This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network |
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This Web site is a component of the SAMHSA Health Information Network. |
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How States Can Use SAMHSA Block GrantsSupporting Services for People with Substance Use Disorders who Are HomelessThe Substance Abuse Prevention and Treatment (SAPT) Block Grant does not require States to plan for or provide services to people who have substance use disorders and are homeless. Still some States are supporting the provision of services to this population using a portion of their block grant funds. These case studies highlight the policy, planning, and funding strategies used by these States, as well as any special programs, incentives or initiatives designed to support services to people who are homeless. Providing Case Management and Housing Assistance in New York Policy and Planning New York State’s Office of Alcoholism and Substance Abuse Services (OASAS) considers safe and stable housing critical to sustaining recovery. The Agency recognizes that a range of appropriate housing options combined with case management and other community resources is key to preventing relapse and homelessness throughout the recovery process. State and local assistance funding and SAPT Block Grant funds are used to directly support case management and transitional services to individuals in HUD Shelter Plus Care and other supportive housing programs. In 2001, OASAS created a Housing and Homeless Services Unit to address the need for housing and supportive services among people with substance use disorders. Using data from the HUD Continuum of Care and Consolidated Planning processes, OASAS identified substantial unmet needs for housing and substance abuse services among people who were homeless. A 2002 survey of counties and local providers identified specific needs for permanent independent housing, housing-related support services, such as transportation and case management, and housing services for special populations. The 2003 planning cycle included a Housing Services Survey designed to further assess the housing options available, as well as the housing-related training and technical assistance needs of providers. OASAS currently is implementing a comprehensive plan to develop a full continuum of housing including emergency, transitional, and permanent supportive housing. An internal workgroup also has been formed to work with the Housing and Homeless Services Unit to identify and address barriers to expanding housing options within the substance abuse treatment system. Funding for Homeless Services SAPT Block Grant funding makes up $19 million of the $68 million the State spends every year serving people who are homeless. State aid contributes $42 million; another $7 million is from HUD, through its Shelter Plus Care program to support permanent housing for formerly homeless substance users. State and local assistance funding and SAPT Block Grant funds are used to support case management directly to individuals in homeless and housing programs such as Shelter Plus Care. About 17 percent of all treatment clients are homeless at the time of admission to substance abuse treatment. OASAS works with providers and with local governments to support a range of services including outreach and referral, case management, crisis/emergency services, inpatient and residential treatment, outpatient treatment, permanent supportive housing, and pilot programs targeting special populations. Strategies used to support these are described below. Special Programs, Incentives, or Initiatives Outreach and referral services. OASAS supports a continuum of services for people who are homeless and have substance use disorders. One example is a collaborative effort with the New York City Department of Homeless Services. The City funds 10 substance abuse treatment providers to conduct outreach, assessment and referrals at homeless shelters. OASAS works with the City to license shelters to provide substance abuse services on-site. OASAS supports similar efforts in upstate New York. Permanent housing programs. OASAS began applying for HUD Shelter Plus Care funding in 1993 to provide rental subsidies and supportive services to formerly homeless clients. It now works with 26 providers to implement 48 projects, accounting for over 800 rental units across the State. OASAS provides administrative, fiscal, and program oversight. Providers sponsor the housing by owning or leasing the units, and provide treatment and supportive services to tenants. Other providers operate housing with funding received through HUD’s Supportive Housing program, as well with Federal Housing Choice rental subsidies and other homeless and housing assistance dollars. Case management and transitional services. Securing Shelter Plus Care and other similar funding provided much needed rental assistance for permanent supportive housing in the State. Still, a critical need existed for case management services to provide the necessary link to supportive services in the community, and to help people move to independent living. In 1999, the State launched a program to provide 30 providers with $2 million in SAPT Block Grant funds for case management and transitional services to individuals in Shelter Plus Care and other housing programs. Capacity building for providers. OASAS has focused on building the capacity of substance abuse treatment providers to develop and deliver housing services. The Agency regularly assesses the housing-related training and technical assistance needs of providers and promotes networking to facilitate understanding among homeless/housing and substance abuse treatment providers of the resources each has to offer. Lessons Learned New York’s approach offers valuable lessons for planning and funding. By making housing a cornerstone for recovery and stability in the community, and by creating a unit within the agency dedicated to homeless and housing issues, OASAS has been able to initiate a comprehensive plan to address the issue. Partnerships, such as the one with New York City’s homeless services agency, also are critical. Additionally, the State does much to coordinate funding from Federal, State and local resources, such as combining HUD Shelter Plus Care and other rental assistance dollars with State and local assistance and Federal block grant funding. The State’s approach to expanding the capacity of the system has been two pronged. By directly tapping into HUD housing resources and using the Shelter Plus Care model, OASAS supports the movement of individuals along the continuum of treatment and housing by making permanent independent housing in the community the preferred option. In addition, OASAS ensures the capacity of substance abuse treatment providers to operate this type of housing by providing technical assistance and resource information. Promoting Partnerships and Collaboration in Illinois Policy and Planning The Illinois Department of Human Services’ Office of Alcoholism and Substance Abuse (OASA) does not formally designate people who are homeless a priority for services. Still, a number of State-initiated efforts are designed to more effectively respond to the treatment and housing needs of people who are homeless. Although no staff person is designated for homeless and housing issues within OASA, staff knowledgeable on the issue are actively involved in Statewide and community-level planning related to homelessness. The State’s approach emphasizes coordination through multi-level partnerships to improve access to treatment and provide linkages to housing and other resources needed to reduce substance abuse and homelessness. In addition, the State collects data on housing status upon admission and discharge within its treatment system. As a result, the State has identified service system gaps and challenges to reducing substance abuse and homelessness. For example, in Fiscal Year 2000, 82 percent of those homeless upon admission to substance abuse treatment were homeless at discharge, pointing to the challenge of addressing not only treatment, but also housing needs. Other data indicated that subgroups of homeless people not identified as a priority for services were unable to access needed treatment. Both pointed to the need for increased access to treatment and for improved linkages between substance abuse and homeless/housing providers. Funding for Homeless Services Illinois’ publicly funded substance abuse treatment system offers a range of diagnostic, treatment, and rehabilitation services delivered through a continuum approach, with clients moving from one level of care to another based on individually assessed needs. Services most often used by people who are homeless include detoxification, residential rehabilitation, outpatient, and intensive outpatient services. The State spends about 11 percent of its total SAPT Block Grant allocation on services to people within its substance abuse treatment system who are homeless. Block grant funds make up approximately one-third of the total spent on this population with State general revenue funding providing the balance. Special Programs, Incentives, or Initiatives To better respond to the needs of people who are homeless and have substance use disorders, the State has initiated special programs to address service system gaps through targeted funding and intergovernmental and multi-system partnerships and collaboration. The Male/Family Reunification Initiative. In 2001, the State began providing funds to the Department of Human Services to fill gaps in services to adult males suffering from substance use disorders. The Male/Family Reunification Initiative, administered by OASA, provides funds to increase service capacity for men at 26 community-based agencies. Currently, the State funds two programs specifically targeted to people who are homeless. Pathways Home is a continuum of residential and outpatient programs for homeless adults with serious mental illnesses and co-occurring substance use disorders in Chicago. Operated by Chicago Health Outreach, the program receives approximately $150,000 in substance abuse treatment funding annually. The program emphasizes gender-specific services that focus primarily on outreach, early intervention, and case management to increase access to services from the substance abuse, mental health, and other service systems. The State also provides about $300,000 annually to fund a collaborative effort between Lakefront Single Room Occupancy (SRO), the State’s largest supportive housing provider, and Cornell Interventions, a substance abuse treatment provider. Cornell staff are based at three Lakefront housing programs to engage and assess male residents and make referrals back to Cornell, which offers a full-range of substance abuse treatment services. Cornell also provides outpatient services on-site at Lakefront, as OASA offers "off-site exceptions" to some licensed treatment providers to provide services at non-licensed facilities such as housing programs and shelters. Lakefront, in turn, places a case manager/leasing agent at Cornell to help clients gain access to permanent supportive housing. Staff from both agencies are cross-trained to better understand the range of treatment and housing options available to their clients. The Homeless Services Integration (HSI) Project. In 2001, OASA received funding under SAMHSA’s Center for Substance Abuse Treatment’s (CSAT’s) Cooperative Agreements for the Development of Comprehensive Drug and Alcohol Treatment Systems for the Homeless program to start the Homeless Services Integration (HSI) Project. Based in Chicago’s West Side, the project supports a multi-disciplinary mobile outreach and case management team that links individuals who are homeless and have co-occurring substance use disorders with needed treatment, housing, and services. The project is a collaborative effort among Federal, State, and local city governments, and nine provider agencies from the homeless services, housing, mental health, and substance abuse treatment systems. Federal funds from the cooperative agreement are used to support a case management team staffed by the various provider agencies. The team links individuals who are homeless to an array of housing and services, including substance abuse treatment funded, in part, by the SAPT Block Grant. OASA provides overall management for the project, while a steering committee of State and community stakeholders serves in an advisory role. The goal of the project is to promote systems change by creating a model for increased access to substance abuse treatment and improved linkages between health, mental health services and substance abuse treatment, and housing to be replicated throughout the State. Staff are cross-trained to better understand the resources offered by the various systems. Licensed substance abuse treatment providers involved in the project are allowed to co-locate staff to provide services at non-licensed facilities such as shelters and housing programs through OASA’s off-site exception. Lessons Learned Illinois’ case study example offers several important lessons. First, collecting and using data on homelessness and housing for those in the treatment system can help identify where services are ineffective or where gaps exist. Second, having agency staff knowledgeable and involved in homeless and housing issues, particularly through local planning efforts, is key to responding to service system gaps. The State has undertaken efforts to improve the effectiveness of its treatment services and to better coordinate them with other resources in the community. This is done by emphasizing partnerships and collaboration at all levels and across multiple systems. One way OASA encourages this is by using Federal project money to develop and test a "best practice" model for systems change that can be sustained and replicated throughout the State. Other strategies include allowing off-site exceptions to treatment providers to co-locate staff at housing and homeless service agencies to improve access to treatment. The State also funds two programs to serve a targeted subgroup of people who are homeless and have substance use disorders. Each strategy strengthens the vital link among the treatment, housing, and other supportive services needed to reduce homelessness. Using Performance Standards in Massachusetts Policy and Planning Since 1996, the Massachusetts Department of Public Health’s (DPH) Bureau of Substance Abuse Services (BSAS) has designated people who are homeless a priority for services. The State’s commitment to providing outreach and services to this population is outlined in the SAPT Block Grant plan. The Agency has a Coordinator of Homeless and Housing Services who advocates for homeless and housing issues both inside and outside the Agency, and who represents the Department on the Executive Office of Health and Human Services’ Interagency Task Force on Homelessness. BSAS is involved in several collaborative efforts to improve planning and coordination of services for people who are homeless. The Department of Public Health sponsors bi-monthly meetings of the Massachusetts Homeless Task Force, which includes State officials, service providers, advocates, and other interested parties. Through these collaborations, a Statewide homeless advocacy coalition, the Massachusetts Housing and Shelter Alliance (MHSA), encouraged the development of strategies to prevent homelessness by reducing inappropriate discharges to streets or shelters. BSAS is one of many agencies implementing these strategies. Funding for Homeless Services Many programs within the State’s continuum of substance abuse treatment services and housing are aimed specifically at serving people who are homeless. In 2002, 19.9 percent of all BSAS admissions were homeless individuals and families, accounting for approximately $5.9 million of the State’s $29.4 million SAPT Block Grant. Block grant funds account for approximately 50 percent of the funding for the in-kind service matches required for the HUD-supported programs described below. Special Programs, Incentives, or Initiatives Performance standards. As a direct result of MHSA’s efforts to reduce inappropriate discharges into homelessness, the State has set certain performance standards in its contracts with providers. To receive funding, vendor agencies must follow BSAS’ guidelines to reduce inappropriate discharges, including referrals to appropriate housing and services in the community. Further, as the State re-bids its network of substance abuse service providers, an even greater emphasis will be placed on the use of performance-based outcomes, such as requiring providers to track individuals’ housing outcomes after leaving treatment. Outreach and assessment. The State provides a number of entry-level services specifically targeted to people who are homeless including outreach, assessment, education, and linkage to services. Massachusetts funds 18 staff positions in nine programs across the State to work in and around shelters to bring chronically homeless people who also use substances into services. The State also matches funds received through HUD’s Continuum of Care to provide outreach on the streets of Boston to engage people into detoxification and treatment. Emergency Shelter Grant funding is used to provide case management and other support services in shelters. Additionally, State funds support positions within a Health Care for the Homeless Clinic in Boston to screen and refer clients needing substance abuse services. Transitional housing and services. For individuals leaving detoxification without a recovery home bed or other housing situation in place, the State now supports two programs to prevent relapse and homelessness during this critical period. The Transitional Support Services (TSS) program provides intensive case management and transitional housing for an average of 30 days. Reflecting the need for such services is the fact that while 32 percent of the program’s 264 beds are targeted to people who are homeless, the proportion of homeless people actually served is much higher. The State also provides matching services for a similar post-detoxification/pre-recovery home program for homeless people that purchases 50 beds from providers across the State using HUD Continuum of Care funding. MHSA, as a vendor, is funded to contract for the beds and provide Statewide coordination; BSAS coordinates the HUD grant and provides matching service funding. Permanent supportive housing. These include housing programs that provide alcohol- and drug-free environments to support people in their recovery. BSAS funds case management to link people in these programs with needed services. Additionally, the Community Housing program, a joint effort among several agencies, provides 73 permanent supportive housing units to formerly homeless families and individuals in recovery. Rental subsidies are through HUD’s Shelter Plus Care program; the State provides the supportive services match by offering case management and linkage to other State-funded substance abuse treatment services. Another collaborative effort is the Aggressive Treatment and Relapse Prevention (ATARP) program, started in 1998 by DPH/BSAS and the Department of Mental Health. Funds from HUD’s Supportive Housing Program provide 60 units of housing for people with co-occurring mental illnesses and substance use disorders. DPH/BSAS also collaborates with DMH and other State agencies in the Housing Options Program (HOP). Through an Interagency Service Agreement (ISA), BSAS funds case management services to individuals in Shelter Plus Care and other subsidized housing. Lessons Learned Massachusetts’ substance abuse agency, BSAS, uses various funding strategies to implement an array of housing and services. This includes targeted State funding for outreach and engagement and for post-detoxification/pre-recovery home services. The State also combines HUD housing resources with State dollars for the supportive services match, with SAPT Block Grant funds making up about half of the in-kind services match. BSAS collaborates with other State agencies to combine permanent housing subsidies and supportive case management to keep people in housing and to link them with services. The State has strong commitment from the top down to support the delivery of housing and services to people with substance use disorders who are homeless. BSAS actively participates in a Statewide homeless task force with representation from key State agencies, service providers, advocates, and consumers. Improved planning and coordination at the State level has led to the establishment of firm polices and procedures regarding discharge planning and linkages to housing and services in the community. These policies are enforced with performance standards written into contracts with providers. |
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