OMH Forensic Housing and Care Coordination
 To engage the community-based mental health system and peers in providing pre- and post-release services to inmates with mental health needs
 To promote access to benefits as an important step toward ensuring continuity of care and promoting full community reintegration and recovery
 To promote systems integration and cross-systems coordination and collaboration

OMH Forensic Housing and Care Coordination
 Individuals with Serious Mental Illness (SMI) being released from New York State prisons to local communities statewide.
 2,900 inmate-patients with mental illness released to the community from Central New York Psychiatric
Center (CNYPC) in 2009
 1,000 with Serious Mental Illness

OMH Forensic Housing and Care Coordination
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Comprehensive Discharge Planning (CNYPC)
– CNYPC Pre-Release Services
In-reach Services
– community provider and peer-run
Dedicated Supported Housing
Transition to Community-based Services
– CNYPC Pre-Release Services; county SPOE; NYC Reentry
Coordination System; parole
Case Management/ACT (ICM / ACT)
– Forensic Case Management Programs (NYC)
Dedicated Parole Mental Health Caseloads

OMH Forensic Housing and Care Coordination
 Approximately 60,000 inmates in 73 DOCS facilities
(NYS DCJS, 2008)
 About 7,800 on OMH caseload (13%)
 DOCS releases about 27,000 people per year
 2,900 inmate-patients with mental illness released to the community from CNYPC in 2009
 1,000 with Serious Mental Illness

OMH Forensic Housing and Care Coordination
1,000 inmate-patients with SMI released annually:
– 51% upstate; 49% downstate
– 80% male; 20% female
– 75% on psychiatric medication
– Many with co-occurring substance use disorders and trauma histories

OMH Forensic Housing and Care Coordination
Community Mental Health Model
 CNYPC operates mental health services in 29 correctional facilities/mental health units statewide
 Inpatient hospital located in Marcy, NY
 Crisis services, residential services, clinic services, medication management
 Special programming

Upstate
Clinton
Albion
Wende
Auburn
Attica
Collins
Groveland
Five Points
Willard
Midstate
Marcy
Great
Meadow
Coxsackie
Elmira
Southport Ulster
Eastern
Woodbourne
Satellite Units: 15 Sullivan
Mental Health Units: 14
Green Haven
Downstate
Fishkill
Taconic
Sing Sing
Bedford Hills
Bayview
Arthurkill
Updated 03/25/10

OMH Forensic Housing and Care Coordination
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25 dedicated staff, serving 29 facilities/mental health unit
Develop comprehensive discharge plans for inmate-patients with a mental health level 1 or 2 (SMI)
Benefits and Referrals for SMI
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SSI/SSDI
Medicaid
Medication Grant Program (MGP)
Mental Health Housing
Clinic Appointment
Case Management

OMH Forensic Housing and Care Coordination
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– Develop plans for inmate-patients with a mental health level of 3 or 4
– Plans may include: Medicaid, MGP and clinic appointment

OMH Forensic Housing and Care Coordination
Community Orientation & Reentry Program (CORP)
 Sing Sing Correctional Facility; 31 participants
 90 Day Prior to Release / In-reach Program
– Community Providers Staff including Peers (Project Renewal,
HALI, Howie T Harp)
 Hands Across Long Island
– Drop In Center
 Entitlement Specialist (CUCS)
– 9/05-8/10: 87% SSI/D eligibility determination

OMH Forensic Housing and Care Coordination
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Bedford Hills Correctional Facility; 36 participants
90 Day In-Reach
Entitlement Specialist
3-6 month intensive case management and psychiatry in community post-release provided by Project Renewal,
Inc.
Forensic Peer Specialist provided by Howie T Harp Peer
Advocacy & Training Center
– In-reach
– Community support

OMH Forensic Housing and Care Coordination
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Jointly funded by NYS OMH & NYS DOP
Offers:
– 50 units of scattered site transitional supported housing
 A team approach to support services that includes:
– Part-time Psychiatrist & Nurse
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Intensive & Supportive Case Managers
Residential Counselors
Peer Specialists
-and-
10 units of scattered site permanent housing for graduates of PSTP

OMH Forensic Housing and Care Coordination
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Serves parolees being released to NYC with a minimum of 12 months on parole, regardless of criminal background
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56% have a history of Violation of Parole
82% have been convicted of violent crimes
Works in close collaboration with NYS Division of Parole
Connects participants to the full range of community based health, mental health, substance abuse, and employment services
Assists participants in developing crucial ADL skills, including structuring their leisure time
Assists participants in securing long term community based housing

OMH Forensic Housing and Care Coordination
 Dedicated team providing transitional (6-9 months) case management to SMI prison releases to NYC
– 6 Intensive Case Managers – one operating out of Bellevue
Shelter dedicated to homeless men
– 2 Supportive Case Managers
– Operates out of South Beach Psychiatric Center

OMH Forensic Housing and Care Coordination
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Project Renewal’s Parole Support and Treatment Program
(PSTP) : 50 transitional units; 10 permanent graduate units
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The Bridge’s Iyana House : 16 units
 Downstate Supported Housing (102 units in NYC)
– 6 – The Bridge; 6 – Postgraduate Center for Mental Health
– New 90 Unit RFP Released 4/25/11
 Upstate Supported Housing (8 units – 4 Monroe; 4 Orange)
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Catholic Family Center
Occupations Inc.
Rehabilitation Support Services

OMH Forensic Housing and Care Coordination
 NEW!! - Funding FPS Program Coordinator from
NYAPRS to develop a statewide Forensic Peer
Specialist Program to facilitate linkage of forensic peer specialists to residents of OMH forensic supported housing units.
 Peers will provide in-reach services as well as peer bridger services in the community

OMH Forensic Housing and Care Coordination
 Memorandum of Understanding (MOU) between
OMH and NYS Division of Parole to establish
Dedicated Parole Mental Health Caseloads
 Facilitate cross-training for both parole officers and housing / service providers
 Establish protocols for coordinating placement of high risk / high need individuals

OMH Forensic Housing and Care Coordination
 Single Point of Entry/Access System (SPOE/SPOA)
– Work with CNYPC Pre-Release Coordinators
 NYC Reentry Coordination System (RCS)
 Director of Community Services/Mental Health
Commissioner
– Conference of Local Mental Hygiene Directors
 DCJS Reentry Task Forces

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
 Centralized referral system for individuals with SMI getting released from NYS prisons to NYC.
Operates like Single Point of Access (SPOA)
 Administered by the Center of Urban Community
Services (CUCS) for OMH
 3 Components
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RCS for Housing
RCS for ACT / Case Management
RCS for Outpatient Clinic Appointments

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
 RCS for Housing (2009)
– Manages access to dedicated OMH forensic housing in
NYC for individuals who are SMI
– Provides referrals to MH housing for any SMI inmate being released to NYC in need of housing
– Manages the video-conference interviews to increase access to housing for inmates prior to release

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
 RCS for CM / ACT / Outpatient Treatment (2010)
– Manages access to MH Forensic and Community Case
Management and ACT services
– Provides referrals to outpatient treatment at downstate
Outpatient Clinics if the PreRelease Coordinators (PRC’s) were unable to obtain appointment prior to release (April
2011)

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
Forensic Mental Health Housing Options
 178 dedicated forensic housing units in NYC:
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Project Renewal’s Parole Support and Treatment Program (PSTP)
The Bridge’s Iyana House
Postgraduate Center for Mental Health & The Bridge’s FHI units
90 Forensic Supported Housing Reentry Units---RFP just released
 200 units for individuals with SMI
– Inmate-patients from state prisons are one priority population
 Other MH housing: 7,100+ units not including
NYNY I/II units

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
 Housing Outcomes
– 157 Applications Received (7/1/09 – 6/30/10)
– 58% Housed
– 79 in supportive housing
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8% Pending (waitlisted)
8% Not Released due to PC Admission
26% Refused, Whereabouts Unknown, Reincarcerated

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
 CM / ACT Outcomes
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112 Applications Received (11/1/10 - present)
59% Enrolled
– 65 ICM, 1 ACT
25% Pending Release Date
– assigned 30 days prior to release
10% Closed: Not Eligible, INS Custody, Lost Parole Date,
Client Choice to Withdraw
6% Discharged from CM:
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3 Graduated/Transferred to other community services
2 Hospitalized
2 Whereabouts Unknown

OMH Forensic Housing and Care Coordination
Reentry Coordination System (RCS)
Key Features of RCS:
 Guaranteed Housing Interview (Videoconference) prior to release
 ICM or ACT team assigned prior to release
 Clinic Appointment Guaranteed within 2 weeks of release
 Training &Technical Assistance to Pre-Release Coordinators
(PRC’s) and Housing Providers
 Case Planning Meetings if rejected by 3 Housing
Providers

OMH Forensic Housing and Care Coordination
Wendy Vogel, OMH wendy.vogel@omh.ny.gov
Lori Schatzel, OMH lori.schatzel@omh.ny.gov
Suzanne Smith, CUCS ssmith@cucs.org