National Alliance to End National Alliance to End HomelessnessHomelessness

Conference CallConference CallJanuary 10, 2008January 10, 2008

Families with Substance Families with Substance Use Disorders – Housing Use Disorders – Housing

OptionsOptions Cynthia C. Crone, APNCynthia C. Crone, APNUniversity of Arkansas for Medical University of Arkansas for Medical

SciencesSciencesPartners for Inclusive CommunitiesPartners for Inclusive Communities

cronecynthiac@uams.educronecynthiac@uams.edu

Arkansas CARES Arkansas CARES and and

Family Homelessness PreventionFamily Homelessness Prevention

Arkansas CARES Arkansas CARES ServicesServices

Addiction TreatmentAddiction Treatment

Collaborative Efforts Collaborative Efforts to to Prevent Family Prevent Family HomelessnessHomelessness

Arkansas CARESArkansas CARES

Comprehensive Comprehensive family treatment family treatment programprogram established established in 1992 to decrease in 1992 to decrease maternal substance maternal substance abuse and promote abuse and promote healthy family healthy family outcomes through outcomes through prevention, treatment, prevention, treatment, education, research education, research and advocacyand advocacy

Recognized for Innovations Recognized for Innovations and Outcomesand Outcomes

2002 – American Psychiatric 2002 – American Psychiatric Association’s Gold Achievement Association’s Gold Achievement AwardAward

2004 – National Association of Public 2004 – National Association of Public Hospital’s Jim Wright Safety Net Hospital’s Jim Wright Safety Net Award for Vulnerable PopulationsAward for Vulnerable Populations

Numerous local and state awardsNumerous local and state awards

Kathleen at AdmissionKathleen at Admission

KathleenKathleen

Kathleen 1 year later…Kathleen 1 year later…

Kathleen and Family – 4 years Kathleen and Family – 4 years laterlater

Kathleen Four Years LaterKathleen Four Years Later

Drug-freeDrug-free

Reunified with ChildrenReunified with Children

Re-MarriedRe-Married

Buying HomeBuying Home

Happy, Healthy Member of SocietyHappy, Healthy Member of Society

Mothers and Substance Mothers and Substance AbuseAbuse

A serious problem associated with:A serious problem associated with: Unemployment and PovertyUnemployment and Poverty HomelessnessHomelessness Child Welfare IssuesChild Welfare Issues Trauma IssuesTrauma Issues Mental and Physical IllnessMental and Physical Illness Arrests and IncarcerationArrests and Incarceration Repeating the Cycles of Poverty, Abuse Repeating the Cycles of Poverty, Abuse

and Dependencyand Dependency

In Arkansas, estimates are that In Arkansas, estimates are that 29% of mothers with children under 29% of mothers with children under

18 need substance abuse 18 need substance abuse treatmenttreatment

Underserved populationUnderserved population Most treatment based on male alcohol Most treatment based on male alcohol

modelmodel Most treatment dollars go to menMost treatment dollars go to men Lack of comprehensive family-treatmentLack of comprehensive family-treatment Children need services as well as Children need services as well as

mothersmothers

Top Needs Expressed by Top Needs Expressed by Mothers at Arkansas CARESMothers at Arkansas CARES

Good jobGood job

Safe, affordable Safe, affordable housinghousing

Top Needs of Mothers Receiving Top Needs of Mothers Receiving Substance Abuse and Child Welfare Substance Abuse and Child Welfare

Svs.Svs.(Grella, 2003)(Grella, 2003)

ServiceService % Needed% Needed % % ReceivedReceived

JobsJobs 62 62 16 16

Housing Assistance 56Housing Assistance 56 66

Family Counseling 54Family Counseling 54 25 25

ChildcareChildcare 46 46 18 18

Help with Benefits 45Help with Benefits 45 16 16

The Disease of AddictionThe Disease of Addiction

Addiction is a Chronic DiseaseAddiction is a Chronic Disease

American Medical Association, 1954American Medical Association, 1954

ChronicChronic, Progressive , Progressive FamilialFamilial Disease Disease Characterized by Characterized by Compulsive UseCompulsive Use in in Spite of Negative Consequences, and Spite of Negative Consequences, and RelapseRelapse

Treatment is EffectiveTreatment is Effective

Treatment WorksTreatment Works(McLellan, et al., 2000)(McLellan, et al., 2000)

Addiction Relapse RatesAddiction Relapse Rates - Less than for - Less than for Asthma and HypertensionAsthma and Hypertension

Adherence to Treatment PlanAdherence to Treatment Plan - Greater with - Greater with Addiction than for Asthma, Diabetes, or Addiction than for Asthma, Diabetes, or HypertensionHypertension

Behavior ChangeBehavior Change (to decrease risk and increase (to decrease risk and increase functional status) functional status) in Addicted Persons -in Addicted Persons - Doubles Doubles that for Asthma, Diabetes, or Hypertensionthat for Asthma, Diabetes, or Hypertension

Are we treating addiction as Are we treating addiction as a chronic disease for which a chronic disease for which

treatment works?treatment works?

Family TreatmentFamily Treatment Recognizes addiction as a Recognizes addiction as a chronic diseasechronic disease

Addresses multiple Addresses multiple health and social health and social issuesissues through integrated services that are through integrated services that are gender and culturally specific gender and culturally specific

Values familiesValues families and keeping them and keeping them together together

Is Is cost beneficialcost beneficial in human and economic in human and economic termsterms

Family Treatment ComponentsFamily Treatment Components(Rebecca Project, 2006)(Rebecca Project, 2006)

Alcohol and Drug TreatmentAlcohol and Drug Treatment Mental Health CounselingMental Health Counseling Vocational Preparation and Job TrainingVocational Preparation and Job Training Parenting ClassesParenting Classes Relapse PreventionRelapse Prevention Supportive HousingSupportive Housing Therapeutic ChildcareTherapeutic Childcare Child-focused Academic Tutoring and Child-focused Academic Tutoring and

AssistanceAssistance Family TherapyFamily Therapy

Arkansas CARESArkansas CARESFunding PartnersFunding Partners

Medicaid

ABC Program

ADAP City of Little Rock

RWJF (LIFP)

Child Care private payPhilanthropy/other donations

State General Revenue

TANF - Workforce

TANF-ADC-DCC Program

SAMHSA-DHHS-ADAP Specialized Women's

Services

HUD-DHHS -Emergency Shelter

Local Initiative Funding Partners (LIFP)

DHHS/DCCECE

USDA CACFP (through DHHS/DCCECE)

Client Families at AdmissionClient Families at Admission

WhiteWhite 73% 73% PregnantPregnant 35% 35% Independent Living 57%Independent Living 57% MarriedMarried 16% 16% Ed. Completed 11.7 yrEd. Completed 11.7 yr Employed 5%Employed 5% Arrested p. 6 mo. 81%Arrested p. 6 mo. 81% Incarcerated Incarcerated 14% 14% Probation/ParoleProbation/Parole 47% 47%

Number Children LivingNumber Children Living

with motherwith mother 2.2 2.2 Open Child Protect. 36%Open Child Protect. 36% Abuse HistoriesAbuse Histories 82% 82% At-risk Depression 80%At-risk Depression 80% At-risk PTSDAt-risk PTSD 44% 44% Methamphetamine 45%Methamphetamine 45% CocaineCocaine 27% 27%

Graduate Outcomes One Year Graduate Outcomes One Year or More After Residential or More After Residential

TreatmentTreatment Drug-freeDrug-free 80%80% EmployedEmployed 65% 65% Permanent HousingPermanent Housing 84% 84% Receiving Housing Assistance Receiving Housing Assistance

57%57% ArrestedArrested 19%19%

Lack of Safe, Affordable Housing Lack of Safe, Affordable Housing Presents Major Barrier to Presents Major Barrier to

Family TreatmentFamily Treatment One –third to one-half of families entering One –third to one-half of families entering

treatment are homeless or near-homeless.treatment are homeless or near-homeless.

Many fear entering treatment due to fear of losing Many fear entering treatment due to fear of losing their children to child protection actions.their children to child protection actions.

There are too few resources for residential support There are too few resources for residential support of mothers of mothers with their children with their children during treatment.during treatment.

At time to transition from intensive, residential At time to transition from intensive, residential treatment to community living many families treatment to community living many families cannot obtain housing supports due to past history.cannot obtain housing supports due to past history.

Arkansas CARES Arkansas CARES Collaborative Efforts to Collaborative Efforts to

Prevent Family HomelessnessPrevent Family Homelessness

Intensive Residential TreatmentIntensive Residential Treatment

Key PartnersKey Partners PrivatePrivate

Black Community Black Community DevelopersDevelopers

UMCHUMCH PublicPublic

SAMHSASAMHSA Alcohol and Drug Abuse TreatmentAlcohol and Drug Abuse Treatment City of Little RockCity of Little Rock TANFTANF Emergency Shelter GrantEmergency Shelter Grant Division of Childcare andDivision of Childcare and

Early Childhood EducationEarly Childhood Education McKinney funded schoolMcKinney funded school programprogram

Expansion of Residential CareExpansion of Residential Care

1999 – SAMHSA Community Action Grant1999 – SAMHSA Community Action Grant Little Rock Housing AuthorityLittle Rock Housing Authority North Little Rock Housing AuthorityNorth Little Rock Housing Authority Pulaski County Housing AuthorityPulaski County Housing Authority

2000 – SAMHSA Targeted Expansion Grant2000 – SAMHSA Targeted Expansion Grant Partnered with North Little Rock Housing Partnered with North Little Rock Housing

AuthorityAuthority City of North Little Rock granteeCity of North Little Rock grantee Eastgate Terrace Residents’ Association supportEastgate Terrace Residents’ Association support NIMBYNIMBY Bank of America PlaygroundBank of America Playground

Eastgate ProgramEastgate Program

Building Bridges Building Bridges Continuing Care ProgramContinuing Care Program

Local Partners and the Robert Wood Local Partners and the Robert Wood Johnson Foundation - $1 Million over 4 Johnson Foundation - $1 Million over 4 yearsyears

Prevent Relapse and Sustain Gains Made Prevent Relapse and Sustain Gains Made During Intensive Treatment through During Intensive Treatment through Intensive Case Management Targeting:Intensive Case Management Targeting: Employment/EducationEmployment/Education Safe, Affordable HousingSafe, Affordable Housing Child CareChild Care Primary and Behavioral Health CarePrimary and Behavioral Health Care TransportationTransportation

Continuing CareContinuing Care Building Bridges Housing PartnersBuilding Bridges Housing Partners

Little Rock Housing AuthorityLittle Rock Housing Authority – Vouchers / waivers – Vouchers / waivers North Little Rock Housing AuthorityNorth Little Rock Housing Authority – waivers – waivers Leased 4 unitsLeased 4 units at Eastgate as “emergency at Eastgate as “emergency

transitional housing” - TANF assists with rent transitional housing” - TANF assists with rent Arkansas Supportive Housing NetworkArkansas Supportive Housing Network – Shelter – Shelter

Plus vouchers for formerly incarcerated clients / Plus vouchers for formerly incarcerated clients / giftsgifts

Arkansas CARES Advisory BoardArkansas CARES Advisory Board assisted with assisted with landlord recruitmentlandlord recruitment

Altrusa InternationalAltrusa International of Little Rock - Incentives of Little Rock - Incentives Little Rock School DistrictLittle Rock School District – – local non-profitlocal non-profit; ; low low

income tax creditincome tax credit housing proposal housing proposal

CAREfully Catered created as CAREfully Catered created as Building Bridges 1st Social Building Bridges 1st Social

EnterpriseEnterprise Multiple partnersMultiple partners

Local funders and RWJFLocal funders and RWJF Arkansas Culinary SchoolArkansas Culinary School Arkansas CARESArkansas CARES Christ Episcopal ChurchChrist Episcopal Church

Non-Profit Organization Non-Profit Organization with Double bottom with Double bottom line:line:Mission Mission andand Margin Margin

Revenue will go back Revenue will go back into continuing careinto continuing care

CAREfully CateredCAREfully Catered

Sacred Authority ChapterSacred Authority Chapter

Leadership from Rebecca Project – Leadership from Rebecca Project – Washington DCWashington DC

Leadership program for women to use Leadership program for women to use their voices in advocacy for other their voices in advocacy for other familiesfamilies

Meeting January 3, 2008: Housing was Meeting January 3, 2008: Housing was a strong messagea strong message

Organizational TransitionOrganizational Transition University of Arkansas for Medical SciencesUniversity of Arkansas for Medical Sciences

1992 - 20061992 - 2006 Department of Obstetrics and GynecologyDepartment of Obstetrics and Gynecology Department of PsychiatryDepartment of Psychiatry

Methodist Family HealthMethodist Family Health2007 - current2007 - current >100 year old non-profit organization>100 year old non-profit organization Location, mission, services remain the sameLocation, mission, services remain the same

What’s in the Works to What’s in the Works to Expand Housing Options?Expand Housing Options?

MFH looking at Low Income Tax Credit MFH looking at Low Income Tax Credit projects – expand populations servedprojects – expand populations served

Working to continue partnerships with Working to continue partnerships with Public Housing – expand to Domestic Public Housing – expand to Domestic Violence ProjectsViolence Projects

Residential Support during Intensive Residential Support during Intensive Outpatient Treatment – variety of funding Outpatient Treatment – variety of funding options include HUD, DCFS, DYS, OADAP, options include HUD, DCFS, DYS, OADAP, Workforce Services, othersWorkforce Services, others

CollaborationCollaboration Takes TimeTakes Time Takes LearningTakes Learning Requires TrustRequires Trust Requires AccountabilityRequires Accountability Requires Being the Leader Sometimes Requires Being the Leader Sometimes

and the Follower Sometimesand the Follower Sometimes Is Fun!Is Fun! Improves ResultsImproves Results

Changing the Rules

Changing the

System

Joint Projects

Information Exchange

Levels of CollaborationLevels of Collaboration

Sid Gardner

Working together, we can Working together, we can break the intergenerational break the intergenerational

cycles of poverty, abuse, and cycles of poverty, abuse, and dependency.dependency.

It’s about Collaboration and a It’s about Collaboration and a Shared Vision!Shared Vision!

..and a thought..and a thought

From the great From the great scientist, Thomas scientist, Thomas Edison:Edison:

““Vision without Vision without execution is execution is hallucination”.hallucination”.