Ryan White Funded Transitional Housing Integration of Care (IOC) Committee meeting of the Ryan White Planning Council:

1. Ryan White Funded Transitional Housing Integration of Care (IOC) Committee meeting of the Ryan White Planning Council: January 4, 2012 New York, NY Lynn Walker, D.Min., M.S.Ed., M.A., Director for Housing Operations, Housing Works, Inc. Kenneth Robinson, M.Ed., M.A., CASAC, Vice President for Housing Operations, Housing Works, Inc.

2. Housing Works, Inc. Housing Works: A Brief Overview • Founded in 1990 – spun off of ACT-UP – now the US’s largest minority controlled provider of housing & supportive services for homeless people living with HIV/AIDS. • Three Adult Day Healthcare Centers, including four complete medical clinics. • Community-based (COBRA) case management programs in all five boroughs of NYC; the largest in NY State. • Advocacy offices in NYC, Albany, Washington & Mississippi • Job Training Program – successful completers receive a FT job at HW at a sustainable wage and with full benefits • Social Enterprise: 12 Thrift Stores; Used Book Cafe; The Works Catering; Gotham Property Management • 183 units of housing

3. Housing at Housing Works • Women’s Housing Program • Transgender Housing Program • Staten Island Housing Program • Stand-Up Harlem House • Bronx Claremont • Jefferson Ave (in dvlpmt) • Keith D. Cylar House • East New York House • www.housingworks.org

4. Housing Works, Inc. Women’s Transitional Housing Program: • Initiated in 2000; City of NY (MHRA/PHS) contract. • As you know, Ryan White funds. • Women living with HIV/AIDS and newly released from a correctional setting. • Program started with 20 scatter-site apartments in Brooklyn with staff offices at our ENY location. • Residents have access to the complete HW continuum of care. • Moved into new 20-unit congregate facility in March of 2009. • Staffed by PD, AA, 2 CMs, and residential staff. • Average length of stay is just greater than one year. • Approximately 70% of residents transition to permanent housing. • Follow-up initiatives indicate that about 50% remain in PH for at least 18 months.

5. Housing Works, Inc. Transgender Transitional Housing Program: • Initiated in 2003; City of NY (MHRA/PHS) contract. • Program started with 20 scatter-site apartments in Brooklyn with staff offices at our ENY location (2640 Pitkin Ave.). • Expanded to 30 apartments in 2010. • Residents have access to the complete HW continuum of care. • Unique – one of the very few housing programs in the U.S. exclusively for gender variant folks with HIV. • Almost all clients have been MTF folks of transgender experience. • Nearly all have been either African American or Latina. • High incidence of substance use, mental illness and sex work with this population. • Average length of stay is approximately 15 months; about 50% move to PH; tend to stay in PH at a high rate. • PD, AA, 2 CMs, and a Residence Mgr.

6. Housing Works, Inc. Can PLWHA with Chronic Substance Use be Housed? • “Housing First” or “low demand” housing models place persons with substance use and/or mental health issues directly into housing w/out requiring sobriety. • Growing evidence shows that these programs achieve housing and service use outcomes comparable to traditional abstinence-only supportive housing.

7. Housing Works, Inc. How Do We Do It? • Strictly enforce house rules • 24 hour security (congregate) • Case management • Life skills training • Home visits • Referral to ADHC and Primary Care • Behavioral contracts/case conferences • Threat of eviction

8. Housing Works, Inc. Does It Work? • Low-demand housing models that enrolled “more challenging” consumers did not see worse housing outcomes, demonstrating that “housing readiness” is not a good predictor of outcomes. • Burt, 2004 • Bendixen, 2008 • Caton, et al., 2007 • Martinez & Burt, 2006 • Rosenheck, et al., 2003 • Sadowski, 2008 • Shubert, 2006 • Tsemberis, et al., 2004

9. Housing Works, Inc. Can We Prove It? • Homelessness and unstable housing are linked to greater HIV risk, inadequate care, poor health outcomes & early death • Studies also show strong & consistent correlations between improved housing status and… • Reduction in HIV/AIDS risk behaviors • Access to medical care • Improved health outcomes • Savings in taxpayer dollars • Dramatic new evidence shows housing is an effective and cost saving HIV prevention & health care intervention for homeless/unstably housed persons with HIV • Go to www.nationalaidshousing.org for references and fact sheets on housing & HIV

10. Housing Works, Inc. Summary of Key Findings on Housing & HIV: • Homelessness and unstable housing are linked to greater HIV risk, inadequate care, poor health outcomes & early death • Studies also show strong & consistent correlations between improved housing status and… • Reduction in HIV/AIDS risk behaviors • Access to medical care • Improved health outcomes • Savings in taxpayer dollars • Recent research shows that that housing is both effective and cost saving as a health care intervention for homeless/unstably housed persons with HIV & other chronic conditions

11. Housing Works, Inc. Housing is Healthcare – Stable Housing Improves Health Outcomes: • Homeless/unstably housed PLWHA whose housing status improves over time are: • More likely to report HIV primary care visits, continuous care & care that meets clinical practice standards • More likely to return to care after drop out • More likely to be receiving HAART • Increased housing stability is positively associated with: • Effective HAART (viral suppression) • Better HIV related health status ( as indicated by viral load, CD4 count, lack of co-infection with HCV or TB) • Placement is supportive housing has been found to reduce mortality among homeless PLWHA by as much as 80% over time

12. Housing Works, Inc. Practice-Based Evidence at Housing Works: • Community based participatory research (CBPR) partnership with the University of Pennsylvania School of Social Policy & Practice • Collaborative agenda setting • Advocacy-based research agenda • Agency-wide standardized assessment process/tools • Incorporating validated measures • Staff training & mentorship • Examining the effectiveness of a housing-first program in promoting HAART adherence for a sample of previously homeless PLWHA • Initial findings: residents 3x more likely to have undetectable viral load at follow up • Exploring the pathways through which housing influences medication adherence

13. . Consumer from the WTHP: • Introduction • Experience with homelessness and incarceration • Navigating the system • Experience with Housing Works • Benefits to her of the program

15. Housing Works, Inc. Get Involved! • Contact Lynn Walker at walker5@housingworks.org and Ken Robinson at robinsonk@housingworks.org • Visit Housing Works’ website at www.housingworks.org • Join the International AIDS Housing Roundtable: http://groups.yahoo.com/group/iahr/ • Endorse the International Declaration on Poverty, Housing Instability and HIV: - http://nationalaidshousing.org/2008/07/endorseconference/ • Use the NAHC Policy Tool Kit to inform local policy & funding decisions: http://www.nationalaidshousing.org/policytoolkit.htm • Share your successes – let NAHC know how you use research findings to inform practice and policy: nahc@nationalaidshousing.org