Linking HMIS With Mainstream Healthcare Databases Evan Scully, Homeward Michael Shank, Virginia DMHMRSAS

Greater Richmond Continuum of Care Population ≈ 1 million: 84% urban, 16% rural 1,158 people found homeless January 25 th, 149 found unsheltered Planning District 15 Independent City of Richmond and counties of Charles City, Chesterfield, Goochland, Hanover, Henrico, New Kent, and Powhatan

Commonwealth of Virginia Richmond Population ≈ 200,000 million, 100% urban Factors in Virginia: Little government funding for housing issues Independent cities isolate urban issues from surrounding counties Medicaid won’t cover primary diagnosis of Substance Abuse

Homeward Richmond’s Regional Response to Homelessness Non-profit founded in 1998 following the report of a city Task Force on Homelessness Original funding included HHS ACCESS demonstration grant Small planning and coordinating agency - no direct services Diverse board Manages the HMIS Coordinates the annual Point In Time count Convenes Continuum of Care committee and generates COC application

Early Findings Comparable to cities of similar size Most persons who are homeless in Greater Richmond have lived in the area for ten years or more. Under 1 year (21%), 1-10 years (28%), years (11%), years (9%), Over 30 years (31%) A high proportion of homeless adults, especially single men, have at least one felony conviction. All persons (37%), Adults in families (12%), Single adults (41%), Single Men (48%), Single women (17%) Local governments need local data! (National statistics don’t vote)

Homeward Community Information System (HCIS) - Gender

Homeward Community Information System (HCIS) - Race

Linking HMIS With Mainstream Healthcare Databases Homeward Community Information System (HMIS) HMIS identifies 7,649 Richmond-area individuals enrolled in homeless services –9,218 records less 1,439 missing or invalid SSNs less 130 duplicate entries (from 1/1/2003 through 6/30/2006) –Records the date of enrollment as documentation of an episode of homelessness Virginia Health Information (VHI) Database VHI identifies 231,275 Richmond-area individuals in inpatient hospital care (from 1/1/2001 through 3/31/2006) Includes 21,115 people in inpatient psychiatric care

Non-HMIS Hospital Stays – Patients & Bed Days

HMIS Hospital Stays – Patients & Bed Days

Overlap found between HMIS and VHI Databases Local Hospital PD 15 Homeless Services 2, ,2757,649 33% Of Homeless Population 20% of General Population In PD15

Length of Hospital Stay (LOS) Avg. Bed Days Used Over 5 year period Statewide = 10.0 PD 15 Non-HMIS = 11.7 HMIS = 21.0

Non-HMIS Hospital Use by Major Diagnostic Category

HMIS Hospital Use by Major Diagnostic Category

HMIS Hospital Use Pre- and Post- HMIS Entry

Linking HMIS With Mainstream Healthcare Databases Homeward Community Information System (HMIS) HMIS identifies 7,649 people enrolled in homeless services Virginia Health Information (VHI) Database VHI identifies 231,275 people in inpatient hospital care Includes 21,115 people in inpatient psychiatric care Community Services Boards (CSB) Database (CCS) –CCS identifies 33,507 people enrolled Richmond-Area Behavioral Healthcare –Consumers of Mental Health and Substance Abuse services

Overlap found between HMIS, CSB and VHI Databases PD 15 CSB Services Local Psych Hospital PD 15 Homeless Services 7,300 21,11533,507 7,649 1, ,123 CSB Consumers with Local Psych Hospital Non-HMIS = 22.8% HMIS = 44.6%

HMIS – by MDC – Pre- and Post- HMIS Entry

PD15 Hospital Cost - 4 Quarters Surrounding HMIS Entry Mental Health and Co-occurring Illnesses (n=208)

PD15 Hospital Cost - 4 Quarters Surrounding HMIS Entry Mental Health and Substance Abuse, or Mental Health and Respiratory Illness, or Mental Health and Trauma and Infections

PD15 Hospital Cost – 4 Quarters Surrounding HMIS Entry “Revolving Door” Psychiatric Admissions

DMH Funding for Housing First February 8, 2007 George Braunstein Executive Director Chesterfield CSB PO Box 92 Chesterfield, VA Dear Mr. Braunstein: We are pleased to announce that the DMHMRSAS will support the Region IV Housing First project, A Place to Start, with a $50,000 challenge grant that was matched through private fundraising efforts and with an additional one time grant of $400,000 to support that program’s start up costs. These funds are provided through Virginia’s Federal Mental Health Block Grant (MHBG).