Promoting Better Health and Housing Outcomes by AIDS Foundation of Chicago

The SAMHSA Consortium Strategic Plan

Promoting Better Health and Housing Outcomes The SAMHSA Consortium Strategic Plan

The SAMHSA Consortium Strategic Plan

September 2013

Dear fellow stakeholders,

The AIDS Foundation of Chicago (AFC) is pleased to present you with this report, which includes the Substance Abuse and Mental Health Services Administration (SAMHSA) consortiumâ&#x20AC;&#x2122;s twenty-three recommendations, as well as the background briefs that detail the scope of our mission and goals to improve and expand services in Cook County. In the fall of 2011, SAMHSA provided AFC with resources to convene a consortium of health and human service leaders in Cook County. SAMHSA charged the consortium with preparing and implementing a strategic plan to improve the lives of people who have experienced homelessness and have histories of mental illness and/or substance and alcohol use. Over the past eighteen months, nearly one hundred public and private stakeholders from four major service sectors participated in the creation of the plan, which consortium leadership unanimously approved this past April. The four systems we aim to integrate include supportive housing, coordinated health care, benefits and entitlements, and homeless outreach. The plan compliments other initiatives that include the Affordable Care Act and related Medicaid expansion, the Chicago Central Referral System for people who are homeless, and the Together4Health care coordination entity. Together, these promise to improve housing stability and health outcomes for our vulnerable target population and bring significant cost savings to taxpayers. We thank you for your support and look forward to your continued participation as we begin implementing the plan. Sincerely,

David Ernesto Munar President/CEO AIDS Foundation of Chicago

Arturo V. Bendixen Executive Director Center for Housing and Health

The SAMHSA Consortium Strategic Plan

The SAMHSA Consortium Strategic Plan necessary for change. A needs assessment survey also informed the groundwork for the strategic plan and was sent to more than 200 representatives of the health, social service, policy, advocacy, and consumer communities in the fall of 2012. The steering committee then provided feedback to the initial draft of the plan at its November meeting.

On April 18, 2013, the Committee approved the strategic plan presented here. Over the next three years, the plan calls for a comprehensive capacity expansion and innovations in Cook County that will: • Increase the number and variety of supportive housing units. • Enroll our population into coordinated care services. • Simplify and expand eligibility for and access to benefits, services, and housing. • Increase and strengthen outreach to link individuals to housing and health services. The SCCC strategic plan works in synergy with several other state, county, and local initiatives, including Chicago’s Plan 2.0 to End Homelessness, CountyCare, and the Illinois Department of Healthcare and Family Services’ pilot Innovations Project, which develops new coordinated care entities that will bring the ACA’s medical home concept into broader practice.

Promoting Better Health and Housing Outcomes

While the environment poses formidable fiscal challenges, the collaboration and its strategic plan offer timely recommendations in delivering housing and health care. The plan presents a roadmap for local policymakers, agencies, and other stakeholders to leverage this momentum toward alleviating the human and financial costs of homelessness in Cook County.

The SAMHSA Consortium Strategic Plan: Executive Summary This report was developed, in part, under grant CABHI TI023567-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. More than 93,000 people in Cook County are precariously housed or homeless over the course of a year.1 Underlying behavioral issues, chronic medical diseases, disability, and economic disparity often complicate this population’s ability to access and maintain stable housing. The county government currently believes that nearly 1,400 adults are chronically homeless, spending extended periods on the streets or cycling in and out of shelters, hospitals, and jails, where they consume a disproportionate amount of costly and limited public services. The Affordable Care Act (ACA) and related state and local initiatives offer Illinois a challenging opportunity to address the needs of some of our most vulnerable citizens: homeless peope with serious mental illness and/or histories of substance and alcohol abuse. By dramatically streamlining and expanding access to Medicaid for low-income people, health reform opens the door to better care for millions of previously uninsured Americans. The ACA also responds to the need for measures that will contain health care costs while improving patient outcomes. By calling for new models of person-centered, coordinated care (also known as medical homes), the ACA promotes an integrated system of physical and behavioral health support, breaking down traditional service silos that have compromised continuity of care for homeless people with multiple, complex health issues.

Numerous studies over the past two decades have shown the importance of stable housing in overall health and life outcomes. Permanent supportive housing, for highly challenged homeless populations, has proven to be a cost-effective intervention that significantly reduces more expensive alternatives (that is, emergency rooms, hospitals, and jails).

Based on these findings, federal agencies, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), have begun to allocate dollars for integrated housing with primary care and behavioral health treatment, requiring in addition that diverse agencies and sectors work together to bring these innovations to scale.

The SAMHSA Chicago Community Consortium (SCCC) is one such cross sector strategic collaboration. Formed in late 2011 under the aegis of a three-year SAMHSA grant awarded to AIDS Foundation of Chicago, the SCCC comprises members of more than forty organizations—including local and statewide advocacy, mental health, substance use, health care, social service, housing service, and homeless coalition groups—as well as representatives of city, county, state, and federal government agencies. The consortium’s overall goals are to: 1) increase systems-level capacity to coordinate and integrate recovery-oriented models of care that improve health and housing stability outcomes among a highly challenged homeless population; and 2) expand access to evidence-based behavioral health services and coordinated care for people who have experienced homelessness as well as serious mental illness and/or long-term histories of substance or alcohol use in Cook County. The SCCC steering committee began to identify and assess the key challenges this population faced in early 2012—a cohort that increasingly includes veterans and people who are formerly incarcerated. It charged nine SCCC workgroups to advance the collaboration’s strategic plan. Workgroups met during the summer of 2012 to prioritize needs as well as policies and practices 1

Chicago Coalition for the Homeless. “The Facts Behind the Faces.” Fall 2011.

The SAMHSA Consortium Strategic Plan

SAMHSA Community Consortium Leadership Council and Steering Committee

Jesse Brown VA Medical Center Luz Hein, Chief, Social Work Service *Eugene Herskovic, VISN 12 Homeless Coordinator

Please note, consortium steering committee members are preceded by an asterisk (*)

Renaissance Social Services *Michael Banghart, Executive Director

AIDS Foundation of Chicago: Arturo V. Bendixen, Executive Director, Center for Housing and Health, and Director, SAMHSA Chicago Community Consortium Marty Hansen, Associate Director, SAMHSA Chicago Community Consortium *Angelique Miller, Director, Access to Wellness SAMHSA Project Alliance to End Homelessness in Suburban Cook County *Jennifer Hill, Executive Director

Sinai Health System *Lori Pacura, Vice President of Patient Care Services, Chief Nursing Officer Supportive Housing Providers Association *Lore Baker, Executive Director Thresholds Mark Ishaug, Chief Executive Officer

Chicago Alliance to End Homelessness *Nonie Brennan, Chief Executive Officer Chicago Department of Family and Support Services *John Pfeiffer, First Deputy Commissioner Chicago Department of Public Health Tony Beltran, First Deputy Commissioner *Bechara Choucair, M.D., Commissioner Chicago Housing Authority *Mary Howard, Vice President, Resident Services Chicago Low-Income Housing Trust Fund *Cary Steinbuck, Executive Director Corporation for Supportive Housing *Betsy Benito, Illinois Director Cook County Criminal Court *Judge Paul Biebel, Presiding Judge Cook County Health and Hospitals Systems *Sidney Thomas, Director of Provider Relations Health and Disability Advocates Stephanie Altman, Program and Policy Director *Sue Augustus, Chief Operating Officer Heartland Health Outreach *Karen Batia, Vice President Heartland Alliance, Executive Director Ed Stellon, Senior Director, Systems Integration Illinois Department of Human Services *Theodora Binion, Director, Division of Alcoholism and Substance Abuse, and Acting Director, Division of Mental Health Gustavo Espinosa, Executive Director, Region 1 Central-Manager, Division of Mental Health Khen Nickele, Division of Mental Health â&#x20AC;&#x201C; Region 1 Central Illinois Department of Healthcare and Family Services *Julie Hamos, Director Sharron Matthews, Assistant Director Gabriela Moroney, Senior Policy Advisor Robyn Nardone, Senior Health Care Policy Advisor Illinois Housing Development Authority Sam Mordka, Sr. Housing Program Coordinator/Interagency Liaison

The SAMHSA Consortium Strategic Plan

The SAMHSA Consortium Strategic Plan 2.5 By June 2015, enroll all eligible individuals in the target population who are in jails into Medicaid and coordinated care services, effective upon release 2.6 By June 2016, enroll at least 75 percent of individuals in the target population into coordinated care services that are well-funded through Medicaid and other sources 3. Simplify and expand eligibility for and access to benefits, services, and housing Streamline and expand the target population’s eligibility for and enrollment in benefits to improve access to health care, housing, and supportive services 3.1 By December 2013, enroll at least one-thousand members of the target population into the Chicago Central Referral System, and at least another eight-hundred individuals by June 2016 3.2 By December 2013, help members of the target population leaving jail reconnect with Medicaid, SSI/SSDI, and VA benefits 3.3 By December 2013, secure Social Security presumptive eligibility for SSI/SSDI benefits for persons with schizophrenia in the target population

SAMHSA Chicago Community Consortium

3.4 December 2014, ensure that at least 90 percent of the target population is enrolled in Medicaid, including Medicaid expansion, and that the process for enrollment is streamlined and accessible

Strategic Priorities and Recommendations

3.5 By December 2014, expand access to benefits and services for the target population through “one door” opportunities

By June 2016, the SAMHSA Chicago Community Consortium will achieve four strategic priorities for people in Cook County who have experienced homelessness and live with (a) serious mental illness and/or (b) long-term histories of substance or alcohol use. 1. Increase the number and variety of supportive housing units for the target population Provide more and a greater variety of supportive housing units, in order to reduce homelessness, improve housing stability, address special needs, and decrease costs

4. Increase and strengthen outreach to link the target population to housing and health services Provide more and improved outreach to assure that the target population can access needed housing and health services 4.1 By December 2014, support the work of outreach teams by providing them with the necessary tools, resources, and worker-to-participant ratios

1.1 By December 2013, survey the variety of services in permanent supportive housing available to and desired by participants

4.2 By December 2014, ensure that all homeless outreach workers are trained in eligibility procedures according to SSI/SSDI Outreach Access and Recovery (SOAR) best practices. This will happen within sixty days of employment

1.2 By December 2014, identify and establish at least three models of supportive housing programs that provide workforce development, and assist residents with employment, entrepreneurship, volunteer, and/or other meaningful activities

4.3 By June 2015, ensure that at least 50 percent of the target population with serious mental illness and substance use disorders is engaged in services that match their level of need/choice

1.3 By June 2016, increase the number of permanent supportive housing units/subsidies for the target population by at least four hundred

4.4 By June 2016, at least 50 percent of the target population served by outreach teams will be housed

1.4 By June 2016, establish fifty bridge housing units—that is, apartments with specialized supports for members of the target population leaving long-term incarceration 1.5 By June 2016, develop a home-sharing program that provides at least one-hundred units to members of the target population

4.5 By June 2016, ensure that all homeless outreach teams have access to adequate clinical support and include persons in recovery 4.6 By June 2016, establish fifteen short-term emergency units with specialized supports for the target population who are homeless or unstably housed

1.6 By June 2016, make available two-hundred existing units by moving on at least two-hundred existing permanent supportive housing or group home residents into independent living apartments 2. Enroll the target population into coordinated care services Enroll the target population into coordinated care that adequately addresses its complex health needs, improves health outcomes, promotes overall well-being, and contains and/or reduces costs 2.1 December 2013, establish an informed estimate of the number of individuals in our target population 2.2 By December 2013, enroll at least five-thousand individuals of the target population into CountyCare 2.3 By December 2014, identify and evaluate at least three models that integrate medical, behavioral, and in-home health care services into coordinated care, including a strategy for shared electronic health information and simplified billing for reimbursement of Medicaid services 2.4 By December 2014, ensure that the Medicaid coverage for substance use and mental health treatment is sufficient to meet the needs of the target population

The SAMHSA Consortium Strategic Plan

The SAMHSA Consortium Strategic Plan week.10

SCCC Strategic Plan: Target Population By June 2016, the SAMHSA Chicago Community Consortium will achieve four strategic priorities for people in Cook County who have experienced homelessness and live with (a) serious mental illness and/or (b) long-term histories of substance or alcohol use. The four strategic priorities are to:

• Increase the number and variety of supportive housing units. • Enroll the target population into coordinated care services. • Simplify and expand eligibility for and access to benefits, services, and housing. • Increase and strengthen outreach to link the target population to housing and health services

Homelessness in Cook County The 2011 Point-In-Time (PIT) count suggested that there were 7,803 homeless people in Cook County, Illinois—an increase of 5 percent from the previous count in 2009. Of these individuals, 1,377 (17.6 percent) met the federal definition of chronic homelessness.2 While the number of chronically homeless individuals remained relatively stable in suburban Cook County, the City of Chicago reported a nearly 67 percent jump. In 2011, almost two-thirds of these individuals were unsheltered, meaning they were found on the street or sleeping in another location not meant for human habitation. The US Department of Housing and Urban Development (HUD) mandates biannual PIT counts to provide a snapshot of the homeless population on a single day. However, the PIT count is not a comprehensive measure of homelessness. It does not include individuals or families living in hotels, “doubled-up” with friends or relatives, or otherwise precariously housed. To get a sense of these additional populations, the Chicago Coalition for the Homeless partnered with the University of Illinois at Chicago Survey Research Laboratory to develop an alternate methodology to measure homelessness, using independent survey results as well as data from the Chicago Department of Human Services and the Chicago Public Schools Homeless Education Program. The Coalition estimates that 93,779 Chicagoans were homeless over the course of a year in 2010–11. Of these, 47.4 percent were families and nearly 6 percent were unaccompanied youth.3 Using broader definitions of homelessness, established by the US Department of Education, the Chicago Public Schools (CPS) identified 16,600 students—or one in twenty-five children and youth in the school system—as homeless and/or precariously housed during the 2011 through 2012 academic year. This represents a cumulative 35 percent rise over the previous three years.4 Homelessness among veterans has re-emerged as a leading concern, as military personnel return from deployments in Iraq and Afghanistan. 5

The Illinois Department of Employment Security estimates that more than 89,000 discharged veterans have returned to the state over the past decade, with 39 percent of these discharges between 2007 and 2009.5

In 2011, veterans comprised nearly 8 percent of the homeless population in Chicago and suburban Cook County, slightly lower than the national rate of 10.6 percent.6 Many people who are homeless also have histories of incarceration. A 2009 through 2010 survey of 29,717 homeless adults in Illinois found that 4.5 percent were in jail or prison immediately prior to becoming homeless.7 Illinois’ prison population has soared by more than 500 percent over the past three decades and is now the eighth largest in the United States, totaling 48,418 men and women.8 With the average prison stay lasting 1.9 years, Illinois’s correctional system now releases more than 30,000 individuals annually—the fourth-highest release rate in the nation.9 More than 60 percent of ex-offenders return to Chicago, totaling about 500 individuals per 2 HUD defines a chronically homeless person as “either (1) an unaccompanied homeless individual with a disabling condition who has been continuously homeless for a year or more, OR (2) an unaccompanied individual with a disabling condition who has had at least four episodes of homelessness in the past three years.” 3 Chicago Coalition for the Homeless. “The Facts Behind the Faces.” Fall 2011. 4 Chicago Alliance to End Homelessness. Chicago’s Plan 2.0: A Home for Everyone. 2012. 5 Illinois Workforce Investment Board. Veterans Task Force Report: Findings and Recommendations. 2011. 6 2007–2011 PIT Count data from the US Department of Housing and Urban Development. 2012. 7 Chicago Coalition for the Homeless. Fall 2011. 8 Bureau of Justice Statistics. Prisoners in 2010. 9 Illinois Department of Corrections. Annual Report FY11.

Ex-offenders face multiple challenges to accessing and sustaining housing, including difficulty securing employment and eligibility restrictions imposed by HUD homeless assistance programs. Under state law, people convicted of serious drug felonies cannot receive cash via Illinois’ public assistance programs. Similarly, individuals with a felony conviction are barred from public housing for five years. According to a 2001 Urban Institute study of Illinois prisoners, only 10 percent of participants who said they needed help finding a place to live received a referral for community-based housing assistance prior to their release, and five percent planned to spend their first night out of prison in a shelter.11

Mental Illness, Substance Use, and Co-Occurring Behavioral Disorders and Homelessness The National Coalition for the Homeless estimates that approximately 20 to 25 percent of single homeless adults suffer from some form of severe and persistent mental illness.12 Additionally, up to 50 percent of homeless adults have substance use issues 13, and one-third has co-occurring diagnoses with both mental health and substance use disorders 14. These rates rise among homeless veterans, with approximately 76 percent experiencing alcohol, drug, or mental health problems.15

Based on national estimates, approximately 30 percent of returning veterans have or will develop serious psychological disorders requiring treatment, including anxiety disorders/PTSD, mood disorders, substance abuse disorders, and traumatic brain injury.16 Many ex-offenders also return to society with longstanding behavioral issues: the Illinois Department of Corrections estimates that nearly 20 percent of the state’s prison population suffers from mental illnesses,17 and more than 60 percent of offenders in Illinois enter prison with a chemical dependency.18 Of the potential 29,000 state inmates that required substance abuse treatment, however, only 7,732 received treatment during 2010 through 2011.19 Behavioral health disorders are even more widespread among people who are chronically homeless. Nationwide, studies estimate that more than 60 percent have lifelong mental health issues, and more than 80 percent have lifelong alcohol and/or drug problems.20 15

Trauma, Violence, and Homelessness Homeless individuals, families, and children are highly likely to have experienced trauma, including childhood neglect; psychological, physical, and/or sexual abuse. A 2010 survey found that more than one in four homeless people in Chicago were victims of domestic violence, and such violence constituted one of the city’s three main causes of family homelessness.21 In addition to being a stressful experience in itself, extended homelessness places individuals at risk for traumatic episodes, such as exposure to street violence and physical or sexual assault.22

Chronic Medical Illnesses and People Who Are Homeless For many homeless individuals struggling with behavioral disorders, the path to recovery and greater life stability is further complicated by underlying chronic health conditions. Co-existing behavioral and medical issues are already prevalent within the general population: Approximately 68 percent of adults with mental health disorders have serious medical conditions, and 29 percent of adults with medical conditions have mental health disorders.23 Within the homeless population, approximately one-fourth of all individuals—and more than half of homeless veterans—have some form of disability.24 People who experience extended homeless-

10 Chicago Metropolis 2020. 2006 Crime and Justice Index. 11 Christy Visher et al. Research Brief: Chicago Communities and Prisoner Reentry. Washington, D.C.: Urban Institute. 2005. 12 National Coalition for the Homeless. Fact Sheet: Mental Illness and Homelessness. 2009. 13 US Department of Housing and Urban Development. Homelessness: Programs and the People They Serve. 1999. 14 Substance Abuse and Mental Health Services Administration. Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illness and Co-Occurring Substance Use Disorders. 2003. 15 National Coalition for the Homeless. Fact Sheet: Homeless Veterans. 2009. 16 Illinois Department of Healthcare and Family Services. Report to the Governor and the General Assembly on the Availability and Quality of Healthcare Services for Illinois Veterans. 2010. 17 IDOC. Annual Report FY11. 18 Chicago Metropolis 2020. 2006 Crime and Justice Index. 19 IDOC. Annual Report FY11. 20 Burt et al. 2001. cited in C. L. Caton, C. Wilkins and J. Anderson. People Who Experience Long-Term Homelessness: Characteristics and Interventions. Paper presented at the National Symposium on Homelessness Research. Washington, D.C. 2007. 21 US Conference of Mayors. Hunger and Homelessness Survey. December 2010. 22 Institute for Children and Poverty. Fact Sheet on Domestic Violence. 2009. 23 B.G. Druss and E.R. Walker. Mental Disorders and Medical Comorbidity. Robert Wood Johnson Foundation. Research Synthesis Report No. 21, 2011. 24 SAMHSA. 2003. and HUD/US Department of Veterans Affairs. Veteran Homelessness: A Supplemental Report to the 2009 Annual Homeless Assessment Report to Congress. 2010.

The SAMHSA Consortium Strategic Plan ness often deal with a complex array of medical challenges in addition to a longstanding mental health or substance use issue. In a representative sample of 150 chronically homeless Chicagoans, 80 percent had long-term histories of substance use, 70 percent had serious mental health issues, 40 percent had co-occurring diagnoses, and 83 percent had multiple (that is, between two and four) concurrent medical illnesses, including HIV/AIDS, hypertension, diabetes, cancer, and/or cardiopulmonary disease.25

Barriers to Care People who seek assistance often face significant challenges to accessing and maintaining continuity of care. First, they must navigate a complex and fragmented system of resources to meet their medical, mental health, substance use, and housing needs. The agencies within this system have historically maintained little communication and coordination among each other. Second, to access care, individuals must overcome economic barriers: poverty, unemployment, lack of health insurance, and difficulty accessing mainstream benefits, such as Supplemental Security Income (SSI) and Medicaid. According to 2007 national data, 41.4 percent of homeless individuals and families entering HUD-funded programs had no financial resources. Only 14.2 percent received earned income; less than 10 percent received SSI, less than 7 percent received Temporary Assistance to Needy Families, less than 21 percent received food stamps, and less than 12 percent received Medicaid.26

The SAMHSA Consortium Strategic Plan Over the past fifteen years, research has documented extreme public costs associated with homeless individuals who suffer from behavioral disorders and other disabilities, including disproportionately high rates of health care utilization and frequent incarceration. A recent study of chronically homeless men with severe alcohol problems found that, during the year prior to their placement in permanent supportive housing, ninety-five individuals accrued more than eight million dollars in public costs including stays in jails, shelters, and detoxification and sobering centers, as well as Medicaid, emergency room visits, and hospitalizations.34 A 2004 analysis of homeless service costs in nine US cities found that, in Chicago, the cost per day for maintaining a homeless individual in a hospital was $1,201. In a mental hospital that daily maintenance cost was $437, and in a prison or jail it was between sixty dollars and sixty-two dollars. The alternative to these facilities is supportive housing, which only costs taxpayers $20.55 per day.35 These stats illustrate the profundity of our point: Housing this vulnerable population and supporting them is not only humane, it provides a significant cost savings to taxpayers. Moreover, the staggering difference among these figures highlights the urgency of this matter. Government funds for social services are scarce, but this model of supportive housing, which includes related health care services, will stretch the dollar further and provide more people with a place to call their own.

Obtaining SSI benefits can be a particularly fraught process: The application process can take several months, and initial applications often end in denial of benefits.

In 2010, the nationwide success rate on first attempt for all SSI applicants was 31 percent, and only 10 to 15 percent among homeless individuals who applied without assistance from case workers or advocates. Currently, the SSI appeals process takes an average of one year.27 Prior to the Affordable Care Act (ACA), qualifying for SSI was also a prerequisite for accessing Medicaid for many single homeless adults. Third, homeless individuals must compete for resources within an already overburdened public health system. In Illinois, this situation has been exacerbated by ongoing fiscal crises at the state level, leading to continual and drastic reductions in funding and services. Illinois has reduced state funding for human services by approximately $1.86 billion over the past decade, adjusting for inflation and population growth.28 Since 2009, the budget for community mental health services has been cut by 30 percent, requiring the state’s Division of Mental Health (DMH) to severely curtail services for individuals not enrolled in Medicaid.29 DMH estimates that more than two million Illinois residents experience symptoms of mental illness within a year; of these, more than 510,000 adults (not including homeless and institutionalized populations) are living with severe mental illness. However, only 114,195 adults statewide were projected to receive DMH-funded services in FY2012.30 The state’s Division of Alcohol and Substance Abuse (DASA) similarly estimates that 1.2 million Illinois residents have a clinically diagnosable alcohol or substance use disorder. In FY2012, DASA projected that it would have the capacity to serve only 1.5 percent of persons in need of alcohol and substance use treatment.31

The Economic Impact of Homelessness Across the US, cities expend between thirty-five thousand and one-hundred fifty thousand dollars per person, per year on public services for homeless individuals.32 Long-term homelessness places an inordinate burden on the system of care: while people who are chronically homeless represent less than one-third of the overall homeless population nationwide, they consume more than 50 percent of the available resources for homeless assistance.33 25 Data from AIDS Foundation of Chicago’s Samaritan Supportive Housing for Health Partnership. December 2010. 26 Martha R. Burt et al. Strategies for Improving Homeless People’s Access to Mainstream Benefits and Services. US Department of Housing and Urban Development. 2010. 27 Martha R. Burt and Carol Wilkins. Establishing Eligibility for SSI for Chronically Homeless People. US Department of Health and Human Services. 2012. 28 Yerik Kaslow and Amy Terpstra. “Ramifications of state budget cuts to human services: Harms vulnerable populations. increases job loss. decreases economic activity.” Center for Tax and Budget. 29 Illinois Hospital Association. “Illinois Mental Health and Substance Abuse Services in Crisis.” Shaping the Debate. May 2011. 30 Illinois Department of Human Services. Illinois Human Services Plan. State Fiscal Years 2010–2012. 31 Ibid. 32 Philip F. Mangano. former Executive Director of the US Interagency Council on Homelessness. Quoted by PolitiFact.com. March 12, 2012. http://www.politifact.com/truth-o-meter/statements/2012/mar/12/shaun-donovan/hud-secretary-says-homeless-person-costs-taxpayers. 33 National Alliance to End Homelessness. Fact Sheet: Chronic Homelessness. 2010.

34 Mari E. Larimer, et al. Health Care and Public Service Use and Costs Before and After Provision of Housing for Chronically Homeless Persons With Severe Alcohol Problems.” The Journal of the American Medical Association. April 1, 2009, Volume 301. No 13. 35 Corporation for Supportive Housing. Costs of Serving Homeless Individuals in Nine Cities. November 2004.

The SAMHSA Consortium Strategic Plan

The SAMHSA Consortium Strategic Plan Health homes provide and coordinate comprehensive care (such as, primary, dental, behavioral health, family services, case management, and social services). The ACA’s provisions include treatment for mental illnesses and substance use disorders as an integral part of improving and maintaining overall health. Health homes will further improve integration with general medical care. The ACA additionally promotes the creation of Accountable Care Organizations (ACOs), networks of health care providers that offer coordinated care, chronic disease management, and the full continuum of health care services. Under this model, when fully implemented, the ACOs will receive a set per capita payment for all of the care they provide to consumers, and the ACOs will be held accountable for the quality and cost of care. This will ultimately phase out the fee-for-service system. The incentive to provide both quality health care and achieve savings will manifest itself in ACOs, which will act similar to insurance companies and integrated health care delivery systems. This differs from the system now, wherein providers receive compensation for the number of individual services they deliver.38

Environmental Context for the SAMHSA Strategic Plan The implementation of numerous health care- and housing-related reforms promises improved and expanded services for people with histories of mental illness, substance use, and homelessness. These advances on the federal, state, and local levels began in 2012 and will continue to create possibilities for innovative, new, collaborative, systems-wide endeavors. The following initiatives will have the greatest positive impact in Chicago and Cook County: the Affordable Care Act (ACA); CountyCare; Medicaid expansion; Coordinated Care Entities (CCEs), such as Together4Health (T4H); Chicago’s Plan 2.0 to End Homelessness; the Chicago Central Referral System (CRS); as well as programs from the Substance Abuse and Mental Health Services Administration (SAMHSA), the State of Illinois Department of Human Services Division of Mental Health (DMH), Division of Alcoholism and Substance Abuse (DASA), and the Veterans Administration (VA). At the same time, there are a number of worrisome cross currents that pose threats or challenges to progress, including: reduced funding for various federal health- and housing-related programs related to sequestration, the fiscal impact of Illinois’ pension crisis on the state budget, the weakened Illinois DMH, and stressed community-based services that result from various state-consent decrees. Moreover, there is the ever present temptation to continue to work in silos.

Implications of the Affordable Care Act In 2014, health insurance programs will cover thirty-two million more Americans because of changes under the ACA.36 In Illinois alone, more than one million residents—most of whom reside in Chicago—will be eligible for coverage, and the vast majority will be low-income.37 The ACA allows for Medicaid expansion to insure nearly all individuals with incomes up to 138 percent of the federal poverty level (FPL), and it requires states to significantly streamline Medicaid enrollment processes. This includes effective outreach and assistance to applicants and the creation of a single, integrated application system with “no wrong door” to apply for coverage. The application will only require people to provide a minimum slate of information to determine eligibility. On July 22, Illinois Governor Pat Quinn signed Senate Bill 26 into law, expanding Medicaid as envisioned by the ACA.

Under expansion, the state will provide health care to 342,000 more Illinoisans who currently don’t qualify for coverage because of income or health. The federal government will pay 100 percent of the cost of coverage for the new Medicaid population for the first three years; after 2020, the federal government will pay 90 percent, and the state will pick up the remaining 10 percent. The ACA also foresees person-centered systems of care, known as health homes, that facilitate access to health services. A health home is not a physical home, but rather a team of health services professionals and navigators, who will educate consumers about coverage options under the ACA. They will also help people enroll in either the expanded Medicaid program or private insurance, via the Health Insurance Marketplace, which will open October 1. 36 Adam Sonfield. “Implementing the Affordable Care Act.” Guttmacher Policy Review. Fall 2011. Volume 14. No. 4. 37 “Affordable Care Act Implementation.” Illinois Department of Healthcare and Family Services (HFS) E-News: February 2013. Accessed March 18, 2013. http://www2.illinois.gov/healthcarereform/Pages/The Affordable CareAct.aspxw.samhsa.gov.

In Illinois, Coordinated Care Entities (CCEs) are the forerunners of ACOs during the initial three-year innovations phase, beginning in fall 2013. CCEs will receive a member per month fee for care coordination, and efforts will focus on making the fee-for-service system more efficient and effective in preparation for the advent of the ACOs.

Transforming Health Care in Illinois In October 2012, the Cook County Health and Hospitals System (CCHHS) received a 1115 waiver from the Centers for Medicare and Medicaid Services to cover uninsured people in Cook County who will become eligible for Medicaid in 2014 under the ACA. The initiative is known as CountyCare, and it pilots the ACA’s Medicaid expansion in 2013. Some experts estimate that it could enroll 115,000 people by the end of the year.39 As of mid-July 2013, CountyCare has received 74,000 applications, and the Illinois Department of Healthcare and Family Services (HFS), which administers Illinois’ Medicaid program, has enrolled 22,000 Illinoisans.40 When individuals enroll in CountyCare, they select, from a list of providers, a patient-centered health home site with a primary care physician. Providers include CCHHS sites, as well as others, such as Federally Qualified Health Centers (FQHCs). There are now over one hundred primary-care CountyCare sites, and CCHHS has not experienced access issues for primary-care or behavioral-health appointments to date. The FQHCs with behavioral health staff provide the service on-site and coordinate services with medical providers.41 However, challenges remain in serving those with more serious mental illness.42 CountyCare also changes the way patients enter CCHHS. They are now assigned “intelligently”—based on risk, complexity, and need—to patient-centered medical homes, instead of using emergency rooms for routine care.43 The patient’s medical home team coordinates all necessary emergency, specialty, diagnostic, outpatient, and inpatient services across the Cook County Health System. Illinois is additionally launching several initiatives to meet the state’s 2012 Medicaid reform law, mandating that 50 percent of Medicaid clients be enrolled in a managed-care plan by 2015. Managed care aims to control costs through better chronic-disease management and coordination, thus averting costly complications and hospitalizations. In October 2012, Illinois chose six health care networks to serve as CCEs through the state’s pilot Innovations Project. These models offer alternatives to traditional Health Maintenance Organizations.44 T4H was chosen as one of the new Cook County CCEs for the Innovations’ Project that same month. Led by Heartland Health Outreach, T4H is a collaboration among thirty-four entities: hospitals, primary-care providers at FQHCs, pharmacies, behavioral-health providers, social-service and housing providers, and systems-level organizations, including Treatment Alternatives for Safe Communities, Inc. (TASC) and the AIDS Foundation of Chicago (AFC). Using a health home model, T4H will offer an integrated, holistic approach to health care that promotes physical, mental, and social wellbeing while improving access to care for adults and seniors with disabilities in Cook County, including people with co-occurring disorders, such as one or more serious mental illnesses and substance use. T4H uniquely focuses on highly vulnerable populations, particularly people who are homeless and high users of Medicaid.45 38 “Working with Medical and Other Programs to Enhance Treatment Integration.” Center for Substance Abuse Treatment TA Package. Accessed April 1, 2013. http://www.uclaisap.org/affordable-care-act/assets/documents/CSAT-TA-Package%205_Primary%20Care.pdf. 39 “Cook County Captures 1115 Medical Waiver.” CCHHS Website October 26, 2012. Accessed October 31, 2012. http://www.cookcountyhhs. org/announcements/john-h-stroger-jr/county-captures-1115-waiver. 40 Gabriela Moroney. Illinois Department of Healthcare and Family Services. E-mail. July 19, 2013. 41 Sidney Thomas. Director of Provider Services. Cook County Health and Hospitals System. E-mail July 22, 2013. 42 Ed Stellon. Interview by Marty Hansen. E-mail. August 16, 2013. AIDS Foundation of Chicago. 43 “CountyCare Begins at Health System.” CCHHS Website. November 19, 2012. Accessed November 21, 2012. http://www.cookcountyhhs. org/announcements/john-h-stroger-jr/countycare-begins-health-system. 44 “Care Coordination Update.” HFS E-News: October 2012. Accessed October 30, 2012. http://www2.illinois.gov/hfs/PublicInvolvement/enews/Pages/October2012.aspx. 45 “State Taps Consortium…to Lead Coordinated Care Program.” Heartland Alliance website. October 16, 2012. Accessed October 31, 2012. http://www.heartlandalliance.org/whoweare/news/state-taps-consortium.

The SAMHSA Consortium Strategic Plan On November 16, 2012, the Illinois Department of Insurance also submitted the state’s application for a Partnership Health Insurance Exchange, meaning Illinois will share the task of administering a health insurance exchange with the federal government. Individuals and families who don’t qualify for Medicaid but are below 400 percent of the FPL will be eligible for a subsidy in the Marketplace. Enrollment in the Marketplace will open on October 1, 2013, with plans becoming effective January 1, 2014. The Quinn administration recently awarded forty-four grants to organizations “who will employ helpers to educate consumers about their new health care options under the Affordable Care Act and to assist people in enrolling in the new Medicaid expansion and Health Insurance Marketplace when open enrollment begins on October 1.”46 And, the Chicago Department of Health (CDPH) will soon launch a major new effort to identify and enroll uninsured Chicagoans.

A Renewed Commitment to Ending Homelessness In August 2012, the City of Chicago officially released its Plan 2.0 to End Homelessness, providing new impetuses to increase access to stable and affordable housing for people who are homeless or are at risk of becoming homelessness.

The plan aims to create a mix of nearly two thousand additional units of permanent supportive housing and subsidies by 2019. Additionally, Plan 2.0 advocates for the creation of the new CRS that, for the first time, allows homeless services providers to connect applicants to permanent supportive housing through a centralized, citywide database. Access to housing is based on applicants’ vulnerability and length of homelessness. The CRS began operating in early 2013, and as of late July providers had entered nearly 6,200 names to the data base. Of those, 1,539 applicants had histories substance abuse treatment, 1,708 had received mental health treatment, and 963 had received care for both. Approximately 1,500 also reported being chronically homeless.47 Plan 2.0 also calls for greater cross-systems integration between private and public systems of care, including the formation of a governmental interagency council on homelessness by the end of 2013. Moreover, it asks that partners work together to implement the federal Homeless Emergency Assistance and Rapid Transition to Housing Act, which seeks to ensure that individuals and families who become homeless return to permanent housing within thirty days.48 An additional note of optimism comes from a successful, state-wide advocacy effort, spearheaded by the Supportive Housing Providers Association. This push secured more funding for Illinois’ supportive housing programs in FY2014.

Housing is a Foundation for Health There is a growing understanding among federal, state, and local policymakers that safe, stable, and affordable housing is essential to maintaining good health. Numerous studies over the past twenty years have also demonstrated that permanent supportive housing for homeless populations with complex health needs can save millions of dollars, reducing high cost-emergency room visits, hospitalizations, and incarcerations. To this end, federal agencies are increasing advocacy efforts for greater integration of primary care, behavioral health supports, and housing opportunities to improve outcomes for highly challenged individuals, including people who are chronically homeless with at least one serious mental illness.49 50

SAMHSA typifies this spirit: Its national goals include enhanced health- and recovery-oriented service systems of care, greater availability of permanent supportive housing and related services, and increased opportunities for those with substance use issues and mental-health disorders. This gives more individuals an opportunity to lead purposeful lives that are integrated into the community. 49 50 Examples include two AFC-led initiatives that provide projects that better serve this target population. With funding from SAMHSA, the first includes AFC’s Access to Wellness and Healthy Connections programs, which deliver in-home, mental-health, and substanceuse recovery services to people living in HUD-based, permanent supportive housing. The second initiative centers on high users of 46 Stephanie Altman. “Training for In Person Counselors and Navigators in Illinois.” Illinois Health Matters website. June 26, 2013. Accessed July 9, 2013. http://www.illinoishealthmatters.blogspot.com/2013_06_01_archive.html. 47 Jamie Ewing. CSH (Corporation for Supportive Housing in Illinois). July 30, 2013. 48 Chicago Alliance to End Homelessness. Chicago’s Plan 2.0: A Home for Everyone. 2012. 49 John O’Brien. “Leading Change – A Plan for SAMHSA’s Roles and Actions. 2011-2014. Strategic Initiative #4: Health Reform.” Pp. 48-58 (draft 10/01/2010). SAMHSA website. Accessed December 10, 2012. http://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf. 50 Kevin Malone. “Health Reform and Behavioral Health” (presentation). SAMHSA Homeless Grantees Conference. Washington, D.C. August 1-2, 2012.

The SAMHSA Consortium Strategic Plan Medicaid who are homeless. Medicaid and health plans may be able to pay for their services in permanent supportive housing in the future. Federal partners, including HUD, HHS, and the US Interagency Council on Homelessness, are also working to improve access to mainstream supports and targeted assistance programs for individuals and families who are homeless and experiencing behavioral health problems. Examples are housing choice vouchers and the Veterans Affairs Supportive Housing vouchers. On the state level, DMH and DASA are reinvigorating coordinated care efforts through the Homeless Action Committee (HAC) and the Recovery Oriented Systems of Care (ROSC) Council. HAC provides DMH with community input on needed services and makes policy recommendations. ROSC seeks to expand comprehensive, community-wide recovery support services across Illinois. DASA and DMH are also working with HFS to broaden the range of behavioral health and recovery-support services, which the newly expanded Medicaid program will pay. Finally, DMH and DASA, under the leadership of Director Theodora Binion, are now formally studying the potential benefits of merging their departments to create an integrated division of behavioral health for Illinois. This has the potential to serve as a catalyst for improved integrated care for the consortium’s target population.51

Impact on Target Population The changes engendered by the ACA and its related state and local initiatives provide new opportunities for Cook County’s most vulnerable homeless individuals—and for the systems that serve them. Given their low incomes and high uninsured rate, people who experience homelessness will significantly benefit from Medicaid expansion and a streamlined application process. In addition, previously uninsured people who are discharged from hospitals or released from jails and prisons will have greater access to health insurance and coordinated care, improving health outcomes and reducing recidivism rates.52 53 For instance, eligible Cook County jail inmates are being enrolled into CountyCare through “a partnership between the Cook County Health and Hospitals System, the Sherriff’s Department, Automated Health Systems and TASC, Inc.,” according to Maureen McDonnell, Director for Business and Health Care Strategy Development at TASC.54 Upon discharge, individuals will then be able to access CountyCare services. There are many other encouraging developments. The health home model holds great promise for improving housing stability for homeless people with complex medical and behavioral health issues. Similarly, the integration of behavioral health and substance use services in health homes will more effectively address the needs of people with co-occurring disorders. In addition, the linkage of permanent supportive housing to new models of coordinated care is a vital step toward improving health and housing stability outcomes and reducing the high public costs of homelessness. The four major priority areas of the consortium’s strategic plan (listed below) support and build upon many of these developments:

• Increase the number and variety of supportive housing units • Enroll the target population into coordinated care services • Simplify and expand eligibility for and access to benefits, services, and housing • Increase and strengthen outreach to link the target population to housing and health services

There is widespread consensus around the policy and practice changes that the consortium’s strategic plan identifies. CountyCare and the CRS are already opening doors for the target population to access benefits and services. The plan will support and encourage these kinds of innovations, while serving as a catalyst to implement other plan-identified initiatives.

Threats Threats to health care and housing reforms are numerous on local, state, and national levels. Perhaps Illinois’ fiscal problems present the direst threats. DMH has absorbed massive budget cuts over the past four years. With the closure of state hospitals, there are fewer long-term psychiatric beds. While there is increased funding, in compliance with the Williams and Colbert Consent Decrees, to support people as they transition from state-operated facilities into the community, Illinois has 51 Patricia Kates-Collins. “Updates from the Field: Co-Occurring Disorders for Substance Use Treatment Providers” Conference. June 25, 2013. 52 National Association of Counties. Community Services Division. “County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage.” March 2012. 53 SHARP (State Healthcare Access Research Project) Toolkit: ACA Implementation in Illinois Part I: “The Medicaid Expansion and the Medicaid Expansion Fact Sheet.” September 2012. 54 Maureen McDonnell. Director for Business and Health Care Strategy Development. TASC. E-mail. July 21, 2013.

The SAMHSA Consortium Strategic Plan

cut core grants for community mental health services. The result is that there are more people with less access to behavioral health care. The state has also reduced funding for substance use and alcohol treatment the past several years.55 (Two positive notes must be sounded. First, FY2014 appropriations for the Illinois Department of Public Health, DMH, and DASA avoid further cuts to agency budgets. Second, PATH [Projects for Assistance in Transition from Homelessness], a component of SAMHSA, has continued to provide outreach, engagement, and ongoing case management during the past several years where other budgets have been slashed.) FY2013 was challenging for Medicaid in Illinois. The state reduced funding, eliminating and restricting some benefits, and increased some copayments. Today, advocates for special populations (that is, people with histories of mental illness, substance use, HIV, and other conditions) are working to ensure that Medicaid expansion provides adequate coverage for peoples’ needs. An additional challenge is that expansion doesn’t solve all of the problems that the cuts from 2012 created. For example, it will not automatically restore adult dental- and eye-care benefits. Lack of action on the Illinois pension crisis continues to cloud funding for human services. In his 2014 budget address, Governor Quinn estimated that the state will lose one billion dollars for these services in the next year due to the pension stalemate. On the ground, many health care providers will face a unique challenge of serving a large number of people who are insured for the first time, a population whose only experience of health care has been with emergency rooms and hospitals. Providers must build relationships with this population in order to begin the health care literacy education process. Enrollment into Medicaid is not enough by itself. Other federal budget cuts have weakened the Health Resources and Services Administration, the primary federal agency responsible for improving access to health care for people who are isolated, medically vulnerable, or without insurance. And, among the threats that federal sequestration poses, is the already-enacted 5 percent reduction of HUD funds for subsidized housing, which jeopardizes services and creates few, if any, new housing units and vouchers.56 Meanwhile, the affordable housing crisis grows in Chicago, as developers convert low-income housing buildings into upscale apartments. While the implementation of the ACA and numerous other opportunities will mitigate these concerns, vulnerable people continue to be at risk in the foreseeable future. The ripple effects of fewer services, reduced benefits, and a shortage of financial and human resources over the past several years will not dissipate quickly.

Addressing these challenges will require strong cross-sector collaborative efforts to expand and transform health care, housing, and supportive services for people in great need.

Historically, the nonprofit and public sectors have attempted to effect change with a narrow focus on single programs, agencies, or governmental departments. This approach has not worked. It has only encouraged work in silos.

This SAMHSA Chicago Community Consortium project, which seeks to improve systems integration to benefit a most vulnerable population, requires exactly this type of broad cross-sector collaboration. The leadership council that the project convened to address these challenges is guiding an important opportunity to advance this work. The project’s strategic plan underscores the urgent needs and exciting possibilities.57

SAMHSA Chicago Community Consortium Consultation Process Strategic Priorities and Recommendations The Substance Abuse and Mental Health Services Administration (SAMHSA) Chicago Community Consortium (SCCC) is a collaboration of more than forty organizations (advocacy, mental health, substance use, health care, social service, housing service, and homeless coalition groups at both local and state levels), as well as representatives of city, county, state, and federal government agencies. The AIDS Foundation of Chicago (AFC) leads this initiative. The consortium’s overall goals are to increase systems-level capacity to coordinate and integrate recovery-oriented models of care that improve health and housing stability outcomes for people in Cook County who have experienced homelessness and live with (a) serious mental illness and/or (b) long-term histories of substance or alcohol use. AFC identified members of a steering committee in its spring 2011 SAMHSA grant application process. AFC met individually with prospective SCCC steering committee members to discuss their roles and provide an overview of the project. As a result, twenty-one leaders that represent the above organizations/agencies joined the steering committee. On March 1, 2012, the steering committee met for the first time and created workgroups to determine the greatest needs of people who are homeless and live with serious mental health and/or substance use issues: Benefits and Entitlements, Criminal Justice and Re-Entry, Permanent Supportive Housing, Substance Use, Mental Health, and Primary Care. Three other groups also met to enhance the process: a consumer, SAMHSA clinicians, and a North Side community group. Steering committee members and their staff subsequently created four new workgroups and, in two areas (mental health and primary care), identified needs by building on the work of a previous group (that is, mental health—the Illinois Department of Human Services Division of Mental Health Homeless Action Committee) and conversations with primary care experts. AFC invited prospective members to participate in these newly established groups. These four groups met several times between May and September 2012. During their first meeting, they identified and ranked needs. During their latter meetings, groups posited at least three key changes in policy and practice based on these suggestions. The workgroup sessions included between five and twelve members, each facilitated by AFC consortium staff. The primary care group put AFC staff in conversation with seven highly recommended members in that field of care, including two physicians and a hospital social worker. With the mental health workgroup, staff telephoned and e-mailed the four principal authors of the 2010 Homeless Action Committee policy paper. These four updated and refined their current perspectives relative to the population. In addition, 46th Ward Alderman James Cappleman organized a meeting with sixteen local social service organizations to address the needs of the homeless population in the North Side community of Uptown. The final two workgroups consisted of consumers and SAMHSA clinicians, who reviewed identified needs and provided feedback.

55 Fiscal Policy Center at Voices for Illinois Children. “Special Report: Overview of the Governor’s FY 2013 Budget.” March 2012. 56 HUD e-mail newsletter. March 11, 2013. “Sequestration Impact on Homeless Assistance Grants Programs.” Accessed June 20, 2013. http:// portal.hud.gov/hudportal/documents/huddoc?id=COCGranteeSeqLetter.pdf. 57 John Kania and Mark Kramer. “Collective Impact.” Stanford Social Innovation Review. Winter 2011.

In total, nearly eighty individuals identified and prioritized needs over thirteen meetings and nine small group conversations between May 24 and September 19, 2012. 19

The SAMHSA Consortium Strategic Plan

Appendix: SAMHSA Consortium Workgroups In September, AFC’s Research Evaluation and Data Services team worked with project staff to develop a needs assessment survey, which they distributed through SurveyMonkey, to incorporate the needs, policy, and practice recommendations that the workgroups identified. Project consultants from Heartland Health Outreach (HHO) also assisted in the process. AFC sent the survey to 220 people in the health, social service, policy, advocacy, and consumer communities, and AFC received eighty-five responses. Over half of respondents (51 percent) represented homeless services, 39 percent worked in mental health, and 22 percent served in the substance use field. One quarter of participants represented city, county, state, or federal government agencies. The greatest numbers were midlevel administrators, followed by supervisors, and agency executive directors. Two percent were participants or prosumers. These results informed the first draft of the consortium’s strategic plan, which AFC presented to the steering committee during their second meeting on November 8, 2012. The policy changes in the draft paralleled, in part, initiatives that are being formulated with the Affordable Care Act, CountyCare, Medicaid expansion, and the establishment of Coordinated Care Entities. The recently released Chicago Plan 2.0 also informed the consortium’s strategic plan. Following the November 8 steering committee meeting, AFC staff met with each steering committee member for an in-depth follow-up conversation. These meetings took place between December 2012 and April 2013. As a result, AFC and HHO consultants carefully revised the plan based on each member’s recommendations. All twenty-one members of the steering committee unanimously approved the strategic plan in spring 2013. AFC staff initiated the implementation process following their planning meetings with HHO consultants and several council members in May and June. The first task and workgroups will meet in September to estimate the number of individuals in Cook County who constitute the target population and to address outreach recommendations.

AFC will play three major roles in achieving the plan’s twenty-three recommendations: • Monitoring progress of innovations already underway, such as CountyCare. • Supporting collaborative efforts, such as assisting with initiatives to help individuals reconnect with entitlement programs after leaving jail. • Leading implementation of recommendations, particularly in outreach where AFC already plays an important coordinating role. The SAMHSA steering committee will meet at least twice annually to review and assess progress toward the plan’s twenty-three recommendations over the three-year implementation process. AFC consortium staff will publish quarterly reports at aidschicago.org to keep stakeholders and the community informed. For a list of members in each workgroup, please see the appendix.

Permanent Supportive Housing Ricardo Anderson, Chicago Housing Authority Nicole Bahena, Chicago Alliance to End Homelessness Arturo V. Bendixen, AIDS Foundation of Chicago Kim Davidson, Deborah’s Place Debra Howard-Frye, Thresholds Paul Luikart, Breakthrough Ministries Tony Mastracci, Mercy Housing Lakefront Lisa Mayse-Lillig, Heartland Human Care Services Dave Thomas, AIDS Foundation of Chicago Criminal Justice and Reentry Hon. Judge Paul Biebel, Cook County Criminal Court John Fallon, Corporation for Supportive Housing Ramon Gardenhire, AIDS Foundation of Chicago Rev. Doris Green, AIDS Foundation of Chicago Elizabeth Hailey-Smith, Administration for Children and Families, US Department of Health and Human Services Michelle Hoersch, Administration for Children and Families, US Department of Health and Human Services Barbra Johnson, Administration for Children and Families, US Department of Health and Human Services Johnna Lowe, Supportive Housing Providers Association Maureen McDonnell, Treatment Alternatives for Safe Communities, Inc. Terre Marshall, Cermak Health Services, Cook County Health and Hospitals Systems Lauran Olson, Jesse Brown Veterans Administration Medical Center Melanie Paul, AIDS Foundation of Chicago Jill Valbuena, Thresholds Nathaniel Wright, Kent College of Law Benefits and Entitlements Stephanie Altman, Health and Disability Advocates Sue Augustus, Health and Disability Advocates Kenya Burnett, Legal Assistance Foundation Sheri Cohen, Chicago Department of Public Health Francis Dixon, Administration for Children and Families, US Department of Health and Human Services Teresa Guardado, Jesse Brown Veterans Administration Medical Center Alice Holden, Centers for Medicare and Medicaid Services, US Department of Health and Human Services Kathleen Molnar, Emergency Fund Julie Nelson, Heartland Health Outreach Cara Pacione, Mt. Sinai Hospital Patricia Reedy, Division of Mental Health, Illinois Department of Human Services Sheri Richardt, Advocate Illinois Masonic Medical Center Sara Musa-Rosario, Cermak Health Services Substance Use Carolyn Hartfield, Division of Alcoholism and Substance Abuse, Illinois Department of Human Services Mildred Hunter, Office of Minority Health, US Department of Health and Human Services Larry Kirkpatrick, Heartland Human Care Services Kate Lowenstein, AIDS Foundation of Chicago Fred Maclin, Christian Community Health Center Ed Stellon, Heartland Health Outreach Jill Wolf, Haymarket Center Gloria Wright, John H. Stroger, Jr. Hospital of Cook County Mental Health Michael Banghart, Renaissance Social Services, Inc. Megan LaFrambois, Heartland Health Outreach

TheThe SAMHSA SAMHSAConsortium ConsortiumStrategic StrategicPlan Plan

200 West Jackson Blvd. Suite 2200 Chicago, Illinois 60606 Tel: 312.922.2322

Khen Nickele, Division of Mental Health, Illinois Department of Human Services Khen Nickele, Division of Mental Health, Illinois Department of Human Services Wasmer, Division of Mental Health, Illinois Department of Human Services DanDan Wasmer, Division of Mental Health, Illinois Department of Human Services Primary Care Primary Care Melissa Brown-Hart, North Housing Supportive Services Melissa Brown-Hart, North SideSide Housing andand Supportive Services David Buchanan, M.D., Erie Family Health Center David Buchanan, M.D., Erie Family Health Center Marie Grimberg, Heartland Health Outreach AnnAnn Marie Grimberg, Heartland Health Outreach Tom Huggett, M.D., Circle Family Health Center Tom Huggett, M.D., Circle Family Health Center Katy Kelleghan, Heartland Health Outreach Katy Kelleghan, Heartland Health Outreach Randy Madonna, H. Stroger, Jr. Hospital of Cook County Randy Madonna, JohnJohn H. Stroger, Jr. Hospital of Cook County LaQuita Malone, Health Resources Services Administration, Department Health and Human Services LaQuita Malone, Health Resources andand Services Administration, USUS Department of of Health and Human Services Ed Stellon, Heartland Health Outreach Ed Stellon, Heartland Health Outreach th Ward Collaboration: Alderman James Cappleman 46th 46 Ward Collaboration: Alderman James Cappleman Sol Anderson, LIFT-Chicago Sol Anderson, LIFT-Chicago Arturo V. Bendixen, AIDS Foundation of Chicago Arturo V. Bendixen, AIDS Foundation of Chicago Anne Bihrle, Mercy Housing Lakefront Anne Bihrle, Mercy Housing Lakefront Bolson, Night Ministry BarbBarb Bolson, TheThe Night Ministry Nonie Brennan, Chicago Alliance to End Homelessness Nonie Brennan, Chicago Alliance to End Homelessness Teresa Cortas, Salvation Army Teresa Cortas, Salvation Army Randall Doubet King, Chicago Alliance to End Homelessness Randall Doubet King, Chicago Alliance to End Homelessness Judy Gall, Alternatives Youth Services Judy Gall, Alternatives Youth Services Mark Ishaug, Thresholds Mark Ishaug, Thresholds Jim LoBianco, StreetWise Jim LoBianco, StreetWise Maura McCauley, Heartland Human Care Services Maura McCauley, Heartland Human Care Services Paul Mireles, Thresholds Paul Mireles, Thresholds Geri Palmer, North Side Housing and Supportive Services GeriJohn Palmer, NorthChicago Side Housing and Supportive Services Pfeiffer, Department of Family and Support Services JohnKathy Pfeiffer, Chicago Department of Family and Support Services Ragnar, Sarah’s Circle Kathy Ragnar, Sarah’s Circle Nicole Richardson, Thresholds Nicole Richardson, Thresholds Ben Rueler, LIFT-Chicago BenBruce Rueler, LIFT-Chicago Seitzer, Community Counseling Centers of Chicago Bruce Counseling Centers of Chicago EdSeitzer, Stellon,Community Heartland Health Outreach Ed Stellon, Health Outreach ShannonHeartland Stewart, Inspiration Corporation Shannon Stewart, Mindy Taylor, Inspiration CornerstoneCorporation Mindy Taylor, Cornerstone Anita Weinstein, EZRA, Jewish Vocational Services Anita Weinstein, EZRA, Jewish Vocational Services SAMHSA Clinicians Group SAMHSA Group MelissaClinicians Brown-Hart, North Side Housing and Supportive Services Melissa Side Human HousingCare andServices Supportive Services LarryBrown-Hart, Kirkpatrick,North Heartland Larry Kirkpatrick, Heartland Human Care Services Kate Lowenstein, AIDS Foundation of Chicago KateLaura Lowenstein, AIDS Foundation of Chicago Nauth, Heartland Health Outreach Laura Nauth, Heartland Health Outreach Sarah Schmitt, Heartland Health Outreach Sarah Schmitt, Heartland Health Outreach Consumer Group Consumer Group Ryan Hart RyanVincent Hart Moorman Vincent Ron Moorman Otto RonNathaniel Otto Wright Nathaniel Wright Special thanks to Jeffrey A. Coady, Psy.D., SAMHSA Regional Administrator (Region V), Commander, US Public Health Service, for assistance federal partners. Special thanksin toenlisting Jeffrey A. Coady, Psy.D., SAMHSA Regional Administrator (Region V), Commander, US Public Health Service, for assistance in enlisting federal partners.

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