AB 109 Realignment and MHSA Housing Anne Cory

AB 109: Realignment and MHSA Housing Anne Cory Corporation for Supportive Housing MHSA Housing Program TA Webinar January 25, 2012 www. csh. org

What to Expect Today n n 2 Not a full explanation of Realignment Focus on MHSA Housing Program impact How to apply what we’ve learned in the Housing Program to meeting your community’s needs under realignment Housing lens

Agenda for Webinar Introduction to Realignment – Criminal Justice Realignment – Other Realigned Programs § Opportunities for Mental Health Staff § Why We Should Care About Housing? § CSH Programs: Returning Home Initiative and FUSE n 3

Introduction to Realignment n n 4 The 2011 realignment plan shifts responsibility and funding for numerous programs from state to local levels. Revenues for local management of programs exceed $6 billion per year. Realignment revenues are deposited into a complicated series of accounts in the new Local Revenue Fund 2011. Counties are agitating for commitment of adequate revenues long term.

Criminal Justice Realignment n 5 Realigned Criminal Justice Programs include: – Adult offenders and parolees; – Court security; – Pre-2011 juvenile justice realignment; – Misc. local public safety grant programs.

Realignment of Health and Human Services Programs n n n 6 Mental Health Managed Care EPSDT Drug and Alcohol Programs Foster Care and Child Welfare Services Adult Protective Services Cal. WORKS/Mental Health Transfer

What Does Realignment Look Like at the Local Level? n n n n 7 Need for substance abuse treatment services Need for mental health services Numbers are not matching projections No benefits sign-ups before return to community Dropping offenders at Mental Health Department Law enforcement lacks knowledge to assess and refer appropriately Intense focus on criminogenics and recidivism

How Does it Look in Your Communities? n n 8 Challenges Loose ends Collaboration Successes

What Issues Can You Address at the Local Level? n n n 9 Discharge Plan: The discharge plan should include probationers’ or parolees’ treatment and other service needs. Probation and parole conditions should be the least restrictive necessary. Probationers and parolees with mental illness or co-occurring disorders should be supervised by probation officers and parole agents with specialized mental health training and reduced caseloads.

What Issues Can You Address at the Local Level? n Probation officers and parole agents should: – reorient the supervision process from enforcement to intervention and ensure that it is community-based. – ensure that probationers and parolees with mental illness receive the services and resources in their discharge plans and are connected to a 24 -hour crisis service. – Develop working agreements with community-based service providers to increase coordination of supervision and treatment goals and to ensure continuity of care once supervision is terminated. 10

What Issues Can You Address at the Local Level? n n n 11 Benefits enrollment – asap Access to psychiatric medications Enrollment in service programs (probationers are eligible for MHSA services, parolees are not)

What are the Barriers at Release? n n n n n 12 No identification, SSI, birth certificate No disability determination Definitions of homelessness can exclude people coming from correctional settings Hard to access health or mental health services Lack of affordable housing resources and access issues Limited income Legal and illegal discrimination (criminal record, mental illness, substance use, homelessness, poverty, race) Post traumatic stress disorder, difficulty reintegrating Family reunification issues, particularly for women

Opportunities for Mental Health Staff n n Planning through Community Corrections Partnerships Community Corrections Partnership recommends local plan for realignment implementation to county board of supervisors. – Executive Committee of CCP: Chief Probation Officer, Chief of Police, Sheriff, District Attorney, Public Defender, Superior Court Presiding Judge, County health & human services representative. 13

Opportunities for Mental Health Staff n n 14 Counties have a lot of discretion on how to use funds: – State providing per parolee amount, per inmate amount, plus additional funding for “innovative” alternatives to incarceration. Opportunity to weigh in to influence how funding is spent (i. e. , diversion programs, housing, services, etc. )

Why Should We Care About Housing? Task Force for Criminal Justice Collaboration on Mental Health Issues: Final Report RECOMMENDATIONS FOR CHANGING THE PARADIGM FOR PERSONS WITH MENTAL ILLNESS IN THE CRIMINAL JUSTICE SYSTEM APRIL 2011 15

Why Should We Care About Housing? n n n 16 Many individuals with mental illness are released from jail and prison without housing arrangements, making it nearly impossible to succeed in managing their mental illness. The California Department of Corrections and Rehabilitation (CDCR) reports that, at any given time, 10 percent of the state’s parolees are homeless. The percentage of parolees who are homeless ranges from 30 percent to 50 percent in major urban areas such as San Francisco and Los Angeles.

Why Should We Care About Housing? n 17 Appropriate housing in the community at the time of release is critical for successful reentry for offenders with mental illness since it serves as the foundation from which this population can access treatment and supportive services. Every offender with mental illness leaving jail or prison should, as a part of his or her discharge plan, have in place an arrangement for safe housing.

What Can We Do About Access to Housing? n n 18 Take on the role of housing advocate for the releasee, and ensure that community partners are doing so as well. Establish agreements with housing programs, including supportive housing, to develop a housing referral network.

What Can We Do About Access to Housing? n n 19 Make MHSA Housing Program units available to offenders with mental illness. Ensure that your county plan includes equal access to MHSA housing for offenders with mental illness.

AB 826 n n Sponsored by CSH & Housing California Authored by Toni Atkins Funding since FY 2007 -08 for program Department of Corrections & Rehabilitation (CDCR) calls the “Integrated Services for Mentally Ill Parolees” program. RFP in 2009: – Mental health services for mentally ill parolees in community. – Unclear whether housing costs could be funded. 20

AB 826 n n Bill would use funds now used for ISMIP to create a supportive housing programs for parolees with mental illness at risk of homelessness. Specifically, would— – Identify inmates at risk of homelessness and parolees who are currently homeless as potential participants; – Offer services to some participants before release to parole; and – Provide housing subsidies and services to participants 21

CSH Work: Housing for Criminal Justice. Involved Individuals

Corporation for Supportive Housing CSH is a national non-profit organization that helps communities create permanent housing with services to prevent and end homelessness. CSH advances its mission through advocacy, expertise, innovation, lending, and grantmaking. 23

Why We Do It: Lavelle’s Story § Lavelle has been arrested more than 150 times, largely for quality-of-life crimes § He suffers from schizophrenia, depression, and drug addiction § Has had inconsistent mental health care and multiple encounters with drug treatment programs § He has spent most of the last 12 years on a revolving door between streets, shelter, hospitals, and jail 24

CSH’s Frequent User Systems Engagement (FUSE) Initiative

The FUSE Premise Thousands of people with chronic health conditions cycle in and out of crisis systems of care and homelessness - at great public expense and with limited positive human outcomes. Placing these people in supportive housing will improve life outcomes for the tenants, more efficiently utilize public resources, and likely create cost avoidance in crisis systems like jails, hospitals and shelter. 26

The Beginning: New York City FUSE n n Demonstration program matching “frequent fliers” with permanent supportive housing and enhanced services. 190 frequent users of jail and shelter, identified through pre-generated data match DHS DOC 27 Neither System

The Blueprint for FUSE

Three Pillars, Nine Steps 29 Data-Driven Problem. Solving Policy and Systems Reform Targeted Housing and Services Cross-system data match to identify frequent users Convene interagency and multi-sector working group Create supportive housing and develop assertive recruitment process Track implementation progress Troubleshoot barriers to housing placement and retention Recruit and place clients into housing, and stabilize with services Measure outcomes/impact and cost-effectiveness Enlist policymakers to bring FUSE to scale Expand model and house additional clients

Cross-System Data Match Provides Recruitment List 0 Q 7? 240 M 1&$F 041% 4 BN@!0 N 4 10 N 01&1? LA 8&28&$ NAME 30 CLIENT_ID 29%@1 A$G AN 940$@# L&81!NA 8 A 2 OFAN(1 0187&1? 3 DOC_LOS DHS_LOS SHELTER DOCFacility Zeilinger, L. 9862966231 45 98 USICH EMTC Hobson, B. 9862966248 64 132 DESC BBKC Kanis, B. 2511910236 75 64 Com. Sol RMSC Cho, R. 7890826000 23 156 CSH EMTC

Results of Cross-System Data Match DHS DOC Neither System 31 Source: Urban Institute

Implementation through Collaboration 32 Partner Role NYC Dept of Correction Data matching, program oversight, policy advocacy, service enhancement funding, facilitate jail in- reach NYC Dept of Homeless Services Data matching, program oversight, policy advocacy, service enhancement funding, facilitate shelter in-reach NYC Dept of Health and Mental Hygiene Services and operating funding and program oversight CSH Program design, assembled and coordinated funding, program oversight and troubleshooting, TA/training, NYC Housing Authority / Housing Preservation and Development Provide Section 8 vouchers JEHT Foundation / Langeloth Foundation Provided funding for service enhancements and evaluation NYC Office of Management and Budget Program oversight John Jay College / Columbia University Program evaluation

Assertive Recruitment Through Jail, Shelter, Hospital In-Reach Courts Psychiatric Hospital Jail/Prison Shelter Street Alcohol/Drug Treatment Hospital Detox 33

Supportive Housing n n n 34 Section 8 Housing Choice Vouchers (or State rental assistance programs) + Mobile Intensive Case Management Services Unit set-asides in new supportive housing buildings or existing supportive housing with turnover Providers trained in Motivational Interviewing, navigating criminal justice system, harm reduction, recognizing “symptoms” of incarceration

Stabilization through Services n n n 35 Low case manager-to-client ratio (1: 10 – 1: 15) Case manager role as “client advocate” and “failure preventer” Emphasis on reduction of “risky behaviors” Non-judgmental, client-centered counseling Team approach to services delivery

“Systems Change” Through Case Coordination n 36 Monthly implementation monitoring meetings to track recruitment, housing placement, housing retention, and recidivism prevention Case conference and intervention in cases of rearrest or re-hospitalization Wraps “system of care” around tenants with supportive housing provider in central coordinating role

Measure Outcomes and Cost. Effectiveness Crisis services use ($) 2 years before FUSE — Crisis services use ($) 2 years after FUSE — FUSE cost over 2 years = 37 Net Savings of FUSE over 2 years

Getting to Policy Adoption and Scale n Bringing FUSE from pilot to full policy: – Early engagement of policymakers, budget officials around the FUSE “experiment” – Communication of outcomes and costoffsets – Advance redirection of public spending from jails, shelters, etc. to supportive housing 38

Sites Implementing or Planning FUSE Replications Implementing FUSE 39 Planning FUSE

Prior Research on High / Frequent Users n n n 40 Hopper et. al. (1997) found that long-term homeless persons with severe mental illness experienced an “institutional circuit” that includes shelters, jails, ED, detox Kuhn and Culhane (1998) found that approximately 10% of shelter users in New York City were ‘episodic’ users of shelter – These individuals are “more likely to be non-White, and to have mental health, substance abuse, and medical problems. ” – “Much of the periods they spend outside of shelter may be spent in hospitals, jails, detoxification centers, or on the street. Indeed, one could argue that part of the very reason that these individuals do not become chronically homeless or long-term shelter residents is their frequent exit to inpatient treatment programs, detoxification services, or to penal institutions. Nevertheless, these clients often find their way back to shelters. ” Culhane et. al. (2002) found that homeless persons with serious mental illness cost $41, 000 annually through usage of emergency public systems Ford (2005) identified 61 frequent flyers of a FL county jail, of whom 82% were homeless, 100% had substance abuse history, and 51% had a mental health history Gladwell (2006) described individual who cost roughly $1 million in public service utilization

Characteristics & Service Needs of Jail-Shelter Frequent Users n n 41 Believed to have high rates of co-occurring and complex issues: – Alcohol and substance use (approx. 80%); earlier data matches found high utilization of crisis drug treatment services (i. e. Medicaid-reimbursed detox) – Mental health issues (est. 30 -50%), including serious mental illnesses (est. 25 -40%) Criminal offenses largely consists of low-level misdemeanors (i. e. “quality of life” crimes), with minor felony histories

Characteristics & Service Needs of Jail-Shelter Frequent Users n n 42 Histories of transience and high level of involvement in multiple systems and services Providers report: – Lack of trust in service providers and inconsistent benefits enrollment – Comparatively high occurrence of behavioral issues and lower degrees of independent living skills – Individuals are difficult to keep in one place and need nearly constant hand-holding as they navigate systems involvement

Research Suggests that Housing with Services Can Break the Cycle n n 43 Intensive service models such as Assertive Community Treatment or Intensive Case Management reduce recidivism Supportive housing significantly reduces involvement in jails and prisons (along with shelter, hospitals, etc. ) among homeless persons with serious mental illness

Criminal Justice So cia l Em plo y es vic r Se He a Beh lth an d a v i or H e alt al h Housing 44 me nt Fractured Systems

Aligning Multiple Systems for Better Results Criminal Justice Housing NYS DOC HUD Social Services Shelter + Care Shelter Plus Care Public Housing Authorities NY/NY III Section 8 45 Service Contracting through Criminal Justice/Human Service Agencies NYC DOC PAROLE PROBATION Bridge Rental Support Client Identification Transitional Case Management Health and Behavioral Health Mental Health Support Services Housing Support ACT Teams Supportive Housing Employment Initiatives both Federal and Local

CSH Returning Home Initiative n n n 46 CSH's Returning Home Initiative started in 2006 and applies the FUSE model in communities across the country. Initiatives integrate the systems and resources of criminal justice, behavioral health, and housing agencies. CSH partnered with a number of leading researchers, including the Urban Institute, the John Jay College of Criminal Justice, the University of Minnesota and Columbia University.

CSH Returning Home Initiative: Early Findings n n n 47 A 39% reduction in the number of days in county jail for participants in Hennepin County. A 50% reduction in the number of days in jail for participants in New York, compared to a comparison group. A 43% reduction in the number of nights spent in shelter by participants in Hennepin County over the course of 22 months.

CSH Returning Home Initiative: Early Findings n n n 48 Preliminary findings from New York show that after 12 months, only 16% of the program group had any shelter admission compared to 98% of the comparison group. Preliminary findings from New York show lower rates of alcohol and drug abuse—specifically injection drug use—among people in the program. In addition, the proportion of people with earnings and/or entitlements is much higher for people in the program.

To Learn More About CSH, FUSE and Returning Home Anne Cory anne. cory@csh. org 510 -251 -1910 x 208 www. csh. org And help with the MHSA Housing Program 49