1. Homeless Housing Initiative May 13, 2016

2. Homeless Housing Initiative Overview 2 In the next several slides we will discuss: The Recovery Philosophy The primacy of stable housing as the foundation of recovery The high public cost of failure to act The Housing First Model foundations and practices Accomplishments to date A real-life example Next steps

3. What is Recovery? The Substance Abuse Mental Health Services Administration (SAMHSA) defines recovery as: “A process of change, through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” 4 major dimensions that support a life in recovery: Home Health Purpose Community 3

4. SAMHSA 10 Guiding Principles of Recovery Hope Person-Driven Many Pathways Holistic Peer Support Relational Culturally-Based Trauma Care Strengths/Responsibility Respect 4

5. Maslow’s Hierarchy of Needs 5 Food, Water and Shelter are the foundation of all human needs

6. The High cost of Homelessness: a Health Hazard which No One Can Afford 6 Higher rates of E.R. & Inpatient Admissions Longer average length of stays Higher prevalence of addictions Higher prevalence of HIV/AIDS Higher prevalence of incarcerations Increased long-term ailments: HTN, diabetes, COPD, hepatitis, STDs, tuberculosis, cancer, heart disease

7. Housing First Model 7 We support our members’ desire to live, work, and play in the community of their choice without preconditions and barriers to entry: Affordable Permanent Supported Housing No admission barriers No sobriety and/or treatment adherence requirements Private apartment setting Low demand, non-intrusive setting Flexible provider support model that honors members’ stage of treatment readiness Accessibility without demonstrating independent living readiness Support services that include: – motivational interviewing, trauma informed care, substance abuse treatment, peer support, living skill development, social skill development, and support navigating the system

8. Laying the foundation to housing supports: Identifying and Engaging Stakeholders 8 Community Outreach Specialists (COS) have begun the process of identifying and outreaching local Continuums or Cares (CoCs) in their regions COS, CoCs and other vested partners are building mutually supportive relationships The COS team attends monthly meetings with the CoCs and other housing partners to obtain a thorough understanding of the specific housing supports in each county

9. Laying the foundation to housing supports: Training 9 We have developed community-specific “Housing Flow Sheets” to help the Care Coordination teams identify the availability and accessibility of the housing resources in each region. We are working with community partners to train our teams to use the VI-SPDAT and are evaluating internal options for VI-SPDAT training. We are working to finalize agreements allowing MCC access to the HMIS system We are developing a comprehensive training curriculum, relevant to our Housing Program and Philosophy to ensure our internal organization understands the essential nature of housing to our members’ ability to recover

10. Laying the foundation to housing supports: Putting the Pieces in Motion - Commitment 10 MCC is currently using our existing system of care to place members on a regular basis. Our Care Coordination teams are completing the VI-SPDATs. We are collecting data to assist in our analysis of member housing and healthcare needs and to provide evidence on which to base our best practice guidelines. We are collaborating with local CoCs to place members when able.

11. 2016 Accomplishments to date Developed reporting mechanism within our electronic medical record to identify homeless members Established HMIS agreements with many of the CoCs Developed staff expertise in completing the VI- SPDAT Developing relationships with housing agencies; Florida Housing Finance Corp, Goodwill Industries, Ability Housing Members are moving into permanent supported housing apartments Developing data reports to identify cost savings from housing the homeless 11

12. Steve’s Story Steve, a Magellan Complete Care (MCC) member is a 59 year old man who had been chronically homeless for the past three years. Prior to receiving stable housing, he survived outdoors in parks and behind stores; sleeping on benches to avoid the ground and what comes with the ground; dampness, dirt, and bugs. He also used hospitals when he “couldn’t take it anymore”. The emergency room would provide respite, a hot meal, a climate controlled environment, safety, and a good night’s sleep. Steve was admitted into a hospital seven times in the last half of 2015. He reported having suicidal ideations as a result of his homelessness. He expressed feeling worthless and no longer could find meaning in his life. He talked about ending his life and had a specific plan to do so. Steve did not have any social supports. This all changed when his MCC Health Guide found a new permanent supported housing project targeting homeless disabled individuals in West Palm Beach. 12

13. Next Step Strategies 13 Increase Safe Haven and/or transitional facilities that adhere to a Housing First philosophy –Reduce imminent risk to homeless members that are being discharged from inpatient settings and/or jail Create flexible crisis prevention fund to prevent evictions and utility disconnections Create flexible move-in assistance fund for application fees, deposits, first/last months of rent, and household items Develop state and local campaigns to end homelessness for individuals with a serious mental illness similar to the “End Veterans’ Homelessness” campaign Develop mobile health clinics for the homeless using telehealth and other available technologies

14. Questions? 14