Housing & Community Corrections Models and Opportunities

1. Housing & Community Corrections Models and Opportunities October 1, 2010 Adult Criminal Justice Treatment / Offender Reentry Program Grantee Conference New Mexico Carol Wilkins Susan Doig /Trilogy, Inc

2. Overview • Where does housing fit in successful strategies for reentry or community corrections supervision for persons with behavioral health disorders? • Housing models • Permanent Supportive Housing • Re-thinking Transitional Housing • What works? • Promising practices • Leveraging resources and opportunities

3. Goals of Housing for People with Behavioral Health Disorders Involved in Criminal Justice System • Help people returning from incarceration or under community corrections supervision • Prevent and end homelessness • Achieve housing stability • Connect with community supports for recovery • Reunify with families • Become better neighbors • Help systems and communities • Reduce costs and consequences of homelessness and recidivism

4. Revolving Door 26% of people in jail were homeless within past year Homeless people with mental illness and/or severe alcoholism can spend years on a costly “institutional circuit” Families with gaps between homeless episodes have high rates of involvement in criminal justice and child welfare systems Re-entry Transitions More than 60,000 people enter shelters from jail or prison each year Most coming from prison stay for only a few days and do not return to shelter Potential to convert and focus some shelter capacity with targeted services for reentry? Homelessness and Incarceration

5. The “Institutional Circuit” A Revolving Door • While many individuals experience some form of homelessness or residential instability after prison or jail, recent research has identified a subset of individuals who repeatedly enter prison or jail • These individuals have a high likelihood of using other services at a high level including: • Substance abuse services (esp. crisis/detox) • Inpatient mental health services • Hospital emergency departments • Homeless shelters • Not served well by any system of care, but use them all in an uncoordinated, chaotic, and costly fashion

6. Family Homelessness and Criminal Justice Involvement • Among families with more than one stay in homeless shelter or transitional housing • High rates of involvement in criminal justice system • Changes in family composition and involvement with child welfare system • “Outcomes are unambiguously negative” • Parental incarceration doubles the risk of homelessness for African American children • 1 in 15 African Americans (of all ages) living in poverty entered a homeless shelter or transitional housing program in 2009

7. Targeting housing interventions to match needs Low Need Individuals who are able-bodied and employable, who face an income/affordability gap; also may need short-term assistance with community reintegration Moderate Need Individuals with limited employment history and educational achievement, and who may have substance abuse, health or mental health challenges High Need Individuals with disabilities such as serious mental illness and chronic health and substance abuse issues who will need longer-term services

8. Potential Residential Outcomes Post-Incarceration Permanent Housing Market Affordable Public Housing/Rental Assistance Service Enriched Permanent Supportive Transitional Housing Homelessness Jail Treatment Bridge Rental Assistance ¾, ½ Housing Transitional Program Street Unsuitable Housing Shelter Emergency Setting Emergency Housing Safe Haven

9. Supportive Housing Is… Permanent affordable housing with combined supports for independent living • Housing is permanent, meaning each tenant may stay as long as he or she pays rent and complies with terms of lease or rental agreement • Housing is affordable, meaning each tenant pays no more than 30% to 50% of household income • Tenants have access to an array of support services that are intended to support housing stability, recovery and resiliency, but participation in support services is not a requirement for tenancy • May be site-based or scattered site • Options available for adults who are single, those who choose to share housing, and families with children

10. Types of Supportive Housing • Single-site:Apartment buildings exclusively or primarily housing individuals and/or families who are formerly homeless and/or have serious mental illness or other chronic health challenges. • Scattered-site:Rent subsidized apartments leased in open market. • Integrated:Apartment buildings with mixed tenancies, but with units set-aside for people with special needs.

11. PermanentSupportive Housing An Evidence-Based Practice

12. Dimensions of Permanent Supportive Housing Fidelity Scale • Choice in housing and living arrangements • Functional separation of housing and services • Decent, safe, and affordable housing • Community integration and rights of tenancy • Access to housing and privacy • Flexible, voluntary, and recovery-focused services

13. Re-thinking Transitional Housing • Costs of serving first-time homeless families in transitional housing are $15,500 to $38,742 • Many transitional housing programs are not serving families with the greatest obstacles to stability • Permanent housing may better meet family needs at lower cost • Transitional housing programs that are very selective/restrictive do not achieve better outcomes than programs serving more high- risk families New approaches • Prioritize child welfare/substance abuse and criminal justice referrals • Collaboration with behavioral health and family dependency courts • Transition-in-place to permanent housing

14. What is Needed to Create Reentry Housing? • Hands-on government involvement • Non-profit partners that with strong commitment • Data and Research • Baseline operating and service resources • Foundation support to galvanize partners and spur public investment • Clear sense of who you are targeting for housing • Housing options that match needs and goals • Clinical practices that reflect the specific challenges • Persistent “in-reach” and upfront engagement of individuals prior to placement • Shift in provider practice from passive tenant selection to active recruitment • Flexibility to use funds creatively to address population needs, transportation, recreation, peer support • Evidence-based service models

15. Service Strategies • Comprehensive Approaches • Guaranteed Housing • Housing support/In home services • Intensive Case management • Team Based approach: ACT or ACT “light” models • Integrated Treatment Approaches: substance abuse, psychiatry, nursing • Low client to staff ratios 10/15 to 1 staff no more than 100 clients per team • Community based service with 2-5 visits per week • Outreach medications • Focus on symptom management and skill development • Access to services 24/7 with unlimited time frames • Individualized recovery based services • Money management *important for dual disorders

16. Organizational Buy In • Educating the Board and all staff on re-entry “The Released” • Hiring and keeping the right staff using behavioral questions in the interview • Recognizing when someone cannot work with this population “Grow or Go” • Transitions from abstinence to harm reduction • Reorganizing if necessary to put the right people in key positions

17. Training • Investing in Trainers to come out to the agency and train an entire team together can lead to better outcomes • Harm reduction models • Motivational Interviewing • Housing First • Trauma Informed Services

18. Pre-release • Accessto the Jail • regular follow up in the institution • Working with Jail staff as a team • not getting in the way of staff with many demands and high numbers of people to link • Following the rules of the institution • safety and access • Assessment and engagement • Clients are engaged with staff prior to release • Continuity • The same team providing in-reach and community services • Medication Upon Release • Putting systems in place that allow immediate access to medications

19. Court • Release of Information • Agreement and permission to attend Court • Specialty Courts • Mental Health • Drug Courts • Probation • Clarify expectations of the court and facilitate client understanding • Advocacy • working with the court to reduce recidivism • Planned Release • picking up the consumer from the institution upon release and driving that person to housing

20. Post Release • Housing people right out of jail • SRO, Halfway house, and or residential substance abuse treatment may be options while permanent placement becomes available • Working with the team to build rapport • Getting immediate needs met • First meal out of jail • Creating incentive to meet with staff, food tabs, money drops • Find out where the person “hangs out” • Working with staff on Assertively serving the client • Goal setting including clients in the process • Involving family and support systems • ID’s, entitlements, medical linkages

21. Strategies forHousing Access Working with Public Housing Authorities and Landlords • Understand eligibility for federal housing programs • Public housing • Housing Choice Vouchers • Targeted programs for special needs populations • Tenant screening and policies regarding criminal backgrounds • Mitigate risks (real and perceived) • Reliable supportive services partnerships • Rent-loss reserves • Cultivate network of housing providers and landlords

22. 135 people enrolled in study so far Control group will show how housing makes a difference 47 in treatment group and offered permanent supportive housing Services linked to housing voucher 36 actively involved in community treatment None are homeless Some in temporary or transitional housing while seeking permanent housing Chicago Frequent Users of Jails & Shelters (FUSE)—early data

23. Supportive Housing Works • According to a study of Denver’s Road Home Housing First effort, people placed into supportive housing had a 76% reduction in days spent incarcerated. Significant reductions were also reported in emergency room visits, detox, psychiatric care, and shelter use. • A study of supportive housing in the State of Maine found a 62% reduction in incarceration for people placed into supportive housing. • In Seattle, studies of supportive housing at 1811 Eastlake demonstrate: • 52% reduction in jail bookings • 45% reductions in days spent in jail • After six months of New York City’s supportive housing reentry program: • 89% of tenants remained stably housed. • 100% of tenants avoided return to shelter. • 89% of tenants avoided return to jail.

24. “Placing people into supportive housing costs about half as much as keeping someone in jail or prison, while also promoting public safety and improving life outcomes for people” - Martin F. Horn, former Commissioner of New York City Department of Correction

25. Opening DoorsThe Federal Strategic Plan to Prevent and End Homelessness • Goals and targets • Finish the job of ending chronic homelessness in 5 years • Prevent and end homelessness among veterans in 5 years • Prevent and end homelessness for families, youth and children in 10 years • Set a path to ending all types of homelessness • Roadmap for joint action by 19 federal agencies • Guide development of programs and budget priorities over 5-year period FY 2010 – FY 2014

26. The Federal Strategic Plan to Prevent and End Homelessness Includes a focus on connections between homelessness, behavioral health and criminal justice • Integrate primary and behavioral health care services with homeless assistance programs and housing to reduce people’s vulnerability to and the impacts of homelessness • Advance health and housing stability for youth aging out of systems such as foster care and juvenile justice • Advance health and housing stability for people experiencing homelessness who have frequent contact with hospitals and criminal justice

27. Leveraging Resources & Opportunities Targeted resources may be available to break the cycle of homelessness and incarceration • Veterans • VASH • Veterans Justice Outreach Specialists • Health Care for Reentry Veterans • Health care and mental health systems investing in housing options for consumers • Vulnerability assessments • Frequent Users of emergency care • People with (or at highest risk for) HIV/AIDS • Families with children • Homeless or at risk of homelessness • Reunifying with children in foster care

28. Leveraging Resources & Opportunities Partnerships with Public Housing Authorities • Policies and procedures for new and returning tenants can be more flexible • understand what the law requires and allows • Develop transitional and permanent reentry housing • Moving to Work (MTW) housing authorities have more flexibility to implement innovative programs • Make re-entry housing part of planning for housing and neighborhood revitalization