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In a development that so far is seen mainly as benefiting treatment centers that traditionally work with the neediest clients, a growing number of addiction treatment facilities are gaining direct expertise as providers of permanent housing for individuals and families with substance use issues.
These facilities are finding that helping to meet clients’ housing needs can assist in building a stronger, more long-term relationship with these individuals, while also being potentially attractive to funders that are increasingly seeing unmet housing needs as a critical barrier to long-term recovery for persons with substance use disorders.
“Branching out into areas such as housing has completely transformed our agency from a specialty health provider to a multiservice provider capable of meeting the multiple needs of our clients,” Mark Hurwitz, CEO of Palladia, Inc. in New York City, told ADAW. “Housing is a major determinant of public health.”
Palladia in 2012 became one of five New York City treatment organizations to receive an initial round of funding under an Office of Alcoholism and Substance Abuse Services (OASAS) initiative to establish permanent supportive housing for families in which the head of household has a substance use disorder (see ADAW, Feb. 27, 2012). Later in the year, Palladia received a second housing grant from OASAS, under a separate housing initiative targeting high utilizers of Medicaid services such as individuals with numerous detox visits.
In all, Palladia now oversees nearly 450 units of permanent housing (some at sites it owns and the rest under scattered-site leasing arrangements), having been involved with various housing initiatives since the 1990s, said Hurwitz. Supportive housing under its control has allowed Palladia to see improvement in a situation where many of its clients were often caught in a revolving door of shelter and city jail stays.
“Many of the doctors who work with chronically ill individuals will say, ‘If I could write just one prescription, it would be for a unit of housing,’” Hurwitz said.
Assuming more control
Odyssey House was another of the five initial grantees under the OASAS housing initiative targeting families where the head of household has a substance use disorder (see ADAW, February 27, 2012). It now has received funding in two rounds of that program to secure a total of 35 apartments for families, said president and CEO Peter Provet, Ph.D.
Provet told ADAW that he believes addiction treatment agencies’ work in the permanent housing area can be successfully structured in more than one way — in fact, Odyssey House has looked into the possibility of entering a partnership venture with a housing developer in which it would lease units directly from the developer. But he does see advantages to a treatment agency building its own in-house expertise in fulfilling clients’ housing needs.
“In general, when you’re dealing with drug addiction, the more control you have, the better,” Provet said. “The addict has a way of splitting [service] systems; it’s part of the disease of addiction. The more agencies that are in the mix, the more complicated it gets to prevent that type of behavior.”
Like Palladia, Odyssey House now has a lengthy history of involvement with housing programs, having cut its teeth in this area via capital development grants from the state Office of Mental Health (OMH). Among its current projects, it is building two new housing facilities in the Bronx that each will serve 60 individuals with serious mental illness.
The OASAS project for which Odyssey House has secured funding for 35 apartment units targets chronically homeless families — Provet says those who benefit from the program are required to have been homeless for at least one year in the past two years.
Odyssey House and the other grantees under the program provide case management and wraparound services to clients; it is not a requirement of the grant program that grantees be delivering direct treatment services to clients that are receiving the housing. Clients are required to contribute a portion of their earnings/benefits toward rent.
Provet said that while it is important to recognize the importance of housing to a stable recovery, he believes the addiction treatment field must guard against buying into the assumption that secure housing and wraparound services alone will suffice for every individual.
“We don’t want to replace treatment with housing,” Provet said. “Housing is not treatment. In the past, some thought long-term residential was for everyone, and now we need as a field to be mindful of this pendulum swinging in the other direction. Housing with wraparound services makes sense for many, but not for all.”
Palladia’s Hurwitz is finding that payers and providers are generally shifting their thinking from seeing the treatment experience as a separation of patients from the community toward a vision of seeing treatment integrated into the community with a variety of social supports. In its staff’s being able to address a wider variety of the interconnected issues that can contribute to poor outcomes, Palladia “helps [clients] have a long-term trusting relationship with us through our staff, who can connect them with services and people,” Hurwitz said.
Public vs. private
To this point, it appears that direct involvement in permanent housing initiatives has captured more attention among treatment facilities that largely serve a lower-income population. Michael Walsh, president and CEO of the National Association of Addiction Treatment Providers (NAATP), told ADAW that he hasn’t heard of any NAATP member organizations moving to develop permanent housing for clients they’re serving.
Yet he added that he believes this could become part of more treatment centers’ plans in the future, for two reasons: because it would allow facilities to keep in closer contact with clients and therefore do a better job of tracking long-term outcomes, and because it is possible that permanent housing might ultimately generate less opposition from local communities.
Provet brought up another interesting twist to the discussion of permanent housing on the public-sector side. With the OASAS initiative for families targeting the homeless, one question that has arisen involves whether time spent in residential treatment for addiction should be considered a period of homelessness. Provet said his organization would interpret that period as being part of the homelessness stage, but he added that state and city regulations in New York appear to argue otherwise. •
New York’s Office of Alcoholism and Substance Abuse Services (OASAS) has awarded the first round of permanent supportive housing grants in New York City for families in which the head of household has a substance use disorder (SUD). The grants went to five treatment agencies that will use the funding to pay rent for these families, which are expected to be single-parent families. There will be 75 permanent supportive housing units funded with $1,875,000.The grants are for chronically homeless families and were announced last year (see ADAW, Dec. 5, 2011).New York City-based Odyssey House, one of the five grantees, has a history of helping people find places to live after treatment, and will use this grant for residents who are transitioning from treatment in one of its facilities. CEO Peter Provet, Ph.D., welcomed the support for families in treatment, saying one of the biggest barriers to recovery is where people will live after treatment.
Almost 60 percent of Odyssey House residents are homeless when they are admitted, although most are single adults who are not eligible for these units. For these single adults, Provet noted that many are “technically homeless but have a few options in terms or relatives or former relationships.” Part of treatment includes “mending past relationships, in particular with family members,” he told ADAW. “So the majority of these people go back to living with family members.” Still, 20 apartments will not be enough to fill the need.
The OASAS funding comes from a transfer from the Office of Temporary and Disability Assistance (OTDA), which was appropriated $1,875,000 in the fiscal year 2011 budget for supportive housing, said Jannette M. Rondo, spokeswoman for OASAS. The language accompanying the appropriation stated that the money could be made available to OASAS or other state agencies through a transfer or sub-allocation. “OASAS expressed interest in these funds and no other agency came forward seeking access to these funds,” said Rondo.
All five of the grantees are based in New York City and certified by OASAS to provide treatment services, and are also working with OASAS currently in providing permanent supportive housing to homeless people with SUDs.
The primary target population for the new grants is families living in OTDA homeless shelters, which are funded with federal Temporary Assistance for Needy Families (TANF) money. These family shelters are transitional housing facilities with an expected length of stay of about one year, with on-site staff supervision as well as child care and social services, said Rondo. About 92 percent of these families consist of single mothers with several children; the remaining 8 percent are mothers and fathers or fathers heading the household.
The second priority population for the grants — the group that will be served by Odyssey House — are women who entered OASAS-certified residential treatment programs with their children when they were homeless; the average length of stay to completion is also 9 to 12 months.
The families do not need to go into treatment first if they have remained in the family shelter for at least six months, said Rondo. “They are considered stabilized,” she said. In addition, all families who participate in the initiative will be given access to OASAS-certified outpatient treatment as well as recovery support services through the Recovery Community Centers now in New York City, some of which are funded by OASAS and some by the federal Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).
The first round of the housing initiative funds 75 apartment units with fiscal year 2012 money. Funding for a second round, which would support another 60 units, is included in the governor’s proposed budget for fiscal year 2013, and would be supported by an additional $1.5 million. By March 31, 2013, OASAS expects to have 135 family apartments fully operational with ongoing funding of $3,375,000. OASAS expects that there will be additional new funding rounds in coming years. New York’s commitment to funding housing for homeless people with SUDs started in 2006.
The family housing initiative is not time-limited — the state and New York City are committed to continue the program “as long as there is documented community need,” said Rondo. State funds are always subject to the annual budget appropriation process.
The process is “turn-key,” which means that the families will assume the responsibilities of signing a lease and paying the rent with a private landlord, said Rondo.
The supportive housing apartment units are not certified by OASAS; they are not transitional residential treatment “beds.” Rather, the units must have passed Department of Housing and Urban Development (HUD) housing quality standards, said Rondo. All buildings must have a documented Certificate of Occupancy, and the number of occupants per apartment must not exceed HUD standards in terms of ages and gender of children.
Some of the units are “scattershot” in nature, rather than all in the same building, reflecting the challenge of finding a single building in New York City. However, the grantees will find units that are as close together as possible so that families can support one another, said Provet.
The grant will help Odyssey House pay the rent for the 20 apartments as well as hire a case manager, a vocational counselor, and a clinical supervisor, said Provet. He said there is typically no problem with landlords accepting these residents, partly because they know the rent will be paid on time, and because the residents have “good behavior.”
In 2014, when the Affordable Care Act kicks in, OASAS expects that the federal Substance Abuse Prevention and Treatment block grant, which now must be used for treatment, will be committed to OASAS-run supportive housing, said Rondo. “However, it is not clear at this time whether SAMHSA will allow block grant monies to pay for ongoing rental subsidies in addition to paying for the costs of operational staff and support staff,” she said. Block grant funding is not allowed to be used for rental subsidies under current law.
OASAS is aware of the need for supportive housing programs outside of New York City. Currently, the OASAS housing portfolio includes about 200 family apartment units in the balance of the state, with most of them funded primarily through HUD grants that pay for the rental subsidies in combination with OASAS state aid monies that pay for case management and other supportive services in those programs.
“One of the critical elements of helping individuals to maintain their recovery from drug and alcohol addiction is stable housing,” said OASAS Commissioner Arlene Gonzalez-Sanchez in announcing the grants Feb. 13. “This grant provides a great opportunity to help them to rebuild their lives and provide a home for their families.”
The New York City Department of Health and Mental Hygiene will procure the additional units.
The five agencies identified to receive the OASAS awards are:
• Housing+Solutions (10 units in Brooklyn, $250,000)
• Women in Need (20 units in Manhattan, $498,900)
• Palladia (10 units in the Bronx, $250,000)
• Odyssey House (20 units in the Bronx, $499,900)
• BASICS (15 units in the Bronx, $374,925)
Housing support for homeless families with substance use disorders
Odyssey House has been selected by the New York State Office of Alcoholism & Substance Abuse Services (OASAS) to receive $499,000 in annual funding to provide 20 permanent supportive housing apartments with case management and vocational services staff for families who were homeless when they entered an Odyssey House intensive residential facility, and are now scheduled to complete that course of treatment.
This innovative housing model will target chronically homeless families; families at serious risk of becoming chronically homeless; and other currently homeless families, in which the head-of-household has a substance use disorder.
The award was announced by New York Governor Andrew M. Cuomo, who called the initiative “another component of the New York/New York III Agreement that has brought together many State and City agencies and departments in a multi-year effort to address homelessness.”
Odyssey House has significant experience working with families in residential and outpatient treatment settings as well as supportive housing programs. At any one time up to 210 women and children live in specially equipped family accommodations in one of the organization’s treatment centers. The comprehensive services provided include: intensive substance abuse, mental health, and family counseling; medical and dental care; vocational, educational, legal, and housing support; and onsite licensed childcare services that include nurseries and early Head Start programs.
Dr. Peter Provet, President and CEO of Odyssey House, welcomed the Governor’s support for families in treatment and added: “As our understanding of what it means to be in recovery evolves, and we develop programs that address the bio-psycho-social needs of families in treatment, the provision of safe, affordable housing is a key component of a holistic approach to treating substance abuse disorders.”
Click here to read the full press release.
The Odyssey House Theatre Project 2011 debuted their original production, “It’s A Different Day,” to a standing room-only audience at 320 Studios on May 9, 2011. The play, written and performed by an ensemble comprised of teens in treatment at Odyssey House, blends hip hop, dance, jazz, classical music, beatboxing, rap, art, spoken word, and short scenes together, and takes a look at the creation of our world from the beginning, to the middle and onward.
The performance was the culmination of a three month workshop in which the teens learned all stages of the playwriting process, from concept development to stage production. The Odyssey House Theatre Project is funded by a grant from the Elizabeth and Barets O. Benjamin Foundation. This is the third year the Foundation has funded the project.
The workshop was directed by Tom Demenkoff of PossibleArts. For more details on the project, visit the Odyssey House Theatre Project website.
Visit our website to see a slideshow of photos from the workshop.
Our Creating Healthy Eating Families (CHEF) program, which focuses on improving the basic nutrition and eating habits of parents and their children, wrapped up its first cycle at Family Re-Entry with a potluck dinner. Residents each prepared several vegetarian dishes demonstrating what they learned during the program. Dishes included bok choy and mushroom stir fry; kale lasagna with whole wheat noodles; and brown rice with broccoli.
At the potluck, participants raved about the program and talked about the changes they had made in their diets as a result. One resident, Teresa, was able to reduce her cholesterol medication by making healthy substitutions, like baking instead of frying. Bernadette, who said she was skeptical of the program at first – “I like fried foods and large portions!” – started using fresh herbs to flavor her food and reduced her sodium intake. Gilbert said CHEF taught him to be mindful of what he was eating and how it affected his health.
Participants met with nutritionist Paulette Sinclair-Weir twice a week for six weeks and learned about topics such as reading nutrition labels, reducing portion sizes, increasing fruit and vegetables, and food safety. Sessions included hands-on cooking instruction to let participants implement their new skills.
The CHEF program was created with a $25,000 grant from Aetna. For more information on the grant, click here.
The Odyssey House Theatre Project for adolescents in treatment will start a new season of performance, writing, and production skills training in early 2011, thanks to a $38,500 grant from the Elizabeth and Barets O. Benjamin Charitable Foundation. This is the third grant the Foundation has made to this innovative theatre project that teaches teens with substance abuse and related disorders how to express themselves through creative writing and performance.
The 2011 grant will support a three-month-long intensive writing and acting curriculum that culminates in the production of an original play written and performed by the teens for a professional stage. The program also includes field trips to expose the students to a variety of NYC live theatre productions, a series of summer workshops, and program evaluation.
This year’s 2010 Odyssey House Theatre Project participants wrote and performed an original play called “When you Shake the Tree,” which looked at what it means to be a teenager forced to grow up fast in a city where drugs, drink, and sex are all in the family. Broadway veteran Norm Lewis, who recently starred in the hit show “Sondheim on Sondheim,” is closely involved in the project as acting coach, spokesperson, and mentor. Norm calls the teens’ work “a surprisingly vibrant shake up of family life: the secrets, the hurts, and the healing.”
Odyssey House President Dr. Peter Provet emphasized this pioneering project would not be possible without the support of the Foundation’s Trustees. “Their commitment to providing underserved youth with creative outlets available to more affluent teens is increasingly rare in the nonprofit world. For our young people, who typically come from families and communities on the margins of society, the program offers significant benefits that carry over in their engagement in treatment and overall improved self-esteem. We owe a debt of gratitude to the Foundation for not only bringing this project to life, but for staying with it as it grows.”
Odyssey House will be developing a new health and wellness initiative called the Creating Healthy Eating Families (CHEF) curriculum through a $25,000 grant from Aetna. The new program will provide hands-on nutrition and cooking classes for mothers living with their children in the Odyssey House Family Centers. The grant will allow Odyssey House to focus on improving the basic nutrition and eating habits of mothers and children, including crafting individual obesity prevention plans to establish goals in the areas of food selection, eating behaviors and frequency of exercise.
Odyssey House treats women identified as being the most at-risk of obesity and developing obesity-related health problems. Most women in our programs are 20-34 years old (the age range that has the fastest growing rate of obesity), mostly ill-educated, and come from impoverished families and communities. Among women, the age-adjusted prevalence of obesity in racial and ethnic groups is higher among African-American and Hispanic women than other groups. More than 90 percent of the approximately 200 women in the Odyssey House Family Centers come from these two groups.
In addition to the documented racial disparity, minimal healthy food options in lower socioeconomic neighborhoods, poverty, excessive postpartum weight retention, and recovery from substance abuse, all contribute to increased risk of obesity. The CHEF program will promote behaviors to improve diet and exercise.
“This is the third grant awarded to Odyssey House by Aetna, and the second to incorporate diet and exercise among our treatment population,” said Odyssey House President Dr. Peter Provet. “With obesity among the top public health concerns facing today’s children, programs such as Odyssey House, where families live with us for several months, offer a unique opportunity to educate parents on the importance of choosing healthy foods for their families.”