AN INTEGRATED PROGRAM FOR HOMELESS ADULTS WITH CO-OCCURRING MENTAL AND SUBSTANCE USE DISORDERS: A GRANT PROPOSAL By Brandon Evans Presented to the School of Social Work California State University, Long Beach May 2013

INTRODUCTION Problem The prevalence of co-occurring mental and substance use disorders is high, in fact, co-occurring mental and substance use disorders affect approximately five million adults in the United States (Jessup & Dible, 2011). Individuals who experience co-occurring mental and substance use disorders stand a greater risk for chronic homelessness, poor health, high suicide rates, HIV/AIDS, and frequent interactions with the criminal justice system when treatment is prolonged (Buckley, 2007; Horsfall, Cleary, Hunt & Walter, 2009). In 2011, data from the Greater Los Angeles Homeless Count Report revealed that there are approximately 51,340 homeless adults living in the County of Los Angeles, among these numbers an estimated 16,942 adults are experiencing a mental illness, and 17,455 are experiencing a form of substance abuse (LAHSA, 2011).. Goals The overarching goal of the program is to decrease the prevalence of co- occurring disorders among the homeless and offer effective treatment for mental illness and substance use disorders. Three commonly used integrated interventions for co-occurring disorders are, screening and assessment for mental illness and substance use disorders, motivational and behavioral interventions, and incorporating a common treatment plan which addresses both illnesses (Foster, Lefauve, Kresky-Wolff, & Rickards, L. 2010).

SOCIAL WORK RELEVANCE The social work profession has had a history of helping vulnerable and oppressed client populations (Sun, 2012). Homeless individuals experiencing co-occurring mental and substance use disorders are considered one of the most vulnerable client populations to work with (Sun, 2012). Social workers are often the first professionals in contact with adults who are homeless and experiencing a co-occurring mental and substance use disorder and thus become ideal candidates to build rapport and begin the assessment process to deliver effective treatment (Drake et al., 2001). Three commonly used social work interventions for co-occurring disorders are, screening and assessment for mental illness and substance use disorders, motivational and behavioral interventions, and incorporating a common treatment plan which addresses both illnesses (Foster et al., 2010).

CROSS - CULTURAL RELEVANCE A recent survey among 642,000 positions held by social workers found that 21 % worked in substance abuse and mental-health related fields (Sun, 2012). Among these health related fields, social workers are often first to come in contact with multicultural and multiracial clients displaying substance abuse and mental illness (Hall, 2001; Sun, 2012). As the diverse population continues to grow, so will cultural diversity among consumers, adding to the challenges social workers face with clients who are multicultural and/or multiracial experiencing a co- occurring disorder (Hall, 2001). It is crucial that social workers be culturally competent with assessment and treatment delivery, all while using theories and interventions that are grounded in multicultural diversity (Hall, 2001; Sun, 2012).

METHODS Target Population The target population for this grant is homeless adults who have a co- occurring mental and substance use disorders and who will be receiving services in Los Angeles County, more specifically, San Pedro, California. Strategies Used in Selecting a Funding Source The grant writer used multiple methods to search for a potential grant that would fund and match the program’s purpose, population, and target area, this included consulting the resource library on the California State University Long Beach (CSULB) campus and the Long Beach Nonprofit Partnership library to locate potential private, public, government, county, and/or state grant funding sources. Funding Source Upon review of all potential funding sources, The McMillen Family Foundation was selected as a funding source for this grant because the criteria of the grant guidelines were consistent with the nature of the program’s purpose and population which it will be serving.

METHODS Sources Used for the Needs Assessment Several sources were used to allow the grant writer a more accurate account of the problem, this included a scholarly search of the literature, Los Angeles Homeless Services Authority (2011), National Coalition for the Homeless (2009), National Alliance on Mental Illness (2003), and the Substance Abuse and Mental Health Services Administration,(2010). Program Budget The approximate budget and funding request for this proposed integrated program and evaluation plan is $192,742 for one year. The funding will include salaries for a consulting psychiatrist, a masters level social workers (MSW), a clinical licensed social worker (LCSW), operational costs, direct and indirect program costs, and administration. Other expenses include; utilities, gift cards, expenditures linked with active referrals associated with the program.

GRANT PROPOSAL Program Summary and Description Upon admission, the program will screen for co-occurring disorders using an integrated assessment, provide assistance in mental health recovery and addiction treatment while providing a safe place for homeless adults with a co- occurring disorder to go to attend individual therapy, psychoeducational groups, and co-occurring self-help groups. Population Served The proposed program will target the growing number of co-occurring mental health and substance abuse (MHSA) disorders among homeless adults living in Los Angeles County, California. The program will run in conjunction with the Beacon House Association of San Pedro. Programs Objectives The program objectives are to, (1)decrease the prevalence of untreated and undiagnosed co-occurring disorders by enrolling new clients into the program each month and providing each with an individual service plan, treatment goals, and a medication plan to work toward recovery, (2) increase client’s level of adherence to psychotropic medications and symptom management through the program’s weekly psychoeducational groups, and (3) decrease the number of homeless clients with a co-occurring disorder by providing emergency housing vouchers. A minimum of 60 emergency housing vouchers will be provided within the first year of the programs operations.

GRANT PROPOSAL Program Evaluation Plan For the purpose of evaluating the program's effectiveness in promoting recovery, the Milestone of Recovery Scale (MORS) will be implemented my each staff member to measure their client’s observable behaviors related to their recovery. The Milestone of Recovery Scale (MORS) is based on a rating scale from 1 to 8, with “1” being an extreme risk, and “8” being advanced recovery. In order to evaluate the programs anticipated goal of serving 180 unduplicated clients’ and providing 120 active referrals in 1year, the program will implement a documentation system on all client records. The information will be entered into an online spread sheet created by the social worker. The program director and the social worker will calculate the numbers each quarter, and then do a final evaluation on the 12 th month to insure the program is within its projected goal of serving 180 clients diagnosed with a co-occurring disorder, and providing 120 active referrals to other agencies. This information will be analyzed and interpreted by the clinical team for future program development.

L ESSONS LEARNED & IMPLICATIONS FOR SOCIAL WORK In the nonprofit world it becomes apparent that grant writing can play an important role in the funding requirements to develop programs to serve clients who need services. Social workers become important players in this process because they are culturally aware and culturally sensitive to the needs of all human lives. The Code of Ethics of the National Association of Social Workers (NASW) reminds us that part of the social worker’s job is to enhance human lives and help meet the basic needs of all individuals (NASW, 2013). This includes the vulnerable, underserved, oppressed, and the ones living in poverty (NASW, 2013). Homeless adults experiencing co-occurring mental and substance use disorders are considered a client population who is vulnerable, underserved, and often living in poverty (Sun, 2012).

REFERENCES Buckley, P. (2007). Dual diagnosis of substance abuse and severe mental illness: The scope of the problem. Journal of Dual Diagnosis, 3 (23), Drake, R., Essock, S., Shaner, A., Carey, K., Minkoff, K., Kola, L.... & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52 (4), Foster, S., Lefauve, C., Kresky-Wolff, M., & Rickards, L. (2010). Services and supports for individuals with co-occurring disorders and long-term homelessness. Journal of Behavioral Health Services and Research, 37 (2), Hall, R. (2001). Biracial sensitive practice: Expanding social services to an invisible population. Journal of Social Services and Social Welfare, 28 (2), Horsfall, J., Cleary, M., Hunt, E., & Walter, G. (2009). Psychosocial treatment for people with co-occurring severe mental illness and substance use disorders: A review of empirical evidence. Harvard Review of Psychiatry, 17 (1), Jessup, M., & Dibble, S. (2011). Validity and reliability of the COJAC screening tools for co-occurring disorders. American Journal on Addictions, 20 (3), Los Angeles Homeless Services Authority. (2011). Greater Los Angeles homeless count report. Retrieved from: Lahsa.org/docs/2011-Homeless-Count/HC11..PDFfile National Association of Social Workers. (2013). Code of Ethics. Retrieved from National Alliance on Mental Illness. (2003). Dual diagnosis and integrated treatment of mental illness and substance abuse disorder. Retrieved from Sun, A. (2012). Helping homeless individuals with co-occurring disorders: The four components. Social Work, 57 (1),