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SAMHSA CMHS CODI Transcript: Financing of Permanent Supportive Housing for Individuals with Co-Occurring Mental and Substance Use Disorders: Challenges, Successes, and Lessons Learned

June 21, 2011

Kathryn Power, MEd

Holly Denniston, MPA

Jessica Katz, MCP

Molly Rysman, MA

Coordinator:  Thank you for standing by. At this time all participants are in a listen-only mode. Today’s call is being recorded. If you have any objections you may disconnect at this time. I’d now turn the call over to Mrs. Beth Fraster. You may begin.

Beth Fraster:  Thank you and good afternoon and welcome, consumers, family members, advocates, service providers, policy makers, administrators and researchers. We had over 1,000 people register for this webinar and we welcome all of you.

Before we begin our presentation we’d like you all to know today’s event is being recorded and will be archived on SAMHSA’s CODI web site at http://coce.samhsa.gov. Twenty-four hours after this presentation, the presentation in its entirety can also be replayed on the Verizon site. This address will be emailed to you following the webinar.

My name is Beth Fraster and I work for Advocates for Human Potential. On behalf of SAMHSA and the CODI project it is my pleasure to serve as your moderator for today’s presentation.

Today’s webinar — Financing of Permanent Supportive Housing for Individuals with Co-occurring Mental and Substance Use Disorders, Challenges, Successes and Lessons Learned — is sponsored by SAMHSA’s Co-occurring Disorders Integration and Innovation, CODI.

This webinar serves a dual role as it is the sixth in a series of CODI webinars centered around SAMHSA’s eight strategic initiatives. This is also a segment of a four-part sequence promoting the adoption and implementation of SAMHSA’s recently released evidence-based practice toolkit on permanent supportive housing.

SAMHSA is dedicated to promoting the use of evidence-based practices in the development of permanent and supportive housing. SAMHSA has dedicated resources to create a webinar series to highlight these practices. On June 15, 2011, SAMHSA presented Part 1 of the series providing an overview of permanent supportive housing and recovery support.

Today we will tie together the issue of financing permanent and supportive housing for the specific population of people who are living with co-occurring mental and substance use disorders as a second installment of the series.

Two more installments of this series will be held in July. These additional installments will enhance today’s presentation and explore the topic of permanent supportive housing and the SAMHSA toolkit more fully. Information about the remaining presentations will be sent to all participants for your general information.

All of the CODI building block webinars are archived on the COCE web site and available to be downloaded and reviewed. The CODI web site address will be noted at the end of the presentation.

For this presentation we have brought together people who have been doing the work, who have been developing and financing housing and know what works; people who have supported the development of the SAMHSA toolkit and the development of evidence-based practices.

We have a full agenda today and are honored to have Kathryn Power here representing the Substance Abuse and Mental Health Services Administration.

Before we begin I’d like to draw your attention to some important logistics.

You may submit questions at any time throughout the presentation. You may submit your questions through the question and answer dialogue box to the right of your screen. Type in your question and send it to the organizer. The presenters will respond to the questions during the question and answer period at the end of the presentation but you may post them at any time as you’re listening.

All participants will receive a follow-up email with a link to an evaluation form. We appreciate everyone’s feedback and will use it in developing future webinars.

I would like to introduce to you now Piper Ehlen. Piper is a staff attorney at Home Base. She is primarily responsible for technical assistance and community education on affordable housing programs, services and support for individuals experiencing homelessness.

She works in the San Francisco Bay area regarding a multiple of areas including planning and strategy regarding services and housing for individuals experiencing homelessness many of whom have co-occurring disorders.

Today she will serve as our facilitator. We are honored to have her lead the threads of our discussion. Piper?

Piper Ehlen:  Thanks, Beth. I’m so happy to be a part of this webinar today which includes presentations from four extremely knowledgeable speakers. The first speaker today is Kathryn Power who is the director for the Center for Mental Health Services at SAMHSA.

Director Power leads a staff of professionals in facilitating the transformation of our nation’s mental health care system into one that is recovery-oriented and consumer-centered. She’s been doing great work on this important transformation.

Director Power is going to give us an overview of SAMHSA’s strategic initiative and how permanent supportive housing fits into those strategic initiatives. Director Power?

Kathryn Power:  Thank you very much, Piper, and good afternoon to everyone. I want to welcome all of you to SAMHSA’s webinar on financing permanent supportive housing for individuals with mental illnesses and co-occurring substance use disorders.

As the director for SAMHSA’s Center for Mental Health Services and as the strategic lead for recovery support initiative I’m very pleased that you’ve joined us this afternoon.

At SAMHSA, as many of you know, our mission is to reduce the impact of substance abuse and mental illnesses on America’s communities. To achieve our mission we have identified eight strategic initiatives to help us improve individual’s lives and capitalize on emerging opportunities.

I’m now going to go through the slides and we’ll walk through those slides with you starting with slide one.

Our strategic initiatives drive everything that we do at SAMHSA. They help us set budget and policy priorities, we use them to manage grants and contracts; we engage partners at every level and measure and communicate progress.

Next slide.

These eight strategic initiatives are tied to the three aims of the U.S. Department of Health and Human Services’ strategic plan so you can see that for health reform and health information technology that meets the aim of the Department in transforming health care

Our strategic initiatives of prevention of substance abuse and mental illness, trauma injustice, military service members, veterans and their families and recovery support meet the aim of improving the nation’s behavioral health.

And finally our strategic initiatives on data, outcomes and quality and public awareness and support make sure that we are achieving excellence in operations.

We know that we’re working to transform mental health care in America by focusing on these areas and we know that we’re working particularly in improving the nation’s behavioral health by concentrating on the areas that are listed there on the slide.

Next slide.

SAMHSA’s theory of change helps insure that the work we support translates into improved lives for individuals with mental and substance use disorders. This theory of change is the pathway that begins with fostering innovation leading to the development of evidence-based practices and that includes permanent housing that supports recovery.

We support multiple vehicles to translate and disseminate information about evidence-based and promising practices and we help build capacity in communities and states for wide scale adoption of these practices.

We work with our federal partners, with states, with tribes, with communities, with individuals in recovery, with family members and with all of you to do so. At SAMHSA we’re focusing on people, on partnerships and on performance.

The next slide.

I’m very pleased to be SAMHSA’s lead for two strategic initiatives; one on recovery support and one on military families.

Next slide.

This graphic representation of the recovery support’s strategic initiative reveals that individuals and families are at the center of everything we do at SAMHSA.  

SAMHSA’s goal is a high quality, self-directed, satisfying life integrated in a community for all people in America. This includes four permanent pieces and in fact you can see these pieces graphically demonstrated in this particular strategic initiative goal and on the next slide we in fact talk about this recovery support goal.

We believe there are four dimensions to recovery. We want to be assured that there is a physically and emotionally healthy lifestyle, that there is a safe, stable and supportive place to live or a home, that there are meaningful daily activities and the independence, income and resources to participate in society or having a purpose and then have relationships and social networks that provide support, friendship, love and hope.

These four dimensions of health, home, purpose and community; those elements are the very definition of services and support that promote recovery for mental and substance use disorders.

Next slide.

To achieve these elements of recovery we hold true to the maxim, “Nothing About Us Without Us,” partnering with individuals in recovery for mental and substance use disorders and their family members to build resilience, to reduce discriminatory barriers and to foster social inclusion.

Next slide.

Each of the recovery support strategic initiative goals is quite relevant to your discussion today because not only do individuals need a safe, stable place to live; they also need recovery support services that help them stay healthy so that they can maintain their housing.

They also need employment and educational opportunities that will allow them to afford housing and services. And they need to have a sense of community that gives them opportunities to benefit from living in housing with individuals from all walks of life.

Next slide.

Permanent housing that supports recovery has emerged as a model as you can see in Recovery Support Goal 4.2 — Home — in which individuals who have mental and substance use disorders can secure stable housing and receive the supports they need to recover. Research and practice reveal that permanent housing that supports recovery decreases symptoms, increases housing stability and is cost-effective.

Next slide.

Some of the activities that we have underway have really been reflections of much of our discretionary portfolio in our housing branches and we’ve begun a number of activities to move the goals of our recovery support strategic initiative forward including the promotion of the use of SAMHSA’s permanent supportive housing toolkit.

webinars such as the one you’re participating in today continue to advance knowledge about how best to finance and implement this evidence-based practice.

And next slide, our immediate next steps, as the recovery support strategic initiative continues to evolve we look forward to working closely with all of SAMHSA’s stakeholders including those of you on the phone today to be certain that all individuals with mental and substance use disorders have the opportunity to live high quality, self-directed, satisfying lives in the community. They deserve nothing less.

Thank you all very much. I appreciate the opportunity to be with you today.

Piper Ehlen:  Thank you, Director Power. As Director Power discussed, housing is a key recovery support for individuals with co-occurring disorders. SAMHSA’s recovery support goal defines home as a stable and safe place to live that supports recovery.

Permanent supportive housing combines affordable housing with the various support services that persons with co-occurring disorders need for recovery. Here to take us through an introduction of permanent supportive housing models and developing and financing options is Holly Denison.

Holly is a senior program manager for project development and finance at the Corporation for Supportive Housing. At CSH she is responsible for researching and documenting financing trends and practices for the development of permanent housing around the country.

She also provides technical assistance and training on various project development and finance issues. Holly?

Holly Denison:  Thank you. Thanks for a great introduction. CSH spends a lot of time focusing on housing and how to build it and how best to incorporate services.

Obviously one of the keys to housing is how to finance, either build or rent space through scattered sites.

Beth Fraster:  Excuse me; we’re going to need you to speak louder.

Holly Denison:  Oh, I’m sorry. Is this better?

So over the past 20 years CHS has not only provided technical assistance around developing permanent supportive housing but has provided lending as well.

One of the first questions that we get is what is the difference between affordable and permanent supportive housing. In affordable housing you have capital dollars that go in to actually build the property or rehab the property if you acquire it. And you have operating financing such as Section 8 vouchers, housing trade vouchers or other types of subsidy.

In permanent housing you also have capital dollars. You also have your rental assistance, your operating dollars. But then you also have a third pot of services, which probably many of you on the call have used for years, and this is an excellent source of funding there.

This is kind of a simple diagram to illustrate the difference between affordable and permanent supportive housing.

And in the presentation from last week or the week before, another presenter talked about the four different models for how to create permanent supportive housing and let me just briefly highlight those again.

We have single site, single purpose. So you have one property with all permanent supportive housing units. You can develop that either through new construction or through acquisition. Some of our projects are only a couple of units and some of our projects are hundreds of units. Many of the projects we have sponsored do fit this model but we also have used the other three models as well.

The second model is also a single property but there’s various different people living in that property. And so some of the units are reserved for supportive housing and some are either affordable or market rates. And these are, again the same as before, developed either through new construction or acquisition.

The projects vary in site and recently especially in North Carolina and Michigan we’ve seen more and more of these types of properties where the state is requiring 10% of units funded through one of their funding sources that we’ll talk about later, low income housing tax credits, finishing 10% of the units created using tax credits for permanent supportive housing.

We also have the two models with property/owner where there’s the property is owned by a specific sponsor. Here the next two options are slightly different.

With master lease housing we have a supportive housing provider who will master lease, who will lease a large number of units either in a number of different properties or in one specific property and then kind of sublease those units out to their tenants.

And our final model is a scattered site where the tenants directly lease units kind of at their choosing depending on where they find units available. So as you can see, the first two options of this project, the sponsor owns the properties. In the second two options they are more leased space either a couple of units or in a master lease model.

And to briefly look at some of the pros and cons of both of these sites, of these models, in the single site model certainly there’s a couple of both. It enhances the ability to provide centralized intensive key services, (unintelligible) case management and other services. Services are often offered onsite and the sponsor has control over the property.

Some of the cons are some of these properties are difficult to build due to community opposition. Certain clients may prefer more integration into the community. And tenants may be less likely to form relationships outside the building.

On the other hand a scattered site also has some pros and cons; the pros of the scattered site model, either the tenant-based lease or the master leasing model. The sponsor does not have to have any development or property management skills so those tasks are performed by others. And it’s certainly easier to achieve geographic diversity with this scattered type model.

The cons of this model however are often there’s not sufficient space to deliver services. There’s lack of control of where the tenants rents the units. Neighborhoods can display a negative attitude towards clients and some clients may feel isolated in the scattered type model.

And so just to take a quick overview of some of the terms that you may have heard around the development of permanent supportive housing, at CHS we call integrated housing, as I said, kind of a mix of populations with a portion of a property being dedicated to supportive housing in the (unintelligible) market or affordable housing.

Other people call it mixed income housing and other people call it mixed population. It’s often the same thing.

Mixed income doesn’t necessarily mean that supportive housing is involved so all three terms that I’ve seen thrown around so I wanted to make sure that you know it’s basically the same thing.

But these models do contract with an excuse, an excuse for (unintelligible) commercial space often on the first few floors but depending on the property and different locations within a property. And the excuse is definitely different than either mixed population, mixed income or integrated housing.

There are four different development team roles that we’ll quickly go over; developer, property manager, owner and service provider.

The owner is obviously the long-term controller of the property and owner. The developer is the person who brings the capital and sometimes the operating but at least the capital dollars to the table and controls the construction.

Service provider obviously provides the services and can be brought on either at the front end through the whole concept phase of the development or brought in after the property’s already been developed or somewhere in between. And then finally the property manager whose responsibility is to manage the asset and manage the physical housing structure.

Many service providers have blurred the line between service providers and property manager but they are two distinctive roles and even if they are similar staffing you can talk about the different responsibilities within those two different roles.

So when you’re putting your development team together and selecting your staff for all these different roles, two key roles for everyone to agree on is number one, that who your population is that you’ll be recruiting, who you’ll be recruiting for your permanent supportive housing units.

So you have to know about your tenant selection plan and how it stipulates helping (unintelligible) your property manager will market to potential tenants and screen your tenants especially with an eye toward credit checks and background checks to insure that our households are screened in rather than screened out.

And the second key goal is embracing their goal, embracing housing stability. Is the property manager prepared to really participate with the service provider to help tenants stay in units? (Unintelligible) destructive behavior involved, (unintelligible) needs to be taken when using the service provider and reaching out to the tenant to insure that or to really promote housing stability and achieve goals that everyone needs to agree to when coming together as a team to create permanent supportive housing.

And you can see here the long list of roles for your development team.

And you should go over each one of these and kind of figure out how they fit in so these are the documents that you should be developing. CSH has templates for all these different polices and plans if you’d like to look on our web site. And these are kind of key documents that are good to insure that the partnership groups will move together.

And then let’s review briefly partnership models. You have your four different models of how you will — different types of projects — your single site either 100% permanent supportive or integrated or your master leasing and scattered sites.

So how do you get to those types of projects? Well, number one is turnkey. What turnkey means is that a long-term owner hires a developer who will develop a project and basically just turn the keys over to that owner who’s often the service provider when the property’s finished being built or rehabbed and the owner and/or service provider often don’t have a lot of involvement in the development process.

So it’s a way for service providers and owners who do not have a lot of development experience to get a project built. So it’s a turnkey model as we refer to it.

Second model is co-development where the service provider and owner are very involved in the development process from the beginning. They might help the developers pick a site, choose the building design, number of units and so forth.

So this model requires a lot more time and sometimes some financial investment either through actual fundraising, paying for services or issuing guarantees than the turnkey model but it’s a way for the owner and developer to be much more involved in the process.

The third option is master leasing, which we reviewed before but to look at it in a slightly different way, master leasing also is a way for developers who maybe have an extended use agreement or other document requiring them to dedicate a certain number of units to supportive housing to reach out to local service providers and engage their services, have them refer tenants to their property and provide services at the site.

So it’s just a great way for the service provider to get involved without having even long-term property management roles than the turnkey model but still getting the tenant population.

And finally a service contract; this is where the service provider is the least involved in the project and the developer has the most involvement and the most control over a long time, over a long period of time.

So a developer could issue a contract with the service provider probably not even to refer as many tenants but to provide a specific set of services onsite to local tenants.

There are definitely some pros and cons of ownership versus leasing. Pros, here’s an extended use agreement meaning there’s probably a 15 to 30 to more year agreement insuring that the units will be dedicated to permanent supportive housing.

This is definitely a key certainly in this down real estate market. There are more units leased than there were just a few years ago. When this market recovers I think we’ll see fewer and fewer available units.

As we all know, we certainly have a shortage of affordable housing and the more units that we can have with a legal agreement dedicating them to permanent supportive housing, the better. So it’s definitely a pro for the ownership side.

Another pro is that this project controls the property management budget. Sponsor controls how the building is designed and then the developer’s work can be shared. So there’s some financial incentives for a service provider to try the ownership model as well.

On the other hand there is certainly a lot more time needed so service providers who currently own a property and needs property management and development expertise as well.

The pros and cons on the leasing side, the units can certainly be bought out quite quickly usually through leasing. Extra developer and property management so they’re not needed and as I said before, it’s easier to achieve geographic diversity.

However through leasing, the leases are often either a year or sometimes they maximum leasing will go five years but certainly not the 15 to 20 years that you’ve seen on the ownership side.

Tenancy can be jeopardized as the rental subsidies don’t keep pace with the rental markets. If your operating subsidies are not increasing at sufficient levels so you can’t help you tenants subsidize their rent, that jeopardizes those units.

And finally it may be it difficult to qualify tenants for vacant units as part of the screening of our tenants all depending on the screening criteria of the property manager.

And so what are the typical sources of federal funding for our projects? As I mentioned before, the three circles; you have capital, operating and services dollars. On the capital side — HUD, Housing and Urban Development, rental — money that’s available through the Continuum of Care, LIHTC which is — this has had so many different names but stands for Low Income Housing Tax Credit, a way to raise significant capital dollars although it requires quite a bit of experience to access those dollars.

HOPWA, Housing Opportunities for People with Aids is available both on the federal and the local level. Home Dollars which is money that comes from the federal Department of Housing and Urban Development but also it funneled through local, city and county.

And finally Section 811 is a whole new Section 1811 reform bill and hopefully it’s more money than in past years will be available through Section 811.

Second pot, operating assistance —again the HUD Continuum of Care dollars are available, most significantly it’s actually for operating but they are, some of that money is available for capital as well as I mentioned. HOPWA dollars are also used for operating housing vouchers under Section 8.

A huge and important source, talking to your local public housing authority is crucial to figuring out how many of these vouchers are available, how many can be project-based which means dedicated to a certain project versus to a tenant or to a sponsor.

They’re an excellent source of rental assistance and kind of the most available usually depending on the area. Section 811 (unintelligible), the most (unintelligible) for the Section 811 program will be through vouchers and then VASH, Veterans’ Administrative Supportive Housing program.

We’re very excited to see that the 2011 budget will have additional VASH vouchers and will help 2012 budget goals but we’re looking at hopefully some continued funding for VASH and that is controlled both by your local public housing authority and your Veterans’ Administration and can be used both for tenant-based vouchers and project-based vouchers.

And finally, services. Most services money is available really on the local level though, as we know, service is available on the federal level so also with HUD dollars; some of that money can be used for services.

So really HUD wants to see more of their dollars used for operating and capital. HOPWA does have money for services and health and human services you have SAMHSA as well as Medicaid under that category.

If you’d like to know more about developing permanent supportive housing please click on our web site. We have a toolkit called Developing and Operating Permanent Supportive Housing which is much more detailed information on the slides that I presented as well as there’s supportive housing financing guide that goes into details on the different funding sources that I briefly reviewed today.

And the HUD, Housing and Urban Development office also has a great web site that talks about their homeless and business programs which are referred to as (Unintelligible), Continuum of Care and as of 2012 or 2013 are legislation.

And of course SAMHSA’s toolkit is an excellent source as well. I do not list that here; I apologize. But we’re all on the call to hear more about the toolkit so (unintelligible) there are additional questions from there.

I think I’ll turn it back over to you, Piper.

Piper Ehlen:  All right. Thank you, (Holly).

Holly Denison:  You’re welcome.

Piper Ehlen:  Holly’s given us a great overview of permanent supportive housing models, development types and financing options. So our next question is, what do these models look like on the ground?

To answer that question we will turn to some recent examples of permanent supportive housing developments that have navigated the decisions that Holly just described.

Jessica Katz is with us to discuss some projects that she has completed. Jessica is the executive director of The Lantern Group in New York City. She oversees the development and operation of permanent, affordable and special needs housing in New York City and currently has 16 buildings in operation, development or planning phases. Jessica?

Jessica Katz:  Hi, everybody. Thank you so much for having me on the call. Again my name’s Jessica Katz; I’m the executive director of The Lantern Group. We are a not-for-profit organization that was founded in 1997.

We’re a little bit different than some of the other supportive housing providers out there in that we really began as an affordable housing developer and grew our social service side of our company. That sort of grew out of the needs of our tenants as opposed to a lot groups who start out as social service agencies and then work towards the housing side because they realize about the housing needs of our tenants. So that makes us a little bit unique as an organization.

We do development, property management and social services and primarily we provide affordable housing for vulnerable populations. We worked with a variety of different groups including formerly Homeless People with Mental Illness, folks with substance abuse disorders, people living with HIV/Aids and young adults aging out of foster care.

We also have two projects that are starting construction this summer that are for formerly homeless veterans who have a history of substance abuse, mental illness or co-occurring disorders.

So we have 13 buildings right now that are completed or in construction and just over 1000 units and then we have 3 buildings in predevelopment. We have onsite services at all of our buildings that help tenants really set their own goals and realize them, make decisions and we’re also very focused on employment and community participation in all of our buildings.

I’m going to focus on two, I’m going to do two case studies today about two of our buildings that are currently - one is open and one is in development. The first is Cedar’s/Fox Hall. It’s a 95-unit building that is in the Bronx in New York City. We opened in 2009. I have a list here of all the financing sources. There were anchors for (unintelligible) with tax exempt bond financing with low income housing tax credits.

So we got tax exempt bonds through the New York City Housing Development Corporation, RHDC, and that comes with 4% low income housing tax credits which we partnered with the Richmond Group to do the syndication on those. And then we got a variety of different grants on top of that through New York State both on their Homeless Housing Assistance program as well as through NYSERDA which is the New York State Energy Research and Development Authority.

We also got funding from the Bronx Borough president and a couple of other landmarks grants. This building was a little bit unusual because, as you can see here, I have funding sources that are both designed towards new construction and new green building as well as historic preservation sources.

And we also got funding through the Corporation of Supportive Housing which we have always appreciated and they’re on the call today.

Rental assistance comes from a variety of sources. We were opening our building in a very difficult time and then we were in an (all-systems) market but we were able to get tenant-based Section 8 for about 30 of our clients as well as VASH vouchers for a group of tenants as well.

So there’s some photos here. So as I said before, this was sort of both a new construction and a historic preservation project. I know that sounds like a contradiction but that’s not how we did it.

So there’s a - we purchased this building that was originally a farmhouse mansion that was built in around the 1860s. I have a picture here on the left side that was circa 1940. This was originally, it was a social club for a while, it was home of the Police Athletic League for a time and then if you see the picture in the middle it was basically a complete bombed out shell by the time we got to it in 2007 for our groundbreaking.

And then on the right you can see a photo of where we are in it today which is we completely restored the existing mansion in the center there and then we use that building for our social service space and then we wrapped a new construction building around the edge of it and there’s 95 units in that building and the two are connected in the back corner but we really wanted to preserve that existing mansion. So we have both historic preservation and new construction in one building here.

The social services in the building are funded through a contract with the New York City Department of Health and Mental Hygiene so the 95 units, 30% or 28 units are set aside for permanent housing for chronically homeless families where the head of household suffers from a disabling medical condition. That typically is a substance use disorder but we’re not exclusively serving that population.

The funding in the building, the funding for the social services are targeted specifically for those 28 families but we manage to work it out so that all the families in the building are eligible for the services and we do see a lot of participation from all the families in the building for our social service program.

We have a list of the onsite staff. We have seven fulltime staff members. We have a program director who’s in charge of all the social service staff and the program operations, an administrative assistant, a housing coordinator whose sole responsibility is really working on rent collection and rental subsidy processing.

That is a property management responsibility in many places but we found in our model that it works better if the housing coordinator is sort of part of the social service team and that way working on budgeting and, you know, filling out all the paperwork for the rental subsidies and things like that are sort of an integral part of how we’re trying to teach people to live independently as opposed to sort of doing a good cop, bad cop thing where there’s a property manager who’s demanding the rent every month and a case manager who’s trying to help you through in a sort of more positive way. We try to integrate those two roles a little bit more.

We have two case managers who spend time developing an individual service plan with each tenant and focus on long- and short-term goals of the tenant themselves generate and can buy into.

We have an employment specialist who’s in charge of implementing The Lantern Group’s support and employment program which is an evidence-based practice for folks with disabilities where we go out immediately and search for private, competitive employment in the market as opposed to some other employment models where you spend a lot of time doing sort of pre-employment training.

We have our tenants go right out there in the market. You know, sometimes they have to learn a few times what works and what doesn’t on interviews and job searches and things like that but we found that this is a great model that we’ve been using in a number of our different buildings.

We also have an activity specialist who in particular is looking at the children and teens in the building and we find that it’s really a great way to engage some of the parents who sometimes may not be so interested in meeting with the social service staff. If we can get the kids involved then the parents sort of follow pretty quickly afterwards.

We also have 24-hour contracted front desk monitors and property management staff including a live-in super.

Some of the green features of our building; we have a lead gold building, we have a passive green roof, a Geothermal heating and cooling system, fiberglass windows and a lot of other water use and energy reduction planning.

One thing that we learned through this process of becoming a lead building is the extent to which you really do need to involve tenants and staff from the beginning. There was a couple of different areas where, you know, where we learned a lot about making sure that tenants are really buying to some of the energy reduction processes that we’re going through. So we have been doing monthly tenant association meetings where we talk a lot about what the lead requirements are.

One is that we have a no smoking policy in the building and another is, for those of you who live in the northeast and are used to these old buildings that are always 85 degrees in the wintertime, we have our thermostats set to between 63 and 73 degrees. That was unusual for some of our tenants and so that was definitely an education process that we had to go through.

We spend a lot of time on community involvement. That’s always really important in any supportive housing development. So we had community support from the local community board and elected officials and we actually ended up getting a $1 million grant from the Bronx Borough president to help us develop some of the green features of the building.

We have that great community space that’s in the mansion. We have offered that for use by a number of different local groups and that’s been a really great way to sort of be an asset to the community, bring people in so people know who we are and what we do.

There’s also a new park that’s just opened up across the street which has been fantastic. It’s been a great additional space for our tenants to hang out, especially those with young children.

The second building I want to talk about is a pure rehab building. It’s a renovation of an existing SRO in the upper left side of Manhattan. It was 149 units that we are developing into 123. We’re increasing the size of the units a bit so that we can make the rooms a little bit more livable.

I have a list of the construction sources here. They’re primarily financed by the low income housing tax credit as well as the New York City Department of Housing Preservation and Development. And then we have social service funding again from the Department of Health as well as New York City Department of Homeless Services.

This building is in construction now. We started in January 2011 and we expect to be completed in about 24 months.

One of the interesting things about this development is that when we purchased the building there were about 50 of the 149 rooms, there was tenants in place in about 50 of them. Some we relocated to other Lantern buildings or city-funded affordable housing in the neighborhood but one of the promises that we made from the beginning was that any tenants who wished to stay in the building throughout the construction period were able to do so and we created a construction phasing plan that would enable that.

Some of the issues that we faced doing an occupied renovation of an SRO; one was the challenges of the tenant relocation versus the challenges of doing the renovation with tenants in place. We opted to choose doing that renovation with tenants in place. We had enough vacancies in the building that we were able to do that.

We needed to worry about negotiating the terms of future tenancy for existing tenants so there was obviously a lot of anxiety when we took over ownership from the existing tenants. And we needed to assure them we were not there to kick them out, we were not there to raise their rent and so we needed to really be explicit about that from the beginning and speak with one voice and create some written agreements with each existing tenant before we started.

Because of the SRO building with common bathrooms and kitchens the property management staff provides the maintenance of those areas.

And also when we took over the building it was in quite difficult shape but we as the new owner, Lantern Group had to be responsible for closing out any preexisting violations from the Department of Buildings which was quite a process.

Again community involvement is incredibly important particularly with a building with existing tenants in it. This project did have community support from all the local elected officials, the local community board and the government agencies.

As part of the way to get that approval, we put a community advisory board in place so once a month we meet with a group of neighborhood stakeholders including the existing tenants of the building, neighbors and representatives from our elected officials.

Despite what we worked really hard to get the support from a lot of the very important stakeholders, we did have a small group of neighbors in the building who were continuing to be opposed and they pursued a lawsuit against the project.

They filed the lawsuit in 2007 and it was not until 2009 that the Supreme Court in New York issued a decision to dismiss the petition. In other words they decided the case in our favor. The neighbors decided to appeal the case and now just now in March, 2011, that appeal was also dismissed so that was a very long process but I think it was worth it.

It was really important I think for sort of the - it was important to show people that we weren’t going to back down and that we wanted to really make sure that people with disabilities are able to live in all the different neighborhoods in New York City. So that was something that we were committed to continuing on despite how much time and money it took to pursue that.

So some of our lessons learned and best practices? One is that active and consistent community engagement both among the tenants in your own building as well as the outside neighborhood is incredibly critical.

We need to really think about planning ahead for operational matters, you know, so we have Cedars as you saw, we have 12 different funding sources. We have to now continuously report to all 12 funding sources so that’s something that you really have to build in as you move from the development phase to the operations phase.

Same thing with green building technologies; we really needed to spend a lot of time making sure that the hand-over from the construction and the development and the design team over to the operations and the social service staff, we really had to think through that and make sure that we really wrote everything down and made sure that everybody understood what the green building technologies were and how to maintain them.

We found in the 13 buildings that we’ve done, the mixed population model really works. We have buildings that have young adults aging out of foster care and low income families; we have ones that have single adults with HIV/Aids and low income families. We’ve really mixed every different populations within the supportive housing world and it really I think creates a much more normalizing atmosphere and so we’re really big proponents of the mixed population model.

Another thing with Cedars, which is a family building, and some of our other family buildings we started out as primarily serving single adults. And one thing that we learned when we started serving families is, you know, as any parent will learn the needs of children are ever-changing and as kids grow up they have different needs and different interests and that’s something that we really had to follow up on in our social service planning, that when we opened the building, kids coming out of the shelter system tend to be 4 or 5, 6 years old and then when we, you know, six years down the road we have a building full of pre-teens so we really had to change our service model and our activities planning around the changing needs of the children and the changing family composition in the building.

Over to you, Piper.

Piper Ehlen:  All right. Thank you, Jessica. So our final presenter today has an architecturally interesting project to share with us to help us combat the myth that permanent supportive housing is ugly or even a blight to the community.

Molly Rysman is the external affairs director for Skid Row Housing Trust in Los Angeles. In her role as external affairs director Molly oversees public affairs, communications, government and public relations and policy analysis and advocacy. Molly?

Molly Rysman:  Hello to everybody out there and thanks for joining us today. I’m going to be doing a case study of a building that we actually have in predevelopment so a little bit different than Jessica’s presentation but I wanted to focus on the Star Apartments because I really think it reflects our best (unintelligible) of what supportive housing should be.

I’m with Skid Row Housing Trust and normally when we describe the Trust we try and use three words which are home, support, success in that we provide homes for people who’ve experienced homelessness, extreme poverty, poor health, psychiatric disabilities and addiction.

And we insure that our residents have access to the critical support services necessary to achieve stability, good health and dignity and that we insure success in the community by reducing homelessness and improving the community through the operation of our sites.

We have been around for 22 years. We were started in 1989. We have successfully placed 23 permanent housing developments into operation since 1989. In those sites we have close to 1500 apartments. We are a property management company, an affordable housing developer and a social services agency.

In addition to the buildings that we have in operation we are in development on two sites, the new Genesis Apartments which is in construction and should be opening in March of 2012 and the Star Apartments which I’m going to be focusing on today.

The Star is currently in predevelopment, we’re not in construction. We’re in the process of assembling the financing to begin construction on the Star. We have most of our financing in place, we have applied for low income housing tax credits and actually got a preliminary award and we hope to hear that we get the final award tomorrow which will be very exciting because that will be the last piece of capital financing we need to actually start construction which would happen in November of this year.

The Star — and I apologize, there’s actually a typo on this slide, the Star is actually going to be 102 apartments — similar to some of the things that we’ve been hearing about throughout the presentation, it is a mixed use building in that it is a residential building as well as it has pretty extensive ground floor commercial.

It’s also mixed population which you’ve also been hearing about in that there will be apartments that are reserved for people who are homeless and there’ll be apartments for people who are just in need of traditional affordable housing.

So it goes from folks who will be coming into apartments directly from the streets up to about 60% of the area median income in terms of the income range.

We are striving for lead platinum certification so this will also be a green building and have a variety of green features. One of the things that’s very unique about the Star is that it’s a prefab construction. Not only will it be the first time that the Trust is using prefabricated apartments but this will actually be the first multi-story prefab construction in Los Angeles. So a lot of new aspects that will be reflected in the Star.

We also are hoping to have a ground floor community medical clinic that will be open not just to our residents but to everyone in the community that we’re very excited about. And we’ve a second floor multipurpose deck that I’ll be talking about further in the presentation.

In terms of the financing, the construction of the building alone costs about $22.3 million so about $219,000 per unit. We are able to insure that we can serve people who are homeless and coming from the streets because we were able to secure 77 Section 8 project-based vouchers to the Star Apartments and project-based vouchers is similar to the Section 8 program in that it makes the rent affordable for people of very low incomes.

But it’s a bit different from tenant-based. It’s actually assigned to the apartments/ Residents after one year are eligible for a tenant-based voucher that they can take anywhere in the community. Or they can stay as long as they want in their apartments at the Star. But the actual voucher, project-based voucher, will stay with the apartment to insure that long-term affordability.

And then part of the services will be offset by having the federally qualified health center operating a medical clinic in the ground floor. And then I’ve got the permanent financing so the capital side of the financing on the right hand of the screen.

Again the largest source of funding is low income housing tax credits. This is a building that we, like I said, hopefully tomorrow we’ll get the final word that we’ve received 9% tax credits so that’s the majority of the equity but also conventional debt, other local financing sources, some state financing through bonds and redevelopment as well.

In terms of context, you know, we had to balance both our residents’ needs, our organizational mission and the community’s desires for this property. And I think Jessica talked quite a bit about the importance of engaging the community which we also find it’s very important to make sure that this is a building that’s going to be embraced by the community.

So we had to do quite a bit of community outreach but also balance that with the fact that we are a mission-based organization and our residents have quite a few needs.

It’s a very unique site in that it is really on the border of Skid Row and the historic core in downtown Los Angeles so on the one hand, on one side of the building you have a block sort of long, of encampments and on the other side you have like high end doggy boutiques, very high end retail and loft developments on one side. So it’s in this very unique place in the community and part of the way we were able to address that context is to focus on providing a beautiful architecturally significant building with this mix of uses onsite.

In terms of the program, I talked about how the building would be mixed population. The apartments that do not have Section 8 vouchers will be 60% of area median income individuals and of the apartments in the total building, 50% will be apartments for individuals who qualify as chronically homeless.

In terms of amenities, we have a variety of amenities in terms of the ground floor commercial, the health clinic as well as there’s a mezzanine level where we’ll have offices for social services staff. And then the second floor deck which has a variety of amenities I think are highlighted on this next slide.

This is a plan view of the second floor deck and one of the wonderful things about this site is we were able to sort of open the building up from the second floor so that we could free up the second floor to have a lot of outdoor space, which we are in Southern California so we have really wonderful weather. And we were able to do quite a bit with creating this outdoor space that will include a variety of amenities.

So we had a big focus on community in this building which has become a huge part of how we see the role of supportive housing is really providing an opportunity for community building and reintegration.

So in addition to the traditional services like mental health and primary health care and substance abuse treatment and case management and benefits advocacy, the second floor will be dedicated to activities like basketball, yoga, gardening, art.

And the design allows for residents to have access to their apartments without having to engage in that community space which allows us to open the community space up to the broader community.

The next slide is an activities calendar from a site that’s in operation now and it’s actually three sites that are next to each other which allows us to have an economy of scale. But it just gives you a sense of all the different activities that we really focus on to promote that community integration.

It is one of the pros of doing site-based supportive housing is that you can have this space and seek funding to do onsite yoga, bingo, morning meditation, recovery groups which is really wonderful. And we found that, you know, and I think it talks about this in the SAMHSA toolkit around permanent supportive housing is this focus on life satisfaction rather than just focusing on reducing systems.

This focus on life satisfaction we found really improves the outcomes for our residents both just from simple housing retention but their health outcomes, their ability to reunite with their families; it really has a profound impact for our residents.

And lastly I just wanted to end with a perspective from one of our residents. He — I won’t read this whole quote but he wrote an article actually in one of our resident newsletters and I was really taken by the fact that he talks about home not just being a place, providing a place for yourself physically in the world but also providing a place for you mentally and emotionally. And I thought that was very powerful.

I mean we all have the need to feel that we belong and our goal at the Trust is to really help build communities that are wonderful places for our residents to live and that promote health and wellbeing.

I will be honest, it’s not an easy task in Skid Row which is a community in Los Angeles that has a lot of issues but it’s a challenge that we really work on collaboratively with our residents, our volunteers, our staff and the larger community. And we’ve found that, you know, through supportive housing there’s quite a bit we can do to help meet that need of our residents.

So with that I think I will end and turn it over to Piper.

Piper Ehlen:  All right. Beth, you want to take us into our question and answer period?

Beth Fraster:  I would love to do that. So I just want to remind everyone that you are still welcome to send in some questions. We do have a list of questions going. And I want to thank all our speakers. We were all given a great amount of information and you have all been — all of our audience members have been very patient as you’ve been waiting to get your questions answered so I’m going to move into that.

If you want to send in a question just remember you can type it in and send it off and our question people will be putting them together for me. So let’s, without further ado, we’ll leave the lines open and (Holly), Jessica, Molly and Piper, you can feel free to — with your experience and knowledge — feel free to enter into the conversation with all of us.

Someone sent in a question asking — let’s see, where do I begin — in the shelter plus care model is there a specific level of care or services that an agency is required to provide?

Piper Ehlen:  Yes, I can answer that actually, this is Piper. So for shelter plus care there is a dollar-for-dollar match so however amount of funding you’re getting through the shelter plus care program for housing, you need to match that with supportive services. But it’s not a cash match, it’s just a service match.

So you can partner up with service providers and provide services equivalent to the amount of funding that you’re getting through shelter plus care. And it’s also not a person-to-person match so like if one person’s subsidy from HUD is $300, that person doesn’t need to have $300 worth of services. It’s a project-wide equivalent instead.

Molly Rysman:  This is Molly. I would just add one of the nice things about shelter plus care is it doesn’t dictate what kind of services you have to provide which really allows each resident to dictate what they want. And we have a lot of shelter plus care and one of the nice things about it is it does allow the services to be really resident-focused.

So each of our residents gets to decide, you know, I want to focus on this and I want to focus in terms of services on, you know, working on my education or reuniting with my family or getting my kids back. Whatever it may be, each resident gets to determine those services for themselves versus the shelter plus care program saying everybody has to get, you know, $100 worth of case management and $50 worth of mental health. It allows it to be much more resident-focused which we appreciate about that program.

Beth Fraster:  And maybe we should actually just take a quick step backwards. Can someone just give a quick overview of what shelter plus care model is? You know, just quickly for those who just needed that to understand the answer to that question?

Jessica Katz:  Hi, it’s Jessica. I can answer that if you want.

Beth Fraster:  Sure.

Jessica Katz:  It’s a federal rental subsidy program so it’s basically — the short answer is it’s Section 8 for homeless and disabled folks. It’s a rental subsidy program that’s for project-based rental assistance but it’s exclusively for people who have a long-term history of homelessness and disability as well.

Beth Fraster:  Great, thank you. Thank you.

Someone else wrote in with a question about credit history and they asked, how is the credit history considered during the tenant selection process. So this actually may be different for each of you. Would anyone like to take a stab at that?

Molly Rysman:  This is Molly and I can take a stab at that. I actually meant to mention that in my presentation. In the toolkit, in the SAMHSA permanent supportive housing toolkit, there’s a whole section of tenant engagement which is great because we’ve really changed the way we do our leasing in order to really insure not only that we’re screening people in; we actually don’t run any sort of credit history at the Trust.

And for some of our programs we’re able to not do any criminal background checks. Most Section 8 programs do require some sort of criminal background check and that’s normally dictated by the housing authority so we don’t do anything above and beyond what our housing authority requires. And we’ve actually been advocating with them to roll back a lot of those requirements in terms of what they check on for criminal background because there’s actually very little that’s required by HUD.

Our housing authority had gone above and beyond HUD and so we’ve been working with them to roll that back. But in addition to that we’ve also been partnering with organizations that do street outreach and also we’ve been using a vulnerability index, the common ground, 100,000 homes tool in our community to really identify the folks who need supportive housing the most.

And we’ve had to move from a sort of passive screening in leasing process to a very proactive process of trying to identify people by name who really need supportive housing in the community and really working with our partners who do street outreach to make sure that they’re able to get in through our process, which we feel is really important.

Supportive housing is not cheap. You know, it’s a model that can be very cost-effective. We know it works extremely well but it’s really underutilizing a resource we feel if you’re not reaching the folks who need it the most. And the only way we’ve been able to figure out to do that is by working with folks who are doing street outreach.

Jessica Katz:  Hi, this is Jessica from The Lantern Group. I think I’ll just add to that. We also at the Lantern Group do not do credit checks. We just found it didn’t add anything to our screening. We do want to look for people who are capable of being stably housed in supportive housing which is not a 24-hour program but we fully expect that people who are chronically homeless, which all of our programs are set aside for, will have terrible credit and so adding a credit check did not, it didn’t add to the information that we needed to figure out what the best fit for our tenants would be.

(Holly Denison):  And finally, this is (Holly), I’ll just add that the integrated field, some developers who are kind of used to screening people using credit checks especially on the affordable on the market side, are kind of hesitant to just (unintelligible) housing they can’t use two different screening criteria as one for permanent supportive housing tenants and one for everybody else.

So what we’ve talked to those property managers about is designing a tenant selection plan that says if your partner was a service provider, these are the credit scores that are acceptable and if you’re not, then here’s the credit scores that are acceptable.

And it’s again; it was the philosophy of screening our tenants in rather than screening them out.

Beth Fraster:  Thank you, everyone. Are there any other practices that have been successful that are part of the evidence-based practices that do help you to make some decisions about tenants, about the choice of who lives in these apartments and who gets the permanent supportive housing or any way that people do get screened in as opposed to screened out?

Molly Rysman:  This is Molly. I can speak to that. In terms of evidence-based practices we employ both housing first and harm reduction and both of those we’ve found to be extremely effective. We are a little bit different than a lot of supportive housing providers or particularly affordable housing developers in that we do not require sobriety upon move in and we don’t require sobriety at any particular point in a residence, you know, residency with us.

And harm reduction has been very effective in working with folks who might actively be using, which of course a lot of folks on the streets are, so it’s been very important for us to be employing that. And that’s allowed us to screen in a lot of people that we otherwise would not have.

We are not an agency that focuses on housing readiness. We really believe anybody who shows an interest in getting a home of their own, once they have their home they’re much more likely to be able to recover and so we can’t - we found that there’s no screenings for housing readiness that really show us much about folks just because life on the street is so chaotic.

Beth Fraster:  Anybody else want to comment on that question or should I move on?

Jessica Katz:  I would just add we supported employment at Lantern as another evidence-based practice. So we’ve had really great success with many of our tenants.

Beth Fraster:  Great. Okay, I’m going to move to a slightly different topic. This question came in for Molly. Someone who is interested in whether you were charging the federal qualified health clinic to utilize the ground floor and is this a source of income for your project.

Molly Rysman:  I do not think it’ll be a source of income. You know, our focus in partnering with the federally qualified health clinic is just to insure that our residents have access to primary medical care. So our negotiations with them will be very much focused on these services that our residents will have access to.

I don’t think we would actually charge them anything in terms of trying to collect rent. It’s not in terms of trying to get money for the property or the organization. It’s really about expanding services. So we haven’t fully negotiated the deal but I don’t think we’ll be charging them any rent.

Beth Fraster:  Okay. This is a more general question but of the various models that we’ve learned about today - the scattered site, the single site, mixed uses — the different models that we’ve heard; which one do you think best accommodates persons with co-occurring disorders? Which ones have you seen work the best, which ones do you think we should be looking towards as we expand our base of housing options?

(Holly Denison):  This is (Holly). I would say it depends on the tenants and it depends on the community. If having the diversity of options, the tenants can choose the setting that works best for them, is really the key.

If you’re in a small community building a 100-unit property and having 10% of the units dedicated to supportive housing, probably wouldn’t really work. It doesn’t fit your community but if other properties around, other buildings are, you know, 10 20 units then building something that fits in with the community (unintelligible) what you’re capacity of your local service provider and increases what tenants, increases options for tenants, that’s going to be your best model.

Beth Fraster:  Anyone else have some thoughts on that question?

Molly Rysman:  This is Molly. I just wanted to add that I also really believe in the importance of housing choice which I know is also focused on in the toolkit and it’s a big part of Housing First and that evidence-based practice is the importance of having choice for folks. And so I think, you know, the more that you can have an array of choices for people who are moving from the streets or recovering from a disability or disabling condition, the better.

So we find some folks do really great in scattered site models; others really thrive in permanent supportive housing that’s site-based. And so it’s, you know, the more choices you have, the better. We see that they all work very effectively.

Beth Fraster:  M-hmm. Okay. This question just came in and it’s more about outcomes. How do you or how can I measure supportive services other than case management related services?

Jessica Katz:  Hi, this is Jessica. So we measure not the amount of services, and we struggled with this a lot, we were looking at a lot of process outcomes about, you know, number of contact hours and how many times per week people are meeting and we sort of decided that it was okay if there was a diversity in those numbers.

We were focusing more on the outcomes for the tenants themselves so how many — if you have five goals in your service plan, how long is it before you can reach three of those goals and are you employed and are you in school and are you making - is your income higher than it was when you came to us.

So we focus less on the kind of process, how much services are you getting and more on what’s going on with the tenant. And we assume that there may be a variety of different kind of styles and amounts of service that might help you get there.

Molly Rysman:  And this is Molly. I just want to support that as well, that it’s really about the outcomes for the residents and what you see there. And one of the important things that we found was that it really is about the progress that each individual makes but not saying what success looks like.

For some individuals they’re able to get some support and vocational rehab and go back to work. For others success may be reuniting with their families and, you know, being a really effective parent or grandchildren to the family they may have been separated from.

For each individual it looks really different and so the idea of focusing on what is the resident’s goal and how are they progressing towards that goal is a really great way of measuring the impact of the program versus either the process outcomes in terms of what your sort of inputs are and also any some sort of subscribed this is what success should look like.

Jessica Katz:  Yes, I’ll just add an example to that that sort of illustrates it. We had, at one of our buildings for young adults aging out of foster care, we had a job club and we were tracking very closely participation in the job club and how much people, how many people were showing up to it on any given day.

So the numbers were going up and up and up and we were all very proud of ourselves. And then the numbers starting going down very precipitously so we were trying to figure out what that was about sort of from the distance of the main office and were a little concerned about it.

Well, then we found out that the reason why people weren’t showing up for job club is because they had jobs. They were showing up to work. They couldn’t go to the job club anymore.

So we had succeeded but then we had this metric that was a little outdated.

Beth Fraster:  Yes, things aren’t always as they seem, huh? That’s great. And measuring outcomes is important and making sure that you’re measuring what you really want to measure is definitely even more important.

In Wyoming, Home Funds can only be used for public housing. Can you use Home Funds for these units?

Molly Rysman:  This is Molly and yes, we are using Home, Home is funding the Star. That must be a local state decision to use Home Funds that way but Home Funds can be used to provide funding to community-based developers to build housing.

Holly Denison:  I would say, this is Holly, and we lend to hundreds of projects every year, I would say we’re actually in a debate (unintelligible) between 30% and 50% of our projects use Home Funds. So it’s a very, very important source.

Beth Fraster:  Okay, thank you. And can someone speak to the average length of stay in these tenant buildings? How long are people with you on average and does it differ with the different types of housing model that you are using?

Jessica Katz:  I’ll take that; this is Jessica. In our congregate supportive housing projects our average length of stay is about three and a half to four years and it tends to be shorter at our HIV/Aids buildings and longer at our mental health buildings I think because people move on to need more physical, you know, need more like a nursing home kind of environment. But typically the average is about three and a half to four years which is, you know, I think a little longer than it is for a generic apartment in New York City so we feel quite proud of that length of stay.

Molly Rysman:  And this is Molly. Ours is similar. Our average length of residency is 3 years and we don’t see so much a difference between buildings as we see a difference between demographics such as we see folks who are under 35 tend to move quicker than individuals who are over 50 which is pretty normal.

You see that generally folks who are older want to stay put longer than people who are younger and have more changes in their lives going on. But we do find that the average is three years.

Holly Denison:  However both of you don’t have limits to how long people have to stay or can stay, right?

Molly Rysman:  No, we don’t have any and no permanent housing can have time limits. And we do find that some individuals, I mean we have a resident who’s been with us 21 out of our 22 years so some individuals decide to stay for a very long time.

Beth Fraster:  Okay. Here’s an interesting question that just came in that I’d like for you all to comment on and to think about. This came in from somebody’s building or planning a proposed housing model. She writes, some of our constituents have criticized the proposed housing model that we are considering building which includes a clinic and a day program as simply a move back to the old-fashioned institutionalized model of a sanatorium. How do you answer that?

Molly Rysman:  This is Molly; I can speak to that since we are doing a health clinic onsite at the Star. You know, it is definitely important that the residential component of what you’re doing and the services component be separated and that is part of the best practices of supportive housing is that the property management function and the terms of folks’ lease is not contingent on their engagement in services. So it’s actually very different.

But we do find that having services onsite in that proximity is extremely beneficial for the residents who want to use it. So we find that very successfully but you can’t, it can’t be a requirement. That’s not how the practice of supportive housing works.

So it is very different and like with the health clinic we’re doing at the Star, the entrance will be to the street and anyone in the community who wants to, can go into the health clinic. But the entrance to the residential portion of the building will be in a totally separate area so they’ll be completely separated; they’ll just be co-located which is different than the traditional institutional model.

Beth Fraster:  Thank you. Does anyone else have anything to add to that?

Yes, I think that the issue of choice and options is very different than institutionalized living.

And this question I think though does bring up another part of the picture though which is, have any of you had any experience serving individuals with complex needs who may need extra support sometimes 24 hours a day, 7 days a week who live in the community though? And do any of your programs offer such service?

Jessica Katz:  Hi, this is Jessica. I’ll take that. The only 24-hour care we provide is really a front desk person who can intervene in the case of an emergency and call the correct emergency service. But we do have a lot of folks particularly again in our HIV/Aids program housing that do require more care than is particularly provided by our onsite staff.

So we have a lot of people who have home health aides coming in either to just do a couple of times a week, just to do some housekeeping and food shopping with folks or people who really need more chronic nursing care. And, you know, we try and keep people in their own apartment as long as we can so that’s been a great resource for us is the visiting nurse service or some other type of home health aide.

Molly Rysman:  And this is Molly. Our program’s very similar in that, you know, folks have a range of needs and some folks do have higher needs than our program provides and they also use in-home health aides to get that care.

Generally once folks need 24-hour care it is more appropriate for them to be in some sort of skilled nursing setting although we’ll work with folks as much as we can because we do understand that health outcomes are better when people are in their own homes.

But I can’t think of anybody who currently has 24-hour care but we do, like I said, have folks with a variety of needs who may be getting additional supports that come in during the day to provide that.

Beth Fraster:  Okay, thank you. We just got another question that really has to do with funding and I think I want to get to that given the topic of this webinar but do any of these programs utilize the SOAR, S-O-A-R, model in acquiring SSI or SSDI for tenants? And can you please let the audience know what the SOAR model is before answering this question?

Molly Rysman:  This is — was somebody else going to speak?

Beth Fraster:  No, no, please, take that question.

Molly Rysman:  This is Molly. I was hesitating because I cannot explain the SOAR model that well although we do have a number of organizations in our community who are utilizing the SOAR model to help individuals who are eligible for social security or supplemental security income, get SSI.

We personally don’t do our own benefits advocacy. All of our benefits advocacy is through our partners so I’m not, like I said, the best person to explain the SOAR model although we do find that benefits advocacy is hugely important. Most of our residents who move in are not receiving any sort of long-term disability benefits although they are eligible.

Most are eligible and not receiving the benefit just because it is so hard to secure when you’re living on the street so that access to benefits advocacy is very important because it increases individual’s income and also has been very helpful in terms of health insurance in California.

Our Medicaid program is not available to anyone just because you’re low income so SSI is one of the few ways for individuals to get Medicaid so in that way it’s been very important. So we do find benefits advocacy really critical and that benefits advocacy be provided onsite or very nearby so residents can work towards securing that. And I guess that SOAR is implemented pretty extensively in Los Angeles.

Beth Fraster:  Okay. Somebody just wrote in about the Community Reinvestment Act and partnering with banks. He asks if there’s any observation regarding the Community Reinvestment Act and partnering with banks that you’ve come across.

Jessica Katz:  Sure, I’ll take that; this is Jessica. The Community Reinvestment Act or CRA is I think is pretty integral to our ability to do tax credit projects. We have a lot of banks who are interested in doing tax credit investments and providing construction loans that I think wouldn’t do so if it weren’t for needing CRA credits. So I think that’s been really integral to getting tax credit investors into the market.

Holly Denison:  And this is Holly Denison. A lot of CSH’s funds that we have available either for grants or loans, we get that money from banks and probably would not give us any money or at least not as good terms without having CRA requirements. So definitely very beneficial for us and for our projects.

Beth Fraster:  Thank you. And now from a different kind of end of the spectrum here, what percentage of the residents are veterans? And do any of you have specific services being offered for veterans right now?

Jessica Katz:  Hi, this is Jessica. We took a look and it looks like right now only about 6% of our current tenants are veterans. That might be a little bit skewed because we have a lot of programs for young adults aging out of foster care who for the most part are too young to have served. But we have only about 6%.

We do have two buildings that are starting construction this summer that are exclusively for formerly homeless veterans with a mental illness so we formed a veterans’ community advisory committee of veterans and veterans advocates to help us navigate that whole system which tends to be run completely parallel to the mainstream mental health system to help us get in more with the VA and find out what services are available to veterans and really create some cultural competency in our organization around veteran services.

Molly Rysman:  And this is Molly. We also are, our rates are about 7% of our residents report that they’re veterans although we don’t require folks to disclose that so we actually wonder if that’s an under-count of the number of veterans we have in our buildings.

We don’t offer ourselves specific services targeted at veterans but we do partner with the VA to have them come in to our buildings to help get folks connected to benefits through the Veterans’ Administration but we don’t have any specific programs for veterans.

We also don’t have any units set aside specifically for veterans. We have not utilized VASH up to this point so we haven’t had folks seeking that out.

Beth Fraster:  Okay. I think we have time for one more question and it seems to be a theme of questions coming in. Are there any other funding source suggestions that you can offer to cover operating costs for existing housing that is losing money due to client turnover in a scattered site model?

And many of you have been calling in wanting to be able to remember all the funding sources that you’ve offered so far but this one is really asking about an existing housing situation that’s losing money due to client turnover in a scattered site model.

Molly Rysman:  This is Molly. I was just going to speak to that because we do actually have two really creative operating sources in California that I know are unique to California but maybe they can be an inspiration for folks to advocate for in other communities.

When we think of operating we think of the rental assistance that really allows you to collect enough rent to be able to operate effectively. And in California our Mental Health Services Act, which was a state proposition to tax millionaires to support Mental Health Services, the Mental Health Services Act includes funding for operating subsidies which is really fantastic.

We personally have not used it at the Trust but I know other developers who have used it.

We also have some really creative thinkers who are running public health departments so Mitch Katz who was the public health director in San Francisco just came to LA and he’s actually been using health dollars to fund housing operations because he finds that it’s been a proven all over the country that it’s cheaper to have people in supportive housing than having them spending inpatient days in hospitals. So he’s using health dollars for frequent flyers of the public health system.

So that’s been really great to have those two sources available. It is, you know, housing retention is really critical to model the financially sustainable so also anything that can be done to reduce housing turnover certainly helps the bottom line. So anything that can be done in terms of services and support is also really helpful in terms of improving the bottom line by helping people stay longer in their homes.

Beth Fraster:  Thank you. Thank you, Molly, for that last question.

I have to end now and I know everybody is very interested in this topic. I want to thank everyone in our audience again for your time and interest in financing of permanent supportive housing for individuals with co-occurring mental and substance use disorders, challenges, successes and lessons learned.

It’s been a great webinar. I want to put out a special thank you to Kathryn Power for her opening remarks and for Piper Ehlen for serving as our facilitator and to Holly Denison, Jessica Katz and Molly Rysman for sharing their knowledge and expertise with us.

If you remember here is the web site where eventually this webinar presentation will live at the http://coce.samhsa.gov web site. Within 24 hours this web site can be accessed through the Verizon site and this address will be sent to you in an email along with our evaluation form.

We ask that you all send this evaluation form back. It’s how we develop new webinars for you that are taking into account your interests and the things that you need to learn. So please take the time to do that.

Please access these web sites; there’s great information on every slide. And with that I want to just say thank you again and this concludes our call for today.

Coordinator:  That concludes today’s conference. You may disconnect at this time.