Nebraska Supportive Housing Plan
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Final Version NEBRASKA SUPPORTIVE HOUSING PLAN MARIE HERB, SHERRY LERCH, AND MELANY MONDELLO TECHNICAL ASSISTANCE COLLABORATIVE 31 SAINT JAMES AVE SUITE. 950 BOSTON, MA 02116 AUGUST 4, 2016 Table of Contents A. Introduction ................................................................................................................... 4 1. Overview of the Task/Key Objectives of the Plan ....................................................................4 2. Policy Framework for DHHS Strategy ......................................................................................4 B. Methodology ............................................................................................................... 10 1. Planning with DHHS Staff and other stakeholders ................................................................. 10 2. Housing and Services Inventory and Analysis ........................................................................ 10 3. Stakeholder Participation and Meetings with Key Informants ............................................... 10 4. Assessment of Services Provided by Each Regional Behavioral Health Authority .................... 11 5. Office of Consumer Affairs Consultation ............................................................................... 13 C. Existing Housing and Services ....................................................................................... 14 1. Description of Available Permanent Supportive Housing (PSH) .............................................. 14 a. State Resources ......................................................................................................................... 14 b. Federal Resources...................................................................................................................... 17 2. Assessment of strengths and current housing initiatives ....................................................... 22 3. Description of Available Services & Supports ........................................................................ 25 a. DHHS: Residential Based ........................................................................................................... 25 b. DHHS Non-Residential Services and Supports ........................................................................... 27 c. Non-DHHS Programs and Services ............................................................................................ 29 4. Assessment of strengths and current services initiatives ....................................................... 31 D. Estimated Need for Affordable Housing for Persons with serious behavioral health conditions living within Nebraska ........................................................................................ 34 1. Methodology Used to Determine Need ................................................................................ 34 2. Projected Need .................................................................................................................... 36 E. Findings ....................................................................................................................... 38 1. Services and Supports .......................................................................................................... 38 2. Supportive Housing .............................................................................................................. 43 F. Strategic Goals ............................................................................................................. 44 1. Initiate and lead an Olmstead planning process that leads to the development of a working ‘Olmstead Plan’ ........................................................................................................................... 44 2. Maximize services and funding strategies to support community integration ........................ 44 3. Expand DBH infrastructure and community planning efforts to meet the challenges of creating a robust supportive housing system ............................................................................................. 50 4. Identify and create supportive housing opportunities ........................................................... 55 5. Increase knowledge of supportive housing principles and practices ....................................... 57 6. Promote community awareness and positive practices for community inclusion ................... 57 G. Appendices .................................................................................................................. 59 Appendix A: Nebraska Behavioral Health Regional Map ....................................................... 60 Appendix B: Literature Review ............................................................................................. 61 Appendix C: List of Focus Group Participants........................................................................ 63 Appendix D: Housing First Handout ..................................................................................... 67 2 | P a g e Appendix E: Essential of Housing ......................................................................................... 69 Appendix F: Questions Used to Guide Interviews Regarding Services and Supports for Individuals with Behavioral Health Disorders in Nebraska.................................................... 72 Appendix G: Housing Scan: Nebraska ................................................................................... 74 3 | P a g e A. Introduction 1. Overview of the Task/Key Objectives of the Plan The Nebraska Department of Health and Human Services (DHHS) Division of Behavioral Health (DBH) engaged the services of the Technical Assistance Collaborative, Inc. (TAC) to work with the Division and related state agencies to develop a Strategic Supportive Housing Plan for Nebraskans living with and recovering from serious behavioral health conditions. This plan offers recommendations in the following general categories: • Develop and align DBH policy to promote supportive housing and community integration as two foundational aspects of the behavioral health service system • Define and establish a supportive housing pipeline over a three- to five-year timeframe • Ensure that effective and evidence-based practices and services are available to promote successful tenancy and community integration • Establish sustainable funding sources for supportive services to individuals living in supportive housing settings • Strengthen provider workforce capacity Each key recommendation is broken down into specific action steps. 2. Policy Framework for DHHS Strategy Since the passage of the Nebraska Behavioral Health Services Act (NBHSA) in 2004,1 Nebraska has worked to transform its behavioral health system from reliance on institutional settings to services that promote and support community integration. Between 2004 and 2009 more than 248 mental health beds were closed at state regional centers and approximately $31 million was transferred from institutional care to community services. Prior to the closures, communities had access to an array of services, including day treatment, halfway houses, emergency community support teams, and more. Between 2004 and 2010, the service array expanded2 to include community-based capacity including dual residential, assertive community treatment, community support — mental health, community support — substance abuse, short-term residential, day rehabilitation and psychiatric residential rehabilitation in order to further support individuals in the community. Initial planning seemed to indicate that the Regional Centers would close altogether; however, services at the Lincoln Center were re- aligned to reflect its changing role within a community-based system of care. Adult behavioral health inpatient, residential, outpatient and other services were closed at regional centers in Norfolk and Hastings: three Regional Centers (in Lincoln, Norfolk and Hastings) continue to operate, providing treatment for forensic patients, individuals with sex offenses and male 1 http://www.nebraskalegislature.gov/FloorDocs/98/PDF/Slip/LB1083.pdf 2 http://dhhs.ne.gov/behavioral_health/Documents/RegionalCenterDischargeFollow- UpServicesFinalReportMay2010.pdf 4 | P a g e adolescents with substance use disorders and in FY 2014 utilized 39.3 percent of DBH’s annual budget. In February 2011, the Division released a five-year strategic plan, the Nebraska Division of Behavioral Health Strategic Plan 2011-2015 that built off of the NBHSA and the work of related Behavioral Health Oversight Commissions, and identified strategies to move DBH toward “the development of recovery-oriented systems of care that are community-based.”3 In November 2012, DBH further evaluated its approach toward supporting individuals with mental illness in integrated community settings within the context of its overall system assessment and implementation of its strategic plan. As part of this assessment process, DBH retained TAC to conduct an evaluation of DBH’s activities in the context of community integration, and to provide guidance regarding ways that DBH could strengthen its approach to supporting community integration within the overall implementation of its strategic plan. On February 5, 2013, TAC spent the day with DBH leadership and facilitated a discussion related to community integration in Nebraska. In a follow-up