Community Engagement Program
The Community Engagement Program (CEP) is an example of a Housing First program employing an Integrated Dual Disorders Treatment team approach to delivering intensive case management services, housing placement in scattered-site apartments, and other supports to individuals who have experienced chronic homelessness. CEP works in partnership with the Portland Housing Authority to provide rent subsidies and with the local Rent Well program to mitigate landlord risks through a landlord guarantee fund.
Problem or Challenge:
The fundamental problem that Housing First programs address is extreme housing instability. For individuals experiencing chronic homelessness, housing instability takes the form of months or years spent in shelters or on the streets, or as is often the case, multiple repeated episodes of homelessness interspersed with time spent in hospitals, detox facilities, jails, or short stays with others. Adults who experience chronic homelessness often have serious and persistent health issues, including mental illness, substance addiction, and primary health conditions that are difficult or impossible to manage while homeless. People experiencing chronic homelessness consume a disproportionate amount of public resources in their utilization of emergency services, health care, and incarceration.
Central City Concern is a nonprofit agency serving single adults and families in the Portland metro area who are impacted by homelessness, poverty, and addictions. It developed the Community Engagement Program in 2004 to help reduce the use of Portland’s emergency services and provide a more appropriate, cost effective way to respond to the needs of persons experiencing chronic homelessness. The program currently serves 170 people.
CEP targets adults who are experiencing chronic homelessness and diagnosed with co-occurring mental and/or physical disabilities and addictive disorders. CEP offers services and access to supportive housing. The program, based on the Integrated Dual Disorders Treatment IDDT model, also known as Integrated Treatment for Co-Occurring Disorders, relies on multidisciplinary teams to provide intensive case management and immediate access to housing. CEP’s funding for these services has come from a variety of government sources, including city and county contracts and competitive federal grants from SAMSHA and HUD.
Referrals and Engagement
The CEP team partners with providers of shelters, jails and street outreach programs to identify frequent users of these programs who are unable to stabilize in mainstream housing and services. As soon as possible after referral a case manager or mentor begins the process of engaging with the individual and explaining the kinds of supports that may be available to assist them in moving into permanent housing. Trust building in this phase has proved to be critical.
CEP participants have been homeless for six years on average; 37 percent of the clients are identified with co-morbidity (meaning two or more disorders) and 53 percent with tri-morbidity (meaning co-occurring mental illness, substance abuse disorders, and physical disabilities or medical conditions).
Housing Rapid Response is a special program within CEP that targets individuals experiencing chronic homelessness who have had multiple arrests (an average of 24 per month) who are referred by the Portland Police Bureau and the Department of Community Justice.
IDDT Team Services
Through the IDDT team, CEP provides a full array of services to assist participants, including housing assistance, mental health services, substance use treatment and referrals, medication management, physical health treatment, around-the-clock crisis management, and assistance in accessing and managing entitlements and benefits. Most services are delivered in a community setting, such as the participant’s residence, in their neighborhood, or (in the case of vocational supports) at their place of employment, rather than in a central office.
The IDDT team is comprised of 13 case managers and two housing specialists. The team is funded by four separate funding streams each with slightly different admission requirement (culturally specific; co-occurring; chronic homelessness). The cost per participant is approximately $9,000 per year (not including rent subsidies). The staff to participant ratio is 1:15. All members of the CEP team share responsibility for the entire caseload. Team members include:
Site operations manager
CEP clinical supervisor
Mental health case managers
Alcohol and drug case managers
Culturally-specific case managers (Serving African American men and women)
Many of the CEP staff self-identify as having experienced addictions, mental health issues, and/or homelessness. The integration of recovering staff allow for peer support to be directly integrated with clinical support.
CEP uses assertive outreach to keep consumers engaged in services. Staff sticks with participants through relapse and recovery and continues to engage them whether housed or homeless. CEP uses a strength-based assessment and treatment plan and Motivational Interviewing to engage participants in self-determined service planning.
CEP helps participants address their health concerns via referral to Central City Concern’s Old Town Clinic, a Federally Qualified Health Center (FQHC). Physicians, a psychiatric nurse practitioner, a medical assistant, and an acupuncturist work with CEP participants to assess and treat a myriad of medical disorders that have often gone untreated.
CEP participants are not required to abstain from alcohol or other drugs. Based on the participant’s choice, housing placements are made in both alcohol and drug-free community settings and in settings that do not require abstinence. In working with people who continue to use alcohol or drugs an emphasis is placed on harm reduction and encouraging them to adopt lifestyle changes that will not jeopardize their housing.
Housing placement and landlord relationships
CEP’s housing specialist helps program participants locate apartments in the private market, in buildings owned by nonprofit housing developers, and within its own agency’s housing developments. Tenants enter into leases directly with landlords. Most participants receive a Shelter Plus Care rent subsidy that is administered by Home Forward, the Housing Authority of Portland. The program generally has between 160 and 190 participants receiving rental assistance through the Shelter Plus Care program at any time. An addendum to the lease outlines expectations of the tenant related to involvement with the CEP program and requires that the individual remain engaged with the program as a condition of receiving Shelter Plus Care rental assistance.
CEP’s high ratio of staff to participants allows the team to respond quickly to problem situations. CEP’s responsiveness helps it preserve positive relationships with landlords. CEP housing specialists teach Rent Well, a program of Home Forward providing a short class on establishing a good relationship with your landlord and how to become a stable and successful renter. Rent Well participants are eligible for the Rent Well Landlord Guarantee, which mitigates landlord risks through a landlord guarantee fund. The fund reimburses up to $2,000 for one bedroom and smaller units and $3,000 for larger units for damages caused by the tenant in excess of the security deposit, one and a half months of non-payment of rent if the tenant does not vacate the apartment in good standing, and court costs and attorney fees where necessary to terminate a tenancy for serious lease violations.
A small cost study of CEP was conducted by Thomas Moore, Ph.D., in 2006. Based on considerable reductions in participants’ use of crisis services, the study found an annual cost savings of 36 percent following enrollment in the program, an average annual savings of $15,000 per person. Participants experienced 58 percent fewer days of inpatient hospitalization and 87 percent fewer emergency room visits. Central City Concern has found that 90 percent of participants remained in housing one year after enrollment in the program (based on 2010-2011 placements).
Contact Info for Follow-up:
Central City Concern
This includes a link to the cost study.
Evidence Based Practice: Permanent Supportive Housing
Evidence-Based Practice: Integrated Treatment for Co-Occurring Disorders
Evidence-Based Practice: Rental Housing Assistance
Evidence Based Practice: Housing First
Promising Practice: Streamlining Access to Housing
Promising Practice: Housing Stabilization Supports
Model Program: HOST (Alameda County CA)