Strategies for Integrating Homeless & Mainstream Systems

Transcription

1 Strategies for Integrating Homeless & Mainstream Systems

2 Presenters Danielle Wildkress, HomeBase Piper Ehlen, HomeBase Wendy Vaulton, Family Homelessnesss Cindy Ward, Department of Human Services Sherrie Downing, Montana

3 Learning Objectives Participants will learn about and understand A. Core Concepts of Mainstreaming and Systems Change B. Steps to Changing a System C. Levels of Coordination 3

4 A. Core Concepts of Mainstreaming and Systems Change Improve coordination of resources move away from silos and towards maximizing resources Improve access to mainstream resources help more people receive benefits Access and utilize non-homeless-targeted resources to support our work E.g. Medicaid, TANF block grants, CDBG Integrated systems of care funding and services are delivered seamlessly 4

5 Improved Access for Clients SOAR: SSI/SSDI Outreach Access Recovery A classic example of improving mainstream access Helps homeless clients w/ MH, AOD or COD access disability benefits Improves coordination between Social Security Administration (SSA), Disability Determination Services (DDS), hospitals, mental health clinics, and homeless service providers Improves quality of case management work Provides a new framework for compiling a disability claim Brings non-homeless targeted resources to clients 5

6 Improved Access to Funding Medicaid A classic example of accessing mainstream system to fund homeless services Many supportive services (health, case management, and others) provided to supportive housing tenants can qualify for Medicaid reimbursement Warning: Medicaid varies widely between states Certification requirements are jurisdiction specific Some are easier, others more complicated Once certified, a homeless service provider has a reliable mainstream source of funding to support its work with eligible clients 6

7 Systems Change The key to successfully addressing and eliminating homelessness lies in substantive system change at the community level, which is only possible to the extent that all entities involved work in concert to eliminate access barriers and create seamless local service systems. * Strategies for Improving Homeless People s Access to Mainstream Benefits and Services, March

8 Barriers to Mainstreaming Access Barriers obstacles that prevent an eligible person from getting available benefits E.g. where programs are located, how they are organized, what they require of applicants Resource Shortages inadequacy of available resources; funding may be finite or capped Eligibility Block program s criteria for who may receive benefit as well as time limits on receipt Many eligibility restrictions are federal policy and hard to influence at the local level 8

9 Tools to Reduce Barriers Address problems at the street level E.g. provide transportation; conduct outreach to streets; co-locate mainstream eligibility workers in homeless assistance programs; provide multilingual services; improve communications among homeless assistance workers and mainstream agency eligibility workers Alter policies/practices regarding eligibility for benefits E.g. establish a priority for homeless households Increase overall capacity thru additional resources Raise funds from state or local sources Allocate other federal funding 9

10 Applying Lessons Learned: Alameda Pre-Release Agreement Alameda County Social Services Agency found that many people on General Assistance (GA) were recently released from the local jail (Santa Rita) without connection to benefits Social Services suspected many were eligible for SSI/SSDI SSI/SSDI would decrease County s GA costs and increase income for citizens upon release 10

11 Alameda Pre-Release Agreement continued Alameda County implemented a Pre-Release Agreement between Santa Rita County jail and SSA Upon discharge, approved applicants can receive SSI/SSDI immediately Effort complimented the larger SSI/SSDI redesign process happening in the County 11

12 Why use the Alameda example? Combines two types of mainstreaming Uses all 3 strategies to overcome structural barriers Reduce structural barriers developed a method to screen inmates and collect records to support a successful SSI/SSDI application prior to discharge from jail Alter policies SSA implemented a new policy (at the local level) of accepting applications while a person is incarcerated Increase capacity expanded county SSI/SSDI advocacy dollars to pay for an advocate at the jail 12

13 B. Steps to Changing a System 1. Form a Workgroup 2. Identify Barriers and Solutions 3. Engage Stakeholders 4. Develop a Plan 5. Data Tracking 13

14 For Today Choose a system that you want to transform It should be a real system or agency that you work with (or around) back home You will use your chosen system in all of the exercises this afternoon My Example: Alameda 14

15 1. Form a Workgroup Who is already at your table and willing to strategize? Providers Government administrators Agency representatives (i.e. the local SSA office) Task List the specific people in your workgroup (i.e. people whose participation you can count on) Identify anyone whose contact information you need 15

16 The Alameda Workgroup When I started, the Alameda workgroup list was small. It included Alameda County Social Service Agency Agency responsible for administering GA Alameda County SSI/SSDI advocates Group of providers including the Homeless Action Center (HAC) 16

17 2. Identify Barriers and Solutions Start with what you know Design a system map List gaps and barriers Brainstorm some solutions to the barriers Develop a list of stakeholders needed to implement your solutions 17

18 What do you know about your system? TASK: Make a list of the players, issues, and research that might be relevant Who already works on the issue either directly or indirectly? What resources are already being used, even if being used inefficiently? What has worked in other similar systems? 18

19 What We Knew in Alameda Suspected many GA recipients were recently incarcerated at Santa Rita jail Due to budget shortfalls, County was redesigning SSI/SSDI advocacy to transition people from GA to SSI/SSDI State had entered into a Pre-Release Agreement People with co-occurring disorders tend to cost systems more Workgroup did not know current jail system, but did know how an improved system would look 19

20 What are the barriers in your system? TASK: List one key barrier in the current system What is a potential solution to this issue? As you start to develop a list of barriers and solutions, create a system map either the current system, an ideal system, or both 20

21 Common Barriers to Mainstream Resources Complex/ arduous application procedures Obtaining full medical records and disability documentation Documentation requirements Denials of claims for incomplete applications Frequent client relocation, and difficulty finding clients Criminal history Eligibility workers lack knowledge/training due to high turnover rates Eligibility workers lack homeless cultural competency Lack of transportation to and from benefits offices 21

22 Common Solutions Facilitate communication with mainstream agency Help gather required documentation and information Complete applications with clients Provide a place to store documents during application process Make appointment for client at benefit office Provide transportation to/from benefit office Coordinate monthly enrollment nights at shelters, drop-in centers, or other service agencies Form a workgroup of policymakers, providers and CoC members to resolve system-wide barriers 22

23 Alameda Barriers and Solutions Barrier: Inmates are not screened for benefit eligibility Solution: Work with jail staff to screen inmates for SSDI-related disabilities, including a better system for collecting medical and MH records * Reduce structural barriers Barrier: Inmates cannot file for SSI/SSDI while incarcerated Solution: Enter into a Pre-Release Agreement with the local SSA office * Alter policies Barrier: No one available to help inmates complete SSI/SSDI application Solution: County dollars for case managers to complete applications at jail * Increase capacity 23

24 The Alameda System Map 24

25 3. Engage Stakeholders Build on existing relationships Create talking points that emphasize benefits to each stakeholder s agency and cross-educate people Be prepared to jump through hoops. You may not find the right person immediately Anticipate different agency cultures; creating a common understanding and language takes time Follow up and be consistent. Show that you are a good partner 25

26 What stakeholders do you need to invite to the table? TASK: Create a list of stakeholders to implement draft plan A few ideas: Local office of a federal agency SSA, VA, DOE, DOL, etc. State, County, or City government social service agencies Political officials or their aides Mental health departments Hospitals primary care as well as psychiatric Criminal justice including jails, prisons, courts GA and other local aid offices Homeless service providers Formerly or currently homeless representatives 26

27 Alameda Stakeholders SSA representative DDS representative Leadership of the jail Mental health services at the jail Physical health services at the jail Inmate services at the jail Chaplaincy (This was in addition to the County Social Services Agency and the HAC the original workgroup.) 27

28 Good Talking Points Focus on the expense of the services (e.g., ER visits) and how better access to a benefit (e.g., Medicaid) could save the agency (e.g., a hospital) money Acknowledge that their staff is overworked By coordinating you can make the system better for everyone Offer to provide case managers to assist with applications and/or act as liaisons Offer cultural competency training to staff Use case studies Some from this workshop! 28

29 What s in it for me? TASK: Develop a list of potential talking points Talking points should Emphasize cost-savings and outcomes, not heartstrings Be framed as an opportunity to partner, not a blame game Illustrate that you are bringing resources to the table, not demanding that an agency do new or more work Include best practice examples to show that the work can be done 29

30 Alameda Talking Points A Pre-Release Agreement could reduce recidivism SSI/SSDI benefits provide income for housing Housing is key to ending cycle of homelessness and incarceration Reducing recidivism will save money (and it is the right thing to do!) There is overlap between people on GA and those in jail If we work together to connect people to benefits, both systems win Our case managers are trained in SOAR and we are willing to devote staff to assisting jail inmates California Dept of Corrections entered into an agreement with SSA This is the best practice, and we can do it, too 30

31 4. Develop a Plan The plan is likely to be a work in progress As you develop a strategy, new barriers will be identified Don t worry, new solutions will be identified, too Include a timeline Set specific goals Some short term and some long term Name individuals, not just agencies, as responsible for tasks Include data tracking that is comprehensive and realistic Meet regularly Monitor progress and keep the momentum going 31

32 Keys to Successful Partnerships Create clear outlines of each party s roles/responsibilities Outline/timeline should be detailed and specific, but not excessive in content Establish specific points of contact within organizations Keep written notes during meetings Review action steps as a group at the end of each meeting Ensures each person knows what s/he should do and when that task should be completed Make all contact information current and readily available Create a follow-up system to ensure established goal is sufficient Be patient but persistent! 32

33 The Alameda Plan Probation Dept (received basic SSI/SSDI training) refers 4 people/month Probation Dept refers inmates likely to be released in 3 months and who have symptoms of a disability HAC and the Chaplaincy social worker (both SOAR trained) work to collect info about inmate s medical and MH history Includes gathering records inside and outside the jail, interviewing the inmate, and working with MH and medical professionals inside the jail HAC files SSI/SSDI application 33

34 The Alameda Plan (cont.) Local SSA office prioritizes the jail applicants and tracks their outcomes Upon approval, SSA notifies inmate and HAC Upon discharge, inmate presents discharge letter (received from the jail) to SSA as proof that he/she is no longer incarcerated (and therefore eligible to receive benefits) SSI/SSDI benefits become effective immediately 34

35 5. Data Tracking Even though this is listed as the final step, you need to think about data from the beginning Data entry points should be integrated into your plan and system map Effectively measuring outcomes will be crucial to ongoing support 35

36 Steps to Creating a Tracking System Start with asking yourself what you will want to know How will we know we are reaching our goals? Determine what data you will need to measure success If possible, collect baseline data Determine the best people and places in the system to collect your data be realistic! Legacy and system-specific databases can be a barrier but cannot be an excuse At a minimum, databases can produce aggregate data Use aggregate data to show system-level improvements where client-level tracking in unavailable 36

37 C. Levels of Coordination Know the 4 Cs Mainstreaming requires systems change; systems change requires partnering. Four levels of interaction Communication people in different agencies talk to each other and share information in a friendly, helpful way. Coordination staff from different agencies work together on a case-by-case basis and may do cross-training Collaboration adds joint analysis, planning, and accommodation to the base of communication and coordination Coordinated community response encompasses all of the essential agencies in communitywide collaboration with the long-range goal of ending homelessness 37

38 Integrated Homeless and Mainstream Systems Moving from silos to true integration takes time! The 4 Cs are a continuum, you may move forward and backwards Alameda went from silos to coordination quickly, and set an example for other systems in the community For your project, think about where you are today and where you want to be not all projects require total system integration 38

39 Questions? If you have any additional questions please contact Danielle Wildkress at 39