State Auditor evaluated HOPWA’s effectiveness and administration. The main problems arose from    - Lack of procedures to track goals - A shortage of client managers and or service providers - Misinformed staff This audit can reflect on our evaluation, mainly focusing on the importance of the case managers for the clients. It is imperative that the staff is well informed and that there is a sufficient number to overlook clients’ progress and rapport.29

30. Literature ReviewFoothill AIDS Project Study #3: Ramirez, Gerardo. Project-Based Section 8 Dilemma: A Focus on Los Angeles. Los Angeles. Diss. University of California, Los Angeles, 1997. “In 1992, a study of HUD’s subsidized stock found that 24% of the multi-family stock was distressed. Of these distressed properties, many are project-based Section 8 rental assisted units. Therefore, tax dollars were being used to subsidize distressed, inferior housing. The problem lies in that it defeats the purpose of providing decent housing and entraps many of the tenants because they would lose their rental assistance if they moved.” (Ramirez 13) Our clients run the same dilemma of living in distressed areas and being forced to stay there. Otherwise their vouchers are voided.

31. Future Research/Program Evaluation & Recommendations Foothill AIDS Project • Evaluate the closed charts who represent clients who were not successful on the TBHP to identify the barriers and challenges that prevented them from being successful. • To see what kinds of programs need to be implemented to increase the likelihood for success of clients in the program.