Human Services Division - It Takes a Team


“It Takes a Team” Addressing Chronic Homelessness in Santa Monica (This paper is being presented to the U.S. Conference of Mayors in Washington D.C., the week of May 2, 2005.)
Nine agencies, 25 professionals, 10 months and $22,000 later, “Molly” has at last been helped out of 20 years of homelessness in Santa Monica. It is complicated. It takes time, money and focus. It works. Background Current City policy provides a balanced approach that considers the need for assistance and services for homeless people in a “continuum of care” model, extending from outreach and day centers to shelters and supportive services intended to result in housed, self-sufficient existence. The City, while addressing needs of our homeless population, provides for the health, safety and welfare of all people in Santa Monica through a combination of local and regional strategies (e.g. community education; outreach and partnerships with neighboring communities; local ordinances; and advocacy for increased county, state and federal funding.) The policies and practices supporting the City’s continuum of care have yielded significant outcomes over the years (hundreds of people have secured housing and jobs.) However, many of the most gravely disabled people in Santa Monica continue to be homeless. Description of Program In July, 2004, City Human Services staff initiated the development and implementation of a collaborative pilot project to reduce the number of chronically homeless persons living on Santa Monica streets and other outdoor public places by helping them to secure housing, benefits and supportive services, including mental health treatment and/or substance abuse treatment. This pilot project is consistent with the goals of many communities which have responded to the call from the National Alliance to End Homelessness and the federal Interagency Council on Homelessness to develop plans and strategies to end chronic homelessness. The Santa Monica pilot project focused on those chronically homeless persons who have been homeless in Santa Monica for at least five years, are the most visible in the community, are high users of police, paramedic and emergency room resources, but are the least successful in accessing services in the homeless continuum of care designed to move them off the streets. Given the reality of Santa Monica’s size, resources, and location within a major metropolitan area, the City expects the pilot project – and any subsequent policies and programs – to “reduce” chronic homelessness, rather than end it altogether. Strategic Well-Coordinated Team Approach A team approach was employed to effectively serve the target population. The team was comprised of representatives from City departments (Human Services, Police, Fire/Paramedics, and Resource Management/Housing), the County Department of Mental Health, and local non-profit homeless service providers. The role of the team was to develop protocols for the project, identify chronic homeless persons for consideration, develop individualized intervention/treatment plans for each client, coordinate case conferences, advocate for needed resources, identify and address barriers to success, evaluate project outcomes, and enlist community support. Initial Results As of March 2005, of the initial group of nineteen participants targeted, four are in permanent housing, three have been issued a housing voucher (searching for housing with assistance of a case manager), two are in jail with a service plan, five are on the street with a service plan, four are in the initial phase of contact and one passed away. (Editor's note: As of July 2005, of the 25 participants who have been engaged, 13 are off the streets, 1 is awaiting placement in housing and all have a service plan. In the coming year, the pilot will be continued and expanded and an estimated 20 new participants will be engaged.) Cost Preliminary review of the total cost per participant in this pilot project shows that the cost (including planning/coordination, outreach/engagement, and housing subsidies and post-placement services) is approximately $22,235 per person annually or $1,853 per month. (This does not include initial jail or hospitalization costs.) Evidence from studies conducted nationwide continue to demonstrate that the cost of placing chronic homeless persons in stable housing is substantially less than sustaining them on the streets while they utilize costly public services. The social and long-term economic cost of not moving chronically homeless persons off the streets is often cited as the most compelling reason for investing targeted resources in intensive services such as the Santa Monica pilot. The participants are often frequent users of other public services including police services, jails, paramedic services, and acute and expensive health services including treatment in hospital emergency rooms. Lessons Learned About Service Delivery A secondary goal of the pilot project is to understand more about the service delivery systems and processes that enable, and unfortunately sometimes constrain, the ability to achieve substantial and sustainable outcomes for the gravely disabled, chronic homeless population; and, to integrate this understanding into new approaches to service delivery. To date, lessons learned from the Chronic Homeless Pilot include: Individual Needs: The situation of each client is unique. Multiple Systems: The prevalence of co-occurring disorders, the severity of the individual’s health, substance abuse and mental health issues, past negative experiences with service delivery, public benefit and criminal justice systems, records of arrest, poor credit, lack of traditional social supports (e.g., family), creates a complicated path out of homelessness with numerous points for a person to lose contact with the systems designed to serve him or her. This complexity requires sustained intervention from multiple service delivery systems: law enforcement and criminal justice; public health, mental health and social services; private non-profits; and personal social networks such as friends and family. Need for Informed Consent: The ability and willingness of individuals to give or withhold informed consent for providers in these multiple systems to share information is critical. Communication: Communication between these multiple systems of service delivery is critical, and often requires providers to rely on personal contacts with colleagues, spend time on weekends or evenings following up, and work with multiple staff within a particular organization to identify the key person with whom to collaborate. High Level of Staff Expertise: The level of intensity required, and the need to sustain the intensity over time, requires that higher level staff step out of their normal routine of service provision to expend extraordinary efforts to coordinate services for one individual. At current staffing levels, this could mean that the level of service to other clients will decrease. Timing and Planning: The succession and timing of events in the path out of homelessness is critical. Planning elements of the path out of homelessness ahead of time, for example, ensuring the availability of key staff from one delivery system to take the “hand off” from another system, can increase the probability of a successful outcome at the key moment an intervention becomes possible. Role of Law Enforcement: For many, the first event in the path out of homelessness is interaction with law-enforcement. Police can play a crucial role in making the linkage with outreach and services. Sometimes, an arrest and incarceration can be the precipitating incident for a psychiatric assessment and subsequent care. Courts: The criminal and civil court systems can also play a key role. In criminal matters, offering services as an alternative to incarceration can be effective. Civil matters, such as the process for placing persons on a 72-hour hold, or into a conservatorship, can be key ways to initiate and sustain treatment and contact with service providers. Existing laws vary in the effectiveness of their application toward positive outcomes. Cost: Staff are assessing the costs involved in this intensive and focused approach to service delivery for the most gravely disabled. It is clear that most of these gravely disabled people will require a lifetime of support to maintain housing and remain off the streets. However, based on studies in San Diego (1997-98) and elsewhere, it is also clear that these chronically homeless people use a disproportionate share of police, paramedics, hospital and other public resources – costly resource use which is reduced when people are in treatment and housing. The pilot project has demonstrated the successful use of a multidisciplinary team to strategically assess a person’s needs and focus resources and interventions. And while it requires additional administrative costs to plan, oversee, manage and coordinate services, the successes and lessons from the pilot effort have led participating agencies – including the City - to commit to expand the pilot in the coming year. # # # # # Contact Information: Stacy Rowe, Human Services Administrator City of Santa Monica 1685 Main Street Room 212 Santa Monica, CA 90401 310.458.8701 stacy.rowe@smgov.net

This page was last updated on 08/26/05.