MARYLAND DEPARTMENT OF HEALTH Housing Options and Resources:

MARYLAND DEPARTMENT OF HEALTH Housing Options and Resources:

MARYLAND DEPARTMENT OF HEALTH Housing Options and Resources: Opening the Door to Recovery Russell Springham, LCSW-C Behavioral Health Administration, Clinical Services Division, Office of Evidence-Based Practice, Housing and Recovery Supports Friday, Oct. 19, 2018 Overview Behavioral Health Administration (BHA): Formally the Mental Hygiene Administration and the Alcohol and Drug Abuse Administration. Core Service Agencies (CSA) Local Addiction Authorities (LAA) and Local Behavioral Health Authorities (LBHA): Located in local Health Departments or free standing agencies, they are local mental health and addiction authorities. Administrative Service Organization (ASO): Beacon Health Options (managed behavioral health care service authorization, claims, payments).

2 Current Housing Resources Continuum of Care (COC) formerly Shelter Plus Care Residential Rehabilitation Program Permanent Housing 3 Continuum of Care Grand Total CoC: 305 units approved by U.S. Housing and Urban Development (HUD). Excluded are: Montgomery, Garret, and Howard Counties as well as Baltimore City Grant funded program through HUD Provides rental assistance for permanent housing to individuals and families with an adult member who has a mental illness or co-occurring disorder and is homeless For more information on eligibility and how to apply, contact the CSA/LBHA of origin for the applicant

4 Permanent Supportive Housing Permanent Supportive Housing (PSH): Housing for individuals served by the Public Behavioral Health System (PBHS) where the person is the lease holder. Housing units are subsidized or affordable. Services are available but not required, and can include offsite Psychiatric Rehabilitation Program, Mental Health Case Management, or Assertive Community Treatment/Mobile Treatment. 5 Residential Rehabilitation Residential Rehabilitation Programs (RRP) 50 programs statewide Total number of RRP beds: 2,496 General Level beds: 863 | Intensive Level beds: 1,633 RRP: Provides a home-like, supportive residential environment Promotes the individuals ability to engage and participate in appropriate

community activities Enables the individual to develop the daily living skills needed for independent functioning 6 Residential Rehabilitation RRP has two levels of care: General and Intensive General Level of Care: Minimum of 13 face-to-face services in the residence monthly. Intensive Level of Care: Minimum of 19 face-to-face services in the residence monthly, with staff on site seven days per week, for a minimum of 40 hours per week. Both levels of care have 24 hour/day on call staff availability. 7 Residential Rehabilitation RRP is accessed by submitting an application to the CSA or LBHA of the county of residency Eligibility is determined by the CSA/LBHA using the BHA priority

population definition and medical necessity criteria applied by the ASO The CSA/LBHA reviews applications, tracks vacancies, maintains waiting lists if necessary, and refers applications when beds become available The RRP application is on the BHA website: http://bha.dhmh.maryland.gov/Pages/Forms.aspx 8 Specialty RRP Housing 9 Transition Age Youth (TAY) Baltimore City, Baltimore, Calvert, Carroll, Charles, Frederick, Howard, Montgomery, Prince Georges, St Marys, and Wicomico Counties Developmental Disability/Mental Health

(DD/MH) Anne Arundel, Carroll, Frederick, and St. Marys Counties Integrated Treatment for Co-Occurring Disorders (ITCOD ) Frederick and Montgomery Counties Deaf and/or Hard of Hearing Baltimore City, Anne Arundel, Baltimore, Frederick, and Prince Georges Counties Geriatric Baltimore City, Anne Arundel, Frederick, Prince Georges, and Wicomico Counties

PSH Public behavioral health systems are required by federal law to provide services in integrated community settings (U.S. Supreme Court, Olmstead vs. LC). PSH is an evidence-based practice (EBP) for assisting persons with severe mental illness find and maintain housing in integrated settings in the community of their choice. EBP toolkit for PSH on the SAMHSA website: http://store.samhsa.gov/product/Permanent-Supportive-Housing-Eviden ce-Based-Practices-EBP-KIT/SMA10-4510 10 PSH Key Elements Tenants having a lease in their own name and the full rights of tenancy under landlord-tenant law Leases do not have any special provisions that would be found in the leases of someone without a mental health disability Support services are available and accessible, but are voluntary, and not required, so a person cannot be evicted for refusing services Rules within the housing are the same as for persons without mental health

disability, and do not restrict who may visit or interfere with the persons life within the community 11 PSH Key Elements The housing is not time-limited and the lease is renewable at the tenants or owners option Prior to moving into PSH, tenants are asked about housing preferences, and are offered the same range of choices available to others at their income level in the same housing market Housing is affordable with tenants paying no more than 30 percent of their household income toward rent and basic utilities (gas, electric, water) Housing is integrated, best achieved in scattered-site locations throughout the community, in order to live in communities or buildings where a majority of persons do not have a mental health disability 12 PSH Key Elements Tenants have choice about the support services they receive, being offered a

range of services, most frequently including Assertive Community Treatment (ACT) or intensive case management. And all such services are focused on a person-centered approach As the tenants needs change over time, they can receive more or less intensive services without losing their housing Support services are designed to promote recovery and help tenants to choose, acquire, and keep housing And finally, the provision of housing and support services are distinct, being provided by separate property management and support services; or if by staff from the same agency, those persons and roles do not overlap 13 Approach Methods Approaches to helping PSH tenants find affordable housing include: Project-based rental assistance: Housing subsidies tied to a particular unit and tenants who chose to live in those units pay a reduced rent Sponsor-based rental assistance: A non-profit agency receives support to buy or lease housing that is then leased to qualified tenants Tenant-based rental assistance: A tenant receives a voucher, entitling the

tenant to a reduced rent, which can be used to rent a unit of the tenants choice from a landlord who agrees to accept the voucher 14 Approach Methods The three approaches can be used to provide services to tenants in two types of settings: Single-site housing is housing in which tenants who receive support services live together in a single building or complex of buildings, with or without on-site support services Scattered-site housing is housing in which tenants who receive support services live throughout the community in housing that can be agencyowned or privately-owned 15 Person-Centered Assessment

16 Person-centered, face-to-face interview Identify: Strengths, assets, preferences, needs, challenges Educate about housing options to ensure informed choice Develop strategies for accessing programs Common Challenges Common challenges and barriers to accessing housing for people with disabilities include: Lack of affordable housing in Maryland Utility arrearages Social Security Income (SSI) maximum benefit amount below Federal Poverty Level (FPL) ($750/month)

Lack of needed documentation: (Social Security card, Social Security Administration (SSA) award letter, Photo ID, Birth Certificate, income verification, etc.) Criminal background checks Credit checks and rental histories 17 Housing waiting lists Documentation Housing Documentation Checklist (work on this sooner, rather than later): Birth certificate (all household members) http://dhmh.maryland.gov/vsa/Pages/birth.aspx Valid government-issued photo ID (passport or state ID)for all household members over 18 Social Security card (all household members)

Proof of citizenship/legal status (if applicable) Child custody Court documentation showing custody or guardianship (if applicable) Divorce decree or separation agreement (if applicable) 18 Identifying Challenges Identify any challenges to accessing housing programs as soon as a person expresses interest in applying: 19 Credit Criminal

Personal Rental History Overcoming Credit Issues Credit is one of the primary factors that property managers consider when determining whether or not to accept an applicant. We help: 1. Obtain a free copy of his/her credit report/understand this information 2. Access legal services if needed (e.g., local Legal Aid office) 3. Identify community resources to assist with paying outstanding debt (e.g., faith-based organizations) 20 Overcoming Credit Issues (continued) 4. Contact a previous landlord or creditor to request a waiver or reduction in payment of debt 5. Determine if a disability or medical issue impacted a persons ability to

maintain good credit 6. Write a letter requesting a reasonable accommodation from the landlord regarding disability-related credit issues 21 Overcoming Criminal Background Case managers should be familiar with how to assist a person to review a criminal record, expunge a criminal record, and submit a reasonable accommodation request. Action steps include: Step 1: Develop a trusting relationship Step 2: Explore the persons past in order to potentially obtain housing Step 3: Check Maryland Judiciary Case Search system and verify accuracy Step 4: Remove open warrants and seek legal counsel if necessary 22 Overcoming Criminal Background

(continued) Step 5: Help the person understand rules/policies regarding criminal activity and housing Step 6: Determine if a change in health/medical situation influenced the behavior Step 7: Support commitment to acceptance of rehabilitation or other supports/services Step 8: Assist with connecting to community resources 23 Overcoming Rental History Case managers should be familiar with how to review rental history and present extenuating circumstances. Action steps include: Step 1: Identify past challenges to rental history Eviction record? Trouble paying rent on time? Difficulty getting along with neighbors? Ability to maintain a safe living environment? Ability to understand tenant obligations?

24 Overcoming Rental History (continued) Step 2: Determine if a persons health, medical, or disability situation impacted tenancy Step 3: Help the person to write an explanation of circumstances Step 4: Reach out to previous landlord to obtain a positive reference Step 5: Assist with connecting to communitys supports/services to overcome current/future challenges to rental history 25 Reasonable Accommodation 26 Reasonable Accommodation Reasonable Accommodation is a change, exception, or adjustment to a rule,

policy, practice, or service that may be necessary for a person with a disability to have an equal opportunity to use and enjoy a dwelling. Reasonable Accommodations require a housing provider to do more: They must make changes in rules, procedures, policies, practices, or services if necessary to afford a person with a disability equal opportunity to use and enjoy a dwelling. 27 Reasonable Accommodation Applying for housing Screening: Credit, criminal background, rental history Household members: Live-in aide, Service or Emotional Support Animals Searching for housing: Search time, high rents, number of bedrooms, acceptable housing types 28

Reasonable Accommodation If you need a reasonable accommodation, you must ask for it. Put your request in writing to the property owner and keep a copy Request must share the fact that you have a disability (you need not share details about your disability) Describe what you want changed and why you need to have the change 29 Reasonable Accommodation In most cases, a property owner has the right to ask for proof that you need the reasonable accommodation. Your medical provider or case manager can write a letter on your behalf Use My Sample Letter for Requesting a Reasonable Accommodation to plan such a letter. Keep a copy of your letter, and be sure it has the date 30 Moving Prep

Plan, plan, plan Identify key individuals Connect with everyone who will be involved Plan a meeting to identify roles and responsibilities of everyone involved in the transition/move Identify items needed for the transition 31 Moving Prep At the meeting, the following questions should have been answered: What is the date and time of the transition/move? How will the participant get to their new residence? Who will help them pack and move their belongings? Do they have a local pharmacy and will their medication be ordered prior to the move? Have medical appointments been scheduled with primary care and mental health providers in the community? Do they have a checking/savings account set up?

32 Do they have their security deposit? Good Tenancy Paying rent on time Maintaining the unit Engaging in friendly neighbor relationships Complying with the terms of the lease Communicating with the property manager Understanding tenant responsibilities 33 Good Tenancy (continued) Knowing who to call and when to call these individuals My Own Front Door: A handbook for people with disabilities on becoming a tenant and staying housed

http://mdod.maryland.gov/housing/Documents/My%20Own%20Front%20Door%20finalPWP.pdf 34 35 Maryland Housing Initiatives Weinberg Initiative Housing First Pilot Project Section 811 Project Rental Assistance (PRA) 36 Weinberg Initiative The Affordable Rental Housing Opportunities Initiative for Persons with Disabilities Partnership between The Harry and Jeanette Weinberg Foundation and the state Provide affordable rental housing options for persons with disabilities Seeks to increase accessible, affordable, and independent housing opportunities

37 Weinberg Initiative (continued) FUNDING House non-elderly, disabled persons at 15-30 percent of Area Gross Median Income (AGMI) Eligibility criteria includes the ability of a tenant to pay up to 30 percent of their income in rent 38 Housing First Pilot BHA and Behavioral Health System Baltimore, in collaboration with the Montgomery County and Prince Georges County LBHAs: Developed and implemented the Housing First Project Serve individuals in Baltimore City, Montgomery County, and Prince Georges County

This project provides assistance to 72 individuals to locate, secure, and maintain permanent housing 39 Housing First Pilot Services include: Housing advocates that assist individuals in securing housing and communicating with landlords, and provide supported housing services to help individuals maintain housing Housing inspections to ensure housing quality Representative payee services for individuals who are required to have a payee by the SSA Housing subsidies to assist in making housing affordable for those in the program 40 Housing First Pilot Eligible individuals: Those with mental illness or a mental illness and a cooccurring substance use disorder who are:

Homeless or at risk for homelessness and served by the Supplemental Security Income/Social Security Disability Insurance (SSI/SSDI) Outreach Access and Recovery (SOAR) Program To be discharged from a state psychiatric hospital to live in any of the three jurisdictions Transitioning from a RRP in any of the three jurisdictions to permanent housing Additionally, all individuals served through this project must have incomes at least 50 percent below the area median income (AMI). 41 Section 811 PRA 42 Section 811 PRA 43

Affordable Housing Partners The Maryland Partnership for Affordable Housing (MPAH): Began in 2011 with grant funding from the Centers for Medicare and Medicaid Services (CMS) and HUD Collaborative partners included the Maryland Department of Healths BHA and Developmental Disabilities Administration (DDA), Money Follows Person, Department of Housing and Community Development (DHCD), Maryland Department Of Disabilities (MDOD), Centers for Independent Living (CILS), consumer organizations, and housing developers Implementation and maintenance of an internet-based affordable housing registry through DHCD and MDOD at www.mdhousingsearch.org and www.socialserve.com 44 Affordable Housing Partners (continued) Applied to HUD for Section 811 PRA Demonstration Project was awarded $20.7 million between two awards to develop 300 units of HUD 811 Projectbased rental assistance DHCD is currently working with MPAH housing developers to create or rehab

existing housing and are training case managers to assist individuals. The Social Serve registry is used to determine eligibility and place individuals on waiting lists 811 housing first became available in 2016 and 2017 and will continue through 2019 45 811 PRA Overview Goal: 300 permanent supported housing units Program Type: Project Based Rental Assistance Located in multi-family housing developed with affordable housing development funds Integrated no more than 25 percent of units designated for people with disabilities 46 811 PRA Overview

Eligible Applicants: Age 18 to under age 62 at time of leasing Disabled as defined by HUD Medicaid recipients Income at or below 30 percent AMI includes SSI level income Tenant Rent Contribution: 30 percent of income for rent and utilities combined 47 811 PRA Population 1. Institutionalized: Nursing facility, Intermediate Care Facilities for Individuals with Intellectual Disability, state psychiatric hospital or hospital where assistance is available under Medicaid 2. At risk of institutionalization due to current housing situation: Homebound or deplorable housing conditions 3. Moving to independent renting: DDA Community Pathways waiver Group Home and Assisted Living Unit, Brain Injury Waiver ALU, BHA Residential Rehabilitation Program

48 811 PRA Population (continued) 4. Homeless (as defined by HEARTH Act) in this order: Actually homeless Imminent risk of homelessness Homeless under other Federal statutes (i.e., unaccompanied youth/families with youth) Fleeing domestic violence 49 811 PRA Units County 50

Property Total 811 Units Location 1 BR 2 BR Estimated Leasing Start Anne Arundel Berger Square Odenton

8 0 8 Fully leased Anne Arundel Towne Courts Annapolis 6 4 2

Early 2019 Baltimore City Riviera Baltimore City 5 4 1 May 2018 outreach in process Baltimore City

300 North AKA Warwick Apts. Baltimore City 12 8 4 Summer 2018 Baltimore City East Baltimore Historic III Baltimore City

2 2 0 July 2018 outreach in process Baltimore City Greenmount & Chase Baltimore City 9 9

0 Summer 2019 Baltimore City Walbrook Mill Baltimore City 10 10 0 Spring 2019 811 PRA Units

County 51 Property Location Total 811 Units 1 BR 2 BR Estimated Leasing start Baltimore Merritt Station

Dundalk 11 0 11 June 2018 leasing in process Baltimore Preserve at Red Run Owings Mills 11

11 0 Summer 2018 Baltimore Red Run Station Owings Mills 11 7 4 Spring 2019

Calvert Calvert Hills East Prince Frederick 12 9 3 Spring 2019 Frederick Sinclair Way

Frederick City 11 8 3 Leasing for 1 turnover unit in process Frederick 520 Market St Frederick City 5 4

1 Fall 2018 property meetings in process 811 PRA Units County 52 Property Location Total 811 Units 1 BR

2 BR Estimated Leasing Start Harford Riverwoods at Tollgate Abingdon 13 0 13 Fully leased Harford

Rock Spring Station Forest Hill 9 8 1 Winter 2019 Montgomery Scotland Townhomes Potomac

5 0 5 Summer 2018 property meetings in process Montgomery Woodfield Commons Damascus 13 13

0 Summer 2018 Montgomery Momentum at Shady Grove Derwood 10 Prince Georges Bladensburg Commons Bladensburg

15 15 0 Fully leased Prince Georges Brinkley Hill Ft. Washington 5 0 5

Fully leased Prince Georges Parkview Manor Hyattsville 6 3 3 Fall 2018 Summer 2019

811 PRA Units County Property Location Total 811 Units 1 BR 2 BR Estimated Leasing Start Queen Annes Village at Slippery Hill

Grasonville 5 5 0 Spring 2019 Queen Annes Willows at Centreville Centreville 5 5

0 Summer 2019 St. Marys Patuxent Crossing Lexington Park 5 5 0 Fall 2018

AKA Queen Anne Park 53 Talbot Galloway Meadows Easton 4 3 1 Fall 2018 Washington

Hopewell Station Hagerstown 4 3 1 Fall 2018 Wicomico Homes at Johnsons Pond Salisbury

4 4 0 April 2018 Leasing in process Section 811 Unit Locations 54 Resources Agency or Online Tool Social Security Administration US Department of Housing and Urban Development Consumer Credit Counseling Services of

Maryland and Delaware Annual Credit Report Guide to Expungement of Nuisance Crimes Maryland Judiciary Case Search Disability Rights Maryland (MDLC) Public Housing Authority Locator 55 Website www.ssa.gov http://portal.hud.gov/hudportal/HUD www.CCC-inc.org or 1.800.642.2227 www.annualcreditreport.com or 1.877.322.8228 http://www.courts.state.md.us/district/forms/criminal/dccr072a. pdf http://casesearch.courts.state.md.us/inquiry/inquiry-index.jsp https://disabilityrightsmd.org/

http://www.hud.gov/offices/pih/pha/contacts/states/md.cfm Resources Agency or Online Tool Housing Choice Voucher Guidebook Craigslist (Furniture, Apartment, Roommates) Weinberg Initiative HUD Section 811 PRA Demo. Baltimore Free Store SNAP Program/Food Stamps Go Section 8 56 Website http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_in dian_housing/programs/hcv/forms/guidebook www.craigslist.com

http://mdod.maryland.gov/housing/Pages/MPAH.aspx http://www.dhcd.maryland.gov/Website/Programs/Section811/Default .aspx http://freestorebaltimore.org/ http://www.dhr.state.md.us/blog/?page_id=5514 www.gosection8.com Resources Agency or Online Tool MD Housing Search Social Serve Fair Housing Act Reasonable Accommodations MD Motor Vehicle Administration Area Median Income MARYLAND CENTERS FOR INDEPENDENT LIVING (CIL) 57

Website www.mdhousingsearch.org www.socialserve.com http://portal.hud.gov/hudportal/HUD?src=/program_off ices/fair_housing_equal_opp/FHLaws/yourrights http://www.hud.gov/offices/fheo/library/huddojstateme nt.pdf 410.768.7442 or www.mva.maryland.gov http://dhcd.maryland.gov/website/programs/prhp/Docu ments/2013_MD_Income_Limits.pdf http://www.msilc.org/map.html Contact Russell T. Springham, LCSW-C Case Management and Housing Coordinator Maryland Department of Health Behavioral Health Administration

Clinical Services Division Office of Evidence-Based Practice, Housing, and Recovery Supports Spring Grove Hospital Center Dix Building 55 Wade Ave., Catonsville, MD 21228 Phone: 410-402-8351 Email: [email protected] 58

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