Note: This is a summary of some of the major findings of the Housing Task Force. For a copy of the complete report, you can find it on the Erie County Department of Mental Health’s website at Questions concerning this report can be directed to Deborah Goldman, Erie County Department of Mental Health, 95 Franklin Street, 12^th Floor, Buffalo, New York 14202, (716)858-8530.

The Erie County Department of Mental Health (ECDMH) established the Housing Task Force in response to a widespread concern that some persons with serious mental illnesses were not receiving the housing services that best met their needs. The Department asked the Task Force to conduct a review of available housing services and to formulate recommendations that will address housing services and to formulate recommendations that will address administrative, operational and programmatic considerations which affect the housing system’s ability to serve persons with mental illnesses and their families.

The Erie County Department of Mental Health charged the Task Force with [the DN] following goals:

. Identify methods and strategies that will enhance coordination, [an omit DN] accessibility and accountability of housing resources including an examination of single entry point and service broker models;

. Integrate and coordinate services across state and local housing systems, the housing continuum and mental health and other human services;

. Respond to system-wide barriers to housing;

. Address the unique service needs of individuals including the possible development of individually tailored supports or special housing units;

.Respond to community concerns surrounding housing that is perceived to be problematic;

.Develop a framework which promotes performance-based outcomes and common utilization management and data collection techniques across providers;

.Maximize recipient choice.

After considerable discussion among Task Force members and a thorough review of the data contained in the Community Residence Housing Needs and Assessment Report, the Housing Task Force concluded that most aspects of the current system of housing and supports in Erie County are successful and meet the needs of most consumers. Early in the work of the Task Force, it was agreed that significant efforts should be directed toward serving consumers with unmet needs and improving those aspects of the housing system that have limitations. It was agreed that an examination of housing denials and provider-initiated terminations should be given top priority. A significant part of the work of the Task Force has been directed toward developing strategies to enable those individuals who are rejected or terminated by housing providers to gain access to the housing and support services that would benefit them. The Task Force makes the following recommendations:

The housing system that serves persons with serious mental illnesses in Erie County must provide a full continuum of residential care and support services to consumers. In addition, consumers must have available the state-of-the-art treatment interventions that address their specific clinical needs. Without a good marriage between housing, treatment, case management, and other supportive services, "hard-to-serve" consumers will struggle to be successful in the community.

In order to achieve the goal of providing fully integrated care for "hard-to-serve" consumers, the Task Force concluded that some level of coordination would be necessary. The Task Force recommends that the ECDMH work toward integrating several of the existing initiatives that serve this population. Through whatever means it chooses, the county should organize the efforts of the various providers and arrange for the collection of data relevant to housing needs and resources (i.e. applications for housing, data on bed availability, lengths of stay, movement between levels of care, etc.).

Establish a housing "Solution Center" for consumers with Special Needs

The Task Force recommends that a housing "Solution Center" with a "no decline" policy be established with the eventual goal of securing housing for any and all consumers who request housing and are in need of it. All denied housing applications would be referred to the Solution Center for review and disposition. In addition to assisting consumers who are initially denied access to housing, the Solution Center would also intervene in cases where a consumer is terminated form their current housing program.

The Solution Center’s membership would include representatives from all involved residential service providers, the ECDMH, and consumers and family representatives.

In order to be considered for assistance by the solution center, the following conditions would need to be met: a.) the individual is a mental health consumer eligible for housing services; b.) The individual’s application for housing has been rejected by all housing providers or he has been served a notice of termination by his current housing provider; c) the individual is currently homeless, an inpatient, at risk of being imminently homeless or residing in clearly substandard housing.

The function of the Solution Center would be to design and fund a housing service plan for each consumer and to subsequently monitor its effectiveness. An initial housing needs assessment would be completed by the agency referring the case. Upon receiving the referral, the Solution Center would conduct additional assessments as needed. The Solution Center would develop a final service plan based on the knowledge of best practices and allocate funds and resources needed to implement the plan. As part of the assessment and service planning process, each referred case would be assigned to a willing provider. Individuals judged to have acute needs will be granted priority access to a bed. Otherwise, applicants will be provided housing on a first come, first serve basis. In other words, if two clients have similar levels of need, the applicant who filed his application first will be offered the available bed. Clearly, serving needs of high risk and historically underserved individuals would be the priority of the Solution Center.

Once the placement is achieved, the service plan would be reviewed every two months to reassess the need for continuing the initial level of intervention or to adjust resources. When the service plan is terminated as a result of the outcomes being achieved, or the consumer disengaging prematurely, follow-up services would be made available to the consumer for a minimum of one year.

The Center would have a variety of resources available to augment the capabilities of categorically funded housing and support service programs. Some of these include: assisted outpatient treatment, intensive case management (ICM), the care coordination team of quality behavioral health, the assertive community treatment team (ACT team), Crisis Services, and Buffalo Psychiatric Center’s housing and support services.

Essential to the function of the Solution Center will be its ability to conduct an assessment of the person in his environment. This will enable providers to target and address the unique factors that pose barriers to an individual’s success in housing. As the Solution Center accumulates knowledge about the needs of the consumers, it will be in a position to propose new and effective service designs that are currently unavailable or perhaps not yet contemplated. Interventions for special populations that present unique challenges to the system may need to be developed (i.e. personality disorders, MICA).

The Solution Center would carefully track all denied or terminated applicants to ensure that their needs are addressed and they are not lost to the system. Such a tracking system would enable the Center to better assess and document any unmet housing needs.

The Task Force recommends that all applications for housing be acted upon by respective housing providers within two weeks of receiving a completed referral. Timely decisions would help reduce the number of consumers who go unserved. In the event that a housing provider determines that it is unable to meet the needs of a particular consumer and therefore denies that consumer’s application for housing, the provider would be required to conduct a housing needs assessment. This assessment would document the resources that would be needed for the housing provider to successfully serve that consumer. A copy of all denied housing applications, with a housing needs assessment attached, should be forwarded to the Solution Center for discussion and follow-up. Consumers should be kept informed as to the status of their applications including who they can contact with questions.

In order to better assess the availability of housing resources, a county-wide housing database should be established which includes a summary of all available housing resources, data concerning consumers currently being served, and information about consumers who have applied for housing but have not, as yet, been placed. The housing database should identify the level of care provided by each housing program and any unique capacities it may have. The Department of Mental Health should develop some means of assessing consumers that would accurately reflect their level of need. This information can be used to prioritize housing placements and best match consumers with housing resources that fit their needs. The database would also be useful in identifying currently unmet housing needs.

The intensity of the housing supports that a consumer receives should be determined by an individual’s needs rather than by the individual’s category of housing. Consumers who choose to reside in apartments or supported apartments should, when needed, be offered higher level supports including, among other things, medication supervision, homemaking services, and assistance with budgeting, shopping, or transportation. The continued need for such enhanced services should be reevaluated every 60 days and be provided for no longer than is necessary. Similarly, a full continuum of enhanced supports should be made available to consumers residing with their families.

It is recognized that, on occasion, a consumer will apply for housing and have needs that are not readily met by existing resources. A "person-centered" menu of housing services should be made available through the Solution Center to those consumers who need additional supports in order to be initially accepted into a housing program or to achieve greater levels of independence in their current housing program. Resources for such enhanced services should be made available by the County Department of Mental Health, perhaps through existing services through the AOT program.

In order to best serve the needs of a broad range of consumers, Erie County must offer a wide range of housing opportunities which vary in the amount of available structure, supervision, security and skill training. The Task Force believes that an improved housing continuum must include a step-down level of care for those individuals being discharged from the Buffalo Psychiatric Center (B.P.C.) or community-based inpatient psychiatric units. Such a step down level of care should provide enhanced services in the areas of nursing, security, line staffing, medication monitoring, and skill building. This enhanced level of care might also serve individuals who reside in the community already but whose level of functioning has declined and now warrants enhanced supports. The feasibility of B.P.C. assuming the role as a "high end" or "enhanced" housing provider should be aggressively explored. In return for B.P.C.’s willingness to function in that capacity, community housing providers will agree to provide placements for consumers who have successfully completed a reasonable stay at B.P.C.’s SOCR and RCCA programs. The use of conditional discharges form B.P.C. might also be explored to determine what value such a tool might have.

As has been stated previously in this report, housing services should be fully integrated with other mental health treatment and support services. Care planning for high risk individuals should involve providers of diverse services including housing, treatment, case management and peer services. Inpatient hospital discharge planning must be timely and fully integrated with housing and outpatient treatment services. Discharging consumers from inpatient settings before a desirable plan for housing and outpatient treatment can be put into place exposes consumers to the risk of failure. Hospital inpatient units must be proactive in planning for discharges and must avoid precipitous discharges at all cost. A high level of inpatient recidivism is detrimental to consumers and can most often be avoided through good discharge planning.

Make medication administration services widely available in the community

It is well established that consumers’ success in the community is dependent on a number of variables, one of the most important being compliance with their prescribed psychotropic medications. Erie County’s system of housing services should provide widely available medication administration services in order to support residents’ medication compliance.

The Task Force concluded that there is a need for improved access to beds at the Community Residence (CR) level. As part of improving such access, the Task Force recommended that attention be directed toward identifying the barriers that consumers face as they attempt to move out of community residences to less restrictive environments. Assisting consumers to move out of community residences to lesser levels of care would free up the supervised beds for others who may have a greater need for them.

Residents and neighborhood groups in the City of Buffalo have voiced numerous concerns in recent years regarding the behavior of persons alleged to have mental illness or substance abuse disorders. Many of these concerns have focused on the individuals who reside in unlicensed rooming houses or substandard apartments in various areas of the city. In order to be responsive to such concerns and to better ensure that needy individuals have access to the services they require, the Task Force recommends that the Department of Mental Health develop and implement a Response Team. The goal of the response team will be to respond to the concerns of community members or public officials by assessing the status of individuals who are the subject of complaints. Crisis Services has expressed a willingness to perform such evaluations. An initial determination would be made as to whether the individual has a mental illness or a substance abuse disorder. If that proves to be the case, Crisis Services would intervene to assist consumers in linking to needed supports or housing services. If the individual does not qualify for such interventions, Crisis Services will use their knowledge of community resources to obtain alternative supports. In either case, the individual or group that files the complaint would be provided with general feedback . Care would be exercised to protect the privacy of individuals approached by the Response Team.