HomeMy WebLinkAboutBOARD STANDING COMMITTEES - 06082009 - FHS Agenda Pkt (2)
Agenda
FAMILY AND HUMAN SERVICES COMMITTEE
June 8, 2009
1:00 P.M.
651 Pine Street, Room 101, Martinez
Supervisor Federal D. Glover, District V, Chair
Supervisor Gayle B. Uilkema, Vice Chair
Agenda Items: Items may be taken out of order based on the business of the day and preference of the Committee
1. Introductions
2. Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers
may be limited to three minutes).
3. #5 – Healthcare for the Homeless – Update
Presenter: Andrea Du Brow, Project Director
4. #5 - Continuum of Care Plan for the Homeless - Update
Presenter: Cynthia Belon, Homeless Programs Director
☺ The Family and Human Services Committee will provide reasonable accommodations for persons with disabilities planning to attend Committee
meetings. Contact the staff person listed below at least 72 hours before the meeting.
Any disclosable public records related to an open session item on a regular meeting agenda and distributed by the County to a majority of
members of the Family and Human Services Committee less than 96 hours prior to that meeting are available for public inspection at 651
Pine Street, 10th floor, during normal business hours.
Public comment may be submitted via electronic mail on agenda items at least one full work day prior to the published meeting time.
For Additional Information Contact: Dorothy Sansoe, Committee Staff
Phone (925) 335-1009, Fax (925) 646-1353
dsans@cao.cccounty.us
Glossary of Acronyms, Abbreviations, and other Terms (in alphabetical order):
Contra Costa County has a policy of making limited use of acronyms, abbreviations, and industry-specific language in its
Board of Supervisors meetings and written materials. Following is a list of commonly used language that may appear in
oral presentations and written materials associated with Board meetings:
AB Assembly Bill
ABAG Association of Bay Area Governments
ACA Assembly Constitutional Amendment
ADA Americans with Disabilities Act of 1990
AFSCME American Federation of State County and Municipal
Employees
AICP American Institute of Certified Planners
AIDS Acquired Immunodeficiency Syndrome
ALUC Airport Land Use Commission
AOD Alcohol and Other Drugs
BAAQMD Bay Area Air Quality Management District
BART Bay Area Rapid Transit District
BCDC Bay Conservation & Development Commission
BGO Better Government Ordinance
BOS Board of Supervisors
CALTRANS California Department of Transportation
CalWIN California Works Information Network
CalWORKS California Work Opportunity and Responsibility
to Kids
CAER Community Awareness Emergency Response
CAO County Administrative Officer or Office
CCHP Contra Costa Health Plan
CCTA Contra Costa Transportation Authority
CDBG Community Development Block Grant
CEQA California Environmental Quality Act
CIO Chief Information Officer
COLA Cost of living adjustment
ConFire Contra Costa Consolidated Fire District
CPA Certified Public Accountant
CPI Consumer Price Index
CSA County Service Area
CSAC California State Association of Counties
CTC California Transportation Commission
dba doing business as
EBMUD East Bay Municipal Utility District
EIR Environmental Impact Report
EIS Environmental Impact Statement
EMCC Emergency Medical Care Committee
EMS Emergency Medical Services
EPSDT State Early Periodic Screening, Diagnosis and
treatment Program (Mental Health)
et al. et ali (and others)
FAA Federal Aviation Administration
FEMA Federal Emergency Management Agency
F&HS Family and Human Services Committee
First 5 First Five Children and Families Commission
(Proposition 10)
FTE Full Time Equivalent
FY Fiscal Year
GHAD Geologic Hazard Abatement District
GIS Geographic Information System
HCD (State Dept of) Housing & Community Development
HHS Department of Health and Human Services
HIPAA Health Insurance Portability and Accountability Act
HIV Human Immunodeficiency Syndrome
HOV High Occupancy Vehicle
HR Human Resources
HUD United States Department of Housing and Urban
Development
Inc. Incorporated
IOC Internal Operations Committee
ISO Industrial Safety Ordinance
JPA Joint (exercise of) Powers Authority or Agreement
Lamorinda Lafayette-Moraga-Orinda Area
LAFCo Local Agency Formation Commission
LLC Limited Liability Company
LLP Limited Liability Partnership
Local 1 Public Employees Union Local 1
LVN Licensed Vocational Nurse
MAC Municipal Advisory Council
MBE Minority Business Enterprise
M.D. Medical Doctor
M.F.T. Marriage and Family Therapist
MIS Management Information System
MOE Maintenance of Effort
MOU Memorandum of Understanding
MTC Metropolitan Transportation Commission
NACo National Association of Counties
OB-GYN Obstetrics and Gynecology
O.D. Doctor of Optometry
OES-EOC Office of Emergency Services-Emergency
Operations Center
OSHA Occupational Safety and Health Administration
Psy.D. Doctor of Psychology
RDA Redevelopment Agency
RFI Request For Information
RFP Request For Proposal
RFQ Request For Qualifications
RN Registered Nurse
SB Senate Bill
SBE Small Business Enterprise
SWAT Southwest Area Transportation Committee
TRANSPAC Transportation Partnership & Cooperation (Central)
TRANSPLAN Transportation Planning Committee (East County)
TRE or TTE Trustee
TWIC Transportation, Water and Infrastructure Committee
VA Department of Veterans Affairs
vs. versus (against)
WAN Wide Area Network
WBE Women Business Enterprise
WCCTAC West Contra Costa Transportation Advisory
Committee
__________________________________________________________________________________________________________________
Schedule of Upcoming BOS Meetings
June 9, 2009
June 16, 2009
June 23, 2009
TO: Family and Human Services Committee
FROM: Cynthia Belon, L.C.S.W.
Homeless Program Director
RE: Report on Homeless Continuum and 10-Year Plan to End Homelessness
DATE: June 1, 2009
Cc: Dr. Wendel Brunner, Public Health Director
This report provides an update on the accomplishments of the Homeless program for 08-
09 and the priorities for the 09-10 Fiscal year. Implementation of the Plan continues
under the leadership of the Contra Costa County Inter-Jurisdictional Council on
Homelessness and with staff leadership, support and guidance from the Homeless
Program.
SUMMARY
For the past five years, particular emphasis has been placed on providing outreach to
those who are chronically homeless, single adults with disabilities who have had several
episodes of homelessness. We have made significant progress in ending homelessness
among this sub-population of homeless community members, assisting them in moving
into permanent supportive housing and with ongoing support, becoming members of the
mainstream community. However, an increasing number of families hit hard by the
recession/economic climate are seeking assistance as they experience homelessness for
the first time or are attempting to prevent their first episode of homelessness. The
Continuum of Care has begun to shift to incorporate the needs of these families, focusing
on prevention and rapid-rehousing to try and minimize the length of time and the effects
on the family members of what homelessness creates. We continue to apply what we
have learned, and are committed to enhancing the system of care to meet the needs of all
homeless persons in our community to the best of our ability, but limited by the
dwindling financial resources that are available.
Attached are several reports, providing a comprehensive description of the performance
measures, goals and objectives, outcomes and demographic information for the
continuum of homeless service delivery system:
Demographic data and key outcomes for the Continuum of Care – taken from our
Homeless Management System, the key findings illustrate the progress made towards
meeting our main goals identified in the10-Year Plan. In addition, demographic data for
the Continuum is provided.
Performance Measures – include five main goals defined in the 10-Year Plan and act as
the basic foundation of all activity of the homeless continuum of care. In addition,
specific objectives and outcomes that are Homeless program-specific are defined for 08-
09 and 09-10.
Program Descriptions – all services currently provided by the County Homeless
program are identified by modality.
Ten-Year Plan Objectives within each Priority – identifies the strategies and actions
for each of the priorities/goals defined within the 10-year plan.
2009 Homeless Count – report on the homeless count conducted County-wide on
January 28, 2009.
KEY OUTCOMES
A total of 5782 people used homeless services from January 2008-April 2009, with
2543 identified as “new” homeless clients (those that had not been in the continuum of
services prior).
66% of homeless residents in our community using interim and/or transitional housing
services successfully exited to stable housing and/or support services.
Of those in permanent supportive housing, 75% of individuals and families have
retained their housing for one year or more.
The majority of homeless residents identify as coming from West County (43%),
followed by Central County (22%); East County (13%); South County (0%); outside of
Contra Costa (3%); 20% did not provide an answer.
Children and youth comprise 23% of the total, and 15% are over 55 years of age.
KEY ACTIVITIES/ 09-10 - Housing
A 24-bed respite program is to be built as part of the site of the current Concord single
adult shelter. All necessary funding has been acquired for the capital development, and
construction is scheduled for mid-June 2009, with completion by Fall 2009. This
program will provide additional medical support for those homeless persons who are
discharged from the hospitals, but need additional stabilization prior to entry into the
homeless emergency shelter system.
In addition, an FQHC satellite clinic will be operating 20 hours per week, and the
Concord multi-service center operated by Anka Behavioral Health will be relocated to
this site.
The current emergency shelter for homeless youth will be expanded to 18 beds from the
current capacity of 12 beds with the addition of a 3400 sq. foot modular placed in
Richmond at the current location All funding has been acquired and site preparation is
scheduled to begin.
Additional Shelter Plus Care vouchers will continue to be added, along with other
housing opportunities within mixed-income housing development projects that will target
both chronic and transitional or newly-homeless individuals, youth and families.
Permanent Connections, a HUD-funded program to provide scattered-site permanent-
supportive housing to 10 transition-age youth (ages 18-24) who are successfully
completing transitional housing programs, will begin in June, 2009. Scattered site means
that the young adults will have the ability to rent an apartment unit anywhere in the
County that they choose, and they will be given a subsidy to cover their rent with support
services provided on and off site to continue to assist in their stabilization and maturation.
The Economic Stimulus funds (Homeless Prevention and Rapid Re-Housing), available
from HUD, will provide financial assistance and services to prevent individuals and
families from becoming homeless or to help those who are experiencing homelessness to
be rapidly re-housed and stabilized. The Homeless Program is working collaboratively
with other County Departments, programs, the City of Richmond and the other
entitlement jurisdictions to develop a Plan for implementation in our community that will
best meet the needs of the homeless population, and will also support and adhere to the
goals and objectives identified in the 10-Year Plan. Stakeholder meetings with
representatives from service providers throughout the County are currently being
convened to determine the program design.
In addition, the homeless accommodation of the Concord Naval Weapons Station is
continuing to be developed, with the County Homeless Program, the City of Concord and
homeless service providers and non-profit housing developers working towards
agreement on the Plan for the homeless conveyance portion of the overall development.
Preliminary approval from the City of Concord and HUD has been given for the
agreements between the members of the Homeless Continuum Collaborative interested in
the development of this conveyance.
KEY ACTIVITIES/ 09-10 – Services
A major focus during this past year has been on training homeless service providers for
the implementation of a demonstration project in Contra Costa, called SOAR. The
purpose of this project is to facilitate access to SSI/SSDI benefits and in less time than
what has been the norm for eligible homeless persons, resulting in an income stream for
homeless persons who are eligible to receive these benefits, and an ongoing revenue
stream for the County that will cover the costs of the recipient’s health services. We are
currently identifying the systemic changes that are necessary to support the
implementation of this new model, with full implementation scheduled for 09-10.
KEY ACTIVITIES/09-10 - Outreach
Project Homeless Connect events continue to be provided on a regular basis. The last
one, held in Antioch Fairgrounds in September, 2008, provided services to over 600
homeless individuals, youth and families, which was the highest number served to date.
The next Project Homeless Connect will be held on June 17th at the Richmond
Auditorium.
Under discussion is a Project Homeless Connect to be held in September that focuses
specifically on health services, and will include vision exams and care along with health
appointments, dental and HIV services.
KEY ACTIVITIES/09-10 – HMIS
The Homeless Management Information System gathers intake and discharge data from
several service providers in the Continuum. However, not all homeless service providers
participate in this data collection system. For the past few years, revisions have been
made in the system in order to produce data that reflects a comprehensive picture of
homelessness in our community.
As part of this process, the Homeless Program HMIS Administrator has been working
with the members of the Continuum, the HMIS Policy Workgroup and the CCICH to
develop the Continuum-Wide data Report, which provides the demographic profile of
homeless residents of our community who are being served by the Continuum.
In the future, the specific services provided to homeless persons from entry to discharge
into permanent housing will be added, collected and analyzed.
In addition, new revisions to the overall system are being required to support the
outcomes from the Economic Stimulus Funds for homeless prevention and rapid-
rehousing. Any provider receiving these funds will be required to participate in the
homeless management information system.
1
The purpose of this report is to highlight the demographic profile of homeless adults, youth,
and families being served in Contra Costa County’s Homeless Continuum of Care. This
report was prepared by the HMIS Policy Group under the direction of the Contra Costa Inter-
Jurisdictional Council on Homelessness (CCICH). HMIS or the Homeless Management
Information System gathers unduplicated, continuum-wide statistics from several
participating homeless providers. A list of these participating agencies can be f ound on
page 7 of this report.
Key Points
1. A total of 5782 people used homeless
services from January 2008 to April 2009.
2. Of these, 2543 people were considered
newly identified homeless, or clients that
have never before entered our system of
services.
3. When individuals were asked, "What city
did you come from," a significant
percentage said they came from cities in
West Contra Costa County.
4. Nearly 23% of Contra Costa's homeless
population is children and youth, and 15% are over the age of 55.
0
500
1000
1500
2000
2500
3000
3500
4000
Total ServedChildren (0-13)Youth (14-24)Adults (25-54)Seniors (55+)
Age
Male
Female
Contra Costa County’s Homeless Continuum of Care
Demographics and Outcomes Report
For Period: 1/1/2008 - 4/30/2009
Report Run Date: 6/01/2009
What city are you from?
East
County
13%
Invalid or
Null
19%
Outside
Contra
Costa
3%
Central
County
22%
West
County
43%
South
County
0%
2
5. Seventy-five percent (75%) of individuals and families in Permanent
Supportive Housing have retained their housing for one year or more.
6. Sixty-six percent (66%) of participants exiting interim and transitional housing
successfully exit to more stable housing and/or support services.
3
General Assumptions
a. This report provides unduplicated continuum-wide statistics, using the last day of the report period as
the effective point-in-time date. This means that if a client entered several programs (or the same
program several times) within the period, this client is counted only once and the report displays only
the latest answer to each question as of the last day of the report period. For example, using a
time period of Jan – Jun „08, if Jane Doe entered 3 distinct programs within the period, and her
answer to Prior Living Situation was different on all three occasions, this report will de -duplicate her
answer to her latest answer as of June 30th, 2008.
Although this report is regarded as a continuum -wide report, there are several agencies that are not
currently participating in the HMIS project and therefore are not represented on this report. These
agencies include but are not limited to the Bay Area Rescue Mission, STAND Against Domestic
Violence, and the Crisis Center. A list of programs, which ARE currently participating in HMIS, is
available on page 6.
b. There are several questions where no answers are provided, which are represented by the category
“Not Stated”. A high occurrence of “Not Stated” may be seen for questions that are not required for
certain subpopulations (e.g. homeless youth, children, etc.).
c. In this report, a household is defined by or may represent either a family with children or a couple
without children.
d. Quality assurance. Several data quality procedures have been instituted to make sure this report
represents the best information we have at the current time. All agencies that contribute data are
required to abide by our continuum‟s HMIS Policies and Procedures and have entry an d exit
protocols in place to ensure admission information is accurately reflected.
Questions and Further Assistance
For questions, please email the County Homeless Program at homeless_program@hsd.cccounty.us.
4
I. How many homeless persons were served during the period of Jan1, 2008 – April 31, 2009? 5782
individuals
II. Of those served, how many were newly identified homeless (clients that have never before
entered our system of services)? 2543 individuals
III. What is the demographic profile of all homeless clients served during period?
1. Where participants presented themselves as homeless:
City Slept In Last Night Total Percentage
Newly
Homeless
Antioch 486 8.41% 200
Concord 908 15.70% 384
Martinez 226 3.691% 108
Pittsburg 171 2.96% 69
Walnut Creek 44 0.76% 22
San Pablo 223 3.86% 103
Richmond 2033 35.16% 983
Other Central County 99 1.71% 47
Other East County 122 2.11% 54
Other South County 7 0.12% 1
Other West County 149 2.58% 75
Outside Contra Costa County 191 3.30% 120
Unspecified Contra Costa 43 .74% 2
Invalid or Not Stated 1080 18.68% 375
Total: 5782 100.00% 2543
Note: Several questions are asked about each participant’s geographic origin, including where they spent the previous night,
what is their current address, and where they last resided for at least 90 days. Acknowledging that no single response offers an
accurate picture of where each person found himself or herself homeless, we report where participants spent the previous
night (before entering continuum services) wherever possible. Where this is unavailable, we report where they last resided for
at least 90 days.
2. Gender:
Gender Total Percentage
Newly
Homeless
Female 2416 41.78% 409
Male 3314 57.32% 516
Transgender 4 0.07% 2
Unknown 1 .02% 0
Not Stated 47 0.81% 45
Total: 5782 100.00% 2543
3. Household configuration:
Household Configuration Total
Newly
Homeless
# of Households (with or without children) 864 316
# of Households with Children 451 201
# of Singles 4058 1870
Total Homeless Persons Served in Contra Costa
5
4. Age (calculated based on this report‟s run date)
Age Range Total Percentage
Newly
Homeless
0-5 291 5.03% 146
6-13 340 5.88% 127
14-17 136 2.35% 55
18-24 529 9.15% 316
25-34 875 15.13% 402
35-44 1145 19.80% 492
45-54 1570 27.15% 637
55-61 617 10.67% 231
62+ 232 4.01% 92
Not Stated 47 0.81% 45
Total: 5782 100.00% 2543
5. Employment status:
Unemployed? Total Percentage
Newly
Homeless
No 690 11.93% 286
Yes 4099 70.89% 1897
Not Stated 993 17.17% 360
Total: 5782 100.00% 2543
6. Chronic homeless status of total served participants:
Is the client chronically homeless? Total Percentage
Newly
Homeless
No 3393 58.68% 1581
Yes 1646 28.74% 608
Not Stated 743 12.85% 354
Total: 5782 100.00% 2543
Note: Chronically homeless persons are defined as unaccompanied individuals who have a disability and have been
continuously homeless for a year or longer, or 4 times in the past 3 years.
7. Race and Ethnicity of total served participants:
Race and Ethnicity Total Hispanics Percentage
Newly
Homeless
White 2417 304 41.80% 955
Black/African American 2646 31 45.76% 1281
Asian 64 7 1.11% 13
American Indian/Alaskan Native 366 293 6.33% 161
Native Hawaiian/Other Pacific Islander 77 9 1.33% 37
Asian & White 6 0 0.10% 0
Am. Indian/Alaskan Native & Black African Am. 14 3 0.24% 5
American Indian/Alaskan Native & White 50 11 0.86% 22
Black/African American & White 29 1 0.50% 7
Other Multi-Racial 65 7 1.12% 17
Race Not Stated 48 0 0.83% 45
Total: 5782 487 100.00% 2543
Note: We follow HUD conventions for describing race and ethnicity. Persons are separately asked which racial category (-ies)
they identify themselves as, and whether or not they identify as Hispanic.
6
8. Monthly income level of total served participants:
Monthly Income Level Total
Newly
Homeless
$0 2808 1413
$1-500 440 206
$501-$1k 1708 602
$1001-$3k 668 248
$3001-$5k 22 12
over $5k 2 0
Null 134 62
Total: 5782 2543
Note: Income includes all sources of income, from employment income to government income
9. Clients with Disabilities
Disabling Condition Total
Newly
Homeless
Don't Know (HUD) 112 4
No (HUD) 2523 1253
Refused (HUD) 12 4
Yes (HUD) 2997 1220
Not Stated 138 62
Total: 5782 2543
10. Types of Disabilities reported by clients who reported to have a disabling condition:
Disability Type Total
Newly
Homeless
Alcohol Abuse (HUD 40118) 1458 250
Developmental (HUD 40118) 105 31
Drug Abuse (HUD 40118) 1521 248
HIV/AIDS (HUD 40118) 96 6
Mental Illness (HUD 40118) 1605 252
Other 116 18
Physical/Medical (HUD 40118) 757 163
Physical/Mobility Limits (HUD 40118) 278 55
Total: 5936 1023
Note: Unlike all other sections of this report, these categories are not mutually exclusive. Many participants reported multi ple
disabilities.
7
IV. What programs are represented in this report for each project type between January 2008 and
April 2009?
Permanent Supportive Housing:
Projects reporting: Garden Park Apartments (CCIH), West Richmond Apartments (Rubicon), Shelter Plus
Care (COHP), Giant Road Apartments (Rubicon), PHPWD (Greater Richmond Interfaith Programs),
Idaho Apartments (Rubicon), Mary McGovern (SHELTER, Inc.), Next Step (SHELTER, Inc.), Rapid
Rehousing (SHELTER, Inc.), Transitional Housing Partnership Program (SHELTER, Inc.), Sunset
(SHELTER, Inc.), HHISN Programs – ACCESS, Access Plus, SIPS, PCH, Lakeside.
Transitional Housing:
Projects reporting: Project Independence (Rubicon), Appian House (County Youth Program), Bissell
Cottages (County Youth Program), Transitional Housing for Families (GRIP), Lyle Morris Family Center
(SHELTER, Inc.), Pittsburg Family Center (SHELTER, Inc.), REACH Plus (SHELTER, Inc.), San Joaquin
(SHELTER, Inc.).
Case Management/Life Skills/Housing Assistance Programs:
Projects reporting: Money Management (Rubicon), FERST Multi-service Centers (Anka), Resource
Center (GRIP), Project Independence (Rubicon).
Emergency Shelters:
Projects reporting: Brookside Shelter (County Program), Concord Shelter (County Program), Emergency
Shelter (GRIP), Mountain View House (SHELTER, Inc.), Winter Nights Shelter.
Unsheltered 2009 Contra Costa Homeless Count
distribution of “unsheltered” homeless by supervisorial district and city
district 1El Cerrito 39El Sobrante 27North Richmond 50 Richmond 433San Pablo 76Total 625
district 2
Crockett 24
Hercules 55
Lafayette 23
Martinez 79
Moraga 8
Orinda 2
Pacheco 27
Pinole 1
Port Costa 0
Rodeo 33Total 252
district 3Alamo 0Brentwood 15Byron 10Danville 3Knightsen 13San Ramon 24Walnut Creek 78Total 143
district 4Clayton 0Concord 294Pacheco 34Pleasant Hill 128Total 456
district 5Antioch 146Bay Point 94Bethel Island 45Oakley 2Pittsburg 109Total 396
number of “unsheltered” Homeless Identified = 1,872
Note: Pacheco count was split and included in the District Totals for both Districts 2 and 4.
2009Sheltered Type of Service Couples Families with Individuals in Children in Individuals Unaccompanied Children Families Families without Children Youthn January 28, 2009, the Contra Costa
Homeless Program, the staff of various homeless
service programs and more than 100 volunteers
conducted its biannual homeless census of
sheltered and unsheltered people experiencing
homelessness in Contra Costa County. The count
is conducted on one day and as such, the data
collected is a “point-in-time” count and is not
meant to represent the number of homeless
clients over the course of a year.
Overall, the count will aid in the implementation
of the 10-year plan to end homelessness (www.
cchealth.org/groups/homeless) which will assess
our progress in accomplishing the goals of the plan
towards ending homelessness in our community.
This summary provides key findings from the count:
notable findings:
The 2009 count found an 8% decrease in
homeless persons in Contra Costa County.
57% of unsheltered homeless persons live in
encampments.
The number of single adults accessing
services has increased by approximately 20%.
The number of homeless individuals in alcohol
and drug treatment programs has doubled.
There was an increase in the number of
homeless individuals making use of food
programs.
•
•
•
•
•Alcohol/Drug Treatment 0 0 0 0 189 0 Employment/Job Training 0 0 0 0 128 0Emergency Housing 2 62 203 118 282 24Food Program/Soup Kitchen 0 4 14 10 220 5 Medical Providers (incl’ hospitals) 0 0 0 0 42 0Mental Health Treatment 0 0 0 0 10 0Multiservice Center 0 5 16 9 396 0Outreach/Engagement 0 0 0 0 45 0Transitional Housing* 1 54 181 112 161 36 Total in each category 3 125 414 249 1473 65 *Permanent supportive housing not reported. number of “sheltered” homeless identified = 1,958
CONTRA COSTA HEALTH SERVICES DEPARTMENT
CONTRA COSTA COUNTY
TO: Family and Human Services DATE: June 8, 2009
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 an annual 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
Since 1990, the Health Care for the Homeless (HCH) Project has provided 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 Workers,
Financial Counselor, Mental Health Specialist, and a Substance Abuse
Counselor.
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 2008, the CCHS saw 12,372 homeless patients who generated 82,432
visits. The attached presentation contains additional information on this
population.
New Actions
The following activities have occurred since the December 2008 briefing to the
Board of Supervisors on HCH activities:
Expanded Medical Services Grant Completed
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 1FTE Nurse Practitioner and 1 FTE Registered Nurse,
along with a Driver/Clerk. The grant required HCH to serve an additional 1,700
homeless patients through this expansion. We have exceeded our goal, as
evidenced by the increase in over 2,000 patients since last year alone. The HCH
Project now operates two teams in different parts of the county, five days per
week.
HCH base funding has increased from $320,000 to its current level of
$846,000. We anticipate that this funding will continue, provided that we maintain
our current level of services to patients.
American Recovery and Reinvestment Act of 2009
In May 2009, the HCH Project was awarded an additional $220,000 in stimulus
funds to address the “Increased Demand for Services.” This amount of funding
was calculated by a formula based on the number of homeless patients served
by the HCH Program. Funding is for a two-year period and is expected to be
used to provide services to additional homeless patients.
In June 2009, the HCH Project submitted an application for a Capital
Improvement Project to replace the Martinez Family Practice Site (Building 2 on
the CCRMC Campus) with a new modular building. This project will modernize
the clinic and streamline clinic flow for maximum efficiency. The new unit will
enhance the effectiveness and efficiency of providing clinical services to patients
through reduced waiting times for clinic appointments at the Martinez site and
throughout the CCHS system. A homeless-specific clinic will be offered at this
site upon its opening. Funding for this project is also calculated on a formula
basis at $683,000, and we will receive notification of a grant award on July 1,
2009.
Stimulus funds through the ARRA are expected to provide an additional
$903,000 for HCH services for the next two years.
Federal Performance Review of HCH Project
During May 2009, the Health Resources and Services Administration conducted
an on-site Performance Review of the HCH Project, with an emphasis on the
following performance measures:
1. Number of patients served by the HCH Program.
2. Percentage of adult homeless patients, ages 18 years and over, with
diagnosed hypertension whose diagnosed blood pressure was less than
140/90.
3. Cost per patient served by the HCH Program.
The site visit went very well, and will be followed by a Performance Report
written by the HRSA Office of Performance Review. An accompanying action
plan for performance improvement will be developed by the HCH Project that will
be submitted to HRSA in July. This presents opportunities to improve our
performance while noting that no problem areas were identified during the site
visit.
Health Care for the Homeless Contra Costa Health ServicesPresentation to the Family & Human Services Committee Contra Costa County Board of SupervisorsJune 8, 2009
Andrea DuBrow, MSW, MPH Administrative ManagerKate Schwertscharf, PHNNurse Program Manager
Who qualifies for services?zAll 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.
Funding for HCH ServiceszSection 330(h) Public Health Services ActHealth Care for the Homeless grant from the Federal Government (BPHC/HRSA) zExpanded Medical Capacity Grant – June 2007-09 to provide services to 1,700 more homeless patients per year. Expect funding to continue. Combined funding $850,000zIncreased Demand for Services- $220K for two years from the Recovery Act, with no expectation of continued funding.
Number of Patients in 2008 z12,372 unduplicated homeless patientsz82,432 visits: mobile clinics, ambulatory clinics, emergency department, mental health, substance abuse programs.
Increased demand for services: 2007 vs. 2008z20% increase in number of patients servedz10% increase in number of patient visits
Why the increase?zExpanded ability to provide services through increased grant fundingzEconomic situation created increased demandzContra Costa Times article, “Local community clinics and public hospitals see big jump in uninsured patients” stated:• “Costa Regional Medical Center has seen a 12 percent boost in emergency room patients in the past year. It typically has less than a 5 percent increase.”zStatewide, California hospitals reported a 33 percent increase in uninsured emergency room patients and a 73 percent jump in consumers having difficulty paying their out-of-pocket medical bills, according to a November survey by the California Hospital Association.
HCH ServiceszMobile 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
Mobile Clinic LocationszAdult Emergency Shelters Concord & RichmondzCalli House (youth), RichmondzBay Area Rescue MissionzGRIP Souper Center & Family Shelter, RichmondzLove-A-Child, BaypointzLoaves & Fishes, AntiochzMulti-Service Centers, Richmond, AntiochzAOD Treatment FacilitieszMonument Futures, ConcordzMonument CorridorzHome Depot : El Cerrito, Pittsburg, ConcordzAmbrose Community Center, BaypointzSalvation Army, AntiochzWinter Nights Interfaith Shelter, Central & East County
Two mobile teams, 5 days/weekzServe multiple locations of the County on the same day zProvide clinical services with the homeless outreach team (Project HOPE)
Specialized Homeless Ambulatory Care ClinicszRichmond, Concord and Antioch health centers offer special clinics just 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
Ambulatory Care, Specialty, & Hospital Services• Family practice care• Specialty care• Outpatient surgery• Emergency Department• Inpatient care• Laboratory• Radiology• Pharmacy
Mental Health ServiceszMental 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 ServiceszSubstance Abuse Treatment Specialist provides screenings, referrals, and coordination of detox and recovery services specifically for homeless patients in shelters and other mobile clinic sites
Patient Demographics 2008z51% malez49% femalez21% of homeless patients are completely uninsured, on no publicly-funded programz56% Medi-Cal; 2% Medi-CarezAll of our patients at 100% of the Federal Poverty Level and below.
Race/Ethnicity of Patients Seen Compared to CCC in 2008RaceHCH CountyWhite34%53%Latino/Hispanic29%21%Black/African American24%9%Asian/Pacific Islander8%13%American Indian/Alaskan Native0.5%0.3%Unknown5%3%
Which Supervisor Districts are Patients From?District20072008I- Supervisor Gioia39%30%II- Supervisor Uilkema10%13%III- Supervisor Piepho8%6%IV- Supervisor Bonilla17%19%V- Supervisor Glover23%26%Other3%5%
Strong Consumer InvolvementzActive consumer advisory boardzProvide valuable recommendations & feedback
Challenges & OpportunitieszDischarge Planning – improved outcomes for homeless patients leaving the hospital through collaboration with local hospitals, HCH, and COHP zRespite Care program- under discussion & development with COHPzDental services – Cuts to Denti-Cal program; developing community-based pro-bono options
Stimulus Funding OpportunitieszTwo-year funding amounts:zIncreased Demand for Services funding• Additional $220,000 to see more patientszCapital Improvement Project funding• Submitted June 1, 2009 for capital improvements to Martinez Family Practice site ($680,000)• Will add a Homeless clinic to Martinez