Homeless ServicesPalm Beach County, Florida

Programs:• Supportive Housing

• Job Training and

Employment• Community Engagement

History:• Founded in 1979• Grassroots agency focused on serving most vulnerable

Mission: The Lord’s Place is dedicated to breaking the cycle of homeless by providing innovative, compassionate and effective services to men, women, and children in our community

• Social Enterprises • Re-entry Services • Advocacy• Case management

SERVING VULNERABLE PERSONS

Disabled/Medically Vulnerable 82%

History of Psychotropic Medications 52%

Severe & Persistently Mentally Ill (SPMI) 29%

Ex-Offender 53%

Chronically Homeless 55%

Substance Abuser 77%

Psychiatric Utilization Rates

• Homeless individuals have a high rate of psychiatric utilization.

• A review of the literature reveals that over 70% of homeless individuals have a past history of psychiatric hospitalization (N.Y. State Office of Mental Health and Roanoke, Virginia Department of Mental Health).

Past Mental Health Issues Among Program Participants

• Of 128 participants in our housing and reentry programs for whom data was available, 83 or 64% reported having had a history of a mental health issue of more than one month duration.

• Of 119 participants for whom data was available, 72 or 61% reported a past history of having had psychiatric treatment.

LOCAL HOMELESSNESS STATISTICS (2013)

• 2,509 individuals and families were homeless in Palm Beach County

• 966 individuals and families were reported to be “doubled-up”

• 1,543 individuals and families met the federal HUD definition of

homelessness

• 85% of those who were counted reported one or more prior episodes

of homelessness in the last three years

• 47% reported that they have been homeless for one year or longer

• 53% of homeless individuals reported a disabling condition

BEST PRACTICES

• SPDAT – Single Prioritization Decision Assistance Tool• Emergency Shelter• Transitional Housing• Permanent Supportive Housing• Housing First Model• Trauma Informed Care• Motivational Interviewing• Client-Directed Outcome Informed• Harm Reduction• Progressive Engagement

CDOI: CLIENT DIRECTED OUTCOME INFORMED

• A framework that ensures we have a practice that is client-directed

• Measures progress toward client’s goals

• Measures alliance between therapist and client

LOCAL PROBLEM

Our participants encountered obstacles with the healthcare system. They reported:

• Long wait times for first and follow-up appointments

• Impersonal services

• Transportation problems

• Confusion over complex medications and diagnoses

• Poor access to services and preventative care

• Inability to pay for medications and co-pays

• Difficulty enrolling into health insurance

PERSONAL STORY

Ray’s journey from incarceration to The Lord’s Place

ASSERTIVE COMMUNITY TREATMENT (ACT) MODEL

Principles:

Client-focusedService mobility

Multidisciplinary teamStaffings every day

Scaled to setting and budgetComponents:

• Psychiatry/Primary Care• Social Work• Nursing• Substance Abuse• Vocational Rehabilitation• Supportive Housing

• Psychopharmacological Treatment

• Individual Supportive Therapy

• Mobile Crisis Intervention• Supportive Employment

LOCAL PARTNERSHIP & COLLABORATION

FAU Community Health Center• Primary Healthcare• Psychiatric Services

Community Partners• Psychotherapeutic Services• Group facilitation

The Lord’s Place• Housing• Case Management• Job Training and Employment

CARE TEAM OVERVIEW

Principles:

• Assist those who are “stuck”• Return stabilized participants to community providers• Educate participants on health issues• Ensure comprehensive screening at outset

Screenings/Assessments:

• Drug and Alcohol • Mental Health• Psychosocial Evaluation• Post-Traumatic Stress Disorder

• Able to serve over 100 clients– Multiple diagnosis, co-occurring disorders

• Able to serve a variety of populations – Families, children, TJC

• Able to connect clients with other services within our agency– Triple P, TCM

CARE TEAM OVERVIEW (Cont.d)

IMPACT OF CARE TEAM

• 508 residents assessed for medical and behavioral health needs

• 95 residents received comprehensive services

• 75% decrease in emergency calls across residential campuses

• 45% decrease in unsuccessful discharges for “high psych need” residents

• 27% decrease in substance abuse relapses across residential campuses

• 4% were involuntarily committed for behavioral health issues while in our

programs

• Of a sample of those who have left our housing and reentry programs, only 12%

reported requiring inpatient behavioral health treatment.

Summary• Staff report 41 psychiatric hospital diversions since the inception of data

collection via ETO for the CARE Team.

• Psychiatric utilization prior to program entry was at over 60%. While in program, only 4% of participants needed involuntary psychiatric commitment. Only 12% of alumni have required inpatient psychiatric treatment. This is for a high psychiatric need population.

• Behavioral health, substance abuse and medical stabilization, linking to community resources and participant education has lead to a significant reduction in psychiatric service utilization among our population.

• Targeted case management at The Lord’s Place can reduce psychiatric utilization and costs.

VISION OF HOMELESS HEALTHCARE

• Expansion of services, i.e. SOAR Program and Rep Payee

• CARE Team includes community engagement for chronic homeless

• Create specialized CARE Teams

• Sustainability of services regardless of pay source

• Preferred healthcare model for local CoC

• Longitudinal research, data and evaluation

• Social Enterprises

Daniel Gibson, MSW, Chief Program OfficerEmail: DGibson@thelordsplace.orgPhone: (561) 537-4670

Michael Hershorn, Ph.D., Director of Research & EvaluationEmail: Mhershorn@thelordsplace.orgPhone: (561) 494-0125 Ext. 3314

Susan Eby, LCSW, Assistant VP of Clinical ServicesEmail: seby@cp-cto.orgPhone: (561) 841-3500 ext. 1028

CONTACT INFORMATION