Alaska Supportive Housing Plan Aligning State and Local Efforts Kevin Martone, Executive Director December 6, 2017

Background DATE ACTIVITY Late 2013 TAC provides informal “Olmstead” guidance to DBH April 2014 DBH and MH Trust actively discussing supportive housing planning December 2014 TAC begins work with MH Trust Authority, DBH, AHFC and others December 18, 2015 TAC report published 2016 TAC provides light touch consultation; DHSS/DBH participate in CMS IAP Track 1; HUD 811 implementation planning August 2017 DHSS and partners awarded TA through CMS IAP October 20, 2017 Strategic PSH plan goals revised by DHSS and AHFC on Alaska Council on the Homeless endorsed amended PSH plan goals and action steps

Housing is part of the overall healthcare system change strategy Housing is part of the overall healthcare system change strategy. It is a primary intervention and should be incorporated into health planning.

Housing First Housing First is a proven approach in which people experiencing homelessness are offered permanent housing with few to no treatment preconditions, behavioral contingencies, or barriers. Studies have shown that Housing First yields higher housing retention rates, reduces the use of crisis services and institutions, and improves people's health and social outcomes. PSH and Rapid Re-housing are Housing First models.

Permanent Supportive Housing Permanent Supportive Housing is integrated, affordable, community based, lease-based housing that provides tenants with the rights and responsibilities of tenancy and links them to voluntary and flexible supports and services. Housing-related services: Broadly defined, they are a range of flexible services that support individuals as they get and keep housing. These services include community-based LTSS that address Instrumental Activities of Daily Living (IADLs), such as teaching a person to maintain a clean home or to manage money.

Who is Permanent Supportive Housing for? Permanent Supportive Housing has evolved from being just for “high functioning” individuals to serving individuals with high needs, including those with behavioral health disorders and other disabilities who are living in: state hospitals nursing homes jails/prisons groups homes, assisted living, residential care homes or other board and care models chronic homelessness

Rapid Re-Housing Rapid re-housing is an intervention designed to help individuals and families quickly exit homelessness and return to permanent housing. Rapid re-housing assistance is offered without preconditions — like employment, income, absence of criminal record, or sobriety — and the resources and services provided are tailored to the unique needs of the household. Housing Identification Rent and Move-In Assistance Rapid Re-Housing Case Management and Services Source: USICH

Who is Rapid Re-housing for? Families Individuals Youth Veterans Survivors of Domestic Violence People experiencing chronic homelessness in some instances

HUD and USICH: Core Principles of Housing First and Rapid Re-Housing Webinar, July 2014

The Role of Systems in PSH and Rapid Re-housing Federal Government Local Government and CoC State Government PSH and Rapid Re-housing

System Platform Martone, 2015 Integrated Healthcare Behavioral Health Supports Housing and Housing Supports Consumer Martone, 2015

A Common Intervention to “Competing” Demands Key Policy Issues Intervention Disabilities Substance Use Disorders Homelessness Community Integration Health Integration High Utilizers Affordable Housing Corrections Supportive Housing Rapid Re-Housing

Alaska Strategic Supportive Housing Plan Objectives Maximize the development of integrated, affordable, lease-based permanent supportive housing (PSH) for Alaskans with serious behavioral health conditions served by DHSS and the Trust. Identify, develop, and implement the services that individuals need to succeed in PSH. Coordinate efforts among state and partner agencies working to develop and ensure access to PSH. Leverage additional federal financial participation through modifications to state Medicaid services.

Strategic Supportive Housing Plan Goals; amended 10/20/17 The Alaska Housing Finance Corporation (AHFC) and the Alaska Department of Health & Social Services (DHSS), working together with their respective partners and stakeholders, will oversee and coordinate implementation of the objectives of the Permanent Supportive Housing (PSH) Plan within their respective organizational structures. AHFC and DHSS will twice yearly jointly report on progress to the Alaska Council on the Homeless. Establish a coordinated and consistent approach to housing and housing related services across all DHSS Divisions. Establish a PSH pipeline to create between 400 and 500 PSH opportunities from 2015-2020.

Alaska Strategic Supportive Housing Plan; amended 10/20/17 Establish a PSH Clearinghouse to coordinate the timely referral of eligible households for PSH opportunities. Establish a variety of funding sources for services delivered in supportive housing settings that are flexible, sustainable, and tailored to individual needs. Expand service delivery in home- and community-based settings to promote housing stability and community integration. Strengthen community provider workforce capacity to deliver home- and community-based housing services that promote wellness, recovery, and community integration.

Coordinated Planning and Implementation Horizontal and Vertical Creating buy-in among all stakeholders Creating buy-in with local leaders and elected officials Social Inclusion and community

Olmstead – Barrier or Opportunity? States are obligated to serve people with disabilities in the least restrictive, most integrated settings possible.

Community Integration Defined “Integrated settings are located in mainstream society; offer access to community activities and opportunities at times, frequencies and with persons of an individual’s choosing; afford individuals choice in their daily life activities; and, provide individuals with disabilities the opportunity to interact with non-disabled persons to the fullest extent possible. Evidence-based practices that provide scattered-site housing with supportive services are examples of integrated settings.” U.S. Department of Justice. Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C.

Community Integration Defined “By contrast, segregated settings often have qualities of an institutional nature. Segregated settings include, but are not limited to: (1) congregate settings populated exclusively or primarily with individuals with disabilities; (2) congregate settings characterized by regimentation in daily activities, lack of privacy or autonomy, policies limiting visitors, or limits on individuals’ ability to engage freely in community activities and to manage their own activities of daily living; or (3) settings that provide for daytime activities primarily with other individuals with disabilities.”

What does success look like? People are housed More integrated PSH More Rapid Re-housing programs and opportunities Principles of Housing First widely adopted Improved access to behavioral health, primary care and other services Services are evidence-based Improved coordination between State agencies for housing and services State and local agencies coordinating housing and services Workforce trained in EBPs like PSH and RRH

Technical Assistance Collaborative, Inc. – TAC Contact Us Technical Assistance Collaborative, Inc. – TAC @TACIncBoston Visit us on the web: www.tacinc.org