3/13/23, 4:20 PM caloptimanofo
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Submitted Date
03/02/2023
How many CalOptima members do you currently provide services to annually? 15,192
Please select the age groups served by your organization:
0-18, 18-49, 50-65, 65+
Please select which CalOptima Health Threshold Languages your services are available in:
Arabic, Chinese, English, Farsi, Korean, Spanish, Vietnamese Please select the areas of Orange County in which your organization currently or expects to provide services.
North Region: Anaheim Brea, All North Region, All Central Region, All South Region Notice of Funding Opportunity Application
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https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 2/13 Please indicate which populations of focus your organization has expertise in serving:
Individuals and families experiencing homelessness., Adults, youth, and children who are high utilizers of avoidable emergency department, hospital, or short-term skilled nursing fa, Adults with serious mental illness or substance use disorder., Adults and youth who are incarcerated and transitioning to the community., Adults at risk of institutionalization and eligible for long-term care.
Are you currently contracted to provide Enhanced Care Management (ECM) services through CalOptima Health?
No
If not are you willing to become an ECM provider?
No
Are you currently contracted to provide Community Supports through CalOptima Health?
No
If not are you willing to become a CS provider?
No
Under which funding opportunity are you applying?
Only organizations with budgets of $5M or less are eligible to apply for Equity Grants.
Capacity Building
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https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 3/13 Provide a brief description of the proposed program and the need it addresses.
The City of Anaheim is piloting a court diversion program named the Anaheim Collaborative Court – Evaluating Strategies & Solutions (ACCESS). The pilot aims to assist individuals experiencing homelessness with a co-occurring mental health and/or substance use condition and who are justice involved with the opportunity to be arraigned and connected to housing, health, and mental health services in lieu of serving jail time. The pilot strategically focuses on identifying and serving individuals with repeated interactions with the criminal justice system to disrupt the process of individuals cycling in and out of local jails. The hallmark of the program is building a system of intervention that can engage unhoused justice-involved individuals before they are discharged back to homelessness. In Anaheim, though significant homeless outreach efforts, there is growing awareness of the individuals who are likely to benefit the most from these services. The pilot has already secured the support of the Orange County Court system, with two court clinicians, a paralegal, and public defender retained to help with assessing needs after arraignment and working proactively with pilot participants to craft individual wellness and housing plans.
The initial work to support the pilot gears towards service mapping and formalizing partnerships.
Orange County has many established, experienced providers who collectively address most service needs. A function of this effort is for all to work together to address mental health, substance use disorder, medical, housing, and other treatment services necessary to engage a population that is often service resistant.
The City’s Housing and Community Development Department has a dual role in the delivery of this pilot. We are the grant administrator for the program’s initial seed funding and we are leading the efforts to address housing gaps. For the latter, our efforts center around securing funding for transitional housing for participants who have a high need for detox services and vocalize a desire for a supportive and sober living environment as part of their treatment plan.
The City invests heavily into the creation of permanent housing placement and prescribes to the Housing First model in all our housing programs. However, through our work, we also recognize the growing need for a transitionary placement before connection to permanent housing. It is widely recognized that there is a lack of affordable housing, seen more acute in the PSH sector, in Orange County. Having the ability to offer transitionary placements to individuals who are ready to accept services, specifically detox and sober living options, helps address a gap in the housing continuum.
As anecdotal evidence of the potential impact of this program, since program start on January 9, 2023, six individuals in Anaheim meeting the target population have engaged with the court who were historically service resistant. ACCESS has enticed five of the six to volunteer to enter the program to assist with the root causes of their homelessness and work on a healing/housing plan.
The immediate response was positively received; however, the need for additional transitional housing while they work through their plans became evident. 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 4/13 Describe how your program embraces the principles of trauma-informed care, non-residency restrictions, and aligned with housing-first and harm reduction principles .
The ACCESS pilot is an effort between the City and County Court systems, service providers, and community advocates. Pilot staff have engaged extensively with the homelessness and recovery community and used their feedback to embed best practices and core principles of each field into program design. All City programs follow housing first/low barrier principles and these expectations are set for providers working on behalf of the City to ensure their operations align with City goals.
For this pilot, staff works especially close with sober living providers to prioritize housing retention; emphasizing connections to supportive services to maintain housing. We prioritize trauma-informed programs, investing in many diversified service providers to serve specific populations. The City has invested in building our data infrastructure to understand program performance and populations served. As such, the City set equity goals to address overrepresentation of subpopulations experiencing homelessness. The City has committed state funding without residency restrictions to the rapid rehousing component of this pilot. This funding along with potential funds from CalOptima will work in tandem to serve people with lived experience (PLEH) regardless of residency status.
The City recognizes best practices to address homelessness and commit to housing being the solution. To address needs holistically and taking feedback from PLEH, the local system of care needs additional sober living beds. PLEH have voiced the need for a safe space to maintain and commit to recovery as part of an individualized plan to housing. The pursuit of funding for transitional beds in sober living homes is not an attempt to enact preconditions on access to housing but a way to create person-centered solutions that come directly from personalized treatment plans. Our hope is to address and reduce rising homeless deaths by reaching individuals at various points including at our courts along with on the streets.
List 3-5 measurable objectives of the program.
Objective 1
Increase number of people connected to pilot services that come off the by-name-list of known, service resistant individuals by 15-20 people between January 2023 to January 2028 Objective 2
Increase number of transitional housing/sober living placements for high needs individuals by 20 people between January 2023 and January 2028
Objective 3
Increase number of connections and placements to dedicated rapid rehousing program by 20 people between January 2023 and January 2028
3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 5/13 Objective 4
Between January 2023 and January 2028, sustain rapid rehousing placements for 20 participants enrolled into dedicated rapid rehousing program for an additional year either through continued subsidy or through self-sufficiency
Objective 5
Divert 4 people annually (20 total) between January 2023 and January 2028 from utilizing emergency services related to overdose or high-risk harm 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 6/13 Briefly describe the anticipated outcomes of the program including how the request increases the number of people connected to permanent housing or number of permanent housing units.
We anticipate that the program will result in an increased number of people with high needs connected to the resources and support they need to resolve their homelessness, address physical and mental health concerns, and disrupt the continuous cycle in and out of the judicial system. The City of Anaheim has extensive networks and partnerships that can help with a plethora of services from storage units to use they pursue their goals to enrollment into rehabilitative services. The gap in federal, state, and local funding contributes to the dearth of transitional housing beds in sober living programs. Many of our recovery advocates identified sober living as the needed pit stop before someone makes their transition to independent living with permanent housing. We see this as a unique opportunity to create a pathway that currently does not exist for individuals that are in a cyclical loop and for whom standard programs have not been successful.
The pilot seeks to serve as many households as our referral partners can refer and that the funding will allow. The current requested amount through this grant would assist roughly 40 participants with up to 18 months of transitional housing. Through conversations with care providers and advocates, we anticipate participant stays in sober living to range anywhere from six months to 18 months.
Thus, the pilot has the potential to serve more clients than anticipated depending on need. After completion of their stay in sober living, the City is ready to receive program participants in our dedicated rapid rehousing to help secure permanent housing, which includes rental assistance for up to 24 months in market rate units. The City has its own Housing Authority with a plethora of different housing vouchers that participants can be connected to if their rapid rehousing subsidy ends and they feel they cannot maintain rent on their own. The Anaheim Housing Authority prioritizes participants of city programs, such as the proposed rapid rehousing program, for connections to city vouchers increasing the chance of pilot participants securing voucher-supported housing after exit from transitional housing.
The pilot aims to serve the “hardest to house” population of people. The participants of this project are all high-needs, chronically homeless individuals who are living unsheltered; with many not connected to any type of housing, health, or mental health service. Through our community outreach teams and Anaheim Police Department, the City has an ongoing by-name list of people who are regularly encountered and repeatedly arrested or cited for infractions related to activities stemming from substance use or mental health conditions. Services were extended to five previously service-resistant individuals as part of the pilot program, who have accepted, effectively connecting 25% of the people on the by-name list to services since launch. The pilot has shown that it can reach a new subset of CalOptima Health-eligible members that have not traditionally engaged with the healthcare system or with health-inducing services as the pilot intercepts people at a critical time in which services are the alternative to possible incarceration. 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 7/13 Briefly describe how you will evaluate your program.
The City has a dedicated grants management team that will monitor and assess the effectiveness of the proposed program. This includes tracking participant statuses in meeting their health goals and housing outcomes. The City has effective and successful infrastructure in place to manage federal Housing and Urban Development Department grants and State of California grants, we will utilize this same structure and team to set up applicable invoicing and program reporting protocols for the CalOptima Health grant on a quarterly basis.
Similarly, the provider for our proposed transitional housing program will utilize the same processes to report on the measurable objectives stated above. As a practice, if the grants management team sees that a program is not meeting agreed upon metrics, we will set up regular check ins with service providers to ensure program participants are meeting milestones. In this case, the grants team will monitor the housing status of pilot participants every six months (for up to 18 months) to see if they are ready to be bridged to rapid rehousing. For participants that are not ready to be bridged, the grants management team will work proactively with our transitional housing provider to problem solve issues around housing barriers.
Briefly describe the impact this will have on CalOptima members.
All pilot participants are eligible for CalOptima Health membership and likely utilize CalOptima Health-funded services as their main source of primary and emergency healthcare. For individuals with multiple touches with the criminal justice system, we understand them to be high utilizers of the local healthcare system due to experiences with chronic mental health and substance use that lead to arrest. The pilot intercepts these households at a critical time and facilitates connections to community supportive services and housing to create holistic positive impact, including registering for CalOptima if not already registered to increase membership.
We anticipate the pilot would not only create improve health outcomes for participants through connection with physical and mental health providers but will also address the social determinants of health. The funding would create a housing resource that is person-centered and currently in limited supply. The participant will be bridged to a permanent housing solution and will have their progress to housing managed by providers that are working in tandem to make the pilot a success.
Lastly, the individual will have their court record expunged through the pilot to help facilitate a pathway to work and housing that will support their health journey. 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 8/13 Briefly describe how this will impact the homeless services system in Orange County.
At present, the local homeless services system has limited funds for transitional housing, under which sober living is an eligible use. Federal and state funding have deprioritized transitional housing, funding only programs that have been grandfathered in. New proposed transitional housing ranks lower in priority than permanent housing programs. While permanent housing is the end goal for all households served, there remains a niche of people experiencing homelessness that have stated that sober living is needed to assist in their journey to housing. The proposed funding would increase not just the stock of transitional housing available in the community but sober living beds available to people experiencing homelessness in Orange County.
Many people experiencing homelessness rely on MediCal-funded sober living beds that are already in limited supply. For-profit operators not contracted with CalOptima Health operate many available sober living beds in the County. Providers communicate that the homeless population have a hard time being able to meet the fees needed to enter sober living. This program allows people experiencing homelessness to stay in local programs rather than be sent to neighboring Los Angeles where there are limited ties to the community and familial support.
How does your organization incorporate the voice of lived experience into your programs?
The City recognizes the informed expertise that people with lived experience bring to our programs.
Every homelessness-planning document and many grant applications solicit the feedback of people with lived experience as a way to create a well-informed and equitable system of care. Starting in 2017, our Homeless Policy Working Group, which included PLEH, assisted in establishing a City resolution that was adopted and outlines the policy framework still used today to address homelessness. The City also sits on the local CoC Board which has a PLEH advisor whom we work with collaboratively to enact regional policies; many of which are enacted countywide following successful implementation first in Anaheim.
Through experience, our grants management team has heard from recovery advocates that work every day with people struggling with substance use conditions about the dearth of available sober living beds in the community and the need for an expanded stock of dedicated beds for people experiencing homelessness. Our team has also heard testimony from people with lived experience of homelessness on the need for a sober living option that is a complement to the housing first principle; for those in which a sober environment is key to maintaining sobriety and achieve recovery.
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https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 9/13 Describe how your proposed project will be sustained beyond the grant period.
The City of Anaheim intends to continue to pursue available funding that will stand up transitional housing in sober living facilities for people experiencing homelessness. We are actively outreaching to the state around the eligible uses for their Homeless Housing, Assistance and Prevention (HHAP) program dollars to expand the scope of their activities to include transitional housing for this particularly high needs group. The City is the anticipated recipient of future rounds of HHAP funding and is able to continue to support the project’s rapid rehousing component through this funding.
Additionally, the City is the recipient of ongoing opioid remediation funds that can help address opioid related disorders. With anticipated progress with this grant, our hope is to set a standard of best practices for those in need of transitional housing as a pathway to healing and housing.
Are there any media opportunities for CalOptima Health associated with this project?
The proposed project is working in tandem with County Court and other community partners and has the potential to gain traction as more people with high needs are connected to services off the street. As the pilot continues to assess and find ways to get people with co-occurring mental health and substance use needs to housing, we anticipate releasing more materials and press releases to the community to expand understanding of our services. Additionally, the City of Anaheim has our own Public Information Office through which media opportunities can be coordinated. With the support already provided we anticipate it to continue to grow and advertise as an innovative, creative, collaborative way to address one of our most vulnerable populations.
Provide the number of CalOptima Health members anticipated to be directly served through this program.
40 How many CalOptima Health members do you serve on an annual basis with housing navigation services?
15,192
How many more members, above and beyond those you already serve, will be reached through this project?
Subtract the number you usually serve from total numbers served. 40 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 10/13 How did you determine this was a capacity building need of your organization? The Anaheim City Attorney’s Office tracks the number of deaths that occur in the city every year.
Reports show that from 2017 to 2021, the City saw a 242% increase in deaths related to substance use amongst members of the homeless community. Through partnership with the recovery and homelessness services community, it was identified that the local system of care lacks sober living beds to connect homeless individuals to after detoxification. Individuals are likely to go through a 24-48 period of detoxification but do not have the means to connect to further sober living resources to sustain their sobriety and make gains towards housing.
In a study conducted by the United Way OC, chronically unhoused individuals were statistically more likely to utilize emergency care and court related services as compared to individuals in PSH.
Unhoused high utilizers, like those targeted by this pilot, absorb so many system resources that if the top 10% of high utilizers in the County were housed, the study anticipates cost of annual services to drop from $45,000 to $10,000 per person. This pilot aims to gain traction amongst the identified “hardest-to-serve” thereby increasing cost effectiveness of system resources while improving health outcomes for individuals .
Complete Program Implementation Plan with Timeline
Do you want to add additional Timeline Objectives?
Yes
Timeline
1/9/2023 to 1/9/2028
Objective
Increase number of people connected to pilot services that come off the by-name-list of known, service resistant individuals by 15-20 people between January 2023 to January 2028 Activities
Network and train outreach and law enforcement teams on pilot resources; create media and conduct extensive outreach amongst community members including service providers and judicial partners; update and confirm final list of known, service resistant individuals; facilitate referrals to ACCESS pilot
Success Metrics
75-100% decrease in the number of individuals on the current by-name list 3/13/23, 4:20 PM caloptimanofo
https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 11/13 Timeline (2)
1/9/2023 to 1/9/2028
Objective (2)
Increase number of transitional housing/sober living placements for high needs individuals by 20 people between January 2023 and January 2028
Activities (2)
Create and issue Request for Proposal to secure transitional housing service provider; review and conduct interviews with proposed transitional housing providers; create and set up monitoring policies for transitional housing program; network with community partners to facilitate referrals to pilot program; create protocols for referral to transitional housing; conduct monitoring and manage funding for transitional housing placements Success Metrics (2)
Increase ACCESS-funded transitional housing program enrollment by 20 individuals Timeline (3)
1/9/2023 to 1/9/2028
Objective (3)
Increase number of connections and placements to dedicated rapid rehousing program by 20 people between January 2023 and January 2028
Activities (3)
Create and issue Request for Proposal to secure rapid rehousing service provider; review and conduct interviews with proposed rapid rehousing providers; create and set up monitoring policies for rapid rehousing program; create protocols for referral from transitional housing to rapid rehousing; conduct monitoring and manage funding for rapid rehousing placements Success Metrics (3)
20 newly executed lease agreements for pilot participants for a period of at least one year Timeline (4)
1/9/2023 to 1/9/2028
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https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 12/13 Please go to the below link, make a copy of the Budget Template, and complete in its entirety.
Program Budget Template
(https://docs.google.com/spreadsheets/d/1fSxuLRTwQrCxOXTjON7P_tc6SSwF4Can/edit? usp=sharing&ouid=116524157908335869738&rtpof=true&sd=true) Objective (4)
Between January 2023 and January 2028, sustain rapid rehousing placements for 20 participants enrolled into dedicated rapid rehousing program for an additional year either through continued subsidy or through self-sufficiency
Activities (4)
Conduct monitoring and manage funding for rapid rehousing placements; create tracking policies for follow up with rapidly rehoused participants; network with supportive services providers to increase chances of housing retention; determine policies for connections to deeper subsidies if needed
Success Metrics (4)
20 sustained or newly executed lease agreements for pilot participants for a period of at least one year
Timeline (5)
1/9/2023 to 1/9/2028
Objective (5)
Divert 4 people annually (20 total) between January 2023 and January 2028 from utilizing emergency services related to overdose or high-risk harm Activities (5)
Network and train outreach and law enforcement teams on pilot resources; create media and conduct extensive outreach amongst community members including service providers and judicial partners; facilitate referrals to ACCESS pilot Success Metrics (5)
Reduce ambulatory and emergency overdose services calls to Anaheim Fire Department related to people experiencing homelessness by 5%
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https://webportalapp.com/sp/task_item_primary_view/caloptimanofo?path=46722771 13/13 Please upload your completed Program Budget using the provided template:
Anaheim CalOptima CapaBuild Budget.xlsx
Total Project Budget
$500,000.00
Total Request from CalOptima Health
$500,000.00
Type of Entity:
Government
Upload the Following Documents
Organizational Budget
For current fiscal year.
City of Anaheim FY 2022-23 Adopted Budget.pdf
Most Recent Statement of Activities
Anaheim ACCESS Info Flyer.pdf
(http://www .wizehive.com/)
Attachment A: Anaheim Capacity Building Program Budget
Organization Name:
Project Title:
Project Start Date:
Project End Date:
Amount Requested
REVENUE
200,000$
‐$
200,000$
Amount Requested
Salaries Annual Salary % FTE
General Manager 52,000 $ 7% 3,640$
Housing/Placement Coordinator 39,350$ 15% 5,903$ Data Entry‐ Client Intake & Exits 16,126 $ 15% 2,419$ Vice President Of Operations 66,050$ 5% 3,303$ CFO 68,250 $ 5% 3,413$
18,676$
Benefits (enter your value) 5% 934 $
19,610$
109,278$
3,276$
2,808$
10,764$
19,188$
1,638$
146,952$
166,562$
Indirect Rate (enter your value) 20% 33,312 $
199,875$
199,875$
Request from CalOptima Health
PROGRAM BUDGET TEMPLATE
Anaheim Housing Community Development
ACCESS Pilot Transitional Housing
14‐Dec‐22
14‐Dec‐27
Utilities
TOTAL REVENUE
EXPENSES
Subtotal for Salaries
Subtotal for Salaries + Benefits
Direct Expenses
Rent & Renter's Insurance
Repairs and Maintenance (including pest control)
Program Supplies
Phone and Internet
TOTAL
Program Surplus <Deficit>
Laundry
Subtotal for Direct Expenses
Subtotal for Salaries, Benefits and Direct Expenses
Subtotal with Indirects
Consultants
The ACCESS program is designed around meeting the individual where they are at in the criminal process.
ACCESS is designed to intervene at the earliest stage of the criminal justice proceedings – at arrest and prior to arraignment – to offer an assessment for risk and needs by a licensed clinician. That clinician creates a treatment plan to share with the client and his public defender. From that point, ACCESS assigns a case manager who then navigates the individual through the treatment plan assisting the individual with their housing and medical needs. ACCESS offers are made in lieu of custodial sanctions.
ACCESS is designed to take referrals not only at in-custody, but also at in the field with outreach and engagement teams, homeless outreach police officers, court proceedings, and from community partners who identified certain individuals who may be benefited from an individualized treatment plan.
How the Program Works
Background
The challenge of the criminal justice system is dealing with the revolving door syndrome where low-level misdemeanor offenders cycle through the system without access to services, mental health and substances abuse care, or meaningful incentives to engage with service providers. To address this problem, the City of Anaheim has engaged the Orange County Public Defender’s Office and the Orange County Superior Court creating the Anaheim Collaborative Court Evaluating Strategies and Solutions or ACCESS.
Population
ACCESS prioritizes chronic
misdemeanor offenders with acute
drug addictions and mental health
issues. Most of ACCESS participants
are chronically homeless with high
needs who have been service
resistant in the past.
ANAHEIM COLLABORATIVE COURT EVALUATING
STRATEGIES AND SOLUTIONS (ACCESS)
ACCCESS Goals
The primary goal of the program is reduction in recidivism secured through changes in individual behavior.The program seeks to improve the quality of life for the community and the individual. Ultimately, the goal of ACCESS is to have the individual successfully in treatment and dismissal of open criminal cases.
ACCESS Requirements
In order to successfully complete the ACCESS program, the individual must be screened and assessed by a clinician for housing and treatment. The clinician is charged with screening the individual for mental health, substance use, and criminogenic factors to determine their risk of recidivism. From there a treatment plan is created and the individual is assigned a case manager. Based on the individual treatment plan, the person may be in the ACCESS program from anywhere from 6 months to 18 months. ACCESS requires the person to be housed, connected and engaged in treatment.
Attachment B: Informational Flyer