Access: The TAC Blog

Last week, I had the pleasure of delivering the keynote address at the annual conference of the Supportive Housing Association of New Jersey. This gathering marked the association’s 20th anniversary, an opportunity to reflect on two decades of work to make permanent supportive housing — i.e., lease-based housing paired with voluntary, flexible services — a primary intervention for people with a wide range of disabilities and for people experiencing or at risk of homelessness. Many other states, too, have invested time and resources in the successful expansion of this approach for their homeless and disabled populations.

In an interesting fluke of timing, the New York Times had published an article the day before the conference, highlighting negative stories about permanent supportive housing (PSH) in New York and painting a picture of a model that had too often failed persons with serious mental illness. The tone of the article was keenly felt by this group of PSH practitioners, and several leaders from other states and policy groups have since contacted me to discuss the article’s potential impact. How could PSH — an approach that leaders in many states are working to expand in order to support the community integration needs of those who are homeless or disabled — be represented as a failure? What are the article’s implications for those seeking to invest in or expand PSH, for providers, and for people determined to live independently?

While the Times article was alarming, strong evidence nevertheless suggests that people with serious mental illness can succeed in PSH, and that use of the model should indeed be expanded. But there are considerations that must be addressed to ensure that PSH meets the needs of the people it is intended to serve. 

Supportive Housing Works

People with serious mental illness have historically lived in institutional settings whether they actually needed to or not. Over time, however, understanding has grown that the policy of housing people in state psychiatric hospitals, for example, is both cost-ineffective and inhumane, and that it fails to demonstrate positive outcomes. Deinstitutionalization efforts from the 1970s to the 1990s meant that many more people with mental illness began living in the community. We all know the story of the resulting growth in homelessness and trans-institutionalization to correctional settings, as public systems failed to develop their community-based services capacity and affordable housing resources to meet the increase in demand. Some people had access to services and residential supports, but many did not, and many still do not today.

When I was a case manager over 20 years ago, "supportive housing" meant doing everything possible to get people with mental illness into housing and helping them stay there. Over time, anecdotal stories of success across the country evolved into an evidence base for what we now know as permanent supportive housing.

There is plenty of evidence to demonstrate the effectiveness of PSH for people with mental illness and for people transitioning from homelessness. Many PSH programs have shown increased housing stability, decreased emergency department and inpatient use, reduced jail days, and significant cost savings compared to homelessness, inpatient care, and other institutional or supervised settings.

Even the statistics noted by the Times suggest that a large majority of people have succeeded in supportive housing. It is important to regard this in light of evidence showing safety and quality of care concerns in New York's adult homes, the housing situation from which many people with mental illness move into supportive housing.

Services Must Be Well-Designed and Adequately Funded

Does supportive housing work for everyone? No. Some people need supervised treatment settings, or prefer group residential programs. However, contrary to the assumptions that used to govern our mental health care systems, supportive housing in the community has been shown to work for a variety of people, including those with the most significant needs who are transitioning from state psychiatric hospitals, nursing facilities, jails, or homelessness. Even people with the most complex conditions need a place to call home that is not contingent on being a "compliant" patient or a "good" client; in fact, providing a choice of housing together with voluntary services has been shown to strengthen retention in housing and services.

In order for PSH to be successful, particularly for persons with complex needs, services must be voluntary, flexible, responsive, robust, and comprehensive. Furthermore, they must be delivered by well-trained staff who are able to provide the right types of services, in the right locations (i.e., where people live), and at the right times, adapting what is offered to meet individuals’ evolving needs. Providers that struggle to adequately support people in PSH are often those with inadequate staffing, which makes them unable to respond quickly and appropriately.

To underfund services is to undermine the ability of providers to meet the needs of PSH tenants. In my experience, the services covered by Medicaid are not, on their own, enough to meet the needs of many people who could otherwise succeed in PSH. If systems will be expected to serve an increasingly complex population, state and county funding agencies and Medicaid managed care organizations must have adequate resources available to pay for a full range of services; successful permanent supportive housing programs are those that braid or blend Medicaid with other resources.

Building On the Evidence

As a former state mental health commissioner, a behavioral health provider, and the family member of someone with a mental illness, it boggles my mind that we would rather pay several hundred thousand dollars per year to house a person in an institutional setting than commit a fraction of that amount to support them in an integrated, community-based setting with demonstrated positive outcomes. Too often, the response to challenges that arise in PSH is an assumption that a person is "not ready," or "needs supervision," instead of a person-centered mindset that tailors and continually adapts services to each individual’s needs and choices.

Yes, people with mental illness and other disabilities may need inpatient treatment, at times. They may need round-the-clock support, at times. They may need assistance with their medications, at times. They may need transportation to medical appointments, at times. People with mental illness and other disabilities may need lots of things — but that doesn’t mean we should return to institutionalization at a cost that is much greater than the sum required to meet all of those needs. With sufficient resources to pay for both rental assistance and robust, flexible services, permanent supportive housing can be a primary intervention for individuals with complex needs.

Systems should move forward on bringing well-designed, fully funded permanent supportive housing to scale, so that all who can benefit from living in safe, independent, community-integrated housing have the opportunity to do so.

A Community Focuses on Solutions to Rising Homelessness

IN LANE COUNTY, OREGON AND ITS LARGEST CITY, EUGENE, service providers, community stakeholders, and elected officials are coming together to improve the community's response to a growing population of people experiencing homelessness. To help understand the problem better, and to identify potential solutions and best practices, the Lane County Department of Health and Human Services engaged TAC in March to conduct a public shelter feasibility study. With the study, the community sought to learn how people enter into homelessness in Lane County, which housing and services they are able to access, and what factors might be contributing to any system bottlenecks.

Over the past seven months, TAC consultants Gina Schaak, Liz Stewart, and Douglas Tetrault have worked to assess Lane County's homeless crisis response and service systems, focusing on both resource capacity and gaps in coordinated entry, diversion, outreach, day shelter, emergency shelter, transitional housing, rapid-rehousing, and permanent supportive housing. To get a comprehensive picture of the existing system, TAC met with Lane County and City of Eugene staff, conducted interviews and focus groups with service providers and other key community stakeholders, and - with the help of the Human Services Research Institute - analyzed data from numerous sources.

On October 10, Liz, Gina, and Douglas presented TAC's preliminary findings to a joint session of Lane County Commissioners and the Eugene City Council, and later that day to community members at a well-attended public forum. TAC explained that Lane County can significantly reduce homelessness best by strengthening all system components. By improving the alignment of policy and training, and consistently implementing best practices throughout both Lane County and Eugene, the community can ensure that its resources are applied effectively. In December, TAC will deliver a final report authored by Liz, Gina, Douglas, and TAC Senior Consultant Lisa Sloane, with specific recommendations on system and policy changes as well as results of system modeling.

Second Annual Rapid Re-Housing Institutes Energize Providers from Across the Country

In partnership with the Department of Veterans Affairs (VA), the Department of Housing and Urban Development (HUD), and the U.S. Interagency Council on Homelessness, TAC designed and delivered the second annual Rapid Re-Housing Institutes last month. Held in Miami, FL and San Diego, CA, these intensive two-day trainings brought together over 800 rapid re-housing practitioners, Continuum of Care leads, government officials, philanthropic groups, and federal partners. Sponsored primarily by the VA's Supportive Services for Veteran Families (SSVF) program, the Institutes focused on rapid re-housing practice and planning, homelessness diversion and rapid exit strategies, and coordinated entry practices. Emerging topics such as shared housing solutions, data-informed system design, and sustainable homeless crisis response systems were also highlighted. TAC, along with our partner Abt Associates, is the primary technical assistance (TA) provider for SSVF, working closely with national partners and other TA firms to deliver high-quality planning and training development for grantees of the program. The Institutes are the only event of their kind to deliberately target both SSVF nonprofit providers and homeless service providers funded by HUD and local groups.

TAC Staff in Action

STAFF ACTIVITIES

TAC Executive Director Kevin Martone co-led a workshop on mainstream vouchers at the annual conference of the National Association of Housing & Redevelopment Officials; Kevin also joined Senior Associate Rachel Post and frequent TAC collaborator Jacob Mihalak to moderate and present in several panels at last month's Supportive Housing and Supported Employment post-conference institute after the Washington State Co-Occurring Disorders and Treatment conference; Rachel also presented at the Washington Council on Behavioral Health's Peer Pathways 2018 conference on supported employment and supportive housing for justice-involved populations, and at the Oregon Housing Conference on the role of supported employment in promoting recovery for people in supported housing.

STAFF TRANSITIONS

We are delighted to welcome two new Senior Associates to TAC! Tyler Sadwith joins TAC's Human Services practice, after over seven years at the Center for Medicare and Medicaid Services advancing strategies to help states introduce behavioral health system reforms and address complex policy, operational, and strategic challenges. Nicole Sweazy will work with our Housing practice, bringing nearly two decades of expertise in affordable housing and federal programs; as Executive Director of the Louisiana Housing Authority, she oversaw the state's permanent supportive housing and homeless programs and was responsible for developing Louisiana's plan to end homelessness.

The destructive nature of substance use disorders and the influence of active addiction on people’s behavior can often lead to homelessness. In fact, The Substance Abuse and Mental Health Administration (SAMHSA) estimates that 38 percent of individuals experiencing homelessness are dependent on alcohol, while 26 percent abuse other drugs, including opioids. With growing recognition of housing as a critical determinant of health and recovery, we must thoughtfully consider what kinds of housing can best help people with addictions optimize their potential for recovery and re-stabilize their lives.

Two recognized housing approaches intended to help people with substance use disorders (SUDs) transition from homelessness are “recovery housing” and Housing First. These approaches operate differently and have unique histories — yet rather than advocate for one over the other, I suggest that fully supporting both approaches should be our priority.

Alcohol and drug-free (recovery) housing is a critically important and currently under-resourced intervention. It can be operated with tiered levels of supports that are matched with the needs of residents, including more intensive supportive services for those exiting homelessness to self-governed Oxford Houses or Recovery Homes. Many residents of recovery housing attest to their need for this safe and supportive living environment in order to promote their long-term recovery from addiction, their health and wellness, and their ability to stay stably housed. 

In the Housing First model, the top priority for service providers is to help individuals and families secure permanent housing. Often the term “low-barrier” is applied in this model, indicating that there are no conditions on tenancy, such as sobriety or participation in treatment. Housing First is based on evidence that stable, lease-based housing plus voluntary acceptance of services can help people make progress on addressing their mental health and addiction disorders.

My advocacy for both models is rooted in 17 years of work on programs designed to help this population. Indeed, my work starting Housing First programs at Central City Concern (CCC) in Portland, Oregon and at Colorado Coalition for the Homeless in Denver was inspired in part by wanting to make sure we were "throwing everything that worked” at ending chronic homelessness and addiction. At CCC, the idea of adding Housing First programming was initially met with some resistance, especially by colleagues who were themselves in long-term recovery. Over time, however, people began to see the value and successful outcomes of offering housing that was paired with individuals’ choices.

Recovery housing can be very effective for clients who are self-initiating detox and treatment. When evidence-based supported employment services, peer recovery mentors, and coordinated outpatient treatment were incorporated into CCC’s recovery housing, we found that high percentages of individuals with primary SUDs who had been homeless completed treatment and remained housed and employed one year post-exit.

With evidence supporting both approaches to housing for people with SUDs, providers and policymakers must be open to a range of approaches to address the diverse preferences and needs of the individuals they hope to serve. For this reason, when I shared the effectiveness of CCC’s recovery housing programs with federal agencies and stakeholders around the country, I also spoke (and still do) about the importance of ensuring housing choice for homeless people with SUDs.

Likewise, the Department of Housing and Urban Development (HUD) discussed in its 2015 Recovery Housing Policy Brief the value of promoting individual choice among housing options for homeless individuals. The brief encouraged expanding the supply of permanent supportive housing and other models that use a low-barrier, Housing First approach, so as not to exclude a large number of people who are unprepared to meet sobriety or abstinence requirements. But HUD also affirmed the importance of providing recovery housing options for people who want and need a sober-living environment. HUD’s Policy Brief outlines the characteristics, practices, and outcomes it expects from recovery housing funded with its homeless dollars.

The expansion of recovery housing received broader federal support in the 2016 Surgeon General’s Facing Addiction in America report, and in another report issued in 2017 by the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Earlier this year, the National Council for Behavioral Health (NCBH) issued a Recovery Housing Guide to help states include high-quality recovery housing among the options offered by their behavioral health systems. NCBH followed this guide with a letter to every Single State Agency, alerting them to SAMHSA’s unprecedented decision to allow State Opioid Response Grants ($930 million) to fund supportive services for individuals with opioid use disorders in recovery housing. 

Research is needed on the long-term effectiveness of both recovery housing and Housing First programs for people with primary SUDs. For now, states and local jurisdictions can use the practices described in the HUD and NCBH policy briefs to expand the capacity of recovery housing and improve the practices of existing programs. Recovery housing can promote housing tenure, long-term recovery, reunification with families and children, economic and educational advancement, improved health and wellness, and community involvement. Many of my colleagues whose experience of recovery housing helped cultivate my understanding of the model also report perhaps the most significant outcome of all: They say they owe their lives to it.

Current legislation in Congress addressing the nation’s opioid crisis has wide bipartisan support and includes several provisions to provide housing-related assistance for people in recovery from SUDs. As the final bill becomes law, states and communities working to combat both addiction and homelessness will become better able to offer housing choice that includes robust recovery housing programs.

New Mainstream Housing Voucher Awards Announced

Last week, the U.S. Department of Housing and Urban Development (HUD) announced the award of almost $100 million in Mainstream Housing Choice Vouchers (HCVs) to 285 public housing authorities in 45 states, the District of Columbia, and Guam. As HUD noted in its press release, the availability of 12,000 new vouchers for non-elderly, low-income people with disabilities "helps to further the goals of the Americans with Disabilities Act by helping persons with disabilities live in the most integrated setting."

Housing agencies must target these new vouchers to at least one of the following groups of people with disabilities:

- People transitioning out of institutional or other segregated settings

- People at serious risk of institutionalization

- People experiencing homelessness

- People at risk of becoming homeless

In its application scoring system, HUD provided significant incentives for public housing authorities (PHAs) to partner with state or local agencies that work with these populations. To help foster such collaborations, TAC and the National Alliance to End Homelessness, the National Association of Housing and Redevelopment Officials,  the National Council of State Housing Agencies, and the Consortium for Citizens with Disabilities co-hosted a series of outreach webinars for service providers, Continuums of Care (CoCs), and disability rights advocates as well as PHA leadership. More than 1,200 PHAs, CoCs, disability organizations, and other local partners participated in preparation for the application process.

What's Next?

Nearly $300 million in HUD's FY 2018 budget for the Mainstream HCV program remains. What does this mean for your community?

Apply: If your community did not apply for funds, start laying the groundwork now for your response to the next opportunity, which is likely to be in the near future.

Reapply: If you applied this summer but did not receive funding, request a debriefing from HUD (as described in the Notice of Funding Availability).

Reach out to your local PHA: Housing authorities that have been awarded vouchers will need the assistance of local homeless, disability, and other service agencies to implement this program effectively!

As TAC's recent report Priced Out: The Housing Crisis for People with Disabilities documents, non-elderly adults with disabilities living on Supplemental Security Income are confronting a housing affordability gap across our nation. These new federal funds can help close the gap for people with disabilities in your community. 

TAC Staff in Action

STAFF ACTIVITIES

TAC Associate Phil Allen teamed up with Bill Burns, director of Family Promise of Onterio County, NY, to bike 100 miles in the 2018 Point to Point ride, raising over $1,000 for the Vermont Foodbank; As part of TAC's work with the Nevada Partnership for Homeless Youth, Associates Ellen Fitzpatrick and Lauren Knott facilitated a meeting in Las Vegas with juvenile justice and child welfare system representatives, youth service providers, young people who have experienced homelessness, and other stakeholders to determine objectives and strategies to include in the group's plan to end youth homelessness in Southern Nevada; Through the Department of Veterans Affairs' Supportive Services for Veteran Families program, Managing Director Marie Herb, Senior Consultant Jim Yates, Associates Phil Allen and Douglas Tetrault, and contractor Naomi Sweitzer have conducted launch meetings throughout the summer in communities that are part of a pilot program focused on rapid resolution of housing crises; Executive Director Kevin Martone participated in Monarch Housing Associates' New Jersey Hill Day in Washington, DC to advocate for strong housing assistance programs; Administrative Assistant Mayra Pabon started as a volunteer at Horizons for Homeless Children; Mayra also represented TAC at a celebration event for graduates of the Boston Center for Independent Living's Transitions Internship Program, including TAC summer intern Jordon Myers (see below). 

STAFF TRANSITIONS

We are happy to announce the addition of two new Senior Associates to the TAC team. Rachel Post, who will work with the Human Services Group, is based in Portland, OR where she has worked both locally and nationally on programs to improve social determinants of health. At TAC, Rachel will provide consultation and support for initiatives that create and sustain integrated health, behavioral health, employment, and housing programs and services for vulnerable populations. Ayana Dilday Gonzalez, who is joining our Housing Group, will be based here in our Boston office; Ayana brings extensive state-level leadership experience developing and maintaining supportive housing projects, and will be working with us on HUD's CoC and 811 Project-based Rental Assistance programs and other HUD multifamily housing Initiatives.

Congratulations to Francine Arienti on her new role as TAC's Human Services Director, and to Associate Ashley Mann-McLellan on her new role as a mom! Welcome to the world, Zoe McLellan!

And finally, thanks and farewell to summer intern Jordon Myers, a Framingham State University student who joined us through the Boston Center for Independent Living's Transitions Internship Program.

Forging Partnerships to Bring New Housing Vouchers into Your Community

In April, The Department of Housing and Urban Development (HUD) issued a Notice of Funding Availability (NOFA) for $100 million in new "Mainstream" housing vouchers for non-elderly people with disabilities - with a focus on those who are living in segregated settings (such as institutions), homeless, or at risk of one of these conditions. All told, the federal FY 18 appropriation included an estimated total of $385 million in new mainstream voucher funding, so additional NOFAs are expected soon.

As the first major infusion of resources into the Mainstream Voucher Program in many years, this NOFA offers a welcome means of boosting stable, affordable, and community-integrated housing opportunities for people with disabilities. To promote the program and support the development of strong partnership applications for the new funding from communities across the country, TAC worked quickly to develop and broadcast four webinars with our partners at the National Association of Housing and Redevelopment Officials, the National Alliance to End Homelessness, the Consortium for Citizens with Disabilities Housing Task Force, and the National Council of State Housing Agencies. Over 1,200 agencies participated in these webinars, which focused on building effective partnerships between Public Housing Agencies, homeless service providers, and disability groups - both to meet HUD's scoring criteria for this NOFA, and for long-term success. The recorded webinars are available on TAC's new resource page created for potential applicant agencies and partners.

Section 811 PRA Grantees Share Successes and Strategies for Integrated Housing

Earlier this month, HUD Section 811 Project Rental Assistance grantees gathered in Washington, D.C. for an 811 PRA Institute. The event brought together housing and service partners from 22 states, all dedicated to creating integrated supportive permanent housing for extremely low-income people with disabilities. The Institute, which was organized and facilitated by TAC and included officials from HUD, provided an opportunity for grantees to share and learn about best practices in program implementation, including key strategies in unit identification and effective practices in referrals and leasing. Visit TAC's Facebook page to see a slideshow from the event!

TAC Staff in Action

Staff Activities

TAC Associates Ellen Fitzpatrick, Lauren Knott, & Ashley Mann-McLellan headed to Las Vegas to help launch "Dream Big," a campaign to end youth homelessness in Southern Nevada; Lauren also participated in the Point Source Youth symposium in New York City, while Ashley stayed in the Southwest to facilitate planning meetings to ramp up efforts to end Veteran homelessness in Albuquerque, NM and assist in coordinated entry efforts for rural areas in the state; Lisa Sloane, TAC's Senior Policy Advisor and Christine Gault, a TAC subcontractor, helped Oregon's Supportive Housing Strategy Workgroup develop permanent supportive housing recommendations for the state's housing and Medicaid/behavioral health agencies; and in April, Associate Douglas Tetrault and Senior Consultant Jim Yates helped plan a full-day strategy meeting focused on emerging practices in homelessness diversion and rapid shelter resolution, with the goal of developing a new pilot in the Department of Veterans Affairs' Supportive Services for Veteran Families program.

FAIRBANKS IS THE REGIONAL HUB for interior Alaska, an area larger than the state of Texas. The city’s need for supportive housing is amplified by its remote rural and frontier location and extreme arctic conditions. Although the number of people experiencing homelessness in Fairbanks — approximately 250 people at any given time — seems small compared to what other major U.S. cities report, the impact of homelessness in this community is an important factor: Even during bouts of -50° Fahrenheit temperatures, Fairbanks routinely has more than 50 people trying to survive in local encampments. There have been times when dramatic temperature changes caught encampment residents off guard, resulting in numerous cold weather injuries and even some deaths.

Since 2014, TAC has worked with state and local partners on strategies to create permanent supportive housing and rapid re-housing opportunities for Alaskans. Last December, TAC was invited to facilitate the Fairbanks Symposium on Homelessness, with the goal of generating momentum toward a community planning strategy for tackling homelessness in some of the most diverse geography and climate in the United States. As in other cities and towns across the country, both the cost of housing and a lack of available units present significant challenges. But the "must do" attitude of the local Fairbanks community has already resulted in remarkable progress, and can serve as a beacon for those working in other rural communities to prevent and end homelessness.

The Fairbanks Housing and Homeless Coalition is leading the charge, representing more than 20 local organizations that provide shelter, support, and opportunities for community members struggling with housing barriers. Since the Symposium, the city’s housing and homelessness coordinator has brought local agencies together for more planning. Collectively, the group has contributed an estimated $58,360 worth of in-kind donations to initiate a program that can quickly connect families and individuals experiencing homelessness to permanent, private market housing through intensive case management, applicable employment services, and tapering financial support. Just this month, the Alaska Mental Health Trust announced that it will fully fund this local rapid re-housing program!

The Fairbanks Rescue Mission, which is already implementing rapid re-housing for Veterans through a federal Supportive Services for Veteran Families grant, has been designated as the lead agency for the award. The funding provided by the Trust will allow the new program to hire two full-time staff members and assist approximately forty families a year with housing, case management, and landlord support. The Trust has given a further boost to efforts in the region by providing funding for the Alaska Coalition on Housing and Homelessness to hire a rural housing planner who can help build local coalitions in rural Alaska and improve the region’s readiness to apply for funding to meet its needs.

Fairbanks’ challenging environmental conditions and extremely rural setting make providing effective and targeted services to the community’s most vulnerable individuals a high priority. Fortunately, the community’s determination to make life better for its least advantaged members is just what is needed. 

VA Awards TAC a New Supportive Services for Veteran Families Contract

THROUGH THE SUPPORTIVE SERVICES FOR VETERAN FAMILIES PROGRAM, the U.S. Department of Veterans Affairs (VA) helps service providers across the country to strengthen the housing stability and independent living skills of very low-income veteran families occupying or transitioning to permanent housing. TAC is honored to have been awarded a new five-year grant from the VA to continue and deepen the technical assistance we have provided to SSVF grantees since the program was launched in 2011. Joining us on the TA team are our longtime partners Abt Associates, the National Alliance to End Homelessness' Center for Capacity Building, the National Coalition for Homeless Veterans, Policy Research Associates, Inc., and Atlas Research.

Nearly 400 SSVF grants fund nonprofit organizations and consumer cooperatives across the country. TAC coordinates and provides specialized TA to all these grantees through in-person trainings, regional gatherings, program site visits, carefully designed products and tools, one-on-one consultation, webinars, and online group learning. By focusing on crisis intervention and housing stability, targeting practices to ensure effective delivery of resources, and using permanent supportive housing to improve both housing stability and behavioral health outcomes, we help communities develop system-level capacity to meet the unique needs of veterans and their families.

TAC Staff in Action

STAFF ACTIVITIES

Ashley Mann-McLellan, TAC Associate, led community-wide rapid re-housing (RRH) trainings in Maricopa County, AZ and Orange County, CA (where she also led an accompanying executive-level training), kicking off efforts to use RRH as a system-wide strategy; Ashley also presented on decision-making and accountability frameworks at a Seattle CoC summit on governance, strategic planning, and racial equity, and gave a workshop on landlord engagement at this month's Housing First Partners conference in Boulder, CO; Executive Director Kevin Martone wrote about the importance of new affordable housing resources in the National Association of County Behavioral Health and Developmental Disability Directors newsletter, drawing on a widely read Access blog post by Senior Associate Gina Schaak and Senior Policy Advisor Lisa Sloane; Lisa was also invited to present on "Housing First and Permanent Supportive Housing 101" to the Oregon Housing and Community Services Department; at a March event, Associate Douglas Tetrault co-presented with the New Hampshire Interagency Council on Homelessness at a discussion on the state's efforts - supported by TAC since 2016 - to end veteran homelessness.

THE OMNIBUS BUDGET BILL for Fiscal Year 2018, passed by Congress and enacted by the president last week, includes a ten percent ($4.6 billion), one-year increase to the U.S. Housing and Urban Development (HUD) budget overall and gives especially strong support to housing programs serving people with disabilities.

Affordable Housing for People with Disabilities — Highlights

• $400 million (est.) will go to new Section 811 mainstream vouchers for non-elderly people with disabilities. TAC estimates these funds will provide nearly 50,000 new vouchers for people with disabilities!

• $82.6 million for new Section 811 Project Rental Assistance (PRA) capital advances and Project Rental Assistance. This increase may provide an opportunity for states that have not yet received PRA funds to benefit from this program!

Other Good News

• $130 million increase for Homeless Assistance grants. The National Alliance to End Homelessness estimates that this increase will be enough to move 20,000 to 25,000 more people from homelessness to permanent housing.

• $40 million for new supportive housing for homeless veterans with disabilities, through the HUD-Veterans Affairs Supportive Housing (VASH) program.

• $20 million for new Family Unification Program vouchers that target two populations: (1) families unifying with children who were placed or are at imminent risk of placement out of the home due to lack of adequate housing for family, and (2) youth (18 to 24 years old) who are aging out of the foster care system.

• A 12.5% increase in the Low Income Housing Tax Credit allocation and a 30% increase in the HOME Investment Partnerships Program (HOME), both of which will help states and localities to increase affordable housing production.

Thanks are due to all of the disability, homelessness, and affordable housing proponents across the country whose hard work and advocacy have ensured that thousands more people with disabilities will have the chance to live in safe, affordable apartments — rather than in institutions, in shelter, or on the streets. Thanks especially to Rep. Rodney Frelinghuysen, outgoing chair of the House Appropriations Committee, who has been a steadfast supporter of housing for non-elderly people with disabilities.

Long-Range Planning for Supportive Housing in New Mexico

Beginning with the successful launch of the New Mexico Behavioral Health Purchasing Collaborative Long Range Supportive Housing Plan in December of 2007, TAC has supported the state's sustained effort to create and maintain independent, decent, safe, and affordable housing options linked to flexible community-based supports - a model commonly referred to as permanent supportive housing (PSH). Now, with the release of the new Strategic Plan for Supportive Housing in New Mexico: 2018-2023, co-authored by Cynthia Melugin of the New Mexico Human Services Department and TAC Senior Consultants Jim Yates and Sherry Lerch, the state is excited and empowered to continue creating new PSH opportunities - while also advancing efforts to realign New Mexico's behavioral health services system. New Mexico aspires to lead by example, adopting innovative strategies to address the challenges of operating PSH across a rural frontier state with a diverse population.

TAC Staff in Action

Staff Activities

Associate Phil Allen, TA & Training Coordinator Kyia Watkins, and Senior Consultant Jim Yates, in partnership with the Department of Veterans Affairs, led a first-ever two-day Program Manager Academy for 75 Supportive Services for Veteran Families (SSVF) program managers from across the country; Associate Amy Horton conducted a site visit in New York, NY as part of SAMHSA's national evaluation of the Cooperative Agreements to Benefit Homeless Individuals (CABHI) grant program; Associate Ashley Mann-McLellan and two young adult TA providers from the National Youth Forum on Homelessness attended a two-day workshop together in King County, WA on incorporating youth voices into ending youth homelessness; Ashley also attended this month’s National Alliance to End Homelessness Conference on Youth and Family Homelessness, where she presented on infusing behavioral health partnerships into housing models; Kevin Martone, TAC’s Executive Director, was at the conference too, facilitating a panel discussion he organized on Medicaid and homelessness — and in February, Kevin spoke at the Families USA Health Action Conference on “Reconstructing a Fragmented Behavioral Health System through Wellness and Whole Person Care”; Senior Associate Gina Schaak and Senior Policy Advisor Lisa Sloane headed to Washington, DC for the National Low income Housing Coalition’s annual legislative forum; and Associate Douglas Tetrault, in partnership with the VA SSVF Program Office, led a day-long planning meeting in San Juan, PR focused on efforts to end homelessness among veterans following the devastation of hurricanes Irma and Maria.

STAFF Transitions

Congratulations to Associate Lauren Knott and her family on the birth of Eliza Everett Knott — glad to have you on the team, Eliza!

IT IS NOW WIDELY ACCEPTED that planning and implementing successful programs to prevent and end homelessness requires direct involvement by people who have themselves been homeless. Individuals with this lived experience, often referred to as “consumers” because of their direct interactions with homeless services, bring a well-informed awareness of the supports that are most needed and desired. Many valued innovations, such as the Housing First approach, are based on consumer preferences shared through interactions and studies.

Continuums of Care (CoCs) — collaborative planning bodies funded by the U.S. Department of Housing and Urban Development to improve homeless service coordination in specific geographic areas or communities — are required to include on their decision-making boards people who are or have been homeless, along with key stakeholders from nonprofit provider organizations, local government agencies, philanthropic organizations, and local businesses. Furthermore, any agency that receives funding through the CoC program must include a person who is homeless or formerly homeless on its own board or other policymaking entity.

However, many CoCs and agencies receiving CoC funds lack well-developed consumer involvement strategies. In response to a 2015 survey, 47 percent of CoCs said consumers influence some decisions, while only about 15 percent indicated that consumers influence all major decisions. Some CoC respondents reported that they want to involve consumers to a greater extent, but are challenged to find people who have enough “interest and stability” to be actively and consistently involved.  

In 2016, the United States Interagency Council on Homelessness reported on a gathering of consumer advocates convened to discuss how decision-making bodies can create a welcoming environment for people with lived experience of homelessness. Based on these findings, together with insights from research on mental health consumer involvement, we’ve put together some tips to help you first build interest and excitement among homeless and formerly homeless people to become actively involved, and then to make sure this involvement is a positive experience for all.

Generate Interest

Clearly “advertise” what the role is and why it is important. For a CoC board, what is the time commitment? What does the board do? For a CoC-funded agency, what input is the agency seeking?

Develop and maintain strong connections to trusted community organizations that provide housing and services to people who are homeless. These partners can identify potential candidates and encourage participation.

Financially compensate board members with lived experience of homelessness for time and travel in a similar fashion to others serving in the same capacity.

Explain responsibilities, reimbursement policies, the time commitment expected, and options for participating in different ways, such as attending meetings or reviewing draft materials. It may be helpful to use the term “like a job” to clarify the level of expectation.

Establish Stability

Language matters! Use “people first” language in all your materials and communications, such as “people who are experiencing homelessness” rather than “the homeless.” Consider your language choices when talking about subpopulations as well, for instance saying “young adults” rather than “kids” when talking about young people experiencing homelessness.

Identify and resolve any barriers to participation, like scheduling conflicts with employment, lack of access to transportation, or the need for child care. Devote part of each meeting to addressing these barriers, and meet with people individually as needed to problem-solve. Consider non-traditional meeting times to accommodate these needs, such as in the evenings or on the weekends. Meet in locations that are accessible by public transportation, and offer child care or child-friendly meeting spaces.

Designate a point person for questions and concerns. This person should check in regularly with the consumer to make sure they understand the board or committee’s processes (meeting agendas, voting procedures) and the content to be discussed during each meeting. It’s also important to bring people up to date on what happened at any meetings they missed. Offer opportunities to provide input in ways besides speaking publicly at a meeting, such as in writing or via email before or after meetings. Individualized connections like this may be especially important when working with board/committee members who have a serious mental illness.

Make every effort to accommodate consumers’ needs, particularly in relation to health difficulties. For people with disabilities, accommodations should include a physically accessible room, materials in appropriate formats (e.g., large print, Braille), and access to Communication Access Realtime Translator (CART) and American Sign Language (ASL) interpreters. The meeting’s facilitator may need to be deliberate in making the space for members with disabilities to be heard – especially those with mental health conditions. As noted earlier, making meetings child-friendly or offering child care can enable participation by people with young children.

Eliminate tokenism by recruiting more than one person with lived experience, and offer other opportunities for inclusion as well. Invite people to suggest ways in which they would like to contribute, and work to create an environment that actively engages and solicits the input of all members of the group, including those with differing communication capacities.

Learn Together

Value consumers and their perspectives regardless of what led to their experience of homelessness.

Include a cross-training component, in which each advisory board member takes five to ten minutes to explain to the group the expertise they have to offer, which for some members will include their lived experience of homelessness. Ensure that this time does not turn into a “job interview” format where members are merely listing qualifications.

Create opportunities for informal interactions between consumers and other committee members, such as sponsoring and paying for group lunches and social outings. 

Consider ways to bring people with lived experience of homelessness into leadership roles within your CoC, through the board and committee membership, or by spearheading specific CoC initiatives. Establish a clear process for those who may be interested and invest time in actively recruiting members.

Make sure everyone is up to speed before shifting gears or making decisions. This includes educating consumer members on the basics of the CoC, and defining common terms and acronyms. Try to use plain, non-specialized language in meetings. Consider making decisions by consensus through group discussion, rather than by majority vote.

It can be challenging for any group to work together across significant differences in background and experience. But it’s worth it! To make their programs as effective as possible, CoCs need the insights and ideas of people with current or recent experiences of homelessness. In turn, the organizational leaders and policymakers who serve on a CoC or agency board offer connections, knowledge, and authority — valuable resources to which consumers on their own often lack access. Continuums of Care that rise to the challenge of fully incorporating people with lived experience of homelessness will be all the stronger for it.

Helpful Resources:

A Quick Guide on Consumer Engagement in Governance of Health Care for the Homeless Projects (2016, National Health Care for the Homeless Council).

Guidance for Consumer Advisory Board Staff Support [on Homlessness Projects] (2017, National Health Care for the Homeless Council).

Nothing About Us Without Us: Seven Principles for Leadership and Inclusion of People with Lived Experience of Homelessness (2016, Lived Experience Advisory Council of the Canadian Obervatory on Homelessness).

Recommendations for Effective Implementation of the HEARTH Act Continuum of Care Regulations (2012, National Alliance to End Homelessness)

Youth Collaboration Toolkit (2017, True Colors Fund)

Thanks to TAC Associate Lauren Knott for her assistance with this post!

Improving Addiction Treatment with Consumer Report Cards

"Consumer report cards are a well-established approach to improving the accountability and quality of health care providers." And, as a team of expert authors including TAC Senior Consultant John O'Brien further observe in a recently published Health Affairs blog post, such accountability is sorely needed in the burgeoning field of addiction treatment. People facing a decision about how best to tackle an opioid use disorder should have some way to determine whether a given treatment option will successfully reduce their key symptoms, improve their health and functioning, and prepare them to manage the risk of future relapses. Drawing on several new reports and tools, the authors recommend specific metrics to identify providers using evidence-based principles in their substance use disorder treatment programs.

TAC Staff in Action

Staff Activities

Senior Policy Advisor Francine Arienti and Associate Amy Horton conducted site visits in Pawtucket, RI, Northampton, MA, and Albany, NY as part of SAMHSA's national evaluation of the Cooperative Agreements to Benefit Homeless Individuals (CABHI) grant program; Managing Director Marie Herb and Senior Associate Gina Schaak met with Fall River (MA)'s Mayor's Task Force to End Homelessness to help produce a strategic plan; Associate Jennifer Ingle led a training for housing support and management staff in Malden, MA on de-escalation and crisis prevention; Associate Lauren Knott presented on "Unstably Housed Youth: Different Needs, Different Services" at the Homes Within Reach conference in December; Associate Ashley Mann-McLellan is serving as the subject matter expert for a monthly webinar series on developing non-time-limited supportive housing for youth experiencing homelessness, produced in partnership with Collaborative Solutions; Ashley also facilitated a recent session with Long Island, NY's Veteran Leadership Team to plan for sustaining its successful work to end veteran homelessness; Executive Director Kevin Martone and Associate Phillip Allen traveled to Alaska for the Fairbanks Symposium on Homelessness, where Kevin gave the plenary address and led a workshop on "Permanent Supportive Housing and Rapid Re-Housing Services," and Phil gave a workshop on "Rapid Re-Housing: A Systematic Approach to Ending Homelessness"; Kevin also traveled to Phoenix, AZ to work with several states on behavioral health care integration at an event sponsored by the National Governors Association.

Staff Transitions

Congratulations to Associate Amanda Tobey and her family on the birth of Parker Collins-Tobey — and welcome to the world, Parker!