SAN DIEGO REPORTS NEW COST SAVINGS FROM TARGETED HOUSING INITIATIVE

San Diego, California, which led the way on cost analysis more than a decade ago, has reported new cost data regarding its successful Project 25 initiative targeted to the longest term homeless individuals on local streets. Just one year old, the initiative - which ultimately housed 30 people - has been able to report $7.6 million in savings for the year.  The United Way of San Diego County, the City and County of San Diego, the Housing Commission, and St. Vincent de Paul Village partnered in the effort.  

Brian Maienschein, Commissioner of the Plan to End Chronic Homelessness and former San Diego City Council member, noted: "These results are beyond what any of us expected. Project 25 is meeting its dual purpose -- to stabilize and better the lives of some of San Diego County's most disadvantaged and suffering community members and saving taxpayers money in the process." San Diego's plan was developed under the leadership of Community Champion and business leader Dene Oliver, OliverMcMillan CEO, and the United Way.  

Round Table President Mangano commended the San Diego leadership for their outcomes, indicating, "These results show once again that the random ricocheting of this population through expensive health and law enforcement systems is more costly than providing both a place to live and customized services to support the tenancy and retain the housing." Mangano noted that foresight in adopting the successful model goes to Los Angeles County Supervisor Zev Yaroslavsky and his Senior Field Deputy Flora Gil-Krisiloff who launched a two-year, $3.6-million Project 50 plan in 2010, targeted to the most vulnerable individuals on Skid Row.   

In more than 65 cost studies across the country the costs of the random ricocheting ranged from $35,000 to $150,000 per person, per year, noted Mangano. In those same cities cost benefit analysis demonstrated that the cost of providing a place to live- a room, studio, or efficiency - and customized support services ranged from $13,000 to $25,000 per person per year. The individuals assisted by the San Diego initiative had been frequent users of law enforcement resources, jails, hospitals, and emergency rooms.  

According to the new data, during 2010, the 35 participants (of whom 30 were housed) used more than $11 million in public resources. Data was reviewed by the Fermanian Business & Economic Institute at Point Loma Nazarene University. With participation in Project 25 beginning in March 2011, the estimated one-year cost for individuals was reduced to $3.4 million, or almost a 70 percent decrease. Data showed the average public cost per participant in 2010 was $317,904, compared to $97,437 in 2011 during Project 25. Emergency room visits were reduced by 77 percent; ambulance rides decreased by 72 percent; arrests dropped by 69 percent; hospitalizations dropped by 66 percent; and jail days were reduced by 43 percent.

San Diego, under the leadership of Dr. Jim Dunford of UCSD Medical Center, was in the forefront in the area of cost analysis for the target population. In 1998, UCSD Medical Center tracked 15 chronic inebriates who visited the hospital emergency room almost daily. In one year, the 15 individuals were transported by ambulance to UCSD's emergency room 299 times, costing the public health system $967,000. In addition to these costs was the expense of the police responding to the scene of an individual creating a disturbance or in need of medical care, resulting in costs to the City and County of San Diego of about $3 million a year. San Diego's Serial Inebriate Program (SIP) was an early response to this problem.

NEW FEDERAL HHS REPORT EXAMINES MODELS OF MEDICAID FINANCING FOR PERMANENT SUPPORTIVE HOUSING FOR CHRONICALLY HOMELESS INDIVIDUALS

CSPECH (Community Support Program for People Experiencing Chronic Homelessness), featured here last month in a story about the Medicaid related innovations of the Massachusetts Housing and Shelter Alliance (MHSA) (Massachusetts Models Innovations to End Chronic Homelessness: Using Medicaid Resources for Services in Housing First), is highlighted as an example of a managed care partnership for chronically homeless individuals in a new report from the U.S. Department of Health and Human Services (HHS).

Medicaid Financing For Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities is the latest release in an HHS series that is providing new sources of information on proven Medicaid models that are targeting chronically homeless individuals. In 2014, Affordable Care Act provisions will result in most homeless people - including the most expensive population of those with disabilities who are experiencing long term homelessness - becoming Medicaid-eligible.

MHSA, a statewide advocacy organization of more than 90 member agencies across the Commonwealth, has established numerous results-oriented partnerships with state government and initiated nationally recognized innovative strategies to end homelessness. Under the leadership of Executive Director Joe Finn, MHSA's most recent venture with state and local partners in health and behavioral health care, Medicaid, and housing agencies has piloted and proven an innovative model of support for individuals who move to low demand housing.   

CSPECH, developed in 2005, provides Medicaid reimbursement for community-based support services for chronically homeless individuals who are placed in permanent housing. CSPECH defined an innovative non-clinical health care worker who provides Medicaid-reimbursed essential and customized supports that create stability and success in housing.

CSPECH, based on a Medicaid cost benefit study, has resulted in a net Medicaid savings of more than $3 million for the first 372 tenants.MHSA partners in CSPECH with ValueOptions, the state's for-profit behavioral health services provider; the state's Medicaid agency (MassHealth); and housing partners in 12 regional supportive housing initiatives across the state. As the HHS report notes, many states are likely to use managed care strategies as they expand coverage. MHSA's record of partnership and results provides an important model for leaders around the country.

The HHS report  also offer examples of models addressing Federally Qualified Health Centers, mental health, substance abuse, Home and Community Based Services, and Health Homes.

PASADENA'S FULLER SEMINARY CONVENES EVENT ON HOMELESSNESS, FAITH, AND PRACTICE

Homelessness, Faith, and Practice was the focus of an event convened by the Office of Urban Initiatives at Fuller Seminary in Pasadena, California. Speakers were Round Table President Philip Mangano, Dr. Joe Colletti, Executive Director of Fuller's Office of Urban Initiatives, and Dr. Sofia Herrera, Co-director of the office and a research assistant professor at Fuller (pictured here).  

School of Theology Dean Howard J. Loewen welcomed attendees and introduced Dr. Herrera, who addressed the differences between acts of charity and acts of justice. She noted that people usually do charity work when they have extra money or time. In contrast, for some people, hearing or learning about an injustice leads them to act, to do something about the injustice.  

Dr. Colletti, who has provided expert support to numerous Ten Year Plans to End Homelessness in California, invited the attendees to consider both the integration of faith in their work and how to end homelessness, rather than manage it. He described to the audience of more than 100 how he began to examine these questions when he first engaged in outreach activities with homeless people.

Mangano recalled how, when he was appointed as Executive Director of the U.S. Interagency Council on Homelessness in 2002 by President George W. Bush, he challenged the mayors of the nation's 100 largest cities to end homelessness through the creation of business plans. Mangano is pictured here.  

Mangano told of his study of the 19th century priest Father Damien, who committed his life to people with leprosy living under official quarantine in a leper colony on the island of Molokai in Hawaii:  

The story takes place in Hawaii, with the outbreak two centuries ago of leprosy. Not knowing that it is a viral outbreak, the fear of contagion led authorities to quarantine those affected. They were put on boats and then literally "dumped" off the coast of one of the Hawaiian Islands, Molokai, and left to swim and scamper to shore to the Kalaupapa Peninsula, cut off from the rest of the island by a ridge of mountains, and the rest of the islands by the open sea.

There, having been forcibly taken from family, friends, home, and community, without order or law, the exiles survived. A miserable and inhumane existence it was - little food, no shelter, often just the clothes on their backs, they survived.

A Belgian priest, Damien, heard of their plight and arranged to be assigned to their help. He went and began the slow process of establishing order and security. Shelter and food. He was soon joined by others. They succeeded in bringing humanness and established a polity. And moved the situation from chaos to order.  

And new exiles joined old detainees. Things were much better - a church, post office, leadership. The encampment became structured and those who were there from the beginning were contented with the new order.

And there they remained. Exiled. Cut off. Abandoned. Apart from all they loved. Wracked with nostalgia for mother, father, sister, brother, and home. But no longer starving or subject to the elements in constant danger.

That's where our men in white coats come in. They are back on the mainland working in a laboratory. And some of their work as medical researchers was focused on Hansen's Disease, what we now call leprosy.

Working diligently in anonymity, they tried and tested formulas and protocols and approaches. Finally, they worked with sulphonic drugs and came to understand and develop a protocol that actually relieved all the symptoms of leprosy.  

It was one of those miracle drug achievements. After many tests that demonstrated the power of the remedy, the medication was made available. And eventually found its way to Kalaupapa. There was skepticism that the afflicted would want it. They were now living what seemed to be contented lives on the Peninsula. They didn't talk so much anymore about going home or seeing family or enjoying friends. So it seemed to the administrators that few would want the medication.

When it was finally offered, they were surprised. Everyone wanted it. Not simply to relieve their symptoms and bring remedy to this debilitating disease, but even more to rid themselves of the overt conditions. They were eager for one thing - restoration. To family, friends, normalcy.

A few stayed behind who had no family left. But as soon as the cure took, everyone else left that place and was reunited with loved ones and places. Their long misery had come to an end. They got what they really wanted. Not a temporary, emergency response that left them isolated and cut off. But a remedy that re-integrated them into the life they so wanted. Their nostalgia ended. Their physical redemption secured. Their long exile ended in tears of reunion.

All precipitated by white coated anonymous lab researchers whose names are lost to us, but whose conspiracy led to a remedy.

I have come to fervently admire those anonymous white coats. Their anonymity and innovation. Unthanked, unknown, they affected the cure.  

So, if you were one of the afflicted, who performed the greatest service for you? Father Damien or the anonymous white coats? Both, I would imagine.

And that's just where we are on homelessness. The remedies are now present. The innovations. They work. They are field-tested. Evidence-based. Proven. A place to live with support services. The remedy.

Fuller Seminary's Office of Urban Initiatives is affiliated with the Institute for Urban Initiatives, a non-profit, non-partisan organization that consists of several community-based and faith-based institutes that respond to the economic, housing, and social needs of neighborhoods, cities, and counties from local community, regional, national, international, and faith-based perspectives.   

You are receiving this e-news issue from The American Round Table as we keep our partners aware of new initiatives to prevent and end homelessness.  

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