Reentry Housing Systems, Programs, and Policy North Carolina DOC May 2007

1. Reentry HousingSystems, Programs, and PolicyNorth Carolina DOCMay 2007 Ryan Moser Corporation for Supportive Housing 50 Broadway, 17th Floor New York, NY 10004 212-986-2966x248

2. Reentry in Perspective • Approx. 2.1 million individuals are incarcerated in total in the U.S. • 1.3 million in state and federal prisons • Another 750,000 are incarcerated or detained each day in local and county jails. • Approximately 670,000 individuals are released from State and Federal prisons each year; that is about 1,840 releases every day. • This does not include jails, roughly four times as many people are released from jails daily. • Nationally, about 54% of homeless persons in shelter report previous incarceration • 49% report previous time in jail • 18% report previous time in prison

3. Incarceration Rates in CSH States *Over 50% of the correctional population in New York is released into the greater New York City area.*In 2006, 103,813 individuals were admitted to NYC DOC facilities with an average daily population of 13,497.

5. Service Needs of Incarcerated Populations • Homelessness • 10% are Homeless upon entry. • Substance Use • 83% of State and Federal prisoners had histories of drug use and that 57% of them were using in the last month before their offense. • Mental Illness • 22% MI (NAEH, CSG) • 16% are MI per DOJ (1999) • 6% male SPMI, 12% SPMI Female (CCJ) • ½ - ¾ of all Inmates Report MI Symptoms

6. Service Needs of Incarcerated Populations, Continued • Educational attainment • 46% of jail inmates report not having completed high school • 13.1% completed only 8th grade or less • Foster care involvement • 11.5% of jail inmates had lived in a foster home, agency, or institution • Familial status/factors • About 70% of women in local jails have young children • 46.3% of jail inmates had a family member incarcerated • 10.9% of jail inmates report being physically or sexually abused prior to age of 18; 20.2% for female inmates • 31% of inmates grew up with parental drug or alcohol use

7. What are the Barriers at Release? • No identification, SSI, birth certificate • No disability determination • Definitions of homelessness can exclude people coming from correctional settings • No access to health or mental health services (excepting emergency care) • Parole or Probation regulations- high risk of technical violations • Lack of affordable housing resources and access issues • Limited income • Legal and illegal discrimination (criminal record, mental illness, substance use, homelessness, poverty, race) • Post traumatic stress disorder, difficulty reintegrating • Family reunification issues, particularly for women

8. Variation:Setting and Individual Psychological Environment Threat of DangerHyper-Vigilant Trust as Liability Physical EnvironmentJail PrisonUrban MaximumRural Medium Minimum HousingGeneral PopulationProtective CustodyAdministrative SegregationSpecial Housing UnitsMental Health Wards Social Environment DOC’s rules and regulations Inmate Code Racial/Ethnic associations Urban/Rural differences Gangs/Organizations Gender Trauma History Character Disorder Substance Use Learning Disability SPMI

9. The Intersection of Mental Health and Corrections

10. Breaking Down the Reentry Population to Target Effectively Low Need Individuals who are able-bodied and employable, who face an income/affordability gap; also may need short-term assistance with community reintegration Moderate Need Individuals with limited employment history and educational achievement, and who may have substance abuse, health or mental health challenges High Need Frequent cyclers Individuals with disabilities such as serious mental illness and chronic health and substance abuse issues who will need longer-term services often fall in this category

11. Potential Residential Outplacements Post-Incarceration Permanent Housing Market Affordable Public Housing/Rental Assistance Service Enriched Permanent Supportive Transitional Housing Homelessness Jail Treatment Bridge Rental Assistance ¾, ½ Housing Transitional Program Street Unsuitable Housing Shelter Emergency Setting Emergency Housing Safe Haven

12. The Cost of the Status Quo • Reinvestment Client Profile: Incarcerated with SPMI • 3758 days of hospital over 21 years @ $400/day • = $1,503,200 • 399 days of jail time over 6 years @ $70 a day • = $27,930 • $1,531,130 = Total Cost • $72,910 = Annual Cost • *Does not include private hospital, treatment, court or arrest costs. • Culhane, Metraux and Hadley (2003) documented that supportive housing tenants each used an average of $40,000 per year in public emergency systems • Individuals cycle between jails, shelters, emergency rooms, and services at high costs (Gladwell’s “Million Dollar Murray,” 2006) • In 1982, national spending on law enforcement was less than $36 billion. This increased 417% ($185.5 billion) by 2003. • This would support 10.3 million units of supportive housing annually.

13. The Good News: There are Alternatives

14. Aligning Systemsthrough Supportive Housing

15. Health and Behavioral Health Criminal Justice Social Services Housing Employment Fractured Systems

16. Aligning Resources to Create Reentry Supportive Housing • Focus on people who are inappropriately or overly incarcerated or institutionalized: • (Homeless) parolees with high risk of violation • Frequent flyers • Street homeless individuals with active substance use • Mentally ill individuals that could benefit from an alternative to incarceration • Determine cost associated with preventable prison, jail, and other systems use • Structure housing and services initiative with projected recidivism reduction target • Obtain private funding to “prime the pump” and achieve initial savings • Invest savings into housing (i.e. operating and services)

17. Supportive Housing Aligning Multiple Systems for Better Results Criminal Justice NYS DOC NYC DOC PAROLE PROBATION Bridge Rental Support Client Identification Transitional Case Management Housing HUD Shelter + Care Public Housing Authorities Section 8 Social Services Shelter Plus Care NY/NY III Service Contracting through Criminal Justice/Human Service Agencies Health and Behavioral Health Mental Health Support Services Housing Support ACT Teams Employment EmploymentInitiatives both Federaland Local

19. Cost Savings Potential for Parole Violators in NY • On average, parole violations result in 120 day prison stays (0.45 years) • Preventing violations for 200-250 individuals would reduce state prison bed needs by 90-100 beds • Closing prison facility of 100 beds would save $2.5-6 million that could be reinvested into a capitalized operating and service fund for supportive housing

20. How is Supportive Housing Financed and Targeted? • Funded through blend of sources: • Capital - Low to no-debt permanent financing & tax credit equity • Operating – Rental assistance or operating contracts (Section 8, Shelter Plus Care, etc.) • Services – Contract or fee-for-service revenues from various human service agencies/programs • Operating and services funding drives eligibility and targeting of units (e.g. mental health, HIV/AIDS, etc.) • There are no dedicated operating and services funding streams for parolees, and many are ineligible for existing streams/housing

21. Integrating Corrections with Supportive Housing • Provide bridge rental assistance for returning inmates during “re-entry” phase (e.g. parole term) • Fund prison- or jail-based “in-reach” services to assess, recruit and facilitate referrals to supportive housing • Enhance case management services in existing units of supportive housing • Capitalize operating and social services reserves to “buy” set-aside units for re-entering individuals in new mixed tenancy supportive housing developments

22. The Fortune Society’s Fortune Academy (The “Castle”) Emergency and Transitional (Phase-Permanent) • Targeted tenancy: Formerly incarcerated men and women, some people living with HIV/AIDS • Model: Emergency housing (18 beds) and Phase-Permanent Supportive Housing (41 units) • Funding: • Capital: HHAP grant, LIHTC, Historic Tax Credits • Operating: HOPWA, HUD SHP • Services: HOPWA, existing agency services

23. Project Renewal, Parole Support and Treatment Program Transitional with Mental Health and Chemical Dependency Focus • Targeted tenancy: 50 individuals with mental illness and substance use issues released from state prison with a minimum of a one-year parole obligation • Model: Transitional (2-year), scattered-site, 50 units • Funding: • Capital: None • Operating and Services: • OMH Supported Housing • DOJ Byrne discretionary grant via NYS Parole

24. The Doe Fund,Ready Willing and Able Transitional with Employment Focus • Targeted tenancy: Formerly incarcerated men in recovery, committed to sobriety, self-help through employment and transition to independent living • Model: Transitional (9-12months), 470+ units • Funding: • Capital: HPD • Operating and Services: • DHS • HUD McKinney-Vento Supportive Housing Program • Earned Revenues • Private Sources • DOJ Byrne Discretionary Grant

25. St. Leonard’s House’s St. Andrew’s Court Emergency and Permanent • Targeted tenancy: Homeless men with histories of incarceration, leaving emergency housing • Model: Supportive housing, 42 studio apartments • Funding: • Capital: Illinois Housing Development Authority grant, 9% tax credits, FHLB AHP • Operating/Social Services: HUD McKinney Shelter Plus Care, IL DOC contract

26. The Bridge, Inc.’s Iyana House Permanent with Mental Health Focus • Targeted tenancy: Women released from state prison on parole with serious mental illness and histories of homelessness • Model: Permanent supportive housing with intensive supports; 18 studios • Funding: • Capital: NYS Office of Mental Health bond financing • Operating: HUD McKinney-Vento Supportive Housing Program • Services: NYS Office of Mental Health net deficit financing

27. Heritage Health and Housing’s MIX Program Emergency and Permanent with Mental Health Focus • Targeted tenancy: Parolees with SPMI • Model: Transitional “Safe Space” (6 beds) and Scattered-site Supportive Housing (18 apartments) • Funding: • Capital: None • Operating/Services: HUD SHP (Transitional) and NYS OMH Supported Housing (Scattered-site)

28. Challenges for Reentry Housing Service Providers and Those Who Work with Them • Prepare providers for intensive recruitment including consistent contact through placement and jail or prison in-reach. • Encourage providers to dedicate staff and plan for high levels of client support during this critical time period. • Help providers develop cultural competence and effective engagement techniques for this population. • Encourage providers to connect with support services and develop staff for MH assessment. • Ensure providers are well versed in navigating public benefits and health systems. • Build provider knowledge about reentry employment strategies. • Help providers build knowledge about criminal justice procedures and policies. • Help providers build capacity with community outreach and NIMBY concerns as well as facility with challenging perceived barriers where possible and appropriate. • Criminal-justice-involved Individuals (CJI) can be difficult to engage during incarceration and difficult to find after release. • CJI are at a high risk of recidivism during from identification through the first 90 days of placement. • CJI may be distrusting of providers and try to manipulate their services. • CJI may have undiagnosed or untreated mental and other health needs. • CJI may have complicated systems usage. • CJI face specific additional employment barriers. • CJI may face ongoing criminal justice compliance requirements. • CJI may be ineligible for particular types of subsidies and funding or may face other restrictions that interfere with successful placement.

29. The NYC Frequent Users of Jail & Shelter Initiative Overview

30. Initiative Background • The Frequent User Initiative emerged through ongoing DOC/DHS collaboration to improve discharge planning services in City jails • Decision to focus on shared population that represents high needs and high cost: • People who are chronically homeless and who cycle frequently and regularly between jails and shelters • Demonstration program intended to: • Develop and refine an intervention in practice • Determine whether supportive housing with enhanced services can break the cycle of homelessness and incarceration among frequent users • Provide basis for larger-scale replication

31. Prior Research on High / Frequent Users • Hopper et. al. (1997) found that long-term homeless persons with severe mental illness experienced an “institutional circuit” that includes shelters, jails, ED, detox • Kuhn and Culhane (1998) found that approximately 10% of shelter users in New York City were ‘episodic’ users of shelter • These individuals are “more likely to be non-White, and to have mental health, substance abuse, and medical problems.” • “Much of the periods they spend outside of shelter may be spent in hospitals, jails, detoxification centers, or on the street. Indeed, one could argue that part of the very reason that these individuals do not become chronically homeless or long-term shelter residents is their frequent exit to inpatient treatment programs, detoxification services, or to penal institutions. Nevertheless, these clients often find their way back to shelters.” • Culhane et. al. (2002) found that homeless persons with serious mental illness cost $41,000 annually through usage of emergency public systems • Ford (2005) identified 61 frequent flyers of a FL county jail, of whom 82% were homeless,100% had substance abuse history, and 51% had a mental health history • Gladwell (2006) described individual who cost roughly $1 million in public service utilization

32. DHS DOC Neither System New York City’s Frequent Users of Jail and Shelter Target population • Approximately 850 individuals at any point in time that have at least 4 jail stays and 4 shelter stays over the past five years • These individuals cycle constantly and persistently with relatively short stays per episode • The following figure illustrates an extreme case of jail-shelter cycling over a two-year period:

33. Characteristics & Service Needs of Jail-Shelter Frequent Users • Believed to have high rates of co-occurring and complex issues: • Alcohol and substance use (approx. 80%); earlier data matches found high utilization of crisis drug treatment services (i.e. Medicaid-reimbursed detox) • Mental health issues (est. 30-50%), including serious mental illnesses (est. 25-40%) • Criminal offenses largely consists of low-level misdemeanors (i.e. “quality of life” crimes), with minor felony histories • Histories of transience and high level of involvement in multiple systems and services • Providers report: • Lack of trust in service providers and inconsistent benefits enrollment • Comparatively high occurrence of behavioral issues and lower degrees of independent living skills • Individuals are difficult to keep in one place and need nearly constant hand-holding as they navigate systems involvement

34. Research Suggests that Housing with Services Can Break the Cycle • Intensive service models such as Assertive Community Treatment or Intensive Case Management reduce recidivism to local corrections (Lurigio et. al., 2000; Ventura et. al, 1998; Hartwell and Orr, 1999; Lamberti et. al, 2004.) • Recidivism and homelessness among persons with serious mental illness is higher among individuals with social disadvantage (poverty, lack of education, etc.) • Suggests that economic supports such as housing and employment services are as important as mental health treatment and case management services (Draine et. al., 2002) • Supportive housing significantly reduces involvement in jails and prisons (along with shelter, hospitals, etc.) among homeless persons with serious mental illness (Culhane et. al., 2002)

35. 50 NYCHA Section 8 vouchers (Project Based) 38 NY/NY I and II supportive housing unit set-asides 12 DHS SRO Support Subsidy-funded supportive housing unit set-asides Supportive services funded through other existing sources (e.g. COBRA, HUD) $650,000 from JEHT Foundation for service enhancements 50 Single-site (Congregate) supportive housing with front-loaded intensive services 50 Scattered-site supportive housing with front-loaded intensive services --------------------------------------------- Total: 100 units of supportive housing with FUSE Resources and Models

36. Frequent User Services Enhancements (FUSE) • Supplemental funding to enhance services attached to unit during first year of tenancy in housing • Uses include client engagement/recruitment, intensive case management, clinical supervision, and additional specialty services • Can be used to lower client-to-case manager ratios, or fund dedicated FUSE service staff to provide intensive support during first year of housing • Grant from the JEHT Foundation provided FUSE in the amount of $6,500 per unit

37. Sample FUSE Funding Phase Chart (12 unit program)

38. In-reach, recruitment, and engagement • Participating providers are responsible for conducting in-reach and recruitment of frequent user clients • Client recruitment can take place in one of two ways: • Shelter match-up: Providers conduct in-reach into shelters where frequent users are found in large numbers, DHS facilitates coordination with shelter operator/staff • Jail-based recruitment: Providers participate in routine in-reach sessions in jail facilities, must be able to attend to temporary housing needs if housing is not ready upon release • Providers interview clients in jail, shelter, or on-site • Providers conduct or arrange for psychosocial assessment and completion of housing applications • Providers assist clients with benefits connections and resolution of eligibility restrictions

39. Model A: Single-Site with Front-Loaded Intensive Services • Congregate style housing situations range from single room occupancy and shared apartments to private studios • Providers use service enhancements to: • Identify clients through jail and shelter in-reach, or from their own programs • Provide pre-placement stabilization and assistance in completing housing packets • Give intensive support and case management during transition and during the first year following placement after service intensity is reduced to a more typical level of services • On-site services include mental health services, independent living skills, and intensive case management • Recreation and support groups provide additional support to supplement staffing and build community • Existing units allow for expedited placement after initial client interviews are complete

40. Model B: Scattered-Site with Front-Loaded Intensive Services • Scatter-site housing situations are market-rate apartments master-leased by the provider; one model uses single rooms in a shared home • Providers use service enhancements to: • Identify clients through jail and shelter in-reach, or from their own programs • Assist with Section 8 applications and provide intensive case management services before placement • Give intensive support during transitions and throughout a critical time period following placement • Provide additional support through peer mentors • Case management services are provided through other agency programs, generally in close proximity to the housing units • Service enhancement helps reduce caseloads for more intensive case management before and after placement

41. Administration and Program NYC DOC and DHS – oversight, identification of target population, troubleshooting CSH – administer service enhancement funding, assist with recruitment, oversight, training and TA John Jay College – process and outcomes evaluation Nine non-profit service providers – provide direct housing assistance to 100 individuals Funding and Policy NYC Housing Authority – provide vouchers and manage approval process NYC DOHMH and DHS – funds supportive services and operating funding for single-site units JEHT Foundation – funding service enhancements NYC HRA – public assistance and approvals for NY/NY I and II units NYC OMB – oversight, policy Initiative Partners

42. Monitoring, Oversight, and Evaluation • Monthly meetings with nine providers, DOC, DHS, CSH, and John Jay • Tracking provider progress in achieving program benchmarks • Recruitment • Placements • Service contacts • Participation in evaluation is required of participating providers • Formal program evaluation measures: • Housing stability/retention • Reduction in jail and shelter use in days • Time between returns to jail/shelter

43. Training and technical assistance • DOC, DHS, and CSH also provide technical assistance and troubleshooting around client recruitment, engagement, services delivery, administration of housing, etc. • CSH is also organizing and funding trainings for providers around: • Understanding needs of forensic individuals (SPECTRM) • Successfully Housing People with Substance Use Issues

44. Early Lessons • “In-reach” and upfront engagement and of individuals prior to placement is key to successful placement • Shift in provider practice required from passive tenant selection to active recruitment • Clients’ involvement in multiple systems increases need for cooperation of multiple agencies, systems, and stakeholders to achieve success and reduce recidivism • “Systems” level troubleshooting is key

45. Reentry HousingSystems, Programs, and PolicyNorth Carolina DOCMay 2007 Ryan Moser Corporation for Supportive Housing 50 Broadway, 17th Floor New York, NY 10004 212-986-2966x248