Integration of Care Committee Meeting Minutes January 16th, 2018

INTEGRATION OF CARE COMMITTEE
TRB Building 227 East 30th St Rm CR718 New York, NY
January 16th, 2018 10:00 pm-12:00pm
MINUTES

Members Present: Danielle Beiling (Co-chair), Lauren Benyola, Bettina Carroll (non-voting), Rose Chestnut,

Mary Correa (phone), Dorothy Farley, Billy Fields,  Ronnie Fortunato, Deborah Greene, Janet Goldberg

(phone), Bill Gross, Graham Harriman, Christopher Joseph (phone), Peter Laqueur, Donald Powell, Saul Reyes

(consumer-at-large), Annette Roque, John Schoepp, Claire Simon (phone),  

Members Absent: Katrina Balovlenkov, Randall Bruce, Michael Ealy, Jan Carl Park, Brenda Starks-Ross, Dorella Walters (Co-chair), Joel Zive

Other DOHMH Attendees: Jose Colon-Berdecia, X. Pamela Farquhar, Dave Ferdinand, Sancia Jones, David Klotz,  Scarlett Macias, Tye Seabrook, Scott Spiegler

Ms. Beiling opened the meeting, welcoming everyone and leading a round of introductions. Mr. Schoepp led the committee in a moment of silence.

Ms. Lawrence introduced the meeting packet and asked if there were any changes to the minutes. The December minutes were accepted. The committee hosted housing providers who have experience housing homeless and unstably housed persons in NYC: Gavin Green of Breaking Ground; Marlene Karlin and Crystal Bradley of CUCS, the Center for Urban Community Services; Tim Campbell and Aracelis Fabian of Coalition for the Homeless; Rebecca Sauer and Tierra Labrada of the Supportive Housing Network of NY.

What is your service model? What are the pros and cons?

• CUCS provide social services and partner with Breaking Ground (BG) BG has a philosophy of housing first. Person centered, trauma informed and evidence based, i.e. wellness and self-management, substance use harm reduction. Do a lot of care coordination, helping connect to mental health and other services. Have some HIV clients. Offer permanent housing – clients sign a lease. We provide a lot of support, i.e. budgeting and more. What works is the joint partnership with BG – they are the landlord, manage the building – we provide the supportive services, but we both work to keep the clients housed. 
• CUCS does all the social services. Once a month meet with BG to discuss clients, discuss arrears.
• BG owns buildings throughout the city and operates outreach teams that cover the city. Teams runs 24/7.

Outreach brings people in, case management teams then manage clients. 

Are HIV clients processed/handled differently?

• Connect HIV+ clients with housing – can get housing much faster than other clients.
• Not allowed to cherry pick who comes into the buildings.
• Work closely with case managers at HASA – can require different services because of the HASA contract.
• Have a number of apartments specifically set aside for HIV

Affordable housing – 80/20s are reticent about housing clients because they need additional services. The money HASA is spending on SROs could be spent on these affordable housing units. Have you considered following clients through the housing continuum.

• Coalition for the Homeless (CFT) is an advocacy and direct services organization. Crisis intervention, job training, multiple housing sites, including scatter site for PLWH focus on children. Our housing is permanent housing, offer on-site support services. Try to work with tenants to make a plan that makes sense. Do not mandate treatment or services. Tailored to the individual.
• CFT’s scatter sites are permeant housing contracted with HASA. The leases are under CFT’s names – makes this easier for our clients. We encourage independent living. Make home visits, assess medical care, legal issues, mental health, substance use. Scatter site means finding housing – budget lines are restrictive when trying to find and maintain quality housing especially when landlords are not invested in that process. HASA sets the requirements that we must adhere to.
• CUCS- Housing first model – tenants come straight from the shelter into our housing – support really helps, but tenants can really struggle – i.e. maintaining sobriety when other tenants are actively using. Housing first means there are no requirements for housing. Belief that a housing can then work toward the goals they have for themselves. Do not push people out because they are using again, etc. Use a harm reduction approach – don’t ask people to go to rehab, but would show them a needle exchange.

What happens before a client is housed?

• Recently had an intimate partner violence issue where HASA wanted to house someone near the person who had abused her. That was a tussle. 

What do you do about slum landlords?

• Have a small maintenance team. But have issues with landlords not making timely repairs, issues with heating, etc. Legal helps, but we will go out and talk to the landlord.

How do you deal with unsafe housing situations?

• Have a HASA tenant who was using meth. He created a lot of problems for other tenants – worked with HASA to find resources to help the person. But in our place everyone has a lease – so you can’t just move people out against their will.
• We assess each apartment before people move in – helps, but isn’t perfect. For safety issues, we will relocate a tenant. Will work with HASA if there is a safety issue.

Do you partner with recovery centers for substance use services? How do you get info from your clients and how does that feedback into programming/services? Used to have housing readiness programs, i.e. budgeting – do you do that?

• Case managers work with clients on housing readiness – not a formalized program since sobriety is no longer required.
• Housing first has shown that it is better to work with someone in housing then before they are housed. Take a harm reduction approach and work with what the clients wants – are they ready for sobriety.

Do you work with methadone clinics?

• BG – many clients on methadone. Have suboxone available in office. We can’t share information with methadone counselors but stay in touch with them. Ensure carfare checks if clients need to get to a methadone clinic far away.
• CFT- work with folks to avoid crisis. Strong focus on harm reduction. Substance use is just one piece. Work on harmonious living, and employment as well.

Managed a shelter plus program for individuals working through substance use – how do you deal with a client not paying rent, using substances, and the landlord telling you that person has to get out.

• CFT – initial step is to talk to the client. If it’s affecting their or others housing – have to work through the HASA process.

If we are housing people – how are we helping people by just housing people without training them? Some people weren’t raised in clean houses?

• Housing first has a lot of advantages – but it’s a challenge – giving them housing – must work with clients. Had to teach our client how to use a broom, open a can. Funding at the end of the fiscal year – buy cleaning kits – make instructional videos – but its not a lot of clients who have this need. Not everyone is successful –work with HASA if client is willing to clean apartment or pay rent. But the idea is not to evict. Sometimes do swaps to find a better fit for folks.
• CUCS – we have a clean team – help develop specific goals around maintaining the apartment. Our medical team will prescribe suboxone.
• SHNNY is a coalition of providers – advocate for policies to end chronic homelessness.
• Supportive housing is a small slice – about 11% of the provided housing. Two types – congregate and scatter site. Regularly meet with HASA. The referral process is a challenge – communication between HASA, agency and housing is an issue. HASA specialist, housing case manager is not always happening or consistent – how to get people on the same page that is more efficient and transparent.
• Scatter sites are at a crisis point due to the housing market and rent regulation/de-regulation. Landlords are much more comfortable working agencies who can guarantee paid rent – but when the lease is held by an agency, the rent goes out of rent-stabilization which means less money for services.

How do you deal with substance use and nutrition – cleanliness in shared communal kitchens?

• CUCS- There has been an uptick in clients using crystal meth. We have psychiatrists that come out.

Have a client who started a fire in the building – refused an assessment – had to work through HASA  What is the HASA process?

• Levels of case conferencing. The way the information is set up to shared – by email, creates an issue – cannot email private client information. Supervisor, case manager and HASA specialist would be in the conference. After a level 3 conference, can petition HASA for court proceedings – but must have HASA’s permission for that. SHNNY advocates that HASA works on a resolutions when they deny permission for court proceedings. This has been a challenge. 

What if the landlord is the problem?

• CFT – advocate for client. Will move the tenant. We are focusing on the folks who have the most serious issues, but it’s very rare we get to a level 3 case conference. The housing first model works when it is properly funded.

Have a BG client – who was assaulted by his neighbor. Asked to be moved but was denied. Has PTSD and has not been able to maintain sobriety because of this incident. Another man who was not paying his portion of the rent, they got adult services involved who did a great job. What do you do with undocumented folks in HASA and those who are not – who don’t have PRUCOL?

• Folks who are not HASA eligible cannot receive HASA funded services, but we have other programs that do work with folks.
• Two rental assistance programs one HOPWA one RWPA works with undocumented persons.

How do we use RWPA resources to address homeless and unstably housed persons? What are the services that you have challenges finding funding for that we should focus on?.

• BG – there are not adequate transitional housing beds, especially for women. Majority of people have mental health issues – the most important, majority have a severe mental health diagnosis – tied with that is substance use services. Then everything else – we help with everything. Transitional housing beds – not shelter beds – such as safe haven beds, level 1. 
• Self-care – teaching people how to bathe, wash clothes, there is not funding for this.  Therapy in supportive housing, one on one therapy services are needed. People who do apartment organizing – very expensive. Hoarding is a process to undo – needs funding.
• 63,000 in the homeless shelters right now. Street homeless and severely disabled. More funding for housing first – put more money into that and permanent housing. Transitional beds are needed. Short term housing creates a struggle. Have psych services on site because its so difficult to get people into care. 
• BG – does street psych – on site psych care and medical care. Really valuable asset. 

How do you help people transition to permanent housing?

• CFT – big question of where people move on to. Housing vouchers have not been viable – cut in rental subsidy and support. There needs to be a route to get folks to a independent housing.
• We have clients who would do well in independent housing, but big question on where they go.
• CUCS – work with clients who want to live independently – wean them off of services, Some clients will never be able to live independently. 

What do you do about families?

• CFT – Special sites for families. Easier to house families. Additional resources for families. Priority should be on single adults with severe mental health issues.

Increased funding for housing means less funding for supportive services. Do you have NARCAN available?

• CUCS – everyone is trained – talking about training security. 
• BG – train clients, friends and distribute Narcan kits to everyone.

Concerns about moving people into 80/20 housing – and maintaining that housing.

What is a safe haven and how could RW funding assist?

• Transitional/Safe havens are smaller – people get a space until they move into permanent housing. Have your own room or share a room, but no more then ten to a room. Better case management to client ratio, more services onsite. More flexibility than shelters around rules. Some have peer support.

Join the Oral Health Subcommittee! Contact Melanie if you are interested. Upcoming meetings to be held Friday, Feb 22^nd, March 15^th and April 5^th from 2-4pm at Cicatelli.

Meeting adjourned at 12:00pm