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Thursday, December 10, 2015

Outreach and Engagement: Collaborative Responses to Homelessness

“You can’t arrest your way out of homelessness,” Officer Nathan Schwiethale states with the confidence borne of success in reaching out to and engaging people experiencing homelessness. He is a member of the Wichita (Kansas) Police Department’s (WPD) Homeless Outreach Team (HOT) that received commendation in early 2015 from the Kansas House of Representatives for its dedication to a new approach to ending homelessness.

This approach focuses on earning the trust of people experiencing homelessness and addressing their needs by working with appropriate service providers. This may divert people away from the court system and get them back on their feet. Through the program, “Karl” regained housing and full-time employment after 32 years of living on the street. “Jimmy,” an overnight user of the Union Rescue Mission, was reunited with his sister back home in Texas. “Robert” and “Rachael,” a couple spending their nights apart at the respective men’s and women’s shelters, launched new careers together.

Making connections to meet needs
 
For these success stories, WPD HOT officers facilitated access to employment and arranged transportation for people they encountered on the street and in shelters. But the help needed can be far more complicated. All members of the WPD HOT are required to complete crisis intervention team (CIT) training for responding to situations involving behavioral health issues. Schwiethale notes, “Our HOT officers use the CIT training on the job a lot. In fact, our goal is to engage one of the HOT officers as a CIT trainer for other officers in the department. We want to have at least 25 percent of all officers trained in CIT.”

The extensive use of CIT training is not surprising. According to the U.S. Department of Housing and Urban Development (HUD) data, 18.43 percent of people experiencing homelessness have a serious mental illness.1 That percentage is higher in the Wichita area, according to COMCARE of Sedgwick County, a SAMHSA grantee provider and key partner of the WPD HOT.2 Chronic substance use is also a significant issue for communities: per the HUD data, as many as 18.39 percent of persons experiencing homelessness have a chronic substance use disorder.3

Crises may also erupt in response to trauma. Having lost the stability of a home, people experiencing homelessness may feel marginalized from society, and they are vulnerable to victimization.4 This can exacerbate earlier trauma brought on by childhood abuse and neglect, domestic violence, community violence, and poverty.5 A study on post-traumatic stress disorder (PTSD) among people experiencing homelessness found that PTSD preceded the onset of homelessness in almost three-quarters of those studied. (Learn more about trauma training for criminal justice professionals) .

SAMHSA: The behavioral health link

As the leader of public health efforts to advance the behavioral health of the nation, SAMHSA has prioritized the availability of permanent housing and supportive services for individuals with mental and substance use disorders. SAMHSA makes funding available through several grant programs, including Projects for Assistance in Transition from Homelessness (PATH).

PATH is a formula grant to the 50 states, the District of Columbia, and U.S. territories used to engage people with serious mental illness, including those with co-occurring substance use disorders. The program has a strong outreach and case management component; in 2013, more than 185,000 people experiencing homelessness benefited from PATH’s outreach services. (Find a local PATH provider.)

In its partnership with the WPD, COMCARE uses PATH dollars to facilitate case management, organize community education, and provide referrals to behavioral health treatment, housing, and employment. It also purchases backpacks, socks, food, drinks, and other supplies for the WPD HOT to distribute, which helps build trust between the officers and those experiencing homelessness.

In its first year, the WPD HOT successfully housed 132 people who previously lived on the street, changing lives while saving the city an estimated $5.3 million in costs such as emergency medical services and unnecessary involvement with the court system. This level of savings is supported by a study from the University of North Carolina at Charlotte, which indicated that placement in permanent supportive housing resulted in an 82 percent reduction in arrests and an 89 percent reduction in nights spent in jail.

Specialized police responses
 
The HOT model is considered one of several specialized police responses (SPR) gaining favor across the country. Among SPRs, CIT is perhaps the most widely recognized. Much like CITs, HOTs consist of highly trained officers, but with specific dedication to issues arising in the population experiencing homelessness. Partnering with homeless service providers, the business community, and other stakeholders, HOT officers connect people experiencing homelessness to housing assistance and mainstream services like health care, job training and placement, and legal assistance. Instead of arresting, ticketing, or jailing people experiencing homelessness, HOT officers act as the connection to aid and assistance.

In addition to the cost savings mentioned earlier, SPRs increase officer safety, enhance job satisfaction among officers, and strengthen community support for the police. The WPD HOT builds this support further by providing education to the community. Officer Schwiethale remembers, “When a camping ordinance was passed, [the WPD HOT] participated in a lengthy interview with the media to clarify that the ordinance was a tool to help HOT officers approach persons experiencing homelessness and get them the help they need. To date, not a single person experiencing homelessness has been arrested based on the camping ordinance.”

Sharing the success
 
The success of the HOT model and other models such as CIT and Mental Health First Aid have prompted SAMHSA to formalize training for its grantees, law enforcement, and, ultimately, for a national audience. Redefining Experiences—Alternatives to Criminalization of Homelessness (REACH), a SAMHSA virtual learning tool, promotes practical, outcome-driven methods that will help end homelessness and provide concrete steps toward implementing a HOT. Learners will discover alternatives to criminalization of homelessness, including creating constructive partnerships with other stakeholder groups. Development of REACH was a consensus-driven process vetted by many federal partners and national experts. It is in the final stages of development and expected to launch in 2016.
Bradford Milton & Maia Banks-Scheetz
Public Health Advisors
Substance Abuse and Mental Health Services Administration

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