HomeMy WebLinkAboutMINUTES - 07082008 - C.102 FHS #
SE `
TO: BOARD OF SUPERVISORS •,�==��.. �-= \; Contra
Family and Human Services Committee'
FROM: o; -_
,.� Costa
DATE: July 8, 2008 - County
s�'9 C----OUx
SUBJECT: Update on the Continuum of Care Plan for the Homeless and Health Care of the
Homeless
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ACCEPT the attached reports from the Health Services Department on the Continuum of Care Plan for the Homeless and
the Health Care for the Homeless Project, as recommended by the Family and Human Services Committee.
FISCAL IMPACT:
No impact from accepting this report.
BACKGROUND:
The Family and Human Services Committee reviewed the attached reports updating the Board of Supervisors on the
activities and accomplishments of the Continuum of Care Plan for the Homeless and the Health Care for the Homeless
Project. This report is being forwarded to the.Board of Supervisors for acceptance in conformance with applicable grant
requirements providing for regular and routine communication with the governing board.
CONTINUED ON ATTACHMENT: YES SIGNA RE: � �• /
RECOMMENDATION OF COUNTY ADMINISTRATOR /./rRECOMMENDATION OF BOARD COMMITTEE
T-"'APPROVE OTHER
SIGNATURE(S): FedkGlover, irQ � Susan Bonilla,Member
�"-"�
ACTION OF BOARD ON , 8 2� V
/ APPROVED AS RECOMMENDED tf OTkER
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT
COPY OF AN ACTION TAKEN AND ENTERED ON MINUTES OF
THE BOARD OF SUPERVISORS ON THE DATE SHOWN.
J UNANIMOUS(ABSENT )
AYES: NOES:
ABSENT: ABSTAIN:
Contact: Dorothy Sansoe(5-1009)
cc: Health Services Department ATTESTED
County Administration JOHN CU EN,CLERK OF THE BOARD OFSUPERVISORS
c
BY: DEPUTY
WILLIAM B.WALKER,M.D.
CONTRA
�ON1 RA !l��OSTA
HEALTH SERVICE:s DIRECTOR
WFNDEL 13RIJNNF,R,M.D. PUBLIC HEALTH
PUBLIC HEALTH DIRECTOR HOMELESS PROGRAM
597 Center Avenue,Suite 325
CONTRA COSTA Martinez, California
• 94553-4675
HE ALT H ' S ERVICES'. PH 925313-6124
FAX 925 313-6761
TO: Family and Human Services Committee
FROM: Cynthia Belon, L.C.S.W.
Director, Homeless Program
REAnnual Report on Homeless Continuum of Care
DATE: June-23, 2008
RECOMMENDATIONS
1. Accept this report from the Health Services Department.
2. Direct staff.to continue to report on an annual basis to the FHS Committee regarding
progress of the Continuum of Care and 10 Year Plan to End Homelessness.
BACKGROUND
This report provides an update on the accomplishments and progress made during the
past year towards meeting the goals of the 10-Year Plan to End Homelessness, approved
by the Board in 2004.
The Homeless program's mission is to ensure an in system of care from
prevention through intervention for homeless adults, youth and families within our
community.
We continue to work towards accomplishing our mission through the development of
policies and practices, community involvement, advocacy and the.coordination of
services that respect human dignity, strengthen partnerships and maximize resources.
CONTRA COSTA INTER-INTERJURISDICTIONAL COUNCIL ON
HOMELESSNESS (see attachment)
Early 2008, the Homeless Continuum of Care Advisory Board, established in 1997, and
HIJIDWG, the group who had been responsible for overseeing the implementation of the
10=Year Plan, merged and became, with Board approval, the CCICH, Contra Costa Inter-
Jurisdictional Council on Homelessness. This new Advisory Board is charged with
providing a forum for communication about the 10-Year Plan, and will provide advice
and input on the operations.of homeless services, program operations, and pr -n
development efforts in the community. There is also a Consumer Advisory Board, who
meets monthly and has membership on.the.Council: They.provide valuable information
regarding gaps in the system of care and how to create more homeless culturally-
competent services, which has resulted in revisions in how and what services are
delivered.
PROGRAMS AND SERVICES
As of today, almost 5000 individuals and families have obtained permanent
supportive housing.
In order to continue to provide permanent housing, and end homelessness, many
programs and services are provided within a continuum to support the transition out of
homelessness. The following are some changes occurring during this past year to create
a more effective system of care:
Emergency shelters for single adults—located in Richmond and Concord, where there
has been a shift to create "interim housing". The goal is, through providing intensive
case management, clients get connected to services and permanent housing more quickly,
and fewer clients recycle through the shelters over and over. The average length of stay
in the shelters has decreased from 60 days to 55 days, while the percentage of clients
moving into permanent housing has increased from 48% to 53%.
In collaboration with EHSD, we have increased access and retention to General
Assistance for homeless residing at the shelters.
With a SAMHSA/CSAT (Federal) grant, we are providing substance abuse detox and
residential treatment beds for clients at the shelters who want to address their addictions.
In addition, housing assistance and.referrals are provided through a Team of Case
Managers. Data from this project, called Transitions Home, shows an increase in the
number of days of sobriety and a decrease in.emergency room visits and criminal
behavior.
Health Care - A Plan for the discharge of homeless patients from all of the hospitals into
the shelters has been developed and implemented. In addition, a Committee has been
formed through the Homeless Program with all of the hospitals to discuss frequent users
of the emergency rooms and to discuss healthcare, services and housing options for these
residents of our community. Another Committee is looking at the lack of dental services
available to homeless in our conununity, as typically prevention services and restorations
are not available.
We are continuing to work towards the implementation of a 24-bed respite care .
program, to be located at the Concord shelter site, for homeless who are not in need of
hospital care but who require more medical assistance than what is provided in the
shelter.
Project Coming Home, our Chronic Homeless Initiative grant-funded program;which
was the precursor and foundation for the 10-Year Plan to End Homelessness, received a
new SAMHSA grant in October 2007 for the services tied to permanent housing for .
chronically homeless individuals with disabilities. This program uses a"housing first"
approach and provides comprehensive services to individuals in their housing, while
assisting them to transition to mainstream services and into the community.
Throughout our system of care, we are'increasing.access to benefits for people who are
homeless in order to facilitate greater success in acquiring and maintaining permanent
housing. We have recently received a grant from the San Francisco Foundation to
implement the SOAR Initiative, or SSI/SSDI Outreach, Access and Recovery, which
will increase access:'to these benefits for persons who,are homeless and will generate
first-time approval of applications submitted for benefits.
Since January, 2008, HUD-funded programs within the Continuum have begun using the
self-sufficiency matrix, a standardized tool for measuring performance of homeless
clients receiving services within all critical areas of their lives. Case managers use this
matrix in coordination with the client, and the matrix has been linked into our homeless
management information system, so that we can generate system-wide data on the
findings.
During this year,'a new 8 bed transitional housing program, Bissell Cottages, was opened
in Richmond for transition-age youth ages 18-24, who need mental health services and
support as they transition into adulthood. In collaboration with County mental health,
through Prop. 63, each young adult is assisted towards wellness and self-sufficiency.
This program adds capacity in transitional housing for transition age young adults, along
with Appian House in El Sobrante.
Project Homeless Connect, a one stop shop where homeless residents in our community
are provided with services, housing referrals, food and homeless court was held in
Concord in October; ?007. Four hundred homeless residents received assistance, and 200
service providers along with 150 volunteers were at the event.
New legislation-The Homeless Program met with the Cities to discuss the
implementation of Senate Bill 2, which strengthens housing element law to ensure
zoning encourages and facilitates emergency shelters and limits the denial of shelters,
transitional housing and supportive housing under the Housing Accountability Act. The
lack of available affordable permanent housing for homeless residents makes it necessary
for most to spend time in an emergency shelter.
I.astly,.the Homeless Program has been actively involved in the planning of the hoineless
conveyance portion of the Concord Naval Weapons Station Reuse Plan. We
facilitated the development of the Contra Costa Countywide Homeless Base Conversion
Collaborative in May 2007, which represents over 30 agencies that work on
homelessness and housing. The Collaborative began by working with the Inter-
Jurisdictional Council to access former federal property in our communities. Fifteen
project partners submitted a Notice of Interest for surplus property at the Naval Weapons
Station for homeless assistance on 9/23/2007. This Consolidated NOI represents a
cutting-edge approach to accessing surplus property and ending homelessness. Since the
September submittal, the Collaborative has been negotiating with the City of Concord,
which acts as the Local Reuse Authority for the CNWS. Major points of negotiation
include using a mixed-income housing model, establishing a trust fund for homeless
housing and services and obtaining free land on the base.
PLANS FOR 08-09
We will be expanding the emergency shelter for youth, Caili House, located in
Richmond, during 08-09, with the purchase of a new modular through Prop. 63 funds.
Loaves and Fishes is planning to move their food service, formerly provided in Concord
near Baldwin Park, to a vacant portion of the Concord emergency shelter facility. Plans
are being finalized for the renovations, which will be paid for by the City of Concord.
The multi-service center, located on Detroit Avenue, and operated by Anka, will relocate
to the Concord emergency shelter facility site as part of the respite care program
development. Projected occupancy date is April 2009
The next Project Homeless Connect will be held on September 10, 2008, at the Antioch
fairgrounds, where homeless are provided access to services and housing referrals are
also provided. The Planning Committee has started to meet, and information to the
community and to homeless residents will be forthcoming.
U
cf+
• p O ,,, cn
. � p A N O . . U N N O •� o f f t5 `�,
rA U `�
br c6 O v.��•+ 'd � � O `� � y � � � p O
N v n U U W N r ! •N to y, O N G 7 15
p N
cd L} N 0 o N in r OD
vViC� rDtn �' E" 7� pr0l1
05
rA -a Op Q O Q � F W • o
V r N N VIA 6` G p. W • • •
., v ,� `n U cn • •
ts
t4
too
, m 'G
v: r W O v7
O
1.7
cn
tlo
zn
.,A o
tD (16
d cn
t.4-( U r • •
0
o T Ld o
a '
FIIS -�
CONTRA COSTA HEALTH SERVICES DEPARTMENT
CONTRA COSTA COUNTY
TO: Family and Human Services DATE: June 23, 2008
Committee Members
FROM: Andrea DuBrow, Project Director, Health,Care for the Homeless
SUBJECT: Health Care for the Homeless Semi-Annual Report
Recommendations
1. Accept this report from the Health Services Department; and
2. Forward this report to the Board of Supervisors for acceptance; and
3. Direct staff to continue to report on a basis to the FHS Committee.regarding
progress and status of the Health Care.for the Homeless Program and to submit
an additional written report to the Board of Supervisors, at six-month intervals.
Background
The Health Care for the Homeless (HCH) Project has been-operated by Contra
Costa Health Services since 1990 and is an essential component of the primary
CCHS health care delivery system. The HCH.Project provides health care
services to the homeless population through mobile clinics, as well as through.
the CCHS.integrated ambulatory system of care, and the Departments of Mental
Health and Alcohol and Other.Drugs. Primary health care services provided by
the HCH Mobile Team include routine physical assessments, basic treatment of
primary health problems such as minor wounds and skin conditions, respiratory
problems, TB screening, acute communicable disease.screening, and
coordination and referrals for follow up treatment of identified health care needs.
A significant portion of the homeless patients seen in the mobile clinics have
chronic diseases, including asthma, hypertension, diabetes, and mental
health/substance abuse issues.
The mobile team is comprised of a`Medical Director, Family Nurse Practitioners,
Public Health Nurses and a Registered Nurse, Community Health Worker,
Financial Counselor; Mental Health Specialist, Substance Abuse Counselor, and
an administrative assistant.
Homeless patients who receive care on.one of the mobile clinics are.referred into,
one of the CCHS ambulatory care health centers for primary and specialty care,
into County mental health and substance abuse services and to Contra Costa
Regional Medical Center for emergency, inpatient hospital, outpatient surgeries,
laboratory and radiology. There are currently three ambulatory care clinics,
located.throughout the County, designated specifically for homeless patients to
help them transition from the mobile clinic setting into the ambulatory care
system. HCH staff members are present at each of these clinics.
During 2007, the CCHS saw 10,310 homeless patients who generated 74,625
visits. The attached presentation contains additional information on this
population.
Expanded Medical Services Grant
In June 2007, CCHS received a two-year $480,000 Federal grant to expand
medical services to homeless patients. HCH acquired the CCHS Health-On-
Wheels Van to expand mobile clinic operations throughout areas of need in
Contra Costa and hired 1 FTE Nurse Practitioner and 1 FTE Registered Nurse,
along with a Driver/Clerk. To date, an additional.1,500 patients have received
medical care through this expansion. Our goal is to serve up to 1,700 additional
homeless patients per year.
Governance of Health.Care for the Homeless Activities
As this committee may recall, Contra Costa Health Services is a recipient of the
Public Health Services Act Section 330(h) Health Care for the Homeless funds,
and as such, it must meet governance requirements set forth by the Health
Resources and Services Administration Bureau of Primary Health Care. The
current governing body for HCH .is the County Board of Supervisors, with input
from the newly restructured Contra Costa Interjuridictional Council on
Homelessness (CCICH). This Council includes homeless consumers and other
key stakeholders of the homeless community. In addition, a Homeless Consumer
Advisory Board meets monthly with Health Care for the Homeless staff, a
representative of the Council, and staff from the Contra Costa Health Services
Office of Homeless Programs. This Consumer Board provides regular reports to
the.Council. Other activities to ensure consumer input into the Health Care for
the Homeless program include focus groups and patient satisfaction surveys
conducted on a regular basis.
Health Care for the Homeless
Contra Costa Health Services
Presentation to the
Family & Human Services Committee
Contra Costa County Board of Supervisors
June 23, 2008
Andrea DuBrow, MSW, MPH
Administrative Manager
Kate Schwertscharf, PHN
Nurse Program Manager
1
Number of Patients in 2007
• 10,310 unduplicated homeless patients
• 74,625 visits: mobile clinics, ambulatory
clinics, emergency department, mental
health, substance abuse programs.
Who qualifies as "Homeless?"
• All homeless people in Contra Costa
County
• Lacking a fixed, regular, adequate nighttime
residence
• Primary nighttime residence in a shelter,
welfare hotel, transitional housing
• "Doubled-up" without name on a lease, couch
surfing, etc.
2
i
Funding for HCH Services
• Section 330(h) Public Health Services
-Act Health Care for the Homeless grant
from the Federal Government
(BPHC/HRSA) — approx. $320K
• Expansion Grant — June 2007-09
Additional $450K to provide services to .
1 ,700 more homeless patients per year.
Services Provided
• Mobile Clinic:
• routine physical assessments'
• basic treatment of primary health problems such as
minor wounds and skin conditions
• treatment for respiratory problems
• TB testing
' acute communicable disease treatment
• referrals for follow up in ambulatory/specialty care
' substance abuse and mental health services
3
FMile Clinic Locations
. Adult Emergency Shelters . Monument Futures, Concord
Concord & Richmond • Monument Corridor
• Calli House (youth), • Home Depot : EI Cerrito,
Richmond Pittsburg, Concord
• Bay Area Rescue Mission . Ambrose Community Center,
Family & Men's Shelters Baypoint
. GRIP Souper Center& • Salvation Army, Antioch
Family Shelter, Richmond * Winter Nights Interfaith
. Love-A-Child, Baypoint Shelter, Central & East
. St. Vincent de Paul, County
Pittsburg . Multi-service centers
. AOD Treatment Facilities
New Expanded Medical Services
• Hired 1 FTE Nurse Practitioner and
1 FTE Registered Nurse
• Increased mobile services dramatically:
• Richmond: available daily
• Concord: four days/week
. East County: three days/week
• Expanded clinical services with the
homeless outreach team (Project HOPE)
4
Ambulatory Care, Specialty, &
Hospital Services
• .3 ambulatory care clinics specifically for homeless
patients at Richmond, Concord, Antioch
•. Family practice care
• Specialty care
• Outpatient surgery
• Emergency Department
.Inpatient care
Laboratory
• Radiology.
• Pharmacy
CAmbulatory Care Clinics
. Operate specialized homeless clinics in
the Richmond, Concord. and Antioch
..health centers for homeless patients
• Bypasses waiting times for appointments
'*!Bypass financial counseling process
*,Make the process more "user friendly" for
homeless patients
• Helps patients transition to mainstream health
care delivery system
5
Mental Health Services
• Mental Health Treatment Specialist
provides screenings, assessments,
referrals into the Mental Health system
for medication and treatment of clients in
the shelters and at other mobile clinic
sites
Alcohol and Other Drug Services
• Substance Abuse Treatment Specialist
provides screenings, referrals, and
coordination of detox and recovery
services specifically for homeless
patients in shelters and other mobile
clinic sites
6 .
CPatient Demographics 2007
• 51 % male
• 49% female
• 22% of homeless patients are completely
uninsured, on no publicly-funded
program.
• 60% Medi-Cal; 3% Medi-Care
• All of our patients at 100% of the Federal
Poverty Level and below.
Race/Ethnicity in 2007
White 33%
Hispanic/Latino 28%
Black/African American 25%
Asian/Pacific Islander 6%
American Indian/Alaskan Native 1%
Unknown 7%
Ftjch Supervisor Districts are
ents From?
I- Supervisor Gioia 39%
11= Supervisor Uilkema 10%
III- Supervisor Piepho 8%
IV- Supervisor Bonilla 17%
V- Supervisor Glover 23%
Other 3%
Strong Consumer Involvement
• Active consumer advisory board
• Provide valuable input for improved
service delivery
8
Challenges & Opportunities
• Discharge Planning
. Respite Care program
• Dental services
• Transportation
9