Housing and Homelessness Committee Memorandum
TO: HOUSING AND HOMELESSNESS DATE: SEPTEMBER 25, 2023
COMMITTEE MEMBERS
FROM: HOUSING AUTHORITY WARDS: ALL
SUBJECT: MEASURE Z – STREET NURSE OUTREACH WORKER PROGRAM UPDATE ISSUES:
Receive an update on the Street Nurse Outreach Worker Program and conceptually approve procuring two substance abuse counselors and two behavioral health peer support specialists with Measure Z funds in place of two street nurse outreach workers.
RECOMMENDATION:
That the Committee:
Receive an update on the Street Nurse Outreach Worker Program; and Conceptually approve procuring two substance abuse counselors and two behavioral health peer support specialists with Measure Z funds in place of two street nurse outreach workers.
BACKGROUND:
On June 16, 2020, City Council reallocated Measure Z funding from two Public Safety and Engagement Team (PSET) officers to the Office of Homeless Solutions (OHS) for nurses or other street health purposes based on the needs of our homeless population. OHS reached out to the County of Riverside University Health Systems to create a Nurse Outreach Workers (NOW) program in the City as they operate The Whole Person Care program, which utilizes trained nurse practitioners to improve the health and well-being of individuals with complex medical, behavioral and social services needs, including behavioral health challenges and substance abuse issues.
This integrated network of medical care with dedicated healthcare professionals was expected to provide much relief to the unsheltered homeless population in the City. Unsheltered individuals experiencing homelessness are statistically high utilizers of the emergency department for primary care services due to lack of ongoing medical care. This could not only be a costly burden on the hospital emergency system but, moreover, a negative factor in preventing and decreasing chronic medical conditions in the homeless population. This can lead to debilitating conditions, worsening the probability of access to housing and increasing the rate of demise on the streets.
On February 12, 2021, the City entered into a contract with the County of Riverside to procure two street nurse outreach workers. Under pressure and, only one nurse had been procured to provide wound care, medical advice, managing chronic conditions such as diabetes and high blood pressure, and connecting people to services like shelter and social services. This nurse’s assignment ended due to the nurse taking a permanent position with Riverside University Health Systems. The two street nurse outreach positions remain unfilled.
DISCUSSION:
In accordance with section 9817 of the American Rescue Plan Act (ARPA) of 2021, the California Department of Health Care Services (DHCS) developed a Medi-Cal Home and Community-Based Services (HCBS) Spending Plan detailing a series of initiatives that will enhance, expand, and strengthen HCBS in California. Housing and Homeless Incentive Program (HHIP) is one of the HCBS Transitions initiatives, which aim to expand and enhance programs that facilitate individuals transitioning to community-based, independent living arrangements.
HHIP is a voluntary incentive program that enables Medi-Cal managed care plans (MCPs) to earn incentive funds for making progress in addressing homelessness and housing insecurity as social determinants of health. HHIP was funded with a one-time allocation of $1.288 billion. One of the HHIP goals is to expand access to housing services and street medicine programs.
The Inland Empire Health Plan (IEHP), a MCPS, identified the need for street medicine in Riverside County and allocated HHIP funding to Healthcare in Action to support a street medicine team that is comprised of one physician assistant and three peer navigators that provide healthcare and other services to individuals experiencing homelessness in the city of Riverside. The team is planning to hire a clinical support partner and two more peer navigators. The PSET team can call upon the street medicine team for assistance in helping homeless individuals with medical needs.
The University of California Riverside School of Medicine is opening a medical clinic in the Riverside Access Center at 2880 Hulen Place that will serve the homeless and low-income community. They will begin accepting patients on September 12, 2023. A psychiatrist will be on staff in October 2023 to assist patients with mental health conditions.
To better assist PSET and homeless individuals with mental health and substance use issues, staff is recommending using the Measure Z funds allocated by City Council for street health and initially supported the street nurse outreach worker to procure two substance abuse counselors and two behavioral health peer support specialists. These new teams would meet homeless individuals where they are at and connect them to programs and resources needed to exit life from the streets.
STRATEGIC PLAN:
The activity within the staff report aligns with Strategic Priority 2 - Community Well-Being, Goal 2.3 to strengthen neighborhood identities and improve community health and the physical environment through amenities and programs that foster an increased sense of community and enhanced feelings of pride and belonging citywide; and the Homelessness Action Plan Goal #2, Increase the Availability of Services with a Focus on Physical, Mental Health, and Substance Use Disorder Treatment.
Community Trust – The Homelessness Action Plan was developed with community input to reduce homelessness by creating and maintaining affordable housing and programming utilizing a whole-person care approach to support individuals and families to achieve housing stability and self-sufficiency.
Equity – The programs referenced in the Homeless Action Plan, ensure that residents receive equitable access to programs and are served with dignity, respect, and compassion regardless of the circumstances, ability, or identity.
Fiscal Responsibility – Funding for this program is coming directly from Measure Z and staff will report out on program expenditures and performance outcomes to ensure program milestones are being met.
Innovation – The use of two substance abuse counselors and two behavioral health peer support specialists will assist in expanding the PSET Outreach teams since each team member will be paired with an outreach worker.
Sustainability & Resiliency – The activity identified in the staff report will help homeless individuals connect with programs that have the end goal of achieving housing stability and self-sufficiency.
FISCAL IMPACT:
The fiscal impact related to this staff report is $456,431.89, which is available in the Measure Z Fund, Public Safety and Engagement Team, Professional Services Account No. 8003901-421000.
Prepared by: Michelle Davis, Housing Authority Manager
Certified as to
availability of funds: Kristie Thomas, Finance Director/Assistant Chief Financial Officer Approved by: Mike Futrell, City Manager
Approved as to form: Phaedra A. Norton, City Attorney
Nurse Outreach Worker Program Update ● Page 9