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Tia Burroughs Clayton, MSS
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Tyrone Quarterman, BA, MPH Candidate
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HousingNow

Pathways to Housing PA

HousingNow Logo

Program Website
Year:
2018
State:
Pennsylvania
Winner Status:
Applicant
Program Type:
Policy and Systems Change
Target Population:
Individuals with a Substance Use Disorder
Setting:
Long-Term Residential Care Facility

Program Description

People are dying. Philadelphia is on track to witness 1,200 opioid-related deaths in 2017, a 33% increase over 2016. Philadelphia’s Kensington neighborhood remains “ground zero” for the purest, cheapest heroin on the East Coast. In late 2016 Pathways to Housing PA launched a pilot program, HousingNow, that is designed to focus on chronically homeless individuals with long-term opioid addiction. It combines our core competencies in Housing First with new ideas encompassing street outreach, needle exchange, Narcan disbursement, and training, along with access to Medication Assisted Treatment that fits the needs of chronically homeless opioid addicts. The program is successful because it uses permanent housing as part of the treatment plan. In many instances, people access treatment and immediately upon discharge use drugs again. Providing housing breaks that cycle. Combined with wrap-around services designed to eliminate many of the barriers to accessing care, the supported housing can make a difference in maintaining sobriety or a Medication Assisted Treatment regime. Peer Counselors provide critical support and guidance in moving towards long-term wellness, and provision of Narcan empowers participants with a life-saving intervention not only for themselves but to people that many service providers do not have immediate access.

Creativity

HousingNow builds on Pathways’ years of experience with a dually diagnosed, chronically homeless population. The first in the in the county using the Housing First model with this population, Pathways created a specialized assertive community-based team (peer specialists, counselors, doctors, nurses, and case-managers) to assist with the permanent housing of 75 people with long histories of addiction, trauma, and chronic homelessness. Using a harm reduction strategy and no preconditions for housing, HousingNow targets high-risk, high-need individuals. We place them in permanent housing and then provide, when ready, services such as community-based intensive case management and care coordination, psychiatry and mental health counseling, nursing, primary care, and additional supportive services such as medication assisted substance use treatment that can lead to a healthier life. Pathways has restored dignity and hope to people, helping them recover and live meaningful lives. Though the size of the program seems small, the impact is tremendous.

Leadership

HousingNow was developed with the leadership and resources of the Pathways staff and local, state, and federal government. It was the City of Philadelphia that asked Pathways to investigate if the Housing First model might work with chronically homeless opioid addicts. Key community partners – Project HOME and Prevention Point Philadelphia – augment the medical, psychiatric, and addiction services provided. Pathways is a passionate advocate for the Housing First model and the HousingNow program and shares its information and data with other agencies who are now turning to us for leadership and training on how to implement models that focus and build on Housing First strengths. We are working on a “toolkit” of our approach to instruct others on our model of connecting with participants. The data compiled will be available to other agencies seeking creative behavioral health interventions and the integration of consumers into the community while supporting independence.

Sustainability

Funding is provided through the City of Philadelphia, as well as a recent SAMHSA grant that has provided a great deal of underwriting for Pathways’ Medical Clinic and a Pennsylvania State Center of Excellence Grant for Opioid Use Disorders. Also, an individual’s insurance will cover the costs of many of the treatment and other services our clients are referred. The Development Department continues its efforts with individual, corporate, and foundation funding that will significantly contribute to the sustainability of the organization and its programs. Core funding is consistent and available in the near term, and Pathways is confident it will continue to find support for the program. Advocacy and education will continue to expand the base of support for programs like this as our work, and the work of partners has demonstrated that recovery support services are a vital part of the continuum of care for people living with addiction.

Replicability

HousingNow is rooted in Pathways’ evidence-based Housing First model which is a high-fidelity program that can be successfully scaled and replicated by other institutions. Critical to the model’s success is organizations, community-based groups, and governments recognizing that to move some addicts from the streets, the first step is not treatment but the safety and stability of permanent housing. It will be the willingness to provide chronically homeless opioid addicts with the housing they need to get off the streets, coupled with support from a specialized team, which will make recovery a reality for some of these individuals. We know that when addicted individuals go without engagement and support the effectiveness of treatment is significantly decreased. HousingNow answers a need in the system of care because coupling housing and recovery support services are vital for some individuals. HousingNow is a model that is working and can be replicated.

Results/Outcomes

To date, the HousingNow team has placed 75 chronically homeless opioid addicts in permanent scattered site housing with the following outcomes: Housing 100% of the participants retained housing throughout the first year. Individuals who move from the streets maintain a risk of returning to homelessness. The team works with the participants to quickly to address behaviors that could negatively impact housing. Medically Assisted Treatment (MAT) 52% of the housed participants in HousingNow received MAT or were abstinent during November 2017. Participants trended toward MAT over time with 45% receiving MAT during the first 6 months of housing and with 62% using MAT or abstinent after 6 months of housing. Narcan 100% of participants received Narcan training, as well as an individualized overdose prevention plan and Narcan. Team members regularly interview participants regarding overdoses. When overdoses occur, self-reported or a hospitalization/emergency department visit, the team presses engagement and overdose prevention plans.