How States Can Use SAMHSA Block Grants

State Strategies to Support Services to People Who Are Homeless

The case studies in this report demonstrate different States’ approaches in policy, planning, and funding to encourage the development and delivery of services for people who are homeless and have mental illnesses and/or substance use disorders. Lessons from each State’s experience are summarized below and in the table that follows. These offer useful guidance on what other States can do to strengthen their response to the issue.

Make homelessness and housing issues a priority. States can institute formal policies that make homelessness and housing issues a priority. A special task force or committee also may be developed within or across systems. Planning and funding priorities consistent with meeting the housing and service needs of homeless individuals may be outlined in the States’ block grant plans or through other mechanisms, such as requests for proposals it releases. An agency also may create a special unit or appoint a staff person specifically to focus on homelessness and housing. Priorities established to address these issues may be incorporated into contracts with local service providers that require attention to these needs. Whatever the strategy or strategies chosen, the key is to make access to housing a vital service system component -- without which treatment and services for mental illnesses or substance use disorders are not as effective.

Develop a plan and build capacity. Collecting data on homelessness and housing variables for those served in mental health and substance abuse treatment systems is extremely valuable. These data can be used to identify population characteristics, and to assess housing and service needs and to identify where services are ineffective or gaps in the current service delivery system exist. This, in turn, may lead to efforts to address service system inadequacies and to better target resources to fill gaps or serve those most in need.

Once service system gaps or inadequacies have been identified, a plan that identifies key goals and priority areas can be made. This requires the involvement of key stakeholders who work with people who are homeless. The result may be the delineation of a formal policy statement or plan that is supported by top leadership and is implemented.

Staff who are knowledgeable about homeless and housing issues can help a substance abuse or mental health agency address the housing needs of its clients. Understanding how things play out at the community level and educating providers and systems about the resources available in other systems is key. State mental health and substance abuse agencies can do much to coordinate Federal, State and local resources to better meet the housing and service needs of those they serve. This includes coordinating State and local resources to provide the supportive services match required by Federally funded housing programs such as HUD’s Shelter Plus Care program. Coordinating resources from HUD’s Continuum of Care with those of the Federal PATH program, and with State and local resources often is essential to ensuring that the full array of services is available. Some States have formed partnerships that support planning and funding activities at the local level. By taking a leadership role, States can help establish homeless and housing needs as a priority at the local level.

Becoming actively involved in State and local planning efforts, and linking these with the treatment and services offered by mainstream mental health and substance abuse systems, also is important. Further, involvement in local planning efforts or on advisory boards can help establish as program funding priorities the needs of specific subgroups of people who are at risk of homelessness.

A number of States see the need to assess the training and technical assistance needs of providers, and to provide information on the resources available throughout their communities for housing and services and on how providers can access them for their clients. Capacity building also can help providers and local communities access HUD Continuum of Care and other housing resources, and can foster greater understanding between systems about the resources each has to offer.

Implement your plan. The State mental health and substance abuse agency responses outlined in this report consist mainly of strategies to provide or better coordinate resources to address the needs of people who are homeless. Most States rely on State substance abuse agency funds, Substance Abuse Prevention and Treatment Block Grant funds and other Federal sources of funding to support services to people with substance use disorders who are homeless. Mental Health Block Grant funds represent a smaller portion of State mental health funding, and other sources of funding, such as Medicaid, are used in many States. These and other Federal funds, such as those targeted through the PATH program, may be used to serve people with serious mental illnesses who are homeless. Even with these funding sources, the need for treatment and housing often exceeds available resources. Therefore, States and local communities must piece together funding from different sources to provide the necessary array of housing, services and supports.

Several States target or leverage resources to fill housing and service gaps. For example, one State uses targeted funds to serve a specific subgroup of people with substance use disorders who also are homeless. Others specifically target substance abuse or Mental Health Block Grant Funds for services such as outreach, case management, and other supportive services. Block grant or State funds also are used as leverage to obtain increased housing resources in the community. Some States, for example, use Federal Substance Abuse Block Grant Funds to provide for all or a portion of the required supportive services match for housing programs like HUD’s Shelter Plus Care program. Another uses State mental health dollars to provide a portion of the required match for construction and development costs for permanent housing programs funded through HUD’s Continuum of Care and uses Federal mental health block grant dollars to fund the operations costs.

Even when States are not using Mental Health or Substance Abuse Block Grant Funds intentionally to serve people who are homeless, they often are taking steps to improve integration and coordination of services funded by multiple sources including block grant funds. States that collect data on housing status upon admission and discharge from State-funded treatment agencies can demonstrate that these funds are being used to serve homeless individuals. One State is using Federal demonstration project money to test a "best practice" model for systems change that can be sustained and replicated throughout the State. The model promotes partnerships and collaboration between State agencies and with local government, and between providers from multiple systems.

Other strategies to improve coordination and integration include creating interagency task forces that oversee planning and implementation, forming partnerships to fund housing and support services or improve coordination of resources and provide more comprehensive care, and cross-training staff from different systems to exchange knowledge about what each has to offer. Systems also may agree to co-locate staff through off-site exceptions or licensing of facilities not typically licensed by the agency. For example, a State substance abuse agency may license homeless shelters to provide substance abuse services on site, or a housing program may place a case manager on-site at a substance abuse treatment program to provide housing assistance and referrals.

Finally, many States are implementing best practice models of housing and services that research and practice indicate to be effective with people who are homeless and have mental illnesses and/or substance use disorders. This includes provision of outreach, assessment and referral services, case management, Assertive Community Treatment and other supportive services, and permanent supportive housing options.

Monitor performance. To ensure successful outcomes, some States have promoted provider and community accountability. Building performance-related outcomes into contracts with service providers is one method. For example, providers may be required to track housing outcomes for individuals leaving treatment settings. State agencies may use data on cost, access, and quality of housing and services to make investment decisions, offering incentives to providers to meet certain standards. They also may require that providers or localities plan to and demonstrate they can meet specific housing related outcomes—such as moving people into permanent housing—in order to receive investment of State dollars to leverage additional housing resources in their communities.

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