Presentation of the State of Indiana's initiative to end-long term homelessness.

1. INDIANA PERMANENT SUPPORTIVE
HOUSING INITIATIVE
2009 NCSHA AWARD FOR COMBATING HOMELESSNESS
SUPPORTIVE HOUSING – IT WORKS!

2. IHCDA STRATEGIC PLAN
 Core strategic value:
 Stop funding programs and start funding solutions
 Strategic Goals
 Ending Long-Term Homelessness
 Aging in Place
 Sustainable Development
 Comprehensive Community Development

3. IPSHI PARTNERS
Indiana Housing and Community Development Authority
Division of Mental Health and Addiction
Office of Medicaid Planning and Policy
Department of Child Services
Department of Corrections
FSSA Transformation Work Group
Indiana Planning Council on the Homeless
Corporation for Supportive Housing
Great Lakes Capital Fund
Indiana Council of Community Mental Health Centers

4. IPSHI –Technical Assistance
Corporation for Supportive Housing
Technical Assistance Collaborative
ABT Associates
Barbara Ritter, MSHMIS
Denny Jones, Indiana University School of Medicine
JoAnn Miller, Purdue University
Megan Maxwell, Community Services IHCDA

5. The Face of Homelessness
 On any given night, approximately 9,000 Hoosiers are
experiencing homelessness. (2010 Point in Time Count)
 Persons with severe mental illness account for about 28 percent of all
sheltered homeless persons.
 Persons with chronic substance abuse issues make up 39 percent of
sheltered adults.
 Veterans represent about 15 percent of the total sheltered adult
population.
 Persons with HIV/AIDS account for 4 percent of sheltered adults and
unaccompanied youth.
 Victims of domestic violence constitute 13 percent of all sheltered
persons.
 40% of heads of households were in Foster Care (2008 AHAR)

6. The Face of Homelessness
 Forty-three percent of individuals entering a shelter
during a particular year are already homeless—that
is, on the street or living in a different shelter
 Of those not already homeless, the most common
path into homelessness is leaving someone else‘s
housing unit, and
 About one in five homeless individuals comes
from an in-patient medical facility or a correctional
facility.
 Just over 40 percent of both homeless men and
women stay in an emergency shelter for a week or
less during a one-year period.
 70 percent stay no more than a month.
 The median length of stay is 14 or 15 days.
• (2007 AHAR)

7. Current System is Costly and Ineffective
 Research indicates that approximately 15
to 18% of people who experience
homelessness are chronically homeless.
 This 15 to 18% consumes more than 60%
of all homeless services – leaving the
homeless services systems struggling to
effectively serve those who could exit
homelessness relatively quickly.
Dennis P. Culhane, University of Pennsylvania

8. Why Permanent Supportive Housing?
 For decades, communities have ―managed‖ homelessness without
addressing the underlying cause.
 Emergency and institutional systems are significant sources of care and
support, yet they discharge people, many with disabilities, into
homelessness .
Government is spending hundreds of
millions of dollars per year, yet homeless
rates are growing .
oThe state‘s $1.9 M Emergency
Shelter Grant served 18,000
unduplicated people in 2007, only
28% left shelter to permanent stable
housing.

9. What is Permanent Supportive Housing?
A cost-effective combination of
permanent, affordable housing with
services that help people live more
stable, productive lives.

10. PSH is for People Who:
 Are experiencing long-term homelessness.
 Cycle through institutional and emergency
systems and are at risk of long-term
homelessness.
 Are being discharged from institutions and
systems of care.
 Without housing, cannot access and make
effective use of treatment and supportive
services.

11. Housing and Services
 Housing
 Permanent: Not time limited, not
transitional.
 Affordable: For people coming out of
homelessness.
 Independent: Tenant holds lease with
normal rights and responsibilities.
 Services
 Flexible: Designed to be responsive to
tenants‘ needs.
 Voluntary: Participation is not a condition
of tenancy.
 Independent: Focus of services is on
maintaining housing stability.

12. Paradigm Shift
– Housing First
 Permanent Supportive Housing within a housing
first model.
 ―Housing first‖ strategy operates under the philosophy that
safe, affordable housing is a basic human right/service need
and not a reward.
 Stable, permanent, affordable housing is a prerequisite for
effective mental and medical health care and treatment for
addiction.
 It offers the stability needed for individuals and families to
achieve their highest level of independence.

13. Permanent Supportive Housing Works
 Local and national studies have demonstrated that PSH is
effective in serving those with most significant barriers who
have cycled in and out of costly systems for years.
Highlights of PSH results:
 Reduced Medicaid reimbursement per tenant using medical
inpatient services by 71% (Connecticut Demonstration Model Highlights,
2002).
 Reduced days in state correctional facilities by 84% (Culhane, Metraux,
Hadley, New York, NY, 2002).
 Reduced emergency room visits 57% (Martinez, Burt, Oakland, CA,
2004).
 Reduced psychiatric in-patient days 60.8% (Culhane, Metraux, Hadley,
New York, NY, 2002).
 Reduced hospitalization admissions by 77% (Mondello, Gass,
McLaughlin, Shore, Portland, ME, 2007).

14. Permanent Supportive Housing Works
 PSH results in the following: (continued)
 Reduced detox visits by 82% (Perlman, Parvensky, Denver, CO 2006)
 Engaged in employment and volunteer activity 62% (Long, Amendolia,
Oakland, CA 2003).
 Increased income by 69% (Mondello, Gass, McLaughlin, Shore, Portland,
Maine, 2007).
 Decreased income from general assistance and veterans benefits by
25 - 36% (Long, Amendolia, Oakland, CA 2003).
 Enhanced community development with increased neighborhood
property values in 8 of 9 projects (Connecticut Demonstration Model
Highlights, 2002).
 Increased housing stability with 75 – 85% still housed after 1 year
(CSH) and of those leaving 1/3 ―graduate‖ to increased independence
(Wong et al., 2006 HUD Report) .

15. Supportive Housing
is Cost Effective
 New York, NY Study reported costs of $17,276 to provide
supportive housing to each tenant per year, but generated
$16,282 in annualized savings. If reinvested in PSH, 95% of
costs would be covered. (Culhane, Metraux, Hadley, 2002).
 Maine Study reported a net cost savings of $93,436 for 99
individuals. (Mondello, Gass, McLaughlin, and Shore, 2007).
 Denver Study found a net cost savings of $4,745 per person with
projected savings of $711,750 for 150 individuals. (Perlman,
Parvensky, 2006).
 Rhode Island Study estimated a net savings of $8,839 per person
for 48 individuals for a total of $424,272. (Hirsch & Glasser,
2008).
 Portland Study found savings of $15,006 per person. The
estimated cost savings for 293 eligible individuals would total
$4,396,758. (Moore, 2006).

16. Current System is Costly and Ineffective
 To do nothing is expensive.
 It costs the City of Indianapolis $32,560 annually in the public health
and criminal justice systems to respond to needs of the average
homeless person with mental illness and/or substance abuse issues.
Doing nothing adversely effects multiple systems:
oCriminal Justice/ Corrections
oCommunity Health Providers and Hospital
oHousing /Neighborhoods
oFamilies / Foster Care
oEconomic /Workforce Development

17. Bringing the costs home
IPSHI Cost (Capital, Operating, and Services) compared to the Costs of Long-Term
Homelessness Associated with Emergency Systems: Medicaid, Shelter and Incarceration
IPSHI Cost Savings
40,000,000.00
35,000,000.00
30,000,000.00
25,000,000.00
Medicaid, Shelter and
20,000,000.00 Incarceration Costs of Long-
Term Homeless
15,000,000.00
IPSHI Cost
10,000,000.00
5,000,000.00
0.00
94 494 894 1200 1435 1435 1435
IPSHI Unit Production
Can we really afford to do nothing?

18. Indiana‘s Tool for Creating
Permanent Supportive Housing
Indiana Permanent Supportive Housing Initiative
 A private/public venture cutting across state
agencies, nonprofit constituencies, private
foundations and the for profit sector.
o Spearheaded by:
 Indiana Housing and Community Development Authority
 Division of Mental Health and Addiction
 Corporation for Supportive Housing
 Great Lakes Capital Fund

19. Indiana‘s Tool for Creating
Permanent Supportive Housing
 Six-year project to adopt national best practices into
an Indiana model for permanent supportive housing.
 The initiative aims to create at least 600 supportive
housing units within Indiana over the three-year
Demonstration Project (2008-2010).
 After the initial demonstration project is evaluated,
long-term funding mechanisms and policies will be
put in place to create an additional 800 units (2011-
2013).
 New finance/funding model for PSH

20. Indiana‘s Tool for Creating
Permanent Supportive Housing
Indiana Permanent Supportive Housing Initiative
Demonstration Project Expansion Project
2008 -2010 2011-2013
Phase 1 Phase II Evaluate Demonstration Projects
Dimensions of Quality
2008 2009 -2010 Arizona Matrix
Improve Assessment Tools and Triage
Develop Best Practices from IPSHI
Target Units Taget Units Recovery Model
2008: 160 2009: 200
2010: 240
Establish New Target Units
Phase 1 Strategies Phase II Strategies 800
Develop New Model Test Model Expand to SOF
Develop Financial Model for Capital and Operataing Costs Devvelop Financial Model for Service Delivery
Set Aside Capital and Operating Resources Develop and Redirect Resources for Service Model
Measure Outcomes Measure Outcomes Measure Outcomes

21. IPSHI-Building a PSH Infrastructure
Provider Community
State Agency
Capacity Support
Development, Behavior Collaboration –
Health, and Homeless Government, Foun
Policy and funding
Assistance Community dations, and
priorities
Community
Funding – Leadership &
New Supportive Capital, Operating Champions
Housing Units , Services

22. IPSHI Goals
 Reduce the number of individuals and families who are
experiencing long-term homeless and cycling in and
out of emergency systems.
 Reduce the number of individuals who become
homeless after leaving state operated facilities by
creating community-based housing and services.
 Expand the reach of PSH to new communities.
 Improve communities by ending long-term
homelessness through community-based partnerships
around safe, decent housing.

23. IPSHI Goals
 Increase the capacity and the number of
non-profits providing supportive housing at the local
level.
 Improve the connection between behavioral health,
housing, employment, and healthcare systems.
 Improve the quality and cost-effectiveness of the
homeless delivery system.
 Establish housing as a provision of recovery

24. IPSHI Target Population
Income Expectations: Permanent Supportive Housing is targeting
extremely low income households (30 percent Area Medium Income and
below).
Housing Status: Four part definition
1. Individual or Family Resides in:
• In places not meant for human habitation, such as cars, parks,
sidewalks, abandoned buildings (on the street
• In an emergency shelter
• In transitional housing for homeless persons who originally came
from the streets or emergency shelters
• In any of the above places but is spending a short time (up to 90
consecutive days) in a hospital or other institution

25. IPSHI Target Population
Housing Status: Four part definition Continued
1. Individual or Family Resides in:
• Is being discharged within a week from an institution, such as a
mental health or substance abuse treatment facility, Community
Mental Health Center residential facility or a jail/prison, and no
subsequent residence has been identified and the person lacks the
resources and support networks needed to obtain housing.
• These are individuals who could live independently in the community, if
provided with supportive housing, and who would be at risk of street or
sheltered homelessness, if discharged without supportive housing.

26. IPSHI Target Population
2. Individuals and families who are currently housed but are at imminent risk of
becoming homeless. (No more than 18% of the units within a specific program
can be subsidized with the IHCDA Project Based Voucher Program for
individuals and families who are currently housed but at imminent risk.) Risk
factors include:
o Eviction within two weeks (including family and friends)
o Residing in housing that has been condemned
o Sudden and significant loss of income
o Sudden and significant increase in utilities
o Physical disabilities and other chronic health issues
o Severe housing cost burden (greater than 50%)
o Homeless in the last 12 months
o Pending foreclosure of rental housing without resources to find new housing
o Overcrowded housing
o Credit problems which preclude household obtaining housing
o Significant medical debt

27. IPSHI Target Population
3. Young adults, ages 18-24, who are diagnosed with a serious mental
illness and are being treated in Indiana State Operated Facilities; or are
leaving or have recently left foster care. These are individuals who
could live independently in the community, if provided with supportive
housing and who would be at risk of street or sheltered homelessness, if
discharged without supportive housing.
AND
4. Has an adult head of household with a disabling condition. Disabling
condition means a diagnosable substance use disorder, serious mental
illness, or chronic physical illness or disability, including the co-
occurrence of two or more of these conditions.

28. IPSHI Target Population
A Permanent Supportive Housing household is a household in
which a sole individual or an adult household member has a
serious and long-term disability that:
 Is expected to be long-continuing, or of indefinite duration;
 Substantially impedes the individual‘s ability to live independently; .
 Could be improved by the provision of more suitable housing conditions; and
 Is a physical, mental, or emotional impairment, including an impairment
caused by alcohol or drug abuse, post traumatic stress disorder, or brain injury;
is a developmental disability, as defined in section 102 of the Developmental
Disabilities Assistance and Bill of Rights Act of 2000 (42 USC 15002); or is the
disease of acquired immunodeficiency syndrome or any condition arising from
the etiologic agency for acquired immunodeficiency syndrome

29. IPSHI Target Population
IPSHI Funding will prioritize
projects serving HUD defined
Chronic Homeless and other
Housing First projects focused on
rapid re-housing individuals out
of shelter, street and places not fit
for human habitation.

30. IPSHI Triage
to Supportive Housing
Housing of Crisis
Origin Supportive
At-Risk Living Situations
(doubled Temporary Setting
up, abusive, unsafe, etc)
Transitional Housing and
Housing
Emergency Shelter Transition in Place
Streets Halfway House
Group Home Housing with
In-Patient Treatment or
Hospitalization Minimal Supports
Rapid Re-Housing and
Prevention Independent Apartment –
Incarceration market rate or subsidized
Reconnection with family
and back to housing of
origin
Homeownership

31. Triage to Supportive Housing
The Indiana Regional Homeless Triage Project
 Focus on improving access and triage into housing
and services for persons who are homeless in
Indiana.
 Asks Continuums of Care from across the state to
come together and discuss their current and
needed resources to house persons and families
who are homeless.
 This year long project will kick off in May 2010.

32. IPSHI Triage to
Supportive Housing
 IRHTP Goals
• Develop a comprehensive system map of housing and
services for the State of Indiana –Critical Time
Intervention model
• Create an intercept model for triage and assessment by
region
• Provide technical assistance and training tailored to the
individual needs of each region
• Integrate IHOPE into each community

33. Key Strategies
Supportive Housing Providers need:
• Capital
 Bricksand Sticks
 One time funds
• Operating
 Funding to support building operations
 Typically provided through a subsidy
• Supportive Services
 Medicaid MRO
 Grants and contracts to fund staff salaries

34. Key Strategies
 Develop financial models for housing and services.
 Develop effective State policies for permanent
supportive housing.
 Promote a public/private partnership to fund and
support PSH.
 Create a pipeline and build local capacity through
the Indiana Permanent Supportive Housing
Institute.

35. Key Strategies
 Convene a funders council to support
pipeline of projects.
• Leverage existing resources for PSH.
• Develop new funding resources (public and private).
• One stop to access multiple funding streams for new
projects.

36. IPSHI Building Blocks
Engaging Engaging State Funders Council TRACKING
PSH Developers: Service Delivery for PSH PROGRESS
Network: Ongoing Evaluation of
Tax Credit Developers Health Capital PSH Projects
CDC’s Employment Operations And
CHDO’s VA Service Homeless Assistance
Homeless Housing Org. Criminal Justice. Etc. System
McKinney Vento CoC Housing and Service Joint State RFP Strategic Plan for PSH
Application(s) Resource Planning For for Next 6Years
Policy and Planning PSH Projects
Dedicated funding
Streams for PSH
Inter Agency Policy
Continuum of Care Indiana Supportive and Planning: Homeless Data
Planning Process Housing Institute And Homeless
And Local 10-Year CSH Partnership Assistance System
Plans to End Local Capacity Building IPCH Evaluation Data
Homelessness DMHA – TWG

37. IHCDA‘s Commitment to Date
IHCDA is committed to reducing the number of homeless
individuals cycling through Indiana‘s systems of emergency care
with the following support:
 Dedicates IHCDA staff for supportive housing
 Creates policy and system change to support PSH
 Prioritizes Funding for PSH
 Promotes Inter-Agency Understanding of the Priorities
 Funds CSH‘s Presence in Indiana
 Funds Indiana Permanent Supportive Housing Institute
 Works with other federal, state and local initiatives that have similar
goals
 Works with foundations and private sector to develop resources

38. IPSHI Achievements to Date
 Capital funds
 Modified the QAP to fund supportive housing through the
LIHTC program
 Set aside HOME and Development funds
 Stimulus funds
 Operating Funds
 State Admin Plan revised to project base 20% of vouchers
for supportive housing projects
 Working with other local PHAs to project base vouchers
for supportive housing
 BOS McKinney Vento funds tied to IPSHI process

39. IPSHI Achievements to Date
Service Model Development
 DMHA advanced IPSHI through the Division's
Transformation Initiative
 Goal of Transformation is to transform Indiana's Mental
Health and Addiction system to a Recovery Based Model
that focuses on providing meaningful, consumer and
family-centered services
 Will discuss this in more detail later in presentation

40. IPSHI Achievements to Date
 Working with Connected by 25 and Department of Child
Services to expand focus on youth aging out of foster care
and to seek opportunities for new federal funding sources
 Finance Project will leverage and redirect Chafee funds and other
resources to IPSHI projects
 Jim Casey Foundation developing strategy to duplicate Connected by
25 Model across the state
 Working with Department of Corrections to develop a
demonstration project identifying those individuals
released from prison who are most at risk of homelessness
 Reach In project
 Robert Wood Johnson Foundation providing seed money

41. IPSHI Service Delivery Model
 A subcommittee of the State‘s Mental Health
Transformation Work Group (TWG) agreed to work with
CSH and the Technical Assistance Collaborative (TAC) to
identify a Model Service Delivery System in Indiana that
integrates the goals of the State‘s Transformation Work
Group (TWG)
 Built on State‘s efforts to improve the finance and delivery
system of mental health services through re-defined
Medicaid Rehabilitation Option (MRO) covered services
 Redefined housing not as an amenity, but a recovery based
service

42. IPSHI Service Delivery Model
 Developed a Crosswalk which integrates MRO recovery
based model with CSH dimensions of quality in supportive
housing and serves as a guide for aligning MRO eligible
services with the services needed in supportive housing
 Identified the amount of gap funding for services not
covered under Medicaid – either because of eligibility
restrictions, timeliness of coverage or services not covered
 Applied for SAMHSA Mental Health Transformation Grant
(MHTG) to assist with funding the gap

43. Key Findings of ‗08 and ‘09 Institute
Team Feasibility Study
 The use of MRO under the new recovery model works as a
principle resource for supportive housing in Indiana
 Those centers that participated in the study see supportive
housing as a strategic and worthwhile endeavor
 The service funding gap represents between 20 and 25% of total
costs as units are coming on-line
 The gap is only 5% after a person has been in housing for a year
 Over time, a majority of participants can be made eligible for
Medicaid
 At best, 75% will SSI or SSDI benefits
 Opportunity for system transformation with upfront support of
the gap

44. IPSHI Service Delivery Model
Potential Service Funding for IPSHI Pipeline
$14,000,000.00
$12,000,000.00
$10,000,000.00
$8,000,000.00 SAMHSA MHTG
$6,000,000.00 State Funding of Gap
MRO Funding of IPSHI
$4,000,000.00
$2,000,000.00
$-
1 2 3 4 5 6 7

45. IPSHI Service Delivery Model
 Assist State in developing a Supportive Housing
Policy
 Identify resources to provide capacity building and
training for community mental health centers and
institute team partners as they transition to new
model
 Pursue strategies for closing the financial gap for
services

46. ISPHI FUTURE
OUR VISION IS TO
END, NOT MANAGE
HOMELESSNESS