50. 22-1174
Recommendation to receive and file a presentation from Project Dignity.
COUNCILWOMAN SUELY SARO, SIXTH DISTRICT
Office or Department:
Suggested Action: Approve recommendation
Supplemental
Resources
The Way Home
Coordinated Access
COALITION
H FOR THE
HOMELESS
Houston Master Plan
System Operations Manual* *June 2022 - Currently being updated TX - 700 Continuum of Care
San Francisco
Road map
https://www.homelesshouston.org/
Appendix
The Way Home
Cordinated Acdess
Housing Prioritization Tool
Answer Score
1a Chronic? Yes/No/Logic 25
1b Where did you sleep last night? (only show if chronic = no) Streets/Logic 1c Shelter/Logic
1d Have you been homeless before? (only show if chronic = no) Yes 1e How many times have you been homeless in the past 3 years? (only show if chronic = no) >4 2 Frequent yes/no from dashboard (don't ask) Yes 2
Do you or anyone in your household have a disabling condition? (only show if chronic = no) Yes/Logic 4 How many times in the past 6 months have you accessed medical services in the ER? 1/Logic 2 3 3
4 4
5+ 5
5a Do you have a serious physical health condition that requires frequent medical care? (Examples: symptomatic AIDS, cancer, Yes/No/Logic 3 tracheotomy, colostomy, open wounds with instructions to keep clean, end-stage renal disease, end-stage liver disease, amyotrophic lateral sclerosis (ALS or Lou Gherig's disease) terminal illness, or in hospice) 5b Observation: Assessor, do you observe signs or symptoms of a serious physical health condition? Yes 5 6a Has a doctor or professional ever recommended mental health services? Yes/No/Logic 2 6b Observation: Assessor, do you observe signs or symptoms of a mental health condition? Yes 7a In the past year, have your drugs or alcohol usage had a negative impact on your life? Yes/No/Logic 7b Observation: Assessor, do you observe signs or symptoms of drugs or alcohol use? Yes 2 How many times in the past year have you been arrested or been in jail/prison/juvenile detention? 1/Logic 1 2 2
3 4
5+ 5
9 Have you experienced domestic violence in the past 60 days? Yes 2 10a Has someone asked (or forced) you to have sex or sell anything in exchange for something? Yes 10b Is someone threatening to harm you or your family if you don't do what they ask? Yes 1 11 Do you have income? No/Logic 1
Chronic Max: 51
Non-chronic Max: 38
PSH: 28+
Non C: 27-18
RRH: 17-10
Income: 9 & below
25 Coalition for the Homeless of Houston/Harris County | Housing Prioritization Subject: Service Delivery
The Way Home
Applies to: The Way Home Effective: 10/1/2020
PURPOSE:
To ensure that homeless individuals and families assessed through Coordinated Access receive services in the most expedient way possible and that access to homeless assistance prioritizes those with the greatest needs who are least likely to end their homelessness in the absence of CoC support.
POLICY:
It is the policy of The Way Home that individuals and families with the most severe service needs and the longest lengths of time homeless are prioritized for housing.
PROCEDURE:
The Harris, Montgomery, and Fort Bend County Continuum of Care and The Way Home, with the input from area homeless providers, have established guidelines that outline the order of priority for housing homeless individuals and families. All current and newly developed Permanent Supportive Housing beds have been dedicated to individuals and families that are chronically homeless. All Permanent Supportive Housing turn-over beds have been prioritized for individuals and families that are chronically homeless. All Rapid Rehousing beds have been dedicated to literally homeless individuals and families. The goal of this policy is to ensure that those individuals and families who have spent the longest times in places not meant for human habitation or in emergency shelters, and who have the most severe service needs are prioritized for housing. Severity of service needs refers to individuals or families who have a history of high utilization of crisis services such as emergency rooms, jails, and psychiatric facilities and significant health or behavioral challenges such as substance use disorders or functional impairments.
ORDER OF PRIORITY IN COC PROGRAM FUNDED PERMANENT SUPPORTIVE HOUSING
1. First Priority - Chronically homeless individuals and families with a disability with the longest history of homelessness and the most severe service needs.
a. The chronically homeless individual, head of household of a family, or youth, when assessed through Coordinated Access, will be assigned a vulnerability score between 28-51, with 51 being the most severe service needs.
2. Second Priority - Literally homeless individuals and families with a disability and the most severe service needs. a. The literally homeless individual, head of household of a family, or youth, when assessed through Coordinated Access, will be assigned a vulnerability score between 18-27, with 27 being the most severe service needs; and i. the CoC has not identified any chronically homeless individuals, families, or youth who meets all of the criteria for housing under the first priority.
3. Third Priority - Literally homeless individuals and families with the most severe service needs. a. The literally homeless individual, head of household of a family, or youth, when assessed through Coordinated Access, will be assigned a vulnerability score between 18-27, with 27 being the most severe service needs; and i. the CoC has not identified any chronically homeless individuals, families, or youth who meets all of the criteria for housing under the first priority.
ORDER OF PRIORITY IN COC AND ESG PROGRAM FUNDED RAPID REHOUSING
1. Priority - Literally homeless individuals and families a. The literally homeless individual, head of household of a family, or youth, when assessed through Coordinated Access, will be assigned a vulnerability score between 10-17, with 17 being the most vulnerable.
ORDER OF PRIORITY IN COC, ESG, & HOME PROGRAM FUNDED HOMELESS PREVENTION & DIVERSION
1. Priority - Imminent or at-risk of homelessness or literally homeless a. The imminently or at-risk of homelessness individual, head of household of a family, or youth, when assessec through Coordinated Access, will be assigned a vulnerability score between 0-9, with 9 being the most vulnerable Table of Contents
Introduction .... ...3
Purpose. ...3
Definitions. ...6
Target Population ..13
System Overview and Workflow.. ..13
Coordinated Access Workflow .. .14
Coordinated Access Policies and Procedures .... ..15
1. Connecting to the Coordinated Access System .15
2. The Housing Assessment Process ....15
.. •
3. Housing Matching ..16
4. Housing Referral. ..17
5. Case Conferences. .22
Fair Housing, Tenant Selection Plan, and Other Statutory and Regulatory Requirements.. ..22 Evaluating and Updating Coordinated Access System Policies and Procedures.. ...23 Termination ..24
Appendix... ..25
2 THE PECC
PROPOSAL
Long Beach Peer Education Community Center
Pam Chotiswatdi, MPH
Angela Lockhart Contact Pam
Ishqa Hillman 714-293-8043
[email protected]
ШО
PEER EDUCATION
Community Center
About
Peer Education Community Center is a working 501(c)3 community-based nonprofit focused on peer-to-peer education and support groups, systemic navigation, industry and community connections, and alternative wellness clinics & harm reduction spaces advocating for community-led programs, social justice, and systemic and social change.
INTERSECTIONS OF
HOMELESSNESS, Homelessness Trauma
DRUG USE, &
MENTAL ILLNESS
Drug use
Laura's Law, a program for people with severe
and persistent mental illness who may pose a
According to a 2020 count of homeless people risk to themselves or others and Newsome new required by the U.S. Department of Housing and proposal. But where do they go & what are the Urban Development. unhoused residents. treatments?
161,000 40K+
estimated unhoused persons in of unhoused persons have a California severe mental illness
Nationally, the figure was just over 20% of
https://www.pbs.org/newshour/nation/gov-
an estimated 580,000. gavin-newsom-proposes-court-ordered- mental-health-treatment-for-homeless-
people0%20unhoused%20residents.
According to Drughelpline.org, rehab costs can
range between:
It costs an average of about $106,000 per year
to incarcerate an inmate in prison in California. $250-$80K About three-quarters of these costs are for
security and inmate health care.
• Medical detox costs from $250 to $800 per day
• Intensive outpatient treatment can be anywhere from $3,000 to $10,000
• Outpatient rehab typically ranges between $1,400 and $10,000 • Residential addiction treatment is the most expensive, from $106,000 $5,000 to $80,000 or more
According to Senior Living.org, assisted-living
per year to incarcerate one
costs:
person in California
$35-$84K
Since 2010-11, the average annual cost
has increased by about $57,000 or about Yearly for residential care and assistance 117 percent. https://www.seniorliving.org/assisted-living/costs/ https://drughelpline.org/
https://lao.ca.gov/policyareas/cj/b_cj_inmatecost#:~:
text=It%20costs%20an%20average%20of,%2457%2C
000%20or%20about%20117%20percent.
EXPERIENCING
HOMELESSNESS
IS TRAUMATIC
IN ITSELF
1963 Community 1967 California
Mental Health Act
1967 Ronald Reagan is elected governor of
How California. At this point, the number of
With good intentions of
providing people with patients in state hospitals had fallen to disabilities and mental illness 22,000, and the Reagan administration Did We uses the decline as a reason to make cuts
humane care and shutting
the doors of horrific asylums, to the Department of Mental Hygiene. the Community Health Act They cut 2,600 jobs and 10 percent of the Get
also created a gap in care. budget despite reports showing that Families and communities hospitals were already below
were not equipped to handle recommended staffing levels. Reagan Here? signs the Lanterman-Petris-Short Act and
or develop the type of
programming needed to ends the practice of institutionalizing care for people with mental patients against their will, or for indefinite illness or disability amounts of time. This law is regarded by some as a "patient's bill of rights". Sadly,
the care outside state hospitals was
inadequate. The year after the law goes
into effect, a study shows the number of
mentally ill people entering San Mateo's
criminal justice system doubles.
From Stanford's Institute for EconomicPolicy Research (SIEPR) May 2022 Publication Homelessness in California: Causes and How Policy Considerations
Key Takeaways
Did We • California's homeless crisis is associated with high housing costs, inadequate shelter spaces, deinstitutionalization, and changes in the criminal justice system.
Get
• To improve housing affordability, California needs to streamline and accelerate housing production and reexamine the regulations that have hindered new housing development.
Here?
• To reduce the unsheltered homeless population, more shelter capacity and increased investment in cost-effective housing are needed. • A large share of the chronically homeless suffers from drug addiction and mental health problems. More treatment facilities and lower barriers for treatment are needed.
https://siepr.stanford.edu/publications/policy-brief/homelessness-california-causes-and-policy- considerations#:~:text=A%20dearth%20of%20shelters,emergency%20shelters%20and%20transitio nal%20housing.
Access to Mental Health Services
How The Kaiser Family Foundation reported in May 2022 that "Many MediCal (40%) and private insurance (45%) enrollees with mental health or substance use needs did not receive treatment. Large shares of insured adults who did not receive treatment cited concerns about costs (54% of MediCal enrollees and 49% of private insurance enrollees) and Did We difficulties scheduling an appointment (30% of MediCal enrollees and 20% of private insurance enrollees) as barriers."
Get Table 1: Among Nonelderly Adults with Any Mental Health or Substance Use Needs, Access and Utilization of Services in the Past Year, by insurance type, 2020
Private insurance
All Nonelderly Adults Medi-Cal Enrollees
Enrollees
Share of Nonelderly Adults with Mental Health or
24.3% 23.2% 23.8%
Substance Use Needs
Here?
share that Received treatment 53.8% 59.6% 54.8%
Average Number of Visits to a Professional 18* 11*
Share that Did Not Receive Treatment 46.2% 40.4% 45.2%
Did Not Receive Care Due to Concerns About 49.1%
57.2% 53.9%
Costs^
Did Not Receive Care Due to Difficulty Scheduling 23.0% 30.2% 19.9% an Appointment^
* Indicates statistically significant difference between MediCal and private insurance enrollees.
SOURCE: KFF analysis of California Health Interview Survey (CHIS) Adult Data Files, 2020. https://www.kff.org/coronavirus-covid-19/issue-brief/a-snapshot-of-mental-health-and-access-to-care-among-nonelderly-adults-in- california/#:-:text=Nearly%20nine%20in%20ten%20nonelderly.care%2C%20including%20mental%20health%20services.
When the system
stops working,
we need to change
the system
Trauma, Mental Illness, SUD, &
Homelessness
The truth is no one wakes up one day and chooses trauma, mental illness, substance use disorder, or homelessness.
We all experience childhood trauma in one way or another, whether from our own families or people or situations we are exposed to. Depending on our own mental capacity,
those experiences direct our outcomes.
No matter what the trauma, If we cannot use tools to
process and heal, we might need to find another way to
feel, we often find that 'other feeling' in a substance. If healing tools are not developed, we may find comfort in a substance.
That substance may create the distraction we need to
survive. Because of the illegality of accessing most
substances, it leads to criminal activity and more self- harm. Because of the lack of a safe supply, often there are potential unintended consequences and overdose.
If we have untreated mental illness with no intervention or care, perhaps we look to self-medicate, which may lead to SUD (substance use disorder) which may or may not
exacerbate the illness into psychosis that may be HOW TRAUMA Irreversible and long-term care maybe needed. If we are THERAPY WORKS:
suffering in all this and then end up in jail or prison, our quality of care is immediately gone. seif attachments
respect
SELF
SELF
healthy
We all have trauma - we all need some form of therapy alachment positive to people feelings
and mental care and choices to fit what works for IMPACT TRAUMA self
individuals - we all need to heal. respect
impact of
→ Man
We all need a place, the space, and the time to heal that is emotions. BEFORE AFTER
not jail or the streets. TREATMENT TREATMENT
DESCRIBED BY BATSON AND ROTH 1994)
We need to be met at a place of no judgement. VISUALLY TRANSLATED BY @LINDSAYBRAMAN We all need a working system that is easy to navigate not fragmented in silos.
Why Tough Love Does Not Work
As we evolve as a society, we discovered that corporal punishment is inhumane to our children and that fear-based education and discipline are not effective. In a 2020 article, Dismantling the Myth of Tough Love, Veronika Tait Ph.D. breaks down four common situations where tough love are not working in society. She defines tough love as "as actions toward another that are cold, withdrawn, or punitive with the intent to improve behavior." She begins in childhood, "Typically, children who are victims of spanking or other harsh punishments have more problem behaviors." She continues, "Researchers have even found that teens who were sent to juvenile detention centers were more likely to commit crimes later compared to similar teens who were not." She reports on the prison system: "There are tens of thousands of people in solitary confinement in prisons across the United States, yet research shows that using SC as a punishment for inmate violence does not decrease the probability of future violence."
She concludes: "Just as spanking models problem solving with violence, some theorists propose that the use of capital punishment demonstrates killing as an appropriate response to those who have wronged us. Adding to the problem is that black offenders are disproportionately sent to boot camps, juvenile detention centers, and SC, and more likely to receive the death penalty when compared to white offenders. Evidence suggests that while black and white offenders are equally likely to commit prison rule violations, black convicts are more likely to be written up for them, leading to more punishments such as SC. Not only are these programs failing their purposes to help rehabilitate and deter future crime, but they are also increasing the racial disparities we see today." https://www.psychologytoday.com/us/blog/pulling-through/202007/dismantling-the-myth-tough-love Trauma Healing and Addiction Treatments
are Not One-Size Fits All
Despite the status quo perception of drug use, not all people who use drugs suffer from addictions or trauma. In a society that is constantly moving and encourages its participants to create and produce at superhuman speeds, many people seek drug use to escape for a few hours of the continuous and intense motion of participating in society. This may look like a weekend at a music festival or a trip into nature or an altered state in the comfort of home. This could be a form of self-psychedelic or self-prescribed therapy.
Some people experience trauma that they cannot escape unless in a continuous altered state. Altered states range in various effects and are dependent on what 'feeling' the person is seeking, sometimes not knowing what it is, until they feel it for the first time. Substances can also be internal such as adrenaline, dopamine, and serotonin uptakes, we can learn certain activities that increase production uptakes just as easily as taking an outside substance.
When the substance overuse becomes too much, people are encouraged to seek 'rehabilitation' or find a Alcoholics or Narcotics Anonymous program, which helps approximately 50% of the people who attempt that path. Many recovery centers are religious-based which deters anyone who experienced religious trauma. Another consideration is trauma from mental health or holistic therapies, where people develop an aversion to certain types of therapy.
https://www.psychologytoday.com/us/blog/mind-matters-menninger/202003/why-addiction-treatment-isn-t-one-size-fits-all https://store.samhsa.gov/sites/default/files/d7/priv/pep12-recdef.paf Tiny Homes (Torrance & Banning)
Restrooms, laundry facilities and daily meals, along with wraparound services in the form of case management and housing navigation.
What is Motels into Transitional Housing
Motel amenities with daily meals, along with wraparound services in happening the form of case management and housing navigation. right now Community Outreach Organizing
On-the-ground grass-roots organizing, varies from established and new groups providing mutual aid, harm reduction supplies, hygienic recourses like mobile showers, laundry, mental and physical care services, vet services, and navigation and connection to government or larger organizations.
Some groups reunite families with people experiencing homelessness, however, trauma sometimes comes from a person's own family; and sometimes families do not have the skills or financial or navigational resources to provide the needs of that person.
Outreach Collaboration with Triage
Organizations and governments collaborating on triage and paths for people experiencing homelessness to treatment and healing centers.
Rehabilitation Centers with Medical/Mental Care
Often rehabilitation centers for substance use disorders are expensive, or do not assist with detox, or do not allow any underlying medical What is conditions or do not allow pets (removing someone's pet can be traumatic experience as well
Needed
Healing Centers as Transitional Housing
A person is attempting to treat addictions and trauma, needs space to focus on treatments and be able to choose a treatment that fits their needs. Wealthy communities have access to various haling treatments that they puzzle piece together that works for them; when trauma happens, they are able to afford time from work to treat and heal traumas.
Facilities - Long-term and Healing Centers
Long-term board & care facilities for people experiencing temporary or permanent psychosis. Healing facilities are needed for people with little to no income be able to have the same access to various trauma and mental health therapies as those with financial access.
Why this model?
There is not one solution to substance use disorder,
healing trauma, being unhoused, or mentalillness.
Approaching the root of the cause with the proper tools and resources and an understanding of how we got to this point will help our society move forward.
THE PECC PROPOSAL
Based on philosophy that unifies several public health and mental heath approaches of meeting people where they are without judgement; creating programs based on client-centered individual acute care, long-term care, and rehabilitation; providing environments focused on a fusion of philosophies.
Multi-Discipline Approach
Harm Reduction Philosophy - "Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for nd
choice of treatments and therapies through fusions of multi-displinary care, and systemic navigation.
Mariame Kaba - "We have built up the skills of being able to ask questions like: What does it mean to actually center a survivor who is harmed? What does it actually mean to support people who have caused harm? What does it mean to take responsibility for saying, "We refuse in our community to condone when this happens?" One of the things that is so important is that harm causes wounds that necessitate healing. That is what so many people are looking for--a way to begin to heal. How are we going to create in our communities spaces that allow people real opportunity to heal?" from We Do This Till We Free Us Traverse City State Mental Hospital Philosophical history: Dorthea Dix Nursing Activism; Dr. James Munson's "beauty is therapy, work is therapy," and the Kirkbride Plan Geel, Belgum - Family foster care model
Intergenerational Living Programs Geel
Traverse City Dorthea Dr. Munson
Kirkbride Plan
State Mental DiX
Hospital
The PECC
ENTRY THROUGH STREET TEAM OUTREACH
Mutual Aid
Proposal Point of triage/intervention
Showers & Laundry
Overview Life Transition - need housing
TRIAGE Health care / mental care needs
SUD - mental health / trauma
SUD - mental health / trauma / health care
SUD - mental health / trauma / health care / senior
(PECC) Multidisciplinary Clinics SUD - mental health / trauma / health care / senior / veteran Mental health - capacity
Low-cost or no-cost Multi-Disciplinary Clinics (MDC) Assisted Living needs Western medical doctors / PAs/ nurse practitioners Full Care needs Mental Health Therapists: hypnotherapists, psychology/psychiatry Senior / Health care / mental care Acupuncture Veteran / Health care / mental care
Yoga / Breath Work
Peer-to-Peer support groups
Plant medicine counseling and access
Social workers and government system navigators
Patient advocates
Death doulas / grief counseling
Psychedelic-assisted Therapy
Safe supply for self-induced therapy
Other treatments
Young adult (aged-out foster children) life-skills education Peer-to-peer community life-skills education Rehab/Detox Healing Lean aKils health & Transitional Ahrs work sesresy
mental care *325* Y) Ahirs creere
Housing
Cob tousing
wwwn&ur tettenteetpur healing/
treatments
Long Term Care
Mental health
Access to
Purpose, Greate, 8
Education assisted living or
full care
What is happening now through various groups in the city
ENTRY THROUGH
HARM REDUCTION & OUTREACH
ENTRY THROUGH STREET TEAM OUTREACH
Mutual Aid
Point of triage/intervention Showers & Laundry
Next Steps
Harm Reduction Safe supplies / Triage in Outreach
Safe consumption site
Point of triage / intervention to introduce to options and programs PECC has plans for a store-front location & mobile unit Needed
OUTREACH TRIAGE
Life Transition - need housing
TRIAGE Health care / mental care needs
SUD - mental health / trauma
SUD - mental health / trauma / health care
SUD - mental health / trauma / health care / senior
SUD - mental health / trauma / health care / senior / veteran Mental health - capacity
Assisted Living needs
Full Care needs
Senior / Health care / mental care
Veteran / Health care / mental care
Triage needs by asking person what they need not telling them what they need. Listening to people and their stories, fears, concerns, & needs.
The Centers
Rehab/Detox Rehab Centers
health &
Various Treatments that fit clients
mental care
Detox assistance / medical assistance
"Traverse" Healing Centers - Short-term Programs
Healing Mental health care
Transitional Trauma Treatments
Housing
Access to MDC
healing/ Purpose & Create
treatments
Long-Term Care Centers - Long-term Programs
Mental health care
Long-Term Care Purpose & Create
Mental health Access to MDC
Access to Long-term care
Purpose, Create, &
Education
Needed
PECC CLINICS
Low-cost or no-cost Multi-Disciplinary Clinics (MDC)
Western medical doctors / PAs / nurse practitioners
Mental Health Therapists; hypnotherapists, psychology/psychiatry Acupuncture
Yoga / Breath Work
Peer-to-Peer support groups
Plant medicine counseling and access
Social workers and government system navigators
Patient advocates
Death doulas / grief counseling
Psychedelic-assisted Therapy
Safe supply for self-induced therapy
Other treatments
Young adult (aged-out foster children) life-skills education Peer-to-peer community life-skills education
https://michaelpollan.com/books/how-to-change-your-mind/ https://aasidpubs.onlinellorary.wiley.com/doi/10.1002/hep.32081#:~:text=Multidisciplinary%20clinics%20(MDCs)%20are%20an,and%20develop%20co hesive%20treatment%20plans
Life Transition - need housing
TRIAGE Health care / mental care needs
SUD - mental health / trauma
SUD - mental health / trauma / health care THE PATHS
SUD - mental health/ trauma / health care/ senior
SUD - mental health / trauma / health care / senior / veteran Mental health - capacity
Assisted Living needs
1 Shelter - SUD Detox / Rehabilitation
Full Care needs
Senior / Health care / mental care 2 Shelter - Healing Center / Transitional Housing Veteran / Health care / mental care
3 Shelter - Mental Capacity - assisted living / full care Rehab Center
Various Treatments that fit clients
Detox assistance / medical aşsistance
Rehab/Detox L8a5h "Traverse" Healing Centers - Short-term Programs Healing:
health.& Transitional
mental care Mental health care
Housing
healing/ Trauma Treatments
treatments
Access to MDC
Purpose & Create
Long Term Care
Mental health
Access to
Purpose, Create, &
assisted living or Long-Term Care Centers - Long-term Programs Education
full care
Mental health care
Purpose & Create
Access to MDC
Long-term care
Support after
Healing "Transitional" Center
Learn Skills
4hrs work Home, Work, Life
4hrs create
Job/Housing