Understanding and Ending the Cycle of Homelessness

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Understanding and Ending the Cycle of
Homelessness Incarceration Through Permanent
Supportive Housing

• John FallonProgram Manager- Re-EntryCorporation
  for Supportive HousingFebruary 1, 2008
• John.Fallon_at_csh.org
• www.csh.org

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What are the barriers at release for someone
leaving jail or prison?

• No identification, SSI, birth certificate
• No medical funding, disability determination
• No psych services- services are not where person
  needs them
• No health care services except expensive
  emergency rooms
• Parole or probation rules
• No housing, no affordable housing
• No income
• Prejudice because of record, MI, substance use,
  homeless, poor, race
• Family relationships damaged
• Hopelessness, despair
• Release planning period, parole-technical
  violations
• Lack of misa programming- drug testing

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Today I will talk about

• I will talk about
• Me
• Criminal Justice and Homelessness
• Changing mental system
• Permanent Supportive Housing
• Policy
• CSH
• Harm Reduction

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I want you to care about this problem

• I truly believe that we can spend money more
  wisely to solve problems related to institutional
  use.
• I had the pleasure to supervise a wonderful
  program at Thresholds where I worked with and
  supervised wonderful residents and staff
• I love the members I worked with and am so
  saddened to see people lost in the system due to
  non-integrated systems.

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Whats the Problem?

• Thousands of people with chronic health
  conditions cycle in and out of jail, prison,
  mental health institutions, detox, emergency
  rooms, shelter and the streets.
• Recidivism rates for this group are extremely
  high
• This group is largely ill-served by these crisis
  systems of care.

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Whats the Problem?

• There is an immense public cost for these poor
  outcomes
• This group needs support that is comprehensive to
  succeed.
• Housing, mental health, employment and other
  components are inter-dependent, but the systems
  that provide them are separate.

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Priced Out of Housing

• In 2002, for the first time ever, the national
  average rent for an efficiency or 1-bedroom
  exceeded the income of a person with a disability
  receiving Supplemental Security Income (SSI).
• In 2002, there was not one single housing market
  in the country where a person with a disability
  receiving SSI benefits could afford to rent a
  modest efficiency or 1-bedroom unit
• Because of their extreme poverty, the 3.5 million
  non-elderly people with disabilities receiving
  SSI benefits cannot afford decent housing
  anywhere in the country without some type of
  housing assistance
• Source Technical Assistance Collaborative,
  Priced Out in 2002

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How Big is the Problem?

• Right now, across the nation, 2,385,000 people
  are locked up in county and state custody

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How Big is the Problem?
The United States also has the highest
incarceration rate at 737 per 100,000 people,
compared to nearest country Russia's 611 per
100,000 The United States has 5 percent of the
world's population and 25 percent of the world's
incarcerated population. We rank first in the
world in locking up our fellow citizens," said
Ethan Nadelmann of the Drug Policy Alliance,
Texas 200,000 22,860,000 1035
US 2,385,000 296,400,000 737 China 1,548,498
1,308,700,000 118 Russia 869,814
142,300,000 611 Source- International Centre for
Prison Studies at King's College London Oct 2006
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How big is this problem?

• Nationally, there will be 672,000 releases from
  state and federal prisons this year
• That is 1,840 people a day
• There are more than 5,000,000 people on probation
  or parole.

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Who Is In Jail?

• Dept. of Justice estimates that up to 16 in
  jails prisons have a mental illness
• About 6 to 12 have a serious and persistent
  mental illness
• The incidence of SMI is about 12 in female
  populations
• In Texas, a random survey in 2004 by the state
  legislature found 15 of admissions identified
  but 34 had been identified and treated
  previously by the public mental health system.

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Texas

• Texas has the second largest prison population in
  the United States
• There are 172,116 people in prison (152,889
  (TJCJ)(28,543 in 1980)
• There are 15,091 people in jails
• There are 18.627 people in private facilities
• That is more than 205,000 people according to DOJ
• In 2004, 55,183 people returned to communities
  from prison and felony jails- a five fold
  increase since 1980
• There are 51 prisons, 3 pre-release facilities, 3
  psychiatric facilities, 1 MR facility, 16 jails,
  13 transfer facilities
• There are more than 430,000 on probation and
  101,000 on parole. In 2002, 53 of admissions
  were because of parole and probation revocations.

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In Harris County

• Harris County now has 9,834 people in a jail that
  holds 11,000. At its present growth rate, it
  will likely pass Cook County as the third largest
  jail in the country.
• 58 of paroled releases in 2004 went to 5 of 254
  counties. No other county had more than 2.
• 26 went to Harris County and 23 to Houston
• 26 of Houstons group went to 7 neighborhoods-
  Alief, East Houston, East Little York/Homestead,
  Kashmere Garden, Trinity/Houston Gardens, Third
  Ward/. And MacGregor- 196-538 supervised
  releases- 52 were unsupervised
• 87 male, 45 AA, 41 White, 14 Hispanic
• Community- 18 AA, 41 White, 33 Hispanic, 6
  Asian

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Why do we care?

• In 1982, we spent as a nation less than 36
  billion dollars on law enforcement costs (prison,
  jail, courts, supervision)
• In 2003, we spent 185.5 billion dollars (417
  increase, or 7.7 a year)
• In 2005, we spent 204 billion dollars or 660 per
  person
• This would operate 11,3 million units of
  supportive housing for a year
• The National Point in Time Count for this year
  was 754,147. The number of chronic homeless was
  listed as 155,623

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Why do we care in Texas?

• In 2005, Texas spent 10,673,000,000 on Criminal
  Justice Expenses
• This would operate 592,949 units of supported
  housing (18,000 per year)
• This is real money that could be invested
  differently
• There are 43,000 homeless individuals identified
  in the point in time count for Texas

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Corrections has become the primary national
mental health system

• Deinstitutionalization
• More rigid criteria for civil commitment
• Lack of adequate housing
• Difficulty in gaining access to community based
  treatment
• Attitude of society in general

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Why we need to increase services for the MI
repeat offender population

• We are paying for these folks now through
  emergency services and have been for a long
  time.
• Here are long-term institution costs and averages
  for just two of the Thresholds jail project
  members.

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The cost of non-treatment

• DO THE MATH
• Client 1 21 years
• 3,758 days of hospital time
• 399 days of jail time (six years is all we have)
• Does not include private hospitals, court or
  arrests

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The cost of non-treatment

• Client 1 Math 21 Years
• 3,758 hospital days 400 a day
  1,503,200
• 399 Jail Days 70 a day
  27,930
• TOTALS 1,531,130
• Annual Total 72,910

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The cost of non-treatmentWhy this is
all-important from a policy perspective

• YOU DO THE MATH, REAL EXAMPLES
• Client 2 30 Years
• 3,958 days of hospital time
• 561 days of jail time
• Does not include private hospitals, VA, court, or
  arrests

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The cost of non-treatment

• Client 2 Math 30 Years
• 3,958 hospital days 400 a day 1,583,200
• 561 jail days 70 a day
  39,270
• TOTALS 1,622,470
• Annual Total 54,082

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The cost of non-treatmentInstitution costs
while in Thresholds program

• Institution time, Client 1 4 Years
• 14 days in jail 70 per day 980.00
• Institution time, Client 2 3 Years
  0.00

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Penny Wise Can Be Pound Foolish

• Intensive Long Term Outreach Services in the home
  are what is generally needed to help break the
  cycle for the most difficult to engage persons
• Without comprehensive services, taxpayers will
  likely continue to pay large amounts of money in
  repeated incarcerations, emergency room visits,
  arrests, psychiatric hospitalizations, and
  decreased public safety. They will also miss a
  chance to enjoy the friendship of people who can
  become good and interesting community members.

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The cost of non-treatment

• These programs are cost effective and if the most
  recidivistic clients are selected, society is
  already paying these costs
• The problem is the costs are in several places
  (OMH, county, department of corrections)
• Our task as policy makers is to recognize
  existing costs and redistribute current
  expenditures in a way that better serves the
  clients and the community
• Our current system is not optimized

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An Exciting Social Experiment

• The President said we want to eliminate
  homelessness in 10 years.

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An Exciting Social Experiment

• This is known as the 10 Year Plan to End
  Homelessness

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A DIGRESSION TO PUBLIC POLICY

• The idea of the 10 year plan is to concentrate on
  the most frequent users of emergency services and
  provide less expensive, more focused, more
  intense, and more effective services for
  predictable crisis
• This will free emergency services for the
  intended purpose of transitory emerging problems
  in crisis
• This will save money, improve lives, and increase
  a sense of public safety
• Ill Goals
• About 7000 households
• 3257 individuals in prisons and jails need PSH

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A Cost-Effective Solution
U. Penn. study of 5,000 mentally ill homeless
people in New York

• Supportive housing created an average annual
  savings of 16,000 per person, per year, by
  reducing use of public services

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NY/NY Background

• Agreement between NY State and NY City
• Funds capital, operating, and service costs for
  3,600 supportive housing units in NYC
• Placement recipients must have an SMI diagnosis
  a record of homelessness
• Data available on 4,679 NY/NY placement records
  between 1989-97

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Research Question
   
How do NY/NY housing placements affect the use
of

• City shelters
• State psychiatric hospitals
• State Medicaid services
• City hospitals (HHC)
• Veterans Administration hospitals
• State prisons
• City jails

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Data Sources

• NY/NY Housing Placements 1989-97
• Single Shelter Users and Stays 1987-99 
• State Hospital Users Stays 1990-96
• Municipal Hospital Users Stays (non-Medicaid)
  1989-96 
• Medicaid-Reimbursed Inpatient Hospital Stays
  1993-97
• Medicaid-Reimbursed Outpatient Visits 1993-97 
• Veterans Hospital Stays 1992-99 
• State Criminal Justice Prison Use Convictions
  1987-97
• City Jail Use 1987-99

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Research Method 1
Pre-Post Analysis
2 Years
2 Years
Post-NY/NY
Pre-NY/NY
Placement
Placement
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Research Methods 2
Cases
Control
4,679
Pool
Persons w/
NY/NY
Placement
Matched Pair Case-Control Design
(observations
from services
system)
P
re-Match
Matched
Pairs

Matched On
Best Match on

Pre Intervention
Race Sex Age
Services Use
SA MH Use
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The Cost of Homelessness
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NY/NY SavingsPer Housing Unit Per Year
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Why Permanent Supportive Housing?

• Supportive Housing breaks the cycle of
  homelessness, especially for those people who
  have been homeless and also deal with mental
  illness.

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The Corporation for Supportive Housing

• Three Core Lines of Business
• Project Specific Assistance
• Capacity Building
• Policy and Systems Change
• Resources
• www.csh.org

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What Is Supportive Housing?A cost-effective
combination of permanent, affordable housing
with services that helps people live more stable,
productive lives.
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Who is Supportive Housing for?

• People who are homeless or
• at-risk for homelessness
• - and -
• face persistent obstacles
• to maintaining housing,
• such as mental health issues,
• substance use issues,
• other chronic medical issues,
• and other challenges.

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Who lives in Supportive Housing?

• People with long histories of homelessness
• Long-term poverty coupled with persistent health
  problems, including mental illness, substance
  abuse and HIV/AIDS
• Those with repeated engagements with temporary,
  institutional settings and crisis care services
• Histories of trauma, abuse and violence
• Single adults, families and unaccompanied youth

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Features ofPermanent Supportive Housing

• Permanent Rental Housing
• Each resident holds lease on his/her own unit
• Resident can stay as long as he/she pays rent and
  complies with terms of lease (no arbitrary or
  artificial time limits imposed).
• Affordable
• Tenants usually pay no more than 30 of income
  for rent.

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Features ofPermanent Supportive Housing

• Flexible Services
• Participation in a program is not a condition
  of residency
• Services are designed project by project for the
  target population and the housing setting
• Services are flexible and responsive to
  individual needs
• Cost Effective
• Costs no more,and often much less, than the cost
  of homelessness and produces better outcomes than
  the expensive system of crisis care

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Supportive Housing Types

• Apartment buildings exclusively housing formerly
  homeless individuals and/or families.
• Rent subsidized apartments leased in open market.
• Apartment buildings with mixed income households,
  including the formerly homeless.
• Long-term set aside of units within privately
  owned buildings.
• Services integrated within existing affordable
  housing developments.
• Single family homes, including shared housing
  environments.

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Funding to Develop Permanent Supportive Housing

• Capital
• Bricks and Sticks
• One time funds
• Operating
• Funding to support building operations
• Typically a Subsidy
• Supportive Services
• Grants to fund staff salaries

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A Proposed Model for Financing Supportive Housing
The Current Funding Model

• Capital
• Existing affordable and supportive housing
  development sources (Housing Trust Funds, HOME,
  bond financing)
• Operating
• Other operating subsidy/rental assistance stream
  to take-out bridge subsidy (McKinney, Sec 8)
• Social services
• Existing service streams from human service
  systems (mental health, substance abuse, TANF,
  Medicaid, etc.)

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St. Andrews Court

• 42 units of supportive housing, 30 for homeless
  ex-offenders with disabilities and 12 for
  parolees.
• Includes integrated financing from HUD McKinney
  Homeless grants, Low-income Housing Tax Credits,
  IL Dept. of Human Services, IL Dept. of
  Corrections, and others.
• Conducts in-reach into correctional facilities
  to provide a smooth transition into supportive
  housing.
• Delivers tailored, comprehensive support services
  to all residents, including mental health,
  substance abuse, and employment services.
• Recidivism rates decrease from 50 to 20 for
  participants in their programs.

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Sanctuary Place

• 63 SRO Units
• 6 3-bedroom townhomes
• For women who are formerly incarcerated and have
  a history of domestic abuse, substance abuse or
  mental illness

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Grais House- Chicago, IL
The 44-unit residence gut-rehabilitation
building provides housing and on-site supportive
services for individuals with psychiatric and
co-occurring substance use disorder Target-
SMI Dual Diagnosis Service Provider Thresholds
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Rowan Trees- Chicago, IL
45 units 6 one-bedroom units that are handicap
accessible and 39 efficiency studios Target- SMI
Dual Diagnosis Service Provider Thresholds
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Sanctuary Place SRO 320 foot studio apartments
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What makes Good Housing That Can Serve
Ex-Offenders?

• First rule- Have it fit into the neighborhood
• Balance the need for specialized services with
  the need to have it fit into the neighborhood
• Make it a home with services and not a program
• Help people to live and integrate into the
  community
• Encourage your house to enhance the neighborhood
  and participate in the neighborhood
• Block clubs, picnics for your neighborhoods

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What makes Good Housing That Can Serve
Ex-Offenders?

• Like other permanent housing but incorporates
• Case management and Counseling Linked with a
  continuum of services beginning inside the
  correctional facility
• Prison and jail-based transition planning
  services provided in coordination with reentry
• Blend with parole- Use Law Enforcement Positively
  and Collaboratively

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A Range of Services to Support Tenants in Their
Goals

• A broad array of services needs to be available
• Mental health and substance use management and
  recovery
• Vocational and employment
• Money management benefits advocacy
• Coordinated support / case management
• Life skills
• Community building and tenant advocacy
• Medical and wellness
• Parenting and child custody supports
• Educational and psychological support and other
  family services

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Most good programs do not require abstinence

• The most effective programs use a harm reduction
  approach starting where a person is at and
  meeting their needs in the order the person
  identifies
• Slower but more effective in the long run
• Requires that services be available when
  requested

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Stages of Change Define Substance Use, Mental
Health, CJ Involvement

• Willingness to change or accept and use services
  varies among individuals and across time within
  individuals.
• This willingness follows predictable patterns and
  can be labeled as stages of change

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The Stages of Change

• Pre-Contemplation-Who, me?
• Contemplation-I can handle it.
• Preparation-I have a goal.
• Action-I am doing this.
• Maintenance-Hey, it works!
• Lapse (Relapse)-Heres what worked.

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Eviction Free Living is a goal of good programs

• There is a tremendous emphasis on avoiding
• eviction in good programs
• Focus is on meeting the persons needs using a
  team approach- increased outreach and active
  listening and problem solving
• A Case-work approach
• Private funding to assist with rent- Focus on
  staying housed no matter what- Build services
  around the person- Volunteers can do this-
  Consumers can do this- Mission based.

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DESIGN A SYSTEM ACROSS TRADITIONAL BOUNDARIES

• Aftercare needs to be designed to ensure
  continued treatment and duplication of the
  necessary components of inpatient hospitalization
  while eliminating unnecessary restrictions.
• Members need their medication all the time- Jail
  and criminal justice interventions interrupt this
  access
• Good Case Management figures out how to use
  existing resources and to examine available
  resources to fit a person into his environment.
• Boundary Spanners (Steadman)

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Medication Means

• Access to Medication (Before Jail, After Jail, In
  Prison, After Prison, Private, Shelters)
• Access to Payment for Medication
• Access to Understanding of Medication
• Access to Necessary Supervision of Administration
  ad Storage of Medication
• Access to Necessary Monitoring of Side Effects
  and Adjustment of Medication on Demand

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National Examples of Reinvestment City of New
YorkState of OhioLos Angeles CountyCook
County/Chicago State of California Supportive
Housing Projects
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And so CSH Began the Returning Home to help
develop PSH for Ex-Offenders

• Begun in Spring of 2006, and largely funded
  through grant from Robert Wood Johnson
• Primary focus on Los Angeles, Chicago, and New
  York City
• Additional work in Michigan, New Jersey, Ohio,
  Rhode Island, and Minnesota
• 2.4 million to be re-granted to partners on the
  ground
• Goal is to create at least 1,000 units of
  permanent supportive housing in three years- 400
  in Illinois
• Advisory Board includes Assistant IDOC
  Commissioner Deanne Benos and Judge Biebel from
  Cook County.

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State of Texas

• State of Texas refused to invest in building new
  prisons.
• This is known as the Texas Justice Reinvestment
  Initiative informed by a collaboration with the
  Council for State Governments
• Instead invested in mental health and substance
  abuse
• Expect 65.1 million dollar savings by 2012

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City of New York

• Frequent Users Service Enhancement (FUSE) pilot
  program serving 100 frequent users
• Rigorous data integration efforts to identify
  frequent flyers
• Collaboration between homeless services,
  corrections, mental health and housing authority.
• Targeted in-reach and outreach to engage them and
  place them in supportive housing. A network of
  providers created to engage and house the
  frequent users.
• JEHT Foundation and multiple public sources of
  financing
• Cost evaluation by John Jay College

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Ohio Dept. of Rehabilitation and Corrections

• ODRC-led pilot focused on placing 85 people with
  mental illness exiting prison into supportive
  housing
• 3 Million Investment over three years
• Targeted prison in-reach programs
• CSH coordination SH provider network
• Engagement of mental health and housing agencies

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Los Angeles County

• LA County Sheriffs Dept. Pilot Program (1.5M)
• LASD investment to support the integration of
  corrections, housing, and human services
• Extensive jail in-reach to identify inmates
  with serious mental illness and link to community
• Network of supportive housing providers to
  collaborate with LASD and mental health agencies
• Accessing rent subsidies

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Cook County, Illinois

• Pilot targeted at 120 frequent users of Cook
  County Jail and shelters.
• Collaboration between Sheriffs Office, IL Dept.
  of Mental Health, City of Chicago.
• Data integration and client identification
  efforts underway. In-reach conducted by
  providers and Cook County Jail.
• Housing subsides from the City of Chicago, mental
  health services from the state.
• Rigorous random assignment study with Urban
  Institute

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State of California

• Pilot program included in FY08 budget with
  bi-partisan support and support from Governors
  office.
• To be administered by CA Department of
  Corrections Rehabilitation.
• Pilot target approximately 225 homeless, mentally
  parolees from state prison.
• Focus on stabilizing parolees in housing with the
  necessary supports.
• Working to coordinate and leverage resources with
  county mental health and supportive housing
  providers.

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• Thanks for your Interest and Attention to this
  subject.
• You can make a difference by making your
  community
• Safer in the long run
• Saving money over repeated institutionalization
• Improving lives
• Doing the right thing

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Examples of Resources Available on CSH Website

• A Guide to Reentry Supportive Housing A Three
  Part Primer for Non-Profit Supportive Housing
  Developers, Social Service Providers, and Their
  Government Partners.
• New Beginnings The Need for Supportive Housing
  for Previously Incarcerated People.
• Preventing Homelessness through Discharge
  Planning.
• Reentry Policy Council Report
• Link to HUD Resource
• www.hud.gov/offices/cpd/homeless/library/bibliobya
  uthor.pdf

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Useful Resources

• National Institute for Corrections
• ABT- Transition from Prison to Community
• US Department of Justice
• GAINS Center- Technical Institute on
  Co-Occurring MISA Disorders- Jails-
  800-311-4246 www.prainc.com, Hank Steadman
• Corporation for Supportive Housing (www.csh.org)
• SAMHSA- 800-729-6686
• Best Approach to Re-Entry
• Continuity of Offender Treatment
• Bazelon Center for MH Law- 202-467-5730 www.bazel
  on.org

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Useful Resources

• American Jail Association / American Correctional
  Association
• Urban Institute- Policy and Profile Papers on
  Prison Re-entry Issues
• Human Rights Watch- www.hrw.org
• Center for Mental Health and Criminal Justice
  Research
• TAPA Center / National Alliance to End
  Homelessness
• Criminal Justice / Mental Health Consensus
  Project- www.consensusproject.org

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For more information, contact

• John Fallon
• Program Manager, Re-Entry
• Returning Home Initiative
• Corporation for Supportive Housing
• 203 N. Wabash, Suite 410
• Chicago, IL  60601
• T 312.332.6690 x21
• C 773.719.4601
• E john.fallon_at_csh.org