Reentry Success through Supportive Housing in Pima County, Arizona

1. Pima County, ArizonaHousing First Matters – Looking at Successful Reentry through Supportive Housing Arizona Housing Coalition 25th Annual Statewide Conference November 14, 2018 1:45p.m. – 3:15 p.m.

2. Welcome & Introductions Matt Pate, LMSW Zach Stout Program Manager Engagement Specialist

3. Criminal Justice Reform Unit Unit Formation and Purpose Why Housing in CJRU? How do you Start? Data Driven Decision-making Jail Bookings Relative Rate Index Homelessness in the Jail Jail Super User U-MATTER Pretrial

4. Criminal Justice Reform Unit

5. Why the County and why the Criminal Justice Reform Unit? National County Statistics: $83 billion invested in community health and hospitals $58 billion invested in human services $11 billion invested in housing and community development $93 billion invested in justice and public safety services 11.4 million people admitted to county jails

6. How do you start? • Who has the data • Data Inventory • Who else does the data matter to: Health and CJ partners • Health Care Partners • Criminal Justice Partners • Coalition building • Engaging decision makers

7. Data Driven Decision-making • Jail Booking and Releases by Ethnicity • Relative Rate Index • Housing Indicator in Jail • Jail Super User

8. Jail Booking and Releases by Ethnicity *Please note the total for Hispanic is for “Hispanic of any race,” so total of population exceeds 100%. Data from the 2016 American Community Survey Population Estimates.

9. Jail Booking and Releases by Ethnicity Racial Breakdown by • Detainees booked in 2017 • Misdemeanor as leading charge • Felony as leading charge • Misdemeanor / Felony • Age • Length of Stay • Drug Charge • General Delivery • Gender • Top statutes per race • Arresting agency • Recidivism

10. Jail Booking and Releases by Ethnicity

11. Jail Booking and Releases by Ethnicity

12. Relative Rate Index • The Relative Rate Index (RRI) is used to measure and compare the racial and ethnic disparities in the criminal justice system • RRI analysis helps to identify where pressure points of disparity are within the system • It does not say why a disparity exists, but it does indicate where additional inquiry is needed • The comparison group is the majority of the population, i.e. Whites

13. RRI Seven Decision Points

14. Housing Indicator in Jail • Pima County Adult Detention Complex (PDADC) started using a homelessness indicator in Fall 2017 • From October 1, 2017 - September 30, 251 people were indicated as homeless • Cross referencing these individuals with our Homeless Management Information System (HMIS) • Gender: 43 Females, 208 Males • 108 people were previously enrolled in an HMIS Program • 28 people are currently enrolled in an HMIS program: However, only 3 of those programs are Permanent Supportive Housing. Most are in outreach programs. • 115 people have not been entered into HMIS • Next step is to cross reference these individuals with other databases to inform referral pathway workflows: • AHCCCS • Pretrial • Tucson Police Department, Mental Health Support Team • Tucson City Mental Health Court • Pima County Consolidated Justice Court

15. Jail Super User

16. Scope of the Problem • Jail Data: • Detainees booked at jail between January 1, 2016 and October 30, 2017 (22 months) • 15 arrested 20+ times • 1 person arrested 41 times • 60% of detainees had dangerous/violent charges • 40% had repetitive low level charges – usually shoplifting, trespassing • 11 of the 15 had FTAs • 94% of the charges in this group are misdemeanors, 4% felony and 2% failure to comply with a court order

17. What Else Could The Funding Be Used For? 2018 Ford Transit Van 350 $33,000 - $39,000

18. Pretrial • Moving Pretrial Services outside of jail allows risk screening of individuals pre-jail booking. • Moving into modular building next to the Jail in January 2019 • Planning permanent building adjacent to the Jail, currently set to open in 2021 • Space for service providers for reentry coordination • Second floor will have approximately 30 transitional housing beds for those experiencing homelessness while longer term options are coordinated • Eligible individuals will not have a jail booking record and will be diverted from jail stays. • Lowers costs to cities • It costs municipalities $325.25 for Jail booking and $99.94 each subsequent day

19. U-MATTER • 3-year grant ($1.47 million) from the US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) to support the implementation of our U-MATTER program (United Medication Assisted Treatment Targeted Engagement Response) • Increase diversion from detention for substance use detoxification; • Identified community members with opioid use disorder (OUD) seeking or receiving MAT (medication assisted treatment); • Partners with the Tucson Police Department and CODAC to co-locate peer navigators when TPD’s MHST (Mental Health Support Team) responds to crisis calls; • Partners with the University of Arizona’s SIROW to conduct quality evaluation around program implementation; • Partners with Pretrial Services to expand eligible individuals for enhanced supervision; • Provides training and professional development to law enforcement agencies, including the Tucson Police Department, the Sheriff’s Department, and program partners.

20. Housing FirstPermanent Supportive HousingPilot Project Project History Feasibility Study Self Funded Pilot Project Project Structure Partnerships

21. Project History • HUD/DOJ Pay For Success Demonstration Site

22. Committee Roster • Maryann Beerling Compass Affordable Housing • Amelia Craig-Cramer Pima County • Attorney’s Office • Joel Feinman Pima County • Public Defender • Dr. Francisco Garcia Pima County Administration • Chuck Huckelberry Pima County Administration • Regina Kelly Pima County • Grants, Management & Innovation • Margaret KishPima County • Community Development & • Neighborhood Conservation • Jan Lesher Pima County Administration • Clint Mabie Community Foundation of • Southern Arizona • Chief Chris MagnusTucson Police Department • Sheriff Mark NapierPima County • Sheriff’s Department • Mike Ortega Tucson City • Manager’s Office • Sally Stang Tucson Housing & • Community Development • Julia Strange Tucson Medical Center • Karin Uhlich Arizona Complete Health • Wendy PetersenPima County Administration • Terrance Cheung Pima County Administration • Spencer Graves Pima County Administration • Matt Pate Pima County Administration • Maggie Crowdes Pima County • Grants, Management & Innovation

23. Feasibility Study Dimensions of PFS Feasibility • Targetable, high-need population that is aligned with the end payer's policy priorities • Value creation to the government entities and financers involved in the project • Availability of necessary data to track the success of the intervention over-time • Evidence-based intervention that is conducive to rigorous evaluation • Ability to replicate or scale a proven intervention with program fidelity • Satisfactory engagement of relevant stakeholders • Availability of sufficient government and commercial/philanthropic capital to finance the project

24. 2016 Population Study • 560 Homeless individuals with a general delivery address entered jail in 2016 more than twice • Just over $3 million associated to housing while incarcerated • 184 individuals matched with local RBHA • 222 individuals matched in HMIS

25. 5 year full scale project

26. 5 year full scale benefits

27. Cost break out

28. Self Funded Pilot Project December 15, 2017 meeting, Steering Committee decided on the following: • Launch a self-funded program • 2-year pilot with potential for multi-year funding • Seek quality program evaluation/sustainability • Utilize performance-based contracting for service delivery April 10, 2018 meeting, Steering Committee decided on the following: • Assemble Hiring Committee for Program Manager • RFP will be limited to Pima County service providers • Allow for eventual service providers ramp-up time • Decision that Program Manager’s first task will be recruitment of Program Evaluator

29. Project Structure • County – $1.5 Million annual budget authority • City – 150 Housing Choice Vouchers • RAND Corporation – Independent Program Evaluation • Corporation for Supportive Housing – Technical Assistance Provider • Contract Service Provider(s) – Housing and support service delivery (RFP to be released November 2018)

30. Project Structure • Performance-based contracting • Eligibility screening prior to pitching services • Monthly Learning Collaborative • Linking Housing First resources to Permanent Supportive Housing resources • Independent Program Evaluation

31. Mental Health, Substance Use and Poverty Generational vs Situational Poverty What does poverty look like? Poverty Data Reframing how we think about Mental Health Mental Health Data The Relationship between Poverty and Mental Health

32. Poverty

33. What does poverty look like? Anne is a 62 year old retired teacher who works a part-time job Here is what a month of her finances look like: Income $2200 (Retirement + P/T work) Mortgage $759 Utilities $173 Food $273 Transportation $55 (Gas, she owns the car) Insurance $232 (Health, Auto, Homeowner’s) Chronic Health Care $230 Internet $60 Phone $50 Entertainment $300 Total Remaining $73 Home Repairs? Chronic Health Concerns? Maggie is a 33 year old single working mother who is also attending college Here is what a month of her finances look like: Income $1648 (30hr/wk @ $14/hr) Rent (FMR) $642 Utilities $100 Food $140 Childcare $550 Transportation $170 (car payment + gas) Car Insurance $95 Internet $60 Phone $30 Total Remaining $ -139 Sustainability? Birthdays? What happens if a child gets sick? Ron is 20 year old and works full time in a minimum wage job Here is what a month of his finances look like: Income $1598 (F/T at $10.50/hr) Rent (FMR) $642 Utilities $100 Food $273 Transportation $48 (bus pass) Healthcare $50 Internet $60 Phone $30 Total Remaining $395 Entertainment? Car? Education? Retirement?

34. Poverty Data • Poverty Rate: National: 14.5% Arizona: 17.4% Tucson: 19.3% Phoenix: 16.5% • Unemployment Rate: • National: 3.7% • Arizona: 4.6% • Tucson: 4.8% • Phoenix: 4.5%

35. Poverty Data

36. Poverty Data

37. Reframing how we think about Mental Health • We all have Mental Health • Mental illness, diagnostic criteria and functioning • Brief History of Mental Health Treatment • What does mental illness look like in our community?

38. Mental Health Data

39. Mental Health Data

40. Mental Health Data

41. The Relationship between Poverty and Mental Health • Resilient • Resourceful • Can and do live rich lives • Neither condition is indicative of intelligence • Both conditions are likely to cause us discomfort in their visual representations • It’s ok to feel discomfort • Let that discomfort motivate you to action

42. The Relationship between Poverty and Mental Health • We aren’t far away from those suffering from poverty and mental illness • Catastrophic Life events • Ill health • Death of loved ones • Stress is a constant compounding factor • Exponential costs of “making mistakes” • Often the victims of exploitation and abuse • Physiological reactions of an overused psychological stress response i.e. worrying • Feelings of isolation and loneliness • Both conditions have a strong relationship to power or more importantly feelings of powerlessness.

43. The Relationship between Poverty, Mental Health, and Criminal Justice Involvement • Challenges meeting our basic needs • Values and Stigma • Accessing services can be stigmatizing • Services are often inadequate and don’t meet our needs • Bootstrap Myth • We don’t know peoples’ history or trauma (careful passing judgment)

44. Changing the Approach The Cycle Targeting Instability Two Stories Housing as a Foundation

45. The Cycle • Homelessness is 7.5 to 11.3 times more prevalent among jail inmates than the general population • Nearly one million adults with serious mental illness are booked into jails annually and many of these individuals have histories of homelessness

46. Targeting Instability • Instability due to: • Mental illness • Substance abuse • Lack of support • Targeting instability alone is not enough • Stabilization begins with permanent housing • Shelter • Privacy • A place to call home

48. Housing as a Foundation

49. Compassionate Governance “The rich nations must use their vast resources of wealth to develop the underdeveloped, school the unschooled, and feed the unfed. Ultimately a great nation is a compassionate nation. No individual or nation can be great if it does not have a concern for ‘the least of these.’” • - Dr. King, Nobel Peace Prize address, 1964

50. For more information… Matt Pate Zach Stout Program Manager Engagement Specialist Matt.Pate@pima.gov Zach.Stout@pima.gov 520-724-2465520-724-3055