The Chronically Homeless Services and Housing (CHSH) project, a program of The Road Home, in Salt Lake City, Utah, is funded through SAMHSA’s Cooperative Agreement to Benefit Homeless Individuals (CABHI) grant. The Road Home was awarded the three-year grant in September 2011.
The goal of the CHSH project is to use a Housing First approach to stably house chronically homeless individuals who have been the most challenging to engage, have a history of substance abuse and/or mental illness, and who have been unsuccessful in accessing existing permanent supportive housing (PSH). Additional goals include enrolling these clients in Medicaid and providing recovery services.
Program objectives include identifying project participants utilizing a focused targeting outreach plan with community input from those providing services on the frontlines and who are familiar with the diverse clientele and the level of need. The Road Home designed the CHSH project with its community partner agencies to fill existing gaps by providing resources and building relationships at the point of client contact, utilizing an interdisciplinary and multiagency outreach team to deliver services, and staying close to the client at every point during the housing process.
The CHSH project, based on a Housing First philosophy, is implemented in the form of a modified Assertive Community Treatment (ACT) Team.This interdisciplinary service delivery model is intended to provide long-term, comprehensive medical, social, and mental health support to clients with severe mental illness to keep them housed and in the community.
The CHSH project’s preliminary results demonstrate that homeless individuals enrolled in the project show marked improvement in a wide range of outcomes, including housing, financial resources, mental health, substance abuse, and social integration.
Housing - At intake, 59 percent of CHSH clients reported living primarily in an emergency shelter and 76 percent had been homeless for more than one year. After six months in the program, 71 percent of CHSH clients were living in their home.
Income - Six months after enrollment, CHSH clients’ average monthly income increased from just under $500 to almost $600, stemmed largely from enrollment in public benefits programs, such as SSI/SSDI and Supplemental Nutrition Assistance Program (SNAP).
Recovery Services - Three-fourths or 74 percent of CHSH clients receive ongoing recovery services related to mental illness compared to only 15 percent of clients two years prior to enrollment. Fewer clients reported experiencing serious anxiety (69 percent to 63 percent) after six months in the program. Reported alcohol use reduced (70 percent to 63 percent) after six months in the program, and both illegal drug use and combined alcohol and drug use were less common at follow-up than at intake.
Improvement in informal social networks - Recent contact with family or friends increased from 50 percent to 63 percent after six months in the program, and there was a marked increase from 13 percent to 30 percent of clients who felt that they could rely on family members for support. The percentage of clients who reported that they had no one to turn to decreased from 35 percent to 11 percent. These numbers suggest that clients’ social isolation is less pronounced while participating in the program in accord with the CHSH program’s focus on social connectedness and support systems.
Emergency medical systems and criminal justice involvement - In the two years prior to CHSH involvement, almost half of the clients had at least two trips to local emergency rooms (ER). After enrollment, ER visits dropped to10 percent and the sum total of visits made by the group dropped from 60 to 15. While this data is preliminary (and reflects nonequivalent time periods), these numbers suggest that the intensive case management provided by CHSH is a promising means for helping clients obtain the appropriate type of health care. Similarly, CHSH clients experienced a lengthy history of criminal justice system involvement with 56 percent jail bookings and 79 percent with court cases in the past two years, representing an immense and expensive burden on the criminal justice system. After CHSH involvement, less than 20 percent of clients were booked in jail on a new charge and less than half (47 percent) had a court case filed (for nonequivalent time periods).
These significant results are testimony to the hard work by the staff and the collaborations with key partners in the project, including the lead agency The Road Home, Fourth Street Clinic, Valley Mental Health, and Volunteers of America-Utah. These partnerships allow each entity to bring to the project their respective area of expertise, from housing case management, outreach, substance abuse and mental health treatment, and medical health care. Fourth Street Clinic, Utah’s primary homeless clinic, is often the first and only chance for a diagnosis and ongoing medical treatment for persons experiencing homelessness. The Fourth Street Clinic staffs a full medical clinic with an onsite pharmacy. The Clinic’s medical outreach team provides medical care to clients who are unable to make it to the clinic or who are resistant to coming to the clinic location.
Valley Mental Health (VMH), a behavioral healthcare provider since1987, provides mental health, substance abuse, and prevention services. VMHalso operates Storefront/SafeHaven, which provides a drop-in day center andtransitional and permanent supportive housing for the homeless population withsevere and persistently mentally ill disorders.
Finally, Volunteers of America-Utah operates detoxification centers that provide outpatient substance abuse treatment, an outreach program, and a youth resource center. Together, this wide range of services provides the support needed for individuals to step out of homelessness and back into the community and the safety net and interventions needed to help them remain in housing.
From left to right: Seth Graves, Buddy Tymczyszyn, Sandra Hollins, Lawrie Allred, Alyson Ainscough, Davey Ornegri, Samantha Dickens, Annie Aquila (squatting), Jonathan Chi (sitting).
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