Transitions to Community Living
September 10, 2013
Robert Weaver, Project Manager
Martha Are, Housing & Homelessness
Federal Focus on ADA and
Olmstead
• Complaint letter and DOJ findings
– The State’s prioritization of investment
in congregate settings at the expense
of community-based settings;
– Many individuals with mental illnesses
have not been provided choices of
where they live
State Response
– On August 23, 2012 Acting DHHS
Secretary Al Delia signed a voluntary
agreement with the US DOJ to settle
claims that the state of North Carolina
had violated the American with
Disabilities Act. This implementation of
this project has been titled Transitions
to Community Living Initiative.
Who is the Priority for Transitions
to Community Living Initiative
• Individuals who are living in adult care homes
who have a diagnosis of serious and persistent
mental illness.
• Individuals who are referred to adult care
homes with a diagnosis of serious mental illness
• Individuals who are in treatment in a state
hospital.
• Individuals living in the community who have
diagnosis of serious mental illness who are
considering moving into an ACH
Settlement Agreement Roles
MCO and DHHS
•
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In-reach
Diversion
Transition planning
Housing slots with rental assistance and
transition supports
ACT fidelity
Supported employment
Quality Assurance and Performance
Improvement
Independent Reviewer
Pre-Screening and Diversion
• Use of Pre-admission Screening and
Annual Resident Review (PASRR) by
January 2013 to identify individuals with
MH needs seeking admission to ACH
• If identified MH need, referred to LMEMCO for care coordination and linking
to services as well as development of a
community integration plan.
In-Reach
• Coordinated by LME-MCO
• Use of certified peer specialists
• Adult Care Homes and State Psychiatric
Hospitals
• Recurrent in-reach
• Begin with ACH determined at risk of
being an IMDs
• Build on Money Follows the Person
(MFP) experience
Transition Planning
• Establish teams coordinated by LMEMCO and headed by Transition
Coordinator
• Development of a comprehensive
person centered plan that is holistic in
nature including both natural supports
and treatment needs.
• Establish interest list and tracking
mechanism
Transition Day
Responsibilities
• Transition Coordinator must be available at
least by phone on moving day.
• MCO assumes responsibility for assisting on
moving day:
– Could be transition coordinator
– Could be housing person
– Could be peer specialist
– Could contract with moving company to do
heavy lifting.
Supported Housing Slots
• Package of rental subsidy, one-time transition
supports, community services
• Total of 3,000;
• First come first served and based on geographic
housing availability and individual preference
• Interest list up to twice the slots of current and
subsequent year
• Establish a Tenant Based Rental Assistance program
(TBRA)
• Build upon experience with targeted/key housing
program
Housing Characteristics
• Tenancy support services to assist in overcoming
barriers to obtain housing and develop skills to
maintain housing
• Enable individuals with disabilities to interact with
individuals without disabilities to fullest extent
• Are scattered site, no more that 20% units occupied
by persons with disabilities
• Afford individuals choice in daily life activities
• Preference for single occupancy in apartment setting
• Not licensed
Transition Year Support
Resources
• Offered if person cannot safely and
adequately meet transition-related
expenses
• Available only during transition year
• One-time start-up costs
– Utility and rent deposits
– Appliances
– Essential furnishings
– One-time home preparation, e.g. pest
eradication, cleaning
Approved Housing Slots
•
•
•
•
•
•
•
•
•
•
•
•
Alliance BH
PBH
CPHS
CoastalCare
ECBH
EastPointe
Mechlink
Partners PBM
Sandhills
Smoky Mount Ctr
WHN
Total
•
•
•
•
•
•
•
•
•
•
•
•
30
20
30
31
24
31
20
20
32
33
22
293
LME/MCO
Alliance BH
Housed
11
PBH
4
CPHS
10
CoastalCare
14
ECBH
4
EastPointe
12
Mecklink
8
Partners BHM
9
Sandhills
13
Smoky Mount Ctr 11
WHN
10
Total
106
Inspected not leased
Total
0
2
1
3
1
0
0
0
0
0
1
14
11
6
11
17
12
12
8
9
13
11
11
114
Assertive Community Treatment
Team (ACT) Fidelity
• By July 2013 all teams must meet fidelity and will
have at least 33 teams serving 3,225 individuals.
• By July 2019, 50 teams serving 5,000 individuals
• Tool for Measurement of Assertive Community
Treatment (TMACT) fidelity scale
• Service definition changes and rate revision
• Training
• Fidelity Review process
Supported Employment
• Seeking to develop evidence based Dartmouth
Individual Placement and Support (IPS) model
• 100 individuals by July 2013 building to 2,500
individuals by July 2019.
• Initiate with through pilot sites using state funding.
Consider as b3 service in out years.
• Training
• Fidelity review process
Quality Assurance and Performance
Improvement
• Tracking length of stay, readmissions, community
tenure
• Personal Outcomes including:
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Incidents of harm
Repeat admissions
Use of crisis beds and community hospital admissions
Repeat ED visits
Time spent in congregate day programming
Number employed, attending school, maintenance of living
arrangement, engaged in community life
• In-reach and discharge
• Quality of Life Surveys
• External Quality Review (EQRO)
Issues of Interest to Housing
Developers & Managers
• DOJ has a strong preference for single
occupancy, which leads to a demand for one
bedroom and studio units.
• Roommates are ok, though DOJ does not
expect many people to choose having a
roommate
• Only 250 of the 3000 persons housed can
live in a development of fewer than 16 units
that has an occupancy requirement for
persons with disabilities
– Cannot have requirements for a specific disability
Issues of Interest to Housing
Developers & Managers
• Rural areas will be more challenged in
identifying appropriate, safe units
– A little more flexibility with large homes
broken up into smaller units
– DOJ wants each tenant to have their own
lease
Issues of Interest to Housing
Developers & Managers
• A conservative statewide estimate is at least 200-300
persons identified for Diversion each month
• DOJ also expects close to 100% of these persons to
be diverted to community housing rather than moving
into ACHs
– Only 1000 of these persons will qualify for a DOJ housing
slot over the 8 years
– Group homes, existing 811s, and other developments with
disability status as an occupancy requirement are
acceptable for all others identified through Diversion
Issues of Interest to Housing
Developers & Managers
• ACT Team is the most intensive
behavioral health community based
service
• Supportive Employment has not
focused on persons with mental illness
prior to implementation of TCLI
• Tenants who are eligible for these
services will be prioritized for them
Issues of Interest to Housing
Developers & Managers
• Additional financial support
– Supplemental Assistance – In Home
– Community Living Voucher
– These funds can be used to assist with
rental payment since the TBRA voucher is
capped at $360
– Funds can be used for other necessary
expenses
Issues of Interest to Housing
Developers & Managers
• Quadel administers the housing
voucher. The lease will be between the
tenant and property; a HAP will be
signed between property and Quadel
• Transition Year funding will be available
for deposits
Issues of Interest to Housing
Developers & Managers
• Tenancy Supports is a new (some
would say fabulous) service
– Tied to housing administrator
– Non-clinical
– Focuses on helping the tenant to comply
with lease requirements
Issues of Interest to Housing
Developers & Managers
• State has an extensive contract with
NCHousingSearch.com
• New portals will be created, including
licensed beds and restricted occupancy
units
• Owners/managers will be able to update
both of these portals daily
Issues of Interest to Housing
Developers & Managers
• NCHousingSearch will also be reaching
out to property owners in communities
persons with housing slots are
interested in living in
• NCHousingSearch will also reach out to
landlords that have leased to an
individual with a housing slot
Questions?
• Robert Weaver – General Information
– 919-855-4814
– robert.weaver@dhhs.nc.gov
• Martha Are – Housing and Homeless
Unit: DAAS
– 919-855-4994
– martha.are@dhhs.nc.gov